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STATE OF NORTH CAROLINA - Wake County Government

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STATE OF NORTH CAROLINA - Wake County Government Powered By Docstoc
					STATE OF NORTH CAROLINA
COUNTY OF WAKE



This contract is made and entered into this _________ day of __________________,
________ by and between Wake County and XX (Provider).

For the purposes and subject to the terms and conditions hereinafter set forth, Wake
County hereby retains the Provider.

TERM OF AGREEMENT:

SECTION I. RESPONSIBILITIES
1. The provider agrees to the following:
   A. To provide services to eligible individuals without regard to race, color, national
      origin, age, gender or ability to pay.
   B. To provide services to eligible individuals in accordance with individualized
      treatment or habilitation plans or plans of care which are developed using
      person- and family-centered planning principles.
   C. To comply with all applicable rules, regulations, standards, policies, procedures,
      and guidelines, including the WCHS Provider Manual, licensing and
      accreditation, established by the Federal Government, State of North Carolina,
      N.C. Division of Medical Assistance and Wake County Human Services. This
      includes, but is not limited to the Provider becoming familiar with and beginning
      compliance with federal HIPAA regulations and guidelines in a timely manner.
      The time frames for compliance can be accessed within the Federal HIPAA
      guidelines at www.ASPE.hhs.gov.
   D. To faithfully and diligently perform the usual and customary duties of this
      profession in an ethical and professional manner.
   E. To assure that eligible individuals are not abused, neglected, or exploited while in
      its care and to assure compliance with all Client’s Rights Rules.
   F. To purchase insurance coverage as specified in Section V and attach certificates
      of insurance coverage to this contract. As insurance is renewed, updated
      Certificates of Insurance shall be sent to the Wake County Risk Manager.
   G. To provide Wake County Human Services, as requested, data and statistical
      information about eligible individuals which the Provider can legally release under
      Federal and State statutes for the purpose of research, study, and planning.
      Such data, excluding eligible individuals names, may be further transmitted to the
      Division of Mental Health, Developmental Disabilities, and Substance Abuse
      Services for research and study.
   H. To comply with statistical reporting requirements as established by the Federal
      Government, State of North Carolina, and Wake County Human Services.
   I. To be bound by and comply with Federal and State confidentiality requirements,
      including but not limited to, N.C.G.S. 122C-52 et al, seq. and, where applicable,
      42 U.S.C. Section 290dd-3 and 42 C.F.R. Part Two. The Provider shall
      undertake appropriate procedures to safeguard confidential information. To the
      extent any provider comes into possession of information that is confidential it
      shall remain confidential and protected.
   J. To maintain eligible individuals’ medical and administrative records in the form
      and detail as required by N.C. Division of Medical Assistance guidelines, State
   rules, regulations, and standards, and Wake County Human Services policies
   and procedures.
K. To assure that all staff are appropriately trained, privileged, and credentialed to
   provide the services specified in this contract.
L. To participate in Wake County Human Services Plan for Quality Improvement or
   to follow a Quality Improvement Plan as approved by Wake County Human
   Services.
M. To maintain status in good standing with the N.C. Division of Medical Assistance,
   if the Provider provides services to individuals who are eligible for Medicaid.
N. To pay back its portion of any and all funds required to be returned by the N.C.
   Division of Medical Assistance or the Division of Mental Health, Developmental
   Disabilities, and Substance Abuse Services as a result of failure on the part of
   the Provider to comply with any Medicaid, Integrated Payment and Reporting
   System (IPRS) or other Funding Source requirements. For services funded on a
   unit-cost reimbursement basis, there will be no year-end settlement procedures
   and no fund balance/over-realized receipt policy. For those funded on any other
   basis, the rules for fund balance/over-realized receipts of the funding source will
   apply and will be communicated to the Provider with the allocation letter.
O. To notify the designated Program Manager within ten (10) working days should a
   contract disagreement arise between the Provider and Wake County Human
   Services. A meeting between the Program Manager (or designee) and the
   Provider shall be arranged. Should this meeting not resolve the disagreement,
   then the Director of Human Services (or designee) and the Provider shall attempt
   to resolve the disagreement. Should the disagreement still not be resolved, each
   party shall further refer the matter to its governing body for further attempts to
   resolve the disagreement.
