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Docusign Envelope lD: C'l 90C649-709E-4E0G,A409-4A1 6CED8C800 <br />3.4.1 Contractor must not bill and HCA must not pay for Services performed <br />under this Contract if the Contractor has charged or will charge another <br />agency of the state of washington or any other party for the same <br />Services. <br />4.Calculating the FFP and Generating an lnvoice <br />The Contractor is responsible for ensuring all data (including all RMTS and financial data) <br />used to calculate the amount of FFP submitted to HCA for reimbursement is accurate, based <br />on actual expenses incurred during the period of performance, and complies with all federal, <br />state, HCA and CMS Regulations, the CAP, Manual, and this Agreement' The Contractor <br />must certiff the accuracyof all data used to calculate the amount of FFP by an Authorized <br />Representative signing the 419-1A lnvoice Voucher (A19). The Contractor must use a <br />System that is statistically valid and in compliance with allstate, and federal laws and <br />R'egulations whether through a third- party or other means as stated in the CAP to calculate <br />the amount of FFP and generate a claim. <br />4.1. The Contractor must submit invoices to HCA for FFP on a quarterly basis' <br />4.2. All data used to calculate the FFP must be from the same period of service. <br />4.3. All data used to calculate the FFP must be the actual cosVexpenditure and not <br />approximated. <br />4.4. The FFP is determined by calculating the total adjusted costs, multiplying these <br />costs by the adjusted RMTS results, and the applicable Medicaid Eligibility Rate <br />(MER), adding any direct charges, and then applying the appropriate FFP rate. <br />4.5. The invoice must be generated within one hundred twenty (120) business days of <br />the end of the quarter and generated based on following five components. <br />4.5.1. Cost Pool construction; <br />4.5.2. Calculating allowable Medicaid administrative time via the System or <br />direct charge method and documentation; <br />4.5.3. Calculation and application of the pertinent MER; <br />4.5.4. Calculation and application of the indirect cost rate; and <br />4.5.5. Application of the appropriate FFP rate. <br />4.6. Cost Pool Construction <br />4.6.1. The contractor must comply with all federal, state, HCA and CMS <br />Regulations, the CAP, Manual, and this Agreement when constructing <br />cost Pools. <br />Washington State <br />Health Care Authority <br />HCA Contraci #K8630 <br />Attachment 5 <br />z3