HomeMy WebLinkAboutMINUTES - 07121994 - 1.72 I .` Cz
TO: BOARD OF SUPERVISORS
FFiOMI: ;;'lark Finucane, Health Services Director Contra
By: Elizabeth A. Spooner, Contracts Administrator Costa
DATE: June 29, 1994 County
SUBJECT: / Approval of Standard Agreement #29-770 with the
.11 State Department of Health Services
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
A. Approve and authorize the Chair, Board of Supervisors, to execute on behalf
of the County, Standard Agreement #29-770 (State #93-19032) with the State
Department of Health Services (DOHS) , for the period from June 1, 1994 through
December 31, 1995, to reimburse the County for the costs of developing the Medi-Cal
Local Initiative (LI) Health Plan.
B. Authorize the Health Services Director, or his designee (Milt Camhi) to
execute subsequent amendments with the State DOHS for the Medi-Cal LI Health Plan.
II. FINANCIAL IMPACT:
Approval of this Contract by the State will result in a maximum payable amount of
$1,137,500. The State DOHS will make payments to the County in two phases. The
Phase I distribution is a lump sum payment of $541,667, with no County match
required. The Phase II distribution of $595,833 (Federal matching funds) will be
paid to the County as invoices are submitted to the State DOHS certifying that LI
development expenditures have been incurred.
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
Senate Bill 456 (Chapter 573, Statues of 1993) , has appropriated $10,000,000 of
State Funds to the State DOHS for distribution to counties or other local entities
to offset the costs of forming the LI and developing its health delivery system in
accordance with the State's plan to expand Medi-Cal managed care. Senate Bill 456
authorized entities, which contract with the State for these funds, to use them to
reimburse costs incurred by local organizations and entities in developing their LI.
The funds are to be distributed by the State DOHS for expenditures at the local
level in a manner which qualifies for Federal Financial Participation under the
Medicaid program.
On May 10, 1994, the Board of Supervisors approved the Department's submission to
the State of an LI Workplan Timeline which was required to qualify the County for
a fixed fee planning grant. The State has approved the Workplan Timeline, and upon
execution of Standard Agreement #29-770 by the State, the initial planning funds
($541,667) will be distributed to the County.
The Board Chair should sign ten copies of the Agreement, including the Disclosure
Form. Nine signed copies of the Agreement and four certified/sealed copies of this
Board Order should be returned to the Contracts and Grants Unit for submission to
the State.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMEN ION OF BOARD C OM
MITTEE
APPROVE OTHER
SIGNATURE(S)
ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
UNANIMOUS (ABSENT ) 1 HEREBY CERTIFY THAT THIS IS A TRUE
AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN
ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD
OF SUPERVISORS ON THE DATE SHOWN.
Contact: Milt Camhi (313-5604)
CC: Health Services (Contracts) ATTESTED
Auditor-Controller (Claims) Phl Bat elor, Clerk of the Board of
State Dept. of Health Services 3UPffiVWr6iWWtyAdlrl L*aW
M382/7-89 BY l Q.- - , DEPUTY
ROVED SY.TIHE
LT�.N,EARD AGREEMENT--' �OpNEY GETlEAAL / r 1. 7Z CONTRACTNWBERAM.Na
,t — 93-19032 00
TAXPAtE"FEDERAL EM IOYER DENTIFICArON NUMSEa
THIS AGREEMENT.made and entered into this 1st day of June ,19_24.
in the Crate of Califomia,by and between State of California.through its duly elected or appointed,qualified and acting
TITLE OF OFFICFA ACTWrFOR STATE AGENCY
Chief, Program Support Br rich Department of Health Services
gNTRACTOR•S NAME ,hereaftereaIIed the State,and
,,a � _ �. � y
County of Contra Costa %vv U .,bcm&fter tailed the Contractor.
WITNESSETH: Thu the Contractor for and in consideration of the covenants.conditioats.agreement,and stipulations of the State he--btaftcr expressed.
does hereby agree to f=ish to the State s=,ices and materials as foilows: (Set forth service to be rendered by Contractor,amount to be paid Contraclor,
time for performance or completion,and attach placer and specifications,if any.)
ARTICLE I - PREAMBLE
Trus is eYared intb as a mmm of implamalixg Sectim 14163 (p) of the W_Jjam and Insti=ties C:de
to pMvide fuxbn3 far activities and efforts in stlgst of the f"Ietiat and aMe1q=rt of a taal Initiative
(as Mined in Sectiai 3-3 belcx).
Semite Bill 455 (Quer 573, Statl It of 1993) an=p:iat al Ten Mi l l icn ($10 mi I I Jcn) of State F1ris to tre
D gmr=ent of Healtl Sa vlry q for rii q=2b t;rn to C=t1 w Cr other 1=a, 61=t um to offszt the DOas Cf
f=niM the tccal Initiative and deje1q itlg its h alth dlivet y system in with the nit I s
plan to a a3re- Sante BLU arhx i zad amities artm=ng with the Ir=a-t fez
those ftzr3s to lZe than to raid r e msts irn ra3 by I Coal c rcter;Qs and H7t1t1e5 ad/cr the r,,-- 1
Initiati:ve in & ??= g the T 1 Initiative. To the full a cr"t pitted by state ad fed=al law, the
fol stall be by the f cr t xms at the 1=1 level in a mrner teat q iml i f;as
f= fademl financ=ial prticiption urler the Mmbenid Ftzgt:m (Welfare ad Trt, res d�; tiQ:�', Se=jm 14163
(p) (5)-
The =st Cf fx�, dasLgung arxJ &-A1 nng tete rcml Ihitsatsve are c;Ql;f;m-rh, aryl It is the intent of tine
utz-E!c the ailh=ty of Wlfare ad In=;=1cm Qxb, So=on 14UD (p), to p:ovicb firth rrg = sx:;=
a pomiat of tdthtuXji this a@ I .
