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Docusign Envelope lD: C.l 90C649-709E-4E00-A409-4A1 6CED8C800 <br />4.13. Certified Public Expenditures <br />The MAC invoice must document that there are adequate non-federal, local <br />matching funds to support the costs of allowable MAC activities and be used as <br />CPE. <br />The Contractor is: <br />4.13.L Prohibited from using any source of funds as CPE that do not comply <br />with federal, state, HCA and cMS Regulations, the cAP, Manual, and <br />this Agreement; <br />4.13.2. Required to certify all sources of funds used as for CPE are accurate, <br />allowable, and in compliance with allfederal, state, HCA and CMS <br />Regulations, the CAP, Manual, and this Agreement quarterly by <br />completing a Certified Public Expenditure Local Match Certification <br />quarterlY and bY signing the 419; <br />4.13.3. Required to use the Budgeting, Accounting and Reporting system <br />(BARSmanual)prescribedaccountingandreportingforlocal <br />governments to identify and document the revenue account codes for <br />all local matching funds reported as CPE; <br />4.13..4. Required to ensure the source of all CPE funds are not federal tax <br />money and are not used as a match for federal money (by the <br />Contractor or any other agencY); <br />4.13.5. Only permitted to use these funds to supplement, not supplant the <br />amount of federal, state and local funds otherwise expended or services <br />provided under this Agreement; <br />4.13.6. Required to have funds available for MAC activities and the funds must <br />be within the Contractods control and budget; <br />4.13.7. <br />4.13.8. <br />4.13.9. <br />4.13.10. <br />Washington State <br />Health Care Authority <br />Prohibited from using provider-related donations or impermissible heath <br />care related tax source for CPE; <br />Prohibited from using any private donations or non-public funds as a <br />source for CPE without authorization from CMS' Center for Medicaid <br />and state operations' National lnstitutional Reimbursement Team <br />(NrRT); <br />Prohibited from requiring or allowing private non-profits to participate in <br />the financing of the non-federal share of expenditures; <br />Prohibited from allowing non-governmental units to voluntarily provide, <br />or be contractually required to provide, any portion of the non-federal <br />share of the Medicaid expenditures; <br />HCA Contract #K8630 <br />Attachment 5 <br />28