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HCA Contract No. K5885-05 Page 8 of 13 <br />4.2. Monthly Data Collection Spreadsheet <br />4.2.1. Due no later than the 10th day of the month following the month in which the services being <br />reported were provided. <br />4.2.2. See Attachment 2, MOUD Monthly Data Collection Spreadsheet. <br />4.3. Data Collection Format <br />4.3.1. HCA anticipates shifting the data collection format from MFT to Program Data Acquisition <br />Management and Storage (PDAMS) system during the term of this Contract. Contractor shall <br />continue to collect data via Managed File Transfer (MFT) method until notified otherwise by the <br />HCA Contract Manager in writing. <br />4.3.1.1. HCA Contract Manager shall notify Contractor of this change no less than ten (10) <br />Business Days before implementing the new collection format. <br />5. COST REIMBURSEMENT <br />The payment format for this Contract is established as cost reimbursement. Reports and receipts must be <br />submitted monthly with each A-19 invoice, as identified in this section and in Contract Section 3.4, Invoice <br />and Payment. <br />5.1. Allowable Expenses <br />Only purchases and staff time which are not part of a Medicaid billable service are allowable. Refer to <br />the following documents for Medicaid billing guidance and fee schedules: <br />5.1.1. Reentry from a carceral setting | Washington State Health Care Authority <br />5.1.2. Reentry Initiative Policy and Operations Guide <br />5.1.3. Provider billing guides and fee schedules | Washington State Health Care Authority <br />5.1.4. Email questions to hcareentrydemonstrationproject@hca.wa.gov <br />5.2. Monthly Estimated Costs <br />5.2.1. The estimated monthly cost reimbursement is as follows: <br />5.2.1.1. July 1, 2026 – June 30, 2027 <br />Monthly Estimated Cost Number of Months Total Costs <br />$17,416 12 $209,000 <br />5.2.2. Adjustments revising twenty-five percent (25%) or more of the Monthly Estimated Costs as <br />identified in this section 5.2 must be submitted to the HCA Contract Manager or designee for <br />approval in writing, via email, at least fifteen (15) Business Days prior to expending the adjusted <br />funds. <br />5.2.3. HCA approval must be granted, in writing, prior to expending funds. <br />Docusign Envelope ID: 700826AD-3CE3-815C-8194-013EF364AA04