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Docusign Envelope lD: 700826AD-3CE3-81 5C-81 94-01 3EF3644,404 4.2. Monthly Data Collection Spreadsheet 4.2.1. Due no later than the 1Oth day of the month following the month in which the services being reported were provided. 4.2.2. See Attachment 2, MOUD Monthly Data Collection Spreadsheet' 4.3. Data Collection Format 4.3.1. HCA anticipates shifting the data collection format from MFT to Program Data Acquisition Management and Storage (PDAMS) system during the term of this Contract. Contractor shall continue to collect data via Managed File Transfer (MFT) method until notified otherwise by the HCA Contract Manager in writing. 4.3.1.1. HCA Contract Manager shall notify Contractor of this change no less than ten (10) Business Days before implementing the new collection format' 5. COST REIMBURSEMENT The payment format for this Contract is established as cost reimbursement. Reports and receipts must be submitted monthly with each A-19 invoice, as identified in this section and in Contract Section 3.4, Invoice and Payment. 5.1. Allowable Expenses Only purchases and staff time which are not part of a Medicaid billable service are allowable. Refer to the following documents for Medicaid billing guidance and fee schedules: 5.1.1. Reentrv from a carceral settinq I Washinqton State Health Care Authoritv 5.1.2. Reentrv lnitiative Policv and Operations Guide 5.1.3. Provider billinq quides and fee schedules I Washinqton State Health Care Authoritv 5.1.4. Email questions to hcareentrvdemonstrationproiect@hca.wa.qov 5.2. Monthly Estimated Costs 5.2.1. The estimated monthly cost reimbursement is as follows: 5.2.1.1. July 1,2026 -June 30,2027 Monthly Estimated Cost Number of Months TotalCosts $17,416 12 $209,000 5.2.2. Adjustments revising twenty-five percent (25%) or more of the Monthly Estimated Costs as identified in this section 5.2 must be submitted to the HCA Contract Manager or designee for approval in writing, via email, at leastfifteen (15) Business Days priorto expending the adjusted funds. 5.2.3. HCA approval must be granted, in writing, prior to expending funds. HCA Contract No. K5885-05 Page8ofl3