P. To comply with Public Law 103-227, Pro-Children Act of 1994, which prohibits
   smoking in indoor facilities or portions of facilities used routinely or regularly for
   the provision of health care, day care, early childhood development, education,
   or library services to persons under the age of eighteen.
Q. To procure prior approval from Wake County Human Services to subcontract out
   the services described in this contract. Approval may be granted by Wake
   County Human Services upon submission and approval of a written plan.
R. To provide services as stipulated in Attachment(s) XX as defined by the NC
   Division of MH/DD/SAS Service Definitions manual and/or the N.C. Division of
   Medical Assistance Medicaid Guidelines.
S. To notify Wake County Human Services within twenty-four (24) hours of:
   1. Any changes in ownership or business address.
   2. Any legal or governmental action initiated against the Agency, including but
        not limited to an action: (1) for negligence, (2) for violation of law, or (3)
        against any license, certification or accreditation, which if successful, might
        impair the ability of the Provider to carry out the duties and obligations
        assumed under this contract.
   3. Insolvency or pendency of bankruptcy by the Provider.
   4. Any other condition or occurrence that might impair the ability of the Provider
        to carry out the duties and obligations assumed under this contract.
   5. Any changes in location of service records shall be made in writing to Wake
        County Human Services. This mandate shall survive the terms of the
        contract.
T. To provide copies of surveys and/or reviews of the program that are performed
   by other regulatory authorities.
   U. To comply with any Wake County Human Services requests for documentation
      from medical records for the purpose of conducting or participating in an audit,
      program review, or any other quality management activity.
   V. To provide Wake County Human Services with a copy of any financial audit
      performed during the term of this agreement on the Provider within 30 days of
      Provider's receipt of the auditor's report.
   W. If Wake County determines under the definitions in Federal Office of
      Management and Budget’s Circular A-133 and/or N.C.G.S. Sec. 143-6.1 that this
      agreement is a subrecipient agreement or if the agreement is modified at any
      time during the term of the agreement to become a subrecipient agreement, the
      Provider agrees to:
      1.      Provide Wake County with four (4) copies of the appropriate financial
              statements in the format required by Circular A-133 and/or N.C.G.S. Sec.
              143-6.1. The statements shall be delivered to Wake County within the
              earlier of 30 days after completion of the statements or nine months after
              the end of the statement period.
      2.      Wake County, as the pass-through entity, reserves the right to engage its
              own independent auditor to conduct a limited scope audit and the
              Provider agrees to make available accounting records for the purpose of
              this audit. The purpose of such an audit will be to monitor the
              subrecipient’s compliance with one or more of the following types of
              compliance requirements: activities allowed or unallowed; allowable
              costs/cost principles; eligibility; matching, level of effort, earmarking; and
              reporting and to charge the subrecipient’s award for the cost of such
              limited scope audit. Additional on-site monitoring by County staff with the
              purpose of ascertaining subrecipient’s compliance with various
              requirements may also be completed as needed.
      3.      If required, a copy of the statements shall be forwarded by the Provider to
              the Office of the State Auditor at 300 North Salisbury Street, Raleigh, NC
              27603-5903 and a statement sent to Wake County that this requirement
              has been completed.
     X. To comply with N.C.G.S. Sect. 122C-146, which requires that every
         reasonable effort be made to collect appropriate reimbursement for program
         costs from individuals able to pay, including collection of insurance and third
         party payments. No one shall be denied services because of an inability to
         pay. The Provider shall adopt a fee schedule for services and apply this
         schedule fairly and equitable to all clients/enrollees. The Provider shall furnish
         Human Services and clients/enrollees with a copy of the Provider's fee
         schedule and notify or advise Human Services when there are changes.
     Y. To bill Medicaid for services provided as approved by Human Services. Per
         Medicaid regulations, the client's/enrollee's copayment for Medicaid-covered
         services is zero.
     Z. To reimburse Human Services for any payments made to the Provider in error
         within fifteen (15) days of discovery by either Human Services of the Provider.
         Such errors include, but are not limited to, duplicate payment, payment for
         services not rendered, non-covered services, non-authorized services, and
         ineligibility.

