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L/UUUWY1I GI IVCIVF t: IL). %, Iz7U%,U4z7-/ V.7GW CUU-M'4V5-'4H IUIJCL/OI.OVV <br />4.7.5.1.2. All daily logs must have a quarterly summary <br />rolling up all time over the quarter. <br />4.7.5.2. These staff must complete a single cost objective <br />certification quarterly using an HCA approved form. <br />4.7.5.3. Each single cost objective staff must be reported individually <br />on the invoice. <br />4.7.5.4. The invoice must report the name, the actual amount of time <br />spent performing allowable MAC activities, and total dollar <br />amount claimed for reimbursement for each staff. <br />4.8. Direct Charge for Interpretation Service Contracts <br />The Contractor may only direct charge for a portion of the Interpretation Service <br />contracts and only for allowable interpretation activities as described in this <br />Agreement. <br />4.8.1. Services direct charged must be for interpretation activities identified as <br />allowable activities within the Manual, the CAP, and this Agreement. <br />The Contractor is prohibited from including any other portion of an <br />Interpretation Services Contract in the calculation for FFP <br />reimbursement. <br />4.8.2. Each interpretation activity must be documented to HCA's satisfaction, <br />in fifteen (15) minute increments, using a patient encounter form that <br />includes, at minimum, the following data elements: <br />4.8.2.1. Appointment time/duration; <br />4.8.2.2. Client Name/ID/transaction information; <br />4.8.2.3. Interpreter Agency; <br />4.8.2.4. Interpreter Name or Employee ID; <br />4.8.2.5. Language/communication type; <br />4.8.2.6. Requestor or nurse name; and <br />4.8.2.7. The forms must be maintained according to SOS Record's <br />retention schedule. <br />4.8.3. The above data from all patient encounter forms, except Client Name/ID <br />Information, must be transferred onto a single spreadsheet that is <br />searchable and sortable must be available upon request. When <br />requested, the data will be provided in a readable, usable, mutually <br />agreed upon format. <br />Washington State 25 HCA Contract #K8630 <br />Health Care Authority Attachment 5 <br />