APPROVED
Therefore, the parties agree .as follows:
CONTINUED ON .14 SHESTS, EACH BEARING NAME OF CONTRACTOR AND CONTRACT NU BE .
The provisions an the reverse side hereof catutitute a part of this agreemenL .._._.._. ..__........ ..__...
e Budget Di i on
-NWIZi�IESS WliiR..OF,this agreement has been executed by the parties hereto,trport u5z date Fust a ve wTittea. By .�,.�.
STATE OF CALIFORNIA ONTRACTOR
AGENCY T�AI:TOR(J fAan an r�&v Uat slat&�fWjW• _ on.A411FAW O.etc.;Department of Seal th Services tow Contra Costa
a
BY(AU TURF) Y MCR tGNATveE, .
PRWTE-M NAME PERSON SIGNNG PRINTF NAME AND TITLE OF PERSON S1 NG
Edward E. Stahlberg Thomas Powers, Chair, Contra Costa Board of Sup
TITLE ADDRESS
chief, Program Support Branch 651 Pine Street, Martinez, CA 94553
AMOUNT ENCUMBERED BY T}II.S PROGRAAArATEGORY(CODE AND TITLE) FUND TITLE
DOCUMENT I Department of General Services
$ Local Assist. , Sect. 1415 7Hlth Care Dep Use Only
541 ,667 (OPTIONAL USE)
PRIOR AMOUNT ENCUMBERED FOR Fed- Cat. No. 93778, 4260-101-001 Exempt from PCC
THIS CONTRACT
C 0 ITEM c"MA STA`rUT•E FISCAL YEAR Per W & I Code
J 4264-601-912 55 1993 11993-94 Section 14087.4 (c)
TOTAL AMOUNT ENCUMBERED TO
DATE OBJECT OF EXPENDITURE(CODE AND-,r LE)
$ 541 ,667 N/A
I hereby eeftily upon my own personal knowledge that budgeted funds I T•B•k NO. B.R.NO.
are available for the period and purpose of the expenditure stated above.
SIGNATUAE OF AUNTNG OFFICE;. A,�� ff J 7�i7r
°AUG 1 2 1994
GCO
CONTTiACTOR STATE AGENCY C1 DEPT.OF GEN.SER. CONTROLLER
STArr 0FcKsarJ9A
STANDARD AGREEMENT
sa¢.z euv:s.n cam►.�....-. - -. _... :�:. . - .::::t= .. _ :.;'T-�-- - ,
1. The Contractor agrees to indemnify,defend and save harm less the State,its officers,agents and employees
from any and aU claims and losses accruing or resulting to any and all contractors,subcontractors.
materialmen,laborers and any other person,firm or corporation furnishing or supplying work services,
materials or supplies in connection with the performance of this contract,and from any and 211 claims and
Icssses accruing or resulting to any person,firm or corporation who may be injured or dam2ged by the
Contractor in the performance of this contracL
2. The Contractor,and the agents and employees of Contractor,in the performance of the agreement,shall
act in an independent capacity and not as officers or employees or agents of State of California.
3.The State may terminate this agreementand be relieved of the payment of any consideration to Contractor
should Contractor fail to perform the covenants herein contained at the time and in the manner herein
provided. In the event of such termination the State may proceed with the work in any manner deemed
proper by the State. The cost to the State shall be deducted from any sum due the Contractor under this
agreement,and the balance,if any,shall be paid the Contractor upon demand.
4. Without the written consent of the State, this agreement is not assignable by Contractor either in whole
or in part.
S. Time is of the essence in this agreement.
6. No alteration or variation of the terms of this contract shall be valid unless made in writing and signed by
the parties hereto,and no oral understanding or agreement not incorporated herein,shall be binding on
any of the parties hereto.
7. The consideration to.be paid Contractor, as provided herein, shall be in compensation for all of
Contractor's expenses incurred in the performance hereof, including travel and per diem, unless
otherwise expressly so provided.
•a�u .
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r ,
County of Contra Costa 93-19032
TABLE OF CONTENTS
ARTICLE I PREAMBLE Pg 1
ARTICLE II IDENTIFICATION OF PARTIES Pg 2
ARTICLE III DEFINITIONS Pg 2
ARTICLE IV TERM AND TERMINATION Pg 3
4 .1 Term of Agreement Pg 3
4 .2 Termination without Pg 3
Cause
4.3 Termination with Cause Pg 3
4 .4 Department of Finance Pg 3
Authorization
ARTICLE V GENERAL PROVISIONS Pg 4
5.1 Assignment/Delegation Pg 4
Novation
5.2 Governing Authorities Pg 4
5.3 Fulfillment of Pg 5
Obligation
5.4 Equal Opportunity Pg 6
Employer
5. 5 Nondiscrimination Clause Pg 6
Compliance
5. 6 Notices Pg 6
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County of Contra Costa 93-19032
ARTICLE VI DISTRIBUTION OF FUNDS Pg 6
6 .1 Amount Available under Pg 6
this Agreement
6 .2 Phase One Distribution Pg 7
6.3 Phase Two Distribution Pg 7
6.4 Additional Funds Pg 7
6 .5 Federal Contract Funds Pg 7
6. 6 Supplemental Local Pg 7
Share Expenditures
6 .7 Use of Funds Pg 7
ARTICLE VII DUTIES OF CONTRACTOR Pg 8
7 .1 Local Initiative Pg 8
Proposed Workplan .