2. Wake County Human Services agrees to the following:
   A. To reimburse the Provider for services according to the conditions outlined in
      Attachment(s) XX.
    B. To provide for or make available to the Provider pertinent rules, regulations,
       standards and other information of the Division of Mental Health, Developmental
       Disabilities, and Substance Abuse Services through its administrative
       publications series including: Federal laws and regulations; other N.C. State
       laws, regulations, and guidelines; and Wake County Human Services standards,
       policies, and procedures.
    C. To maintain the WCHS Provider Manual on Wake County’s website and to notify
       Providers via email of revisions.


SECTION II. MONITORING OF CONTRACT
Wake County Human Services shall comply with N.C.G.S. Sec. 122C-142 which
requires Human Services to monitor this contract to assure compliance with rules of the
Commission for Mental Health, Developmental Disabilities, and Substance Abuse
Services and the Secretary of the North Carolina Department of Human Resources and
applicable general statutes. Such monitoring shall include reviewing limitations on the
period of the contract, maximum amount paid, products, completed operations, audits,
financial and program reports, compliance with applicable standards, quality of service,
confidentiality, eligible individuals rights, and any other terms or conditions of this
contract.

SECTION III. RELATIONSHIP OF PARTIES
The Provider is an independent contractor of Wake County Human Services. It is further
agreed by the Provider that it and its officers, employees, subcontractors, and agents
shall obey all State and Federal Statutes, rules, and regulations which are applicable to
the operation of the program referred to in this contract. The Provider’s officers,
employees, subcontractors, agents, and other personnel shall not be employees of nor
have any other contractual relationship with Wake County or Wake County Human
Services in the performance of contract services hereunder.

SECTION IV. INDEMNIFICATION
The Provider agrees to defend, indemnify, and hold harmless Wake County, N.C. and
Wake County Human Services from all loss, liability, claims or expense (including
reasonable attorney’s fees) arising from bodily injury, and/or death or property damage
caused in whole or in part by the negligence or misconduct of the Provider, except to the
extent same are caused by the negligence or misconduct of Wake County, N.C. or Wake
County Human Services, to the extent permitted under North Carolina Law. Nothing in
this section is intended to affect or abrogate the County's sovereign immunity defenses.

SECTION V. INSURANCE REQUIREMENTS
The Provider shall obtain and maintain at its sole expense, all insurance as required in
the following paragraphs and shall not commence work until such insurance is in force
and certification is received and accepted by the Wake County Risk Manager and Wake
County Human Services.
Professional Liability Insurance:
Limits of no less than $1,000,000 per occurrence/$2,000,000 aggregate. To be provided
by the Provider rendering medical or other professional services under this contractual
relationship.
Commercial General Liability Insurance:
Combined single limits of no less than $1,000,000 each occurrence and $1,000,000
aggregate. This insurance should include contractual liability.
Commercial General Liability insurance policies shall be endorsed (1) to show Wake
County as additional insured, as their interests may appear, and (2) to amend
cancellation notice to thirty (30) days.
Workers’ Compensation Insurance:
Limits for Coverage A meeting the statutory requirements of the State of North Carolina;
and Coverage B Employers Liability for an amount not less than: $100,000 Each
Accident; $500,000 Disease Policy Limit; and $100,000 Disease Each Employee.
Automobile Liability Insurance:
If transportation of clients or use of company or personal vehicles is required to fulfill the
terms of this contract, then proof of automobile liability insurance will be required with
limits of no less than $500,000 combined single limit or $250,000 per person, $500,000
per occurrence bodily injury and $100,000 property damage. Policy must cover any
automobiles including nonowned and hired. Commercial automobile policies shall be
endorsed (1) to show Wake County as additional insured, as their interests may appear,
and (2) to amend cancellation notices to thirty (30) days.

