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Docusign Envelope lD: C1 90C649-709E-4E00-A409-4A1 6CED8C800 <br />ATTACHMENT 1: STATEMENT OF WORK <br />The purpose of this Agreement is to support Medicaid related outreach and linkage activities <br />performed by Local Health Jurisdictions (LHJ) to Washington State residents who live within its <br />jurisdiction. These activities assist residents who have no or inadequate medical coverage' and <br />includes explaining the benefits of the Medicaid program, assisting them in the Medicaid <br />application and renewal processes, and linking them to Medicaid covered services' This <br />Agreement provides , pio""r" for partially reimbursing the Contractor for allowable and <br />reasonable expenses associated with the time its staff spend performing Medicaid <br />Administrative Claiming (MAC) activities. <br />The contractor must provide staff and perform all activities necessary to do the work outlined in <br />this Agreement. <br />1. Contractor ResPonsibilities <br />The Contractor is responsible for monitoring its MAC program to ensure compliance with all <br />applicable laws, regulations and guidelines specific to the MAC program as described in this <br />Agreement and comply with all roles, responsibilities, limitations, restrictions' and <br />dJcumentation requirements described in the CAP, Manual, associated federal and state <br />regulations, and this Agreement. Only expenses that are reasonable and allowable' are <br />peimitted for reimbursement. HCA expects the MAC program to be managed similarly to <br />other federal awards and expects the RMTS and Fiscal coordinators to report to, or work <br />closely, with an administrator assigned oversight authority of the LHJ. <br />The Contractor must: <br />1.1 Provide the necessary staff to perform the allowable MAC activities described in <br />the cost Allocation Plan (cAP), and perform the work necessary to ensure all <br />applicable laws, regulations and guidelines specific to the MAC program and this <br />Agreement are in compliance including but not limited to: <br />l.l.l.CodeofFederalRegulation(cFR)rifle42andTitle45; <br />1.1.2. 1903(wX6XA) of the Social Security Act; <br />1.1.3. Deliverinq Services in School-Based Settinqs: A CgmDrehensive Guide <br />to Medicaid Services and Administrative Claiminq 2023; <br />1.1.4. Revised Code of Washington (RCW); <br />1.1.5. The LHJ MAC Claiming Manual; <br />1.1.6. HCA-approved LHJ MAC training documents; <br />Washington State <br />Health Care AuthoritY <br />HCA Contract #K8630 <br />Attachment 5 <br />16