7 .2 Phase Two Cost Claiming Pg 8 ,
7 .3 Audits Pg 10
7 .4 Federal Disclosure Pg 11
7 .5 Conflict of Interest- Pg 11
Current & Former
Employees
7 .6 Drug-Free Workplace Pg 12
7 .7 Books and Records Pg 13
7 . 8 Confidentiality of Pg 14
Information
7 .9 Contractor' s Duties Pg 14
to Maintain
Confidentiality
7 .10 Project Director Pg 14
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t k
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County of Contra Costa 93-19032
ARTICLE VIII DUTIES OF THE DEPARTMENT Pg 15
8.1 Phase One Distribution Pg 15
8.2 Phase Two Distribution Pg 15
8.3 Federal Financial Pg 15
Participation
8.4 Conditioned Payment Pg 15
Exhibit A NONDISCRIMINATION CLAUSE
Exhibit B FEDERAL CONTRACT FUNDS
Exhibit C HEALTH PLAN INVOICE
Exhibit D MONTHLY SUMMARY INVOICE
Exhibit E FEDERAL REGISTER
Exhibit F DISCLOSURE FORM
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• County of Contra Costa 93-19032
ARTICLE II - IDENTIFICATION OF PARTIES
This agreement is between the State Department of Health Services,
(Department) and the County of Contra Costa (Contractor) .
ARTICLE III - DEFINITIONS
Unless otherwise expressly provided or the context otherwise
requires, the following definitions of terms will govern the
construction of this agreement:
3 .1 "Department" means the State Department of Health
Services .
3 .2 "DEES" means the United States Department of Health and
Human Services.
3 .3 "Local Initiative" means a prepaid health plan formed or
developed at the local level for purposes of contracting with
the Department regarding health care services to certain Me i-
Cal beneficiaries .
3 .4 "Local Initiative Proposed Workplan" means a document
submitted by the Contractor in accordance with Section 7 . 1
below, to receive the Phase One Distribution from the
Department, in accordance with Section 8 . 1 below. The Local
Initiative Proposed Workplan shall include major milestones ,
tasks, and due dates proposed for the development of the Local
Initiative.
3 .5 "Phase One Distribution" means the portion of the funds
available to the Contractor under this agreement upon delivery
of the Local Initiative Propose Workplan and the invoice
reflecting delivery of the Local Initiative Proposed Workplan.
3 .6 "Phase Two Distribution" means the funds available to the
Contractor under this agreement in excess of the Phase One
Distribution, but not including any Supplemental Local Share
Expenditures .
3 .7 "Supplemental Local Share Expenditures" means amounts in
excess of the aggregate of the Phase One Distribution and
Phase Two Distribution, that are expended by the Contractor or
other persons or entities in activities and efforts toward
developing the Local Initiative health delivery system.
3.8 "State" means the State of California.
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County of Contra Costa 93-19032
ARTICLE IV - TERM AND TERMINATION
4.1 Term of Agreement
This agreement will become effective on June 1, 1994, and
shall continue in full force and effect through December 31,
1995 .
4.2 Termination without Cause
The Contractor or the Department may terminate this agreement
without cause at any time by giving written notice to the
other party. Written notification will be given no later than
ninety (90) days prior to the effective date of termination
and will state the effective date.
4.3 Termination with Cause
a. The Department may terminate this agreement for cause
upon thirty (30) days written notice to the Contractor.
Notification will state the effective date of and the grounds
for termination.
b. The Department will terminate this agreement upon thirty
(30) days notice in the event that it receives notice that
DHHS has determined that the Contractor does not meet the
requirements for participation as a Contractor under
applicable provisions of the Medicaid Program, Title XIX of
the Social Security Act .
C. The contractor may terminate this agreement for cause
shown at any time by giving written notice to the Department
to that effect, stating the reasons for the termination. The
termination will become effective thirty (30) days after the
Department receives the Contractor' s written notice.
4.4 Devartment of Finance Authorization
This agreement will not be effective unless approved by the
Department of Finance.
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County of contra Costa 93-19032
ARTICLE- V - GENERAL PROVISIONS
5.1 Assignment/Delegation/Novation
a. Novation
After the formation of the Local Initiative Health Plan
(LIHP) in a manner acceptable to the Department, Contractor
may propose an amendment to substitute the LIHP as a party to
this agreement in place of the Contractor and to transfer all
of the Contractor's rights and obligations under this
agreement to LIHP. The Department agrees to execute an
amendment which will release Contractor from all obligations
under this agreement and will transfer all of Contractor' s
rights and obligations to LIHP.
b. Assignment
After formation of the Local Initiative Health Plan (LIHP)
in a manner acceptable to the Department, Contractor may
propose an amendment to assign rights under this agreement to
the LIHP. The Department agrees to execute an amendment which
will transfer Contractor' s rights to the LIHP.
c. Delecation
After formation of the Local Initiative Health Plan (LIHP)
in a manner acceptable to the Department, Contractor may
propose and amendment to delegate obligations under this
agreement to the LIHP. The Department agrees to execute an
amendment which will delegate Contractor' s obligations to the
LIHP.
5.2 Governina Authorities
This agreement will be governed and construed in
accordance with the following Statutes and
Regulations :
1. Welfare and Institutions Code, Division 9, Part 3,
Chapter 7, commencing with Section 14000.