All insurance companies shall be licensed in North Carolina.

Certificates of insurance shall be signed by a licensed North Carolina agent/broker and
notice of change or cancellation will be given to the Wake County Risk Manager. The
certificate holder on the Certificate of Insurance shall read:

                Wake County
                Risk Management
                P.O. Box 550
                Raleigh, NC 27602

If the Provider does not meet the insurance requirements as specified, alternate
insurance coverage satisfactory to Wake County may be considered.

Any liability arising on behalf of the Provider with regard to this contract is not limited by
the insurance requirements listed above.

Nothing in this section is intended to affect or abrogate the County's sovereign immunity
defenses.

SECTION VI. NON-APPROPRIATION
It is the express intention of the parties that this contract shall remain in effect contingent
upon Wake County Human Services receipt of public funding for the provision of
services to eligible individuals or staff through performance of the terms of this contract.
Upon thirty days (30) written notice of loss of such funding, Wake County Human
Services shall be relieved of the obligations of this contract and the term hereof shall
automatically expire. In the event this contract is terminated prior to its expiration date,
payment for services shall continue to the date of termination unless otherwise specified
in the notice of termination.

SECTION VII. CANCELLATION
Either party shall have the right to cancel this contract at its sole option, for any reason
whatsoever, upon at least thirty days (30) written notice to the other party. In case of
alleged abuse and/or neglect of an eligible individual, by an employee or agent of the
Provider, Wake County Human Services reserves the right to terminate the contract
immediately. In the event this contract is terminated prior to its expiration date, payment
for services shall continue to the date of termination unless otherwise specified in the
notice of termination.

SECTION VIII. NOTICES
All notices hereunder may be hand delivered or mailed. If mailed, they shall be sent
registered or certified U.S. mail, return receipt requested, to the respective addresses
listed below or to such addresses as the parties may hereafter require in writing.
Notices sent by mail shall be deemed to have been given when deposited in the U.S.
mail     with   postage      prepaid     and    addressed     as    set   forth   below:
 Wake County Human Services
 Contracts Manager
 P.O. Box 46833
 Raleigh, NC 27620-6833

Wake County Human Services shall make notifications regarding changes in policy and
procedure, rules, regulations, and the WCHS Provider Manual via email. Providers are
responsible for ensuring WCHS Contracts Manager is informed of the Provider’s current
email address by notification to the above address.

SECTION IX. ENTIRE AGREEMENT
The parties have read this contract and agree to be bound by all of its terms and further
agree that it constitutes the complete and exclusive statement of the agreement between
the parties. This agreement may be modified or amended by an executed document
authorized by both parties. State Mandated reimbursement rates and changes in the services
inventory may be modified to the extent documented in official correspondence by memorandum
signed by each party.

SECTION X. GOVERNING LAW
Both parties agree that this Contract shall be governed by the laws of the State of North
Carolina.

IN TESTIMONY WHEREOF, WAKE COUNTY AND XX through their authorized officers
and by their own hands have hereunto set forth their hands and seals of the day and
year first above written.

                                                     WAKE COUNTY

    By:__________________________:_X                 By_________________________
    XXXXXXXXXXXXXXXXXXXXX                            XXXXXXXXXXXXXXXXXXXX

    Date:________________________                    Date:______________________

                                                     By:________________________
                                                     __


                                                     Date:______________________
                                                     __


56-2121806
Provider IRS Identification No.

This instrument has been preaudited in the manner required by the Local Government
Budget and Fiscal Control Act.
                                ___________________________________________
                                                 Finance Director
   Attachment: Purchase of Service FY03-04

I. Non-Medicaid Purchase of Services

A. Client Eligibility and Referral
   1. Eligible clients include individuals who are referred and authorized by               Formatted: Bullets and Numbering
   Wake County Human Services (WCHS).
   2. Medicaid eligibility must be sought and maintained for all persons in need
   of Medicaid-covered services.
   3. Services covered under this contract will be reimbursed only when
   referred and authorized by Wake County Human Services.
   4. The Provider shall enroll or refuse enrollment of the consumer within the
   period of time specified in the WCHS Provider Manual. If enrollment is
   refused, the Provider shall refer the consumer back to the referring WCHS
   department for assistance and shall return all original and copies of the
   referral information to the referring WCHS Program Manager.
   5. Opening paperwork is due within 10 days of the Provider commencing
   services, according to the Required Client Records procedure found in the
   WCHS Provider Manual.

