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Docusign Envelope lD: C'l 90C649-709E-4E00-A409-4A1 6CEDBC800 <br />1.5.3. <br />1.6. <br />1.7 <br />1.8 <br />1.9 <br />1.10 <br />1.11 <br />Washington State <br />Health Care Authority <br />The Contractor must ensure the Coordinators accurately perform all <br />responsibilities listed in the cAP, the Manual, and this Agreement. <br />lncluding but not limited to the following: <br />1.5.3.1. The coordinators must participate in any scheduled RMTS <br />consortium conference calls; and <br />1.5.3.2. The Coordinators must ensure federal, state, and HcA MAC <br />policies are imPlemented. <br />Certify all data entered into the System is true and accurate, and based on actual <br />expenditures incurred during the period of performance of the invoice. This <br />certification must be maintained within the System. This includes, but is not limited <br />to: calendaring, Staff/Participant lists, salary and benefits, direct charges or other <br />claimed costs, indirect rate, MER, and any other data used to generate a claim to <br />HCA for reimbursement. <br />Verify all data that is determined necessary to be stored electronically within the <br />System or other associated websites, or databases as described in the CAP' <br />Manual and this Agreement is physically entered and stored according to the SOS <br />Retention Schedule. This data includes, but is not limited to: calendaring, <br />Staff/Participant lists, salary and benefits, direct charges or other claimed costs, <br />indirect rate, MER, and any other data used to generate a claim to HCA for <br />reimbursement. <br />Prepare an annual MER proposal by using HCA form 13-954 (Medicaid <br />Administrative Claiming Local Health Jurisdiction Medicaid Eligibility Rate <br />proposal) to include the MER calculation and formula, the data sources used to <br />determine the MER, the data collection process, the Contractor's monitoring <br />process to ensure accuracy of the MER and any other relevant information. <br />1.8.1. The proposal must be submitted to HCA no later than December first of <br />each year. <br />1 .8.2. The proposal must be updated and re-submitted if the data source or <br />collection, calculations, or monitoring changes thirty (30) business days <br />prior to the change. <br />Submit a quarterly CPE certification identifying the revenue account codes as <br />found in the BARS manual with each invoice validating the accuracy of the CPE. <br />Submit an annual certificate of indirect costs by using HCA form 02-568 (Certificate <br />of lndirect Costs) that certifies the accuracy of indirect cost rate proposal submitted <br />to their Cognizant Agency each January. <br />Certify the accuracy of all data used to determine a quarterly MAC reimbursement <br />by signing the A19 by an Authorized Representative. This certification extends to <br />all RMTS data, MER data and financial data. <br />HCA Contract #K8630 <br />Attachment 5 <br />19