2 . Division 3, Title 22, California Code of
Regulations, commencing with Section 50000.
3 . Title 42, Code of Federal Regulations and,
4. Title 42, U.S. Code, commencing with Section 1396.
5 . All other applicable laws and regulations.
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County of Contra Costa 93-19032
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5.3 Fulfillment of Obligation
a. It is the express intention of both the Department and
the Contractor that the terms of this totally integrated
writing will comprise their entire agreement, and such
terms are not subject to rescission, modification, or
waiver except as defined in a subsequent written
instrument executed in the same manner and with the same
authority. In furtherance of this agreement the
Department and Contractor mutually agree and request that
any reviewing tribunal determine any claim of rescission,
modification or waiver predicated upon any evidence other
than a subsequent written instrument executed in the same
manner and with the same authority as this writing to be
void.
b. The informal toleration by either party of defective
performance of any independent covenant in this agreement
will not be construed as a waiver of either the right to
performance or the express conditions which have been
created in this agreement.
C. Satisfaction of the requirements pursuant to this
agreement does not ensure that the Contractor will be
awarded a contract to operate as a Local Initiative. The
Department reserves the right to award or not award a
Local Initiative contract in the best interest of the
Medi-Cal Program.
d. Neither this agreement, nor the receipt of payments
hereunder, shall create any obligation for the
Contractor, or for any other person or entity, to enter
into a contract or any arrangement with the Department ,
or with any other person or entity, to establish or
operate a Local Initiative. Similarly, the Local
Initiative Proposed Workplan submitted by the Contractor
under Section 7 . 1 of this agreement shall not create any
obligation for the Contractor, or for any other person or
entity, to perform (or attempt to perform) any step or
action referred to in, or contemplated by, the Local
Initiative Proposed Workplan.
e. Except as expressly set forth in. this agreement, it
is not the intention of either the Department or the
Contractor that any person (including Medi-Cal
beneficiaries) or entity (whether or not related to the
Local Initiative) shall be an intended third party
beneficiary of any rights of either party to this
agreement.
5
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County of Contra Costa 93-19032
5.4 Equal Opportunity Employer
In the performance of this agreement, Contractor will not
discriminate against any employee or applicant for employment
because of race, color, religion, ancestry, sex, age, national
origin, physical disability, or marital status. Contractor
will take affirmative action to ensure that applicants are
employed and that employees are treated during employment
without regard to their race, color, religion, ancestry, sex,
age, national origin, physical disability, or marital status .
The action will include, but not be limited to the following;
employment, upgrading, demotion, or transfer, recruitment or
recruitment advertising, layoff or termination, rates of pay
or other forms of compensation, and selection for training,
including apprenticeship. Contractor will post in conspicuous
places, available to employees and applicants for employment,
notices to be provided by the Department setting forth the
provisions of this Fair Employment Practices paragraph.
5.5 Nondiscrimination Clause Compliance
Contractor will comply with the provisions of the
Nondiscrimination Clause which is incorporated by this
reference as Exhibit A entitled Nondiscrimination Clause
(consisting of one (1) page.
5. 6 Notices
All notices to be given under this agreement will be in
writing and will be deemed to have been given when mailed, to
the Department or Contractor at the following addresses :
State Department of Health Services County of Contra Costa
Chief, Contract Development Section Board of Supervisors
Medi-Cal Managed Care Expansion Branch 651 Pine Street
714 P Street, Room 1400 Martinez, CA 94553
P.O. Box 942732
Sacramento, CA 94234-7320
ARTICLE VI - DISTRIBUTION OF FUNDS
6.1 Amount Available Under This Agreement
The maximum amount payable for this agreement will not exceed
$1, 137, 500 . Monies appropriated by the Legislature under the
authority of Welfare and Institutions Code, Section 14163 (p) ,
to provide funding for this agreement are not subject to
specific fiscal years, - therefore, any requirement for
performance by the Department of the Contractor for the period
subsequent to June 30, 1994 is not subject to requirement of
future appropriations by the Legislature.
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County of Contra Costa 93-19032
6.2 Phase One Distribution
The Department shall pay to Contractor the lump sum of
$541, 667 . 00 promptly upon approval of the Workplan submitted
by Contractor pursuant to Section 7.1.
6.3 Phase Two Distribution
Subject to Section 8 .4 the Department shall pay to Contractor
the amount on each invoice submitted pursuant to Section 7.2
promptly upon approval of that invoice, up to a maximum of
$595, 833 .
6.4 Additional Funding
--f additional State or Federal funding becomes available
during the term of this agreement, and any required State
Budget appropriation is made, this agreement may be amended to
increase the maximum Phase Two Distribution.
6. 5 Federal Contract Funds
Exhibit B (entitled "Federal Contract Funds) , consisting of
one (1) page, is incorporated by this reference.
6 . 6 Surmlemental Local- Share--Expenditures
Nothing in this Agreement shall prevent the Contractor from
seeking reimbursement for Supplemental Local Share
Expenditures which have not been reimbursed through this
Agreement, in connection with the non-federal share of
administrative expenditures under the Medi-Cal State Plan to
the extent permitted by federal law and 42 C. F.R. Section
433 .51.
6 .7 Use of Funds
The Contractor shall use the funds received under this
agreement for the purposes contemplated by Section 14163 (p) of
the welfare and Institutions Code, including, at the
Contractor,discretion (and to the extent permitted by federal
law) , for the purposes described in Section 14163 (p) (4) .