   B. The Authorization Process
       1. Authorization for each type of service is required. The WCHS Provider             Formatted: Bullets and Numbering
     Manual specifies WCHS positions authorized to sign service authorizations
     for specific populations and/or services.
       2. The development of a single, Unified Service Plan is expected for all
     individuals receiving funding under this contract, utilizing a person- and
     family-centered planning philosophy. A “single, Unified Service Plan”
     means one plan for each individual served that covers all services provided
     by WCHS and its contract providers. During the development of the plan,
     the client must be educated regarding all appropriate service options from
     which s/he can make an informed choice. The Unified Service Plan
     requirement, where not already in practice, shall be implemented with all
     new/updated service plans developed after December 1, 2003.
       3. For clients having more than service provider, all provider agencies shall
     participate in the development of the Plan along with the client and his/her
     parent/guardian where applicable. The "Lead Provider" is responsible for
     coordinating the Unified Service Plan development. The first provider in the
     following hierarchy is considered the Lead Provider for the client’s services: 1)
     Case Manager, 2) Therapist (for DD-funded clients, this does not apply) 3)
     Residential Provider, 4) Day Program Provider, and 5) any remaining Provider.
     The Lead Provider should schedule service-planning meetings, inviting all
     Providers, in the month prior to the month in which they are due. Providers are
     expected to make reasonable efforts to participate. Minimally, all Providers are
     expected to contribute goals specific to their services for inclusion in the Unified
     Plan. All Providers shall be provided with a complete copy of the client’s plan,
     inclusive of all goals, to enhance coordination of care.
    4. Services that require orders for Medicaid reimbursement also must have
  orders for non-Medicaid reimbursement from WCHS. When WCHS is not the
  Lead Provider, the Provider of the service is responsible for obtaining necessary
  service orders.
    5. The Authorization process requires submission of the Authorization
  Request, with a Unified Service Plan, and other required paperwork as
  specified in the WCHS Provider Manual.
    6. The Authorization Request shall reflect the needed service(s), the
  frequency and duration of those services, and must be based upon formal
  and informal assessments and the service planning process.
    7. The Provider must verify its receipt and acceptance of the approved
  Authorization by signing and returning a copy of the Authorization form
  within 10 working days to the appropriate WCHS Service Director or
  designee.
    8. In cases where the client/guardian disagrees with Wake County
  Human Service’s decision regarding authorization of services, the WCHS’
  complaint process will be followed.
    9. The Provider must provide and document services provided according
  to Statutory, Divisional, and Federal requirements.
    10. The Provider is required to submit service event data to WCHS as
  specified in the WCHS Provider Manual.
    11. WCHS may require that additional documentation be submitted to
  WCHS for review. WCHS may also require continuing submission of
  documentation, particularly if WCHS is the designated Case Manager.
    12. The Provider may not bill WCHS for services that fall outside the
  authorized dates of service, exceed the number of hours authorized, or do
  not address the approved Unified Service Plan goals. The Provider must
  notify involved WCHS staff if intensive outpatient or support services are
  adjusted to a level of intensity less than that authorized.
    13. If services cannot be carried out as authorized, the Provider must
  notify the WCHS Program Manager who authorized the service as soon as
  possible, prior to the interruption of service whenever possible. The
  Provider must notify the WCHS Program Manager in writing prior to
  discontinuation of services other than outpatient therapies to a client within
  the authorized period, according to the time frame specified in the WCHS
  Provider Manual. Discharge summaries are required for any service that is
  discontinued.

