Common use of HCA Responsibilities Clause in Contracts

HCA Responsibilities. Health Care Authority is responsible for performing oversight of the Contractor’s MAC program to ensure the effective administration of the MAC program and complying with all roles, responsibilities, limitations, restrictions, and documentation requirements described in the CAP, Manual, and this Agreement. Including but not limited to the following: 8.1. Maintain oversight of the Contractor’s MAC program and monitoring activities including review of all components of the time study, claiming, training, or anything MAC related. 8.2. Direct the MAC activities reimbursable at the enhanced seventy five percent (75%) rate for all Skilled Professional Medical Personnel (SPMP) participating in the Contractor’s MAC program. 8.3. Review the Contractor’s monitoring activities to ensure monitoring is occurring and any identified issues are addressed as deemed appropriate by HCA. This will include but is not limited to the following: Review of time study responses; Accuracy of coding; Appropriateness of code changes; Sufficiency of backup documentation; and Non-response rates. 8.4. Verify the Contractor has entered all necessary data into the System and verify all data entered was certified by the Contractor as accurate. 8.5. Review all claimed costs prior to issuing reimbursement to ensure they are allowable, reasonable, and are supported by documentation that is sufficiently detailed to permit HCA, CMS, or others to determine whether the costs are necessary for the proper and efficient administration of the state plan. This includes but is not limited to; source documentation of staff costs, operating expenses, and subcontracted vendor costs. 8.6. Review the RMTS Consortia organization and membership, including the Lead Agency identified, annually and issuing an official notice of approval or denial. 8.7. Review all MAC related training materials prior to their use in the MAC program and issuing an official notice of approval or denial. This includes multimedia video, audio, digital, or other electronic sources, and paper based training materials. 8.8. Evaluate RMTS and claiming data prior to issuing quarterly reimbursements to ensure the RMTS results and claimed costs are appropriate according to all applicable laws, Regulations and guidelines specific to the MAC program. This evaluation will also be used to identify trends, best practices for the MAC program, quality assurance, training needs, areas in need of improvement, or other concerns related to the MAC program and HCA’s oversight responsibilities. 8.9. Issue corrective action plans as necessary and determined by HCA’s oversight capacity that includes but is not limited to, quarterly reviews of RMTS and claiming data, the Contractor’s failure to be in compliance with all applicable laws, Regulations and guidelines specific to the MAC program and this Agreement, or other quality assurance needs. 8.10. Produce and update the CAP, Manual, Contracts, training materials, or other MAC related documentation as needed and make it available to the Contractor.

HCA Responsibilities. Health Care Authority is responsible for performing oversight of the Contractor’s MAC program to ensure the effective administration of the MAC program and complying with all roles, responsibilities, limitations, restrictions, and documentation requirements described in the CAP, Manual, and this Agreement. Including but not limited to the following: 8.1. Maintain oversight of the Contractor’s MAC program and monitoring activities including review of all components of the time study, claiming, training, or anything MAC related. 8.2. Direct the MAC activities reimbursable at the enhanced seventy five percent (75%) rate for all Skilled Professional Medical Personnel (SPMP) participating in the Contractor’s MAC program. 8.3. Review the Contractor’s monitoring activities to ensure monitoring is occurring and any identified issues are addressed as deemed appropriate by HCA. This will include but is not limited to the following: Review of time study responses; Accuracy of coding; Appropriateness of code changes; Sufficiency of backup documentation; and Non-response rates. 8.4. Verify the Contractor has entered all necessary data into the System and verify all data entered was certified by the Contractor as accurate. 8.5. Review all claimed costs prior to issuing reimbursement to ensure they are allowable, reasonable, and are supported by documentation that is sufficiently detailed to permit HCA, CMS, or others to determine whether the costs are necessary for the proper and efficient administration of the state plan. This includes but is not limited to; source documentation of staff costs, operating expenses, and subcontracted vendor costs. 8.6. Review the RMTS Consortia organization and membership, including the Lead Agency identified, annually and issuing an official notice of approval or denial. 8.7. Review all MAC related training materials prior to their use in the MAC program and issuing an official notice of approval or denial. This includes multimedia video, audio, digital, or other electronic sources, and paper based training materials. 8.8. Evaluate RMTS and claiming data prior to issuing quarterly reimbursements to ensure the RMTS results and claimed costs are appropriate according to all applicable laws, Regulations and guidelines specific to the MAC program. This evaluation will also be used to identify trends, best practices for the MAC program, quality assurance, training needs, areas in need of improvement, or other concerns related to the MAC program and HCA’s oversight responsibilities. 8.9. Issue corrective action plans as necessary and determined by HCA’s oversight capacity that includes but is not limited to, quarterly reviews of RMTS and claiming data, the Contractor’s failure to be in compliance with all applicable laws, Regulations and guidelines specific to the MAC program and this Agreement, or other quality assurance needs. 8.10. Produce and update the CAP, Manual, Contracts, training materials, or other MAC related documentation as needed and make it available to the Contractor. 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