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County of Contra Costa 93-19032
ARTICLE VII - DuTIES OF THE CONTRACTOR
In discharging its obligations under this agreement, the Contractor
shall perform the following duties :
7 .1 Local Initiative Proposed Workplan
To receive the amount referred to in Section 6.2, the
Contractor shall submit an original and one (1) copy of the
Local Initiative Proposed Workplan and an invoice for the
Local Initiative Proposed Workplan to the Department at the
address specified in Section 5 . 6 of this agreement. The
invoice shall be in the format reflected in Exhibit C (Fixed
Price Invoice) of this agreement, which is incorporated herein
by reference. The Local Initiative Proposed Workplan shall be
subject to approval by the Department, which shall not be
unreasonably withheld.
7 .2 Phase Two Cost Claiming
Phase Two cost claiming is subject to Section 8 .4.
a. Administrative and Related Activities
The Contractor, shall perform administrative and related
activities in support of the development of the Local
Initiative health delivery system. These include the
following activities on or after September 30, 1993 .
(1) Developing and attending various committees, councils and
other forums to encourage public and private support for Local
Initiative development activities;
(2) Attending meetings and education programs sponsored or
coordinated by the Department or other persons or entities
regarding the Department' s plan for expanding Medi-Cal managed
care;
(3) Developing and negotiating contracts related to the
development of the Local Initiative health delivery system;
(4) Recruiting, employing and training Local Initiative
management and staff;
(5) Evaluating financial, legal and practical aspects of
potential system components of the Local Initiative, including
performing quantitative analyses to assess the financial
viability of the proposed models of the Local Initiative and
evaluating the potential capitation rates, as well as
contracting for any outside actuarial, legal and/or accounting
consultants;
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County of Contra Costa 93-19032
(6) Educating Medi-Cal beneficiaries and consumer groups
regarding the Local Initiative;
(7) Educating providers regarding the Local Initiative;
(9) Any other administrative and related activities in
support of the development of the Local Initiative health
delivery system.
b. Contractor shall notify the Department by October 1, 1994
of its intent to claim for Phase Two Distribution Funds .
Should Contractor elect not to claim for Phase Two
Distribution Funds, Contractor agrees to amend this
agreement to reduce the amount payable under this
agreement.
C. Invoices
(1) Contractor shall submit invoices in
triplicate, addressed to:
Department of Health Services
Chief, Contract Development Section
Medi-Cal Managed Care Expansion Branch
714 P Street, Room 1400
Sacramento, CA 95814
(2) Invoices shall reference this agreement and the time
period covered.
(3) The Contractor shall submit invoices in the format
contained in Exhibit D (Monthly Summary Invoice) of this
agreement and incorporated herein by reference. Contractor
shall not submit more than one (1) invoice per month.
If such invoices claim expenditures for Skilled Professional
Medical Personnel (SPMP) , the Contractor must submit the
invoice in accordance with federal guidelines for
reimbursement of eligible costs applying to SPMP and their
direct supporting staff, which are included in Exhibit E (FFP
Guidelines for Securing Federal Match for the Activities of
Skilled Professional Medical Personnel) consisting of 14 pages
and incorporated herein by reference in this agreement. The
Contractor shall certify in each invoice that the claim for
payment is based on actual expenditures incurred for the
period claimed, and the Contractor shall retain records of the
costs supporting the certification, in accordance with Section
7.7 of this agreement.
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county of Contra Costa 93-19032
d. Revisions
After review and evaluation of Invoices submitted by the
Contractor, the Department may request revisions of Invoices
as requirements of this agreement. Contractor shall comply
and complete all revisions and provide additional information
requested by the Department within 30 days from the date the
revision request was mailed to Contractor by the Department .
7.3 Audits
Single Audit Act of 1984
In accordance with Public Law 98-502 and OMB Circular A-128 ,
it is stipulated between the parties hereto that:
a. The cost to the single audit will be charged to the
federal assistance program providing funds for this agreement
on a "Fair share" basis . The amount chargeable to federal
assistance programs for the cost of the single audit is
calculated based on the ratio of federal expenditures to total
expenditures of the Contractor. The State' s share of the
single audit cost under this contract is based upon the ratio
of federal funds received under this agreement to total
federal funds received by the Contractor each fiscal year.
b. The Contractor shall include a clause in any contract the
Contractor enters into with the audit firm doing the single
audit to provide access by the State or Federal Government to
the working papers of the independent auditor who prepares the
single audit for the Contractor.
C. Federal or State auditors shall have "expanded scope
auditing "authority to conduct specific program audits during
the same period in which a single audit is being performed,
but the audit report has not been issued. The federal or state
auditors shall review and have access to the current audit
work being conducted and will not apply any testing or review
procedures which have not been satisfied by, previous audit
work that has been completed.
The term "expanded scope auditing" is applied and defined in
the U.S. General Accounting Office (GAO) issued Standards for
Audit of Governmental Organizations, Programs, Activities and
Functions, better known as the "yellow book" .
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County of Contra Costa 93-19032
7 .4 Federal Disclosure
Contractor shall Comply with all necessary federal
disclosure requirements in accordance with Title 42, Sections
455 .104, 455 .105, 455 . 106 of the Code of Federal Regulations .
Contractor shall complete and submit to the Department Exhibit
F (Instructions and Definitions for Disclosure Forms) ,
consisting of seven (7) pages .
7.5 Conflict of Interest-Current and Former Employees
a. Current State Officers and Employees
(1) Contractor shall not utilize in the performance of
this contract any state officer or employee in the state
civil service or other appointed state official unless the
employment, activity, or enterprise is required as a condition
of the officer or employee' s regular state employment .
Employee in the state civil service is defined to be any
person legally holding a permanent or intermittent position_ in
the state civil service.
(2) If any state officer or employee is utilized or employed
in the performance of this contract, Contractor shall first
obtain written verification from the State that the
employment, activity, or enterprise is required as a condition
of the officer' s , employee's or official' s regular state
employment and shall keep said verification on file for three
years after termination of this contract.
(3) Contractor may not accept occasional work from any
currently employed state officer, employee or official .
(4) If Contractor accepts volunteer work from any currently
employed State officer, employee, or official, Contractor may
not reimburse, or otherwise pay or compensate, such person for
expenses incurred, including, without limitation, travel
expenses, per diem, or the like, in connection with volunteer
work on behalf of the contractor.
(5) Contractor shall not employ any state officers, employees,
or officials who are on paid or unpaid leave of absence from
their regular state employment.
(6) Contractor or anyone having a financial interest in this
contract may not become a state officer, employee, or official
during the term of this contract. Contractor shall notify each
of its employees, and any other person having a financial
interest in this contract that it is unlawful under Public
Contract Code, Section 10410 for such person to become a state
11
t
Co=ty of Contra Costa 93-19032
officer, employee, or official during the term of this
contract unless any relationship with the Contractor giving
rise to a financial interest, as an employee or otherwise, is
first terminated.
(7) Occasional or one-time reimbursement of a state employee' s
travel expenses is not acceptable.
b. Former State Officers and Employees
(1) Contractor shall not utilize in the performance of
this contract any formerly employed person of any state
agency or department that was employed under the state
civil service, or otherwise appointed to serve in the State
Government, if that person was engaged in any negotiations,
transactions, planning, arrangement, or any part of the
decision making process relevant to the contract while
employed in any capacity by any state agency or department .
This prohibition shall apply for a two-year period beginning
on the date the person left state employment.
(2) Contractor shall not utilize within 12 months from
the date of separation of services, a former employee of
the contracting state agency or department if that former
employee was employed in a policy making position in the
same general subject area as the proposed contract within
the 12-month period prior to the employee leaving state
service.
C. Failure to Comply with Subparts "a" or "b"
(1) If Contractor violates any provision of Subparts "a"or "b"
above, such action by Contractor shall render this contract
void, unless the violation is technical or nonsubstantive
7 .6 Drug-Free Workplace
Contractor certifies to the State that it will provide a
drug-free workplace by doing all of the following:
a. Publishing a statement notifying employees that the
unlawful manufacture, distribution, dispensation,
possession, or use of a controlled substance is prohibited in
the person' s or organization's workplace and specifying the
actions that will be taken against employees for violations of
the prohibition.
12
County of Contra Costa 93-19032
b. Establishing a drug-free awareness program to inform
employees about all of the following:
(1) The dangers of drug abuse in the workplace.
(2) The person' s or organization's policy of
maintaining a drug-free workplace.
(3) Any available drug counseling, rehabilitation, and
employee assistance programs.
(4) The penalties that may be imposed upon employees
for drug abuse violations .
C. Requiring that each employee engaged in the performance
of the contract or grant be given a copy of the statement
required by subdivision (a) and that, as a condition of
employment on the contract or grant, the employee agrees
to abide by the terms of the statement.
d. Contractor agrees this contract may be subject to
suspension of payments or termination of this contract ,
or both, and the contractor may be subject to debarment ,
in accordance with the requirements of the Government
Code Section 8350, et seq. , if the Department determines
that any of the following has occurred:
(I) The contractor or grantee has made a false
Certification.
(2) The contractor violates the certification by
failing to carry out the requirements of
subdivisions (a) through (c) above.
7 .7 Books and Records
The Contractor will maintain books and records necessary
to disclose how the Contractor discharged its obligations
under this contract.
These Books and records will include, but are not limited to,
all physical records originated or prepared pursuant to this
contract including working papers, reports submitted to the
Department and Financial records.
These books and records wi*11 be maintained for a minimum of
five years from the termination date of this contract,
or, in the event the Contractor has been duly notified
that the Department, DHHS, or the Comptroller General of
the United States, or their duly authorized
13
County of Contra Costa 93-19032
representatives, have commenced an audit or investigation of
the contract, until that time as the matter under audit or
investigation has been resolved, whichever is later.
The Contractor will allow the Department, DHHS, or their
duly authorized representatives to inspect, evaluate, copy,
and audit these books and records at any time during normal
business hours.
7 . 8 Confidentiality of Information
Names of persons receiving public social services are
confidential and are to be protected from unauthorized
disclosure in accordance with Title 42, CFR, Section 431. 300
et seq. , and under Section 14100 .2 , W&I Code and regulations
adopted thereunder. For the purpose of this contract, all
information, records, data, and data elements collected for
this contract and pertaining to beneficiaries will be
protected by the Contractor from unauthorized disclosure.
7 .9 Contractor' s Duties to Maintain Confidentiality
With respect to any identifiable information concerning a
beneficiary that is obtained by the Contractor or its
subcontractors, the Contractor: (1) will not use any
information for any purpose other than carrying out the
express terms of this contract, (2) will promptly
transmit to the Department all requests for disclosure of
information, (3) will not disclose except as otherwise
specifically permitted by this contract, any information to
any party other than the Department without the Department ' s
prior written authorization specifying that the information_ is
releasable under Title 42, CFR, Section 431.300 et sec. ,
Section 14100 .2 W&I Code, and regulations adopted thereunder,
and (4) will, at the expiration or termination of this
contract maintain the confidentiality of the information.
7 .10 Protect Director
Contractor shall designate a person as Project Director and
transmit that designation to the Department. The Project
Director will be responsible for completion of all documents
pursuant to this agreement and will serve as Contractor' s
liaison to the Department.
14
County of Contra Costa 93-19032
ARTICLE VIII - DUTIES OF THE DEPARTMENT
In discharging its obligations under this agreement, the Department
will perform the following duties:
8.1 Phase One Distribution
The Department shall pay to the Contractor the Phase One
Distribution amount referred to in Section 6.2 upon written
approval by the Department of the Local Initiative Proposed
Workplan and receipt of the Contractor's invoice for the Local
Initiative Proposed Workplan. The Department shall not
unreasonably withhold approval regarding the Local Initiative
Proposed Workplan, and shall pay the Phase One Distribution
amount in full promptly after approval of the Contractor' s
invoice and the Local Initiative Proposed Workplan.
8 .2 Phase Two Distribution
Subject to Section 8 . 4 the Department shall review invoices
submitted by the Contractor pursuant to Section 7.2, and upon
approval shall pay promptly the approved amount up to a
maximum of $595, 833 . The Department may request clarification
or revision of any invoice which the Department determines
cannot be approved, but will not unreasonably withhold its
approval of any invoice.
8 .3 Federal Financial Participation
The Department shall seek and obtain federal financial
participation for all expenditures under this agreement to the
full extent permitted by State and Federal law.
8.4 Conditioned Payment
Payment under Phase Two is conditioned on receipt of written
confirmation from DHHS that Federal financial participation is
available to match funds expended under this agreement .
15
County of Contra Costa 93-19032
Exhibit A
NONDISCRIMINATION CLAUSE
(OCP - 1)
1. During the performance of this contract, Contractor and its
subcontractors will not unlawfully discriminate against any
employee or applicant for employment because of race,
religion, color, national origin, ancestry, physical handicap,
medical condition, marital status, age (over 40) or sex.
Contractors and subcontractors will insure that the evaluation
and treatment of their employees and applicants for employment
are free of such discrimination. Contractors and
subcontractors shall comply with the provisions of the Fair
Employment and Housing Act (Government Code, Section 12900 et
seq) and the applicable regulations promulgated thereunder
(California Code of Regulations, Title 2, Section 7285.0 et
seq) . The applicable regulations of the Fair Employment and
Housing Commission implementing Government Code, Section 12990
et seq, set forth in Chapter 5 of Division 4 of Title 2 of the
California Code of Regulations, are incorporated into this
contract by reference and made a part hereof as if set forth
in full . Contractor and its subcontractors will give written
notice of their obligations under this clause to labor
organizations with which they have a collective bargaining or
other agreement.
2 . This Contractor will include the nondiscrimination and
compliance provisions of this clause in all subcontracts to
perform work under the contract.
County of Contra costa 93-19032
Exhibit B
FEDERAL CONTRACT FUNDS
1 . It is mutually understood between the parties. that this
contract may have been written before ascertaining the
availability of congressional appropriation of funds for the
mutual benefit of both parties in order to avoid program and
fiscal delays which could occur if the contract were executed
after that determination was made.
2 . This contract is valid and enforceable only if sufficient
funds are made available to the states by the United States
Government for the Fiscal Year 1993-94 for the purposes of
this program. In addition, this contract is subject to any
additional restrictions, limitations, or conditions enacted by
the Congress which may affect the provisions, terms or funding
of this contract in any manner.
3 . It is mutually agreed that if the Congress does not
appropriate sufficient -funds for the program, this contract
shall be amended to reflect any reduction in funds .
4 . The Department has the option to void the contract under the
30-day cancellation clause or to amend the contract to reflect
any reduction in funds .
Coaiutty of Contra Costa 93-19032
Exhibit C
HEALTH PLAN INVOICE
TO : Department of Health Services
Medi-Cal Managed Care Division
Managed Care Expansion Branch
714 P Street, Room 1400
Sacramento, CA 95814
Attn: Sandra C. Pierce
FROM :
submits this invoice for documents in accordance
with the terms of Contract Number
Purpose: Payment for documents submitted:
Documents :
1. Local Initiative Workplan
Amount Requested $ Amount Approved $
Please Remit Funds to:
Attn:
Authorized Signature Date
Comty of Contra Costa 93-19032
EXHIBIT D
(Must be submitted on County letterhead)
Monthly Summary Invoice
Period of Service_/ /to
Contract Number. Mvoice Number.
COST CATEGORIES ! COST POOL#1 I COST POOL#t2
( FORMULA SPMP I FORMULA Non—SPMP
(A)Total Federal I Add Une Z S I =o= )000000(
Enhanced Share I totals from )
Costs I each separate )
I invoice. I
(S)Total Federal I Add Line AA $ I Add Line AA $
Non—Enhanced I totals from I totals from
Share Costs I each separate I each separate
invoice for I invoice for
I Cost Pool 81. I Cost Pool#r2.
I I
(C)Total Federal I A + B $ I B $
Share ( I
(D)TOTALto be Reimbursed by Federal Government(FFP)
(Add Line C Cost Pool#1 +Line C Cost Pool#t2) $
I certify that the information provided on this invoice is true and correct,based on actual expenditures incurred forthe period claimed,
and that the fundstcontributions necessary to match expenditures for administrative activities which have been provided
pursuant to the requirements of 42 CFR 433.45.