C. Responsibilities of the Provider
The responsibilities of the Provider include, but are not limited to the
following:
    1. To provide services as defined by NC Division of MH/DD/SA, NC                  Formatted: Bullets and Numbering
  Division of Medical Assistance, the Infant/Toddler Manual, the WCHS
  Provider Manual Service Definitions, and in accordance with the Unified
  Service Plan or the Individualized Family Service Plan and the clients’
  wishes,
    2. To secure and maintain licensure for all services for which licensure is
  required by the State of North Carolina.
    3. To secure and maintain accreditation from the Council of Community
  Programs for all non-licensed services provided, unless WCHS agrees to
  directly provide such accreditation or accepts accreditation from another
  certifying body.
    4. To check the criminal background and motor vehicle violations of all
  direct service staff prior to their provision of client services.
    5. To verify credentials and check licenses of professional staff prior to
  the provision of services.
    6. To investigate and document all allegations of client abuse and neglect,
  misappropriation of client or facility property, diversion of drugs belonging to a
  client or facility, and fraud against a client or facility, within five working days of the
  date that the facility becomes aware of the alleged incident; and, upon completion
  of the investigation, report all relevant information in writing to the Health Care
  Personnel Registry (919) 715-0159 [per North Carolina Administrative Code
  T10:03B.1000].
    7. To check the status of all direct care providers, prior to hire, by calling the
  Health Care Personnel Registry (919) 715-0562.
    8. To ensure that staff carry appropriate insurance on their vehicles in
  cases where transportation is provided to a client in staff vehicles.
    9. To provide supervision and support of paraprofessional staff by
  Qualified Professionals.
    10. To document as required for clinical and billing purposes.
    11. To participate in WCHS audits and reviews, as requested.
    12. To maintain an official record of all services provided and follow
  retention and medical record guidelines unless otherwise specified by the
  Service Director.
    13. To meet the competency/privileging requirements as required by the
  state of North Carolina.
    14. To have the capacity to do separate cost accounting for periodic
  services provided within a residential program or vocational program and
  report the costs separately for Cost-Finding purposes.
    15. To not bill a client for Medicaid-covered services. For all other clients,
  the Provider agrees to charge the individual/family according to their ability
  to pay.
    16. To participate in the development and monitoring of outcomes for each
  service they provide.

D. Wake County Human Services Responsibilities
The responsibilities of WCHS include, but are not limited to the following:
    1. To reimburse the Provider for services according to the rates specified                  Formatted: Bullets and Numbering
  in Attachment: WCHS Contract Provider Service Codes and Rates FY0304.
    2. To provide for or make available to the Provider pertinent rules, regulations,
  standards and other information of the Division of Mental Health, Developmental
  Disabilities, and Substance Abuse Services or the Infant/Toddler Manual through
  its administrative publications series including: Federal laws and regulations; other
  N.C. State laws, regulations, and guidelines; and Wake County Human Services
  standards, policies, and procedures.
    3. To provide training, support, and technical assistance on an as-needed
  basis.
    4. To provide monitoring and oversight of service provision to assure
  quality of services provided.
    5. To provide, on a regular basis, both Medicaid and Division compliance
  audits.
    6. To process payment for services according to NCDMHDDSA Prompt
  Payment requirements. Should payments for services be delayed beyond
  the allowed period because of wrongful acts or omissions of Wake County,
  Wake County will pay 1% per month simple interest on the amount of
  payments wrongfully delayed.
    7. To process complete and accurate Service Authorization Requests
  within 10 working days of receipt.

E. Conditions of Payment
Non-Medicaid Covered Services: Service Reporting Forms (and service
documentation if required), shall be submitted by the fifth working day of the
subsequent month, either by hand delivery to the designated WCHS office or
via USPS mail. The Provider will be reimbursed upon acceptance of
documentation and receipt of invoice that are determined to be accurate and
complete.

Alternate schedules for submitting service documentation may be required by
the designated WCHS Service Director.

All dates of service which fall within a given quarter must be reported and billed no
later than fifteen (15) days following the end of the quarter. If the Provider fails to do
so, payment may be denied.