Signature
Title Date
;r
__' iht2-as Tuesday
vol sa vo. 218 Novemaer 12, 1985
pees 46627-46736
Ma
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--..,. BANNI "an IMteiv To Uw file Fedara OWWOM .
: For ielorteatton on brie tags in Adfam& i:7:wW
" — M Phllmkiphm PA. see tutmmornmat tta tltCVMJ& tma of'
tltia iosaie. ... .nt •. . . .. .
Selected Subjects
t _
Air Pollution Control
Enwro=emal Protection Agency
—�••= MFcedde tt Tradc Ct;mmission
s-- Aviation Safety
_• = = Ft:deral Avtanca:'�:sntstrauoa
_
Coast C.
� FlsA+artes
Nal!=1 Ocuan:c ano Atmosonenc Adauttiatmtton
••-—— Grant Pmarams
Envtronmenta! C:ltsrt tin A_sncy
Hw=cous weste
Envtronmcmai Prctcc::.::: .lhjency
Loan Programs—+•*using &no Coca reAuty Qtwiopment
Education Oeoar=ent
fJt�ttYtd
Hea!ta C_:e Firanc: ::'t.:rruustrattan
_ Milk Markettnq Ortscn
Ag*teumtrat marxettntt Service
_ Nuc:ear Power Pants ano Reactors
=-�
Nuclear Ret:_u:atory Com.=ion
South Africa
_ Firomm Assets Cmn:rt:t Assets
. »OuTtNtHd twatOE
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Exhibit E
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Tuesday
November 12, 1585
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2.5tifSS LAW L I LS A-V
1 E :..1 e R A K Y'
:AL t.i.t t;.'`. I . - '5EC9
o i t uescay. `ovemper !2. 1183 : Ru!t!s anct Ri:•sruanosta
` ate c:rtVE=F_--•ancsci Ptuuuoalzon nonmedical staff.Thin is evident eu in :nta2ssen FFP.These t ntma are The
P1 fcr w.: easatsuann and Traimnte of he Senate FinanceContnttttee recon came as those in the tts•eposed rules.
ns billed P-c-e:s:onCl uet=fcai Personnel :hat acceimpented the 1%5 Sa+ctsi With the fri loatag thioles .
Settarn 1:171aI ei the Social Sec=ty Securitym
aendments lReport of the We have further ciarified
cl pruvlues fxransbie Federal Committee on Finance to Acc3arnaanv "supporting staff'by:aciuding copvinit
ail„.:na rz:_s to States far H.R.6VUL 06ta Cons-ist Sessr S.Rept. itaff anc sale and recaft t3ssics tin
drrsm_irtin-!4-:r=ons under No.VX.Pt.1.{tote 30.1965.p.831.The addition to secretarial sad asamograpwc
edicata.T`e mmantt of acutities that term"skilled professional medical staff as dmlts
ental stall to athe
"m a nrcrssary ler the proper and persannei"is not meant to inciude referents:to the term-detiicsl staff'
an icicnt ttpnratmn of a State%tedicaid nonmedical hesith profssstts:sttb.such cotuistrat with tai Euiarally arapled
lan.inciud:nt comas naatum and as public administrators. medical budget definition of the term we aline have
--his stint"for most of the sgenc'y's staff. directors or aarttym iobb?WL or senior referenced these stall as"dkucdy
rc fir2neen st the M rite of So manapess of public assaatamcs or supporting staff to choly the Hovel of
its. er•cant.However.cc.tein spetzfte costs. Wedi=d prugmaus.We recogcfte that it direct supetwion(ia:m-bat,filial-Level
ch as cot taensstion and trairtits3 of is necessary to have a vuxtsty of supervision l requtred tot tltrleee ssta#l.as
:or "ilcd prafesstonsi meditai pe:sottnei nonmedical haaith professionals and spetxfied in the at---
rid t:ien=i staff directly support nj that these personnel may possess an t, We have pro. a for ruelopiumis of
nild ese 1101 itrse#.administration of equivalent level of education.work -x years or luaitster gra1immung to
"R• amsiv piatirtmi se-races. and certain experience.and certification as those to academic degstesre or mein
or sons ret>tted to the Medicaid the medical care fieri.However.the law medically teriatsed pQofassiloW as
••ent ana t..-"t infumation System does not provide for 75 percent Federal
proicssfoaai education
mat for theducation aid IN
tiilS�N. nanrxd tit hf-lies sFFQ rtes. matching perstl•
stall 17* of the Act provides "Supporting staff"is definer:in the I.Costs must be iaroLndtrittln directly
r Ft-tlertts- !t r.•nc at 75 pe.u.n fur Senate report as"clerical atafl."=Ye reiatea to the odmrn»trattioer of the tirte
•ra traintsix tai skilled have interpreted clerical staff to mesa •LX pragmm. FFP zt 75 pereewt is
-o ie-w3nat t_•-:rat oersonnei aria their nee etariai.sterlostrapatc. and cotsyiag avatiabie aniq for the carat of
directt•. +v r—,nt stsiT.It also arra ides personnel.and fife anti retards citrks compensnuon.trace!and traimms of
.for'5 ut.-rccn:c?p`or skilled that provide direct support to the skilled stilled proiesmonsi medical peirsonnel
arpfctstnrsr r•c,cai !tuff and directiy professional medical per3onnist.the and their directly rvpporaaa staff wits
for pponln+si,if of other public acerties costs of other subprafessionai stall not are involved in aetivitias that etre
ith vitirtt Ott