When a Provider is billing WCHS for a service event that is covered by a third party
payor, the Provider will attach a copy of the written denial from the third party payor
to the Service Reporting Form. WCHS will reimburse the provider for only those
services that were authorized by WCHS and denied by the third party payor. If there
are claims that cannot be billed due to lack of written response from third party
payors, the Provider shall notify the appropriate service director in writing within 15
days of the end of the previous quarter. This notification shall include the following
information: date of contact, person spoken to, telephone number, and outcome of
discussion.

Acceptance of documentation by Wake County Human Services does not
imply review by Wake County Human Services for accuracy and/or adequacy.
When discovered, incomplete or inaccurate documentation shall be returned
to the Provider for correction prior to processing. The Provider has up to 21
days to return the corrected and/or completed documentation to Wake
County Human Services. If the Provider fails to do so, payment may be
denied.

F. Method of Payment

Authorized Services will be paid at rates found in the Attachment Service
Codes & Rates.

Activity and Client Assistance Funds may be authorized on an individual
basis, if consistent with the client 's service plan and if the funds are available.
A maximum amount allowable will be specified. Activity funds can be used
for the staff's participation in activities with the client when appropriate, but not
for food for staff. Client Assistance funds may only be used for the items
specified in the Authorization. The Provider shall be reimbursed at cost plus
a 5% processing fee, upon invoice, with copies of receipts. The total shall not
exceed the maximum specified.

G. Revenue Adjustment

Providers shall neither bill nor be reimbursed by WCHS for services which are
also reimbursed by other State and Federal government sources such as the
Department of Vocational Rehabilitation, Health Choice, Medicaid, CAP-MR,
and CAP-C. Thus, there is no need to report revenues from these sources
except when required for services for individuals served by WCHS-MR/MI
Services.

H. Failure to Perform Services

A penalty of up to fifty dollars per day ($50.00) shall be deducted from
payment for each failure to perform services in accordance with this contract
or the client's service plan. The process shall occur as follows:
1. WCHS shall contact the Provider's supervisory staff and verbally discuss
such nonperformance on the first occurrence. Both parties shall attempt to
resolve the issue. Provider will respond with a written corrective action plan.
2. WCHS shall provide written notification of a second incidence of failure to
perform services in accordance with this contract.
3. A third incidence relating to the same client may result in a reduction from         Formatted: Bullets and Numbering
    payment up to fifty ($50.00) per day (but no more than the cost of the
    services provided) until the issue is resolved.
II.    Purchase of Medicaid Services 2003-04

For all services billed under Wake County Human Services’ Medicaid Billing Provider
Number, the authorization rules specified the sections A., B., C., D., G., and H. above
apply, except in the following cases:
   1) The services are authorized by Value Options or MRNC (outpatient and child          Formatted: Bullets and Numbering
        residential beyond a certain number of visits/days) and were not ordered by
        WCHS staff; and
   2) Other professional periodic services when not ordered by WCHS staff (i.e., Med
        Administration).

Additionally, terms are added to the sections above as follows:

E. Conditions of Payment

Medicaid-Covered Services: The Provider shall bill services electronically via NCECS
or other software, using the codes and procedures specified in the WCHS Provider
Manual. The Provider will be reimbursed upon receipt of funds from EDS/Medicaid and
verification that services fall within authorized ranges.

F. Method of Payment

CPT and H code services shall be reimbursed at 88.5% of Medicaid receipts.

Y-code services shall be reimbursed at 86.76% of Medicaid receipts.

Child Residential Services shall be reimbursed at the following rates:
Y2343 HRI Criterion V                                                    $246.66
Y2347 HRI Level 1 Foster Care                                            $38.03
Y2348 HRI Level III 4 beds or less                                       $232.36
Y2349 HRI Level III 5 beds or more                                       $185.69
Y2360 HRI Level IV 4 beds or less                                        $241.07
Y2361 HRI Level IV 5 beds or more                                        $241.07
Y2362 HRI Level II Therapeutic Foster Care                               $97.92
Y2363 HRI Level II Group Homes                                           $136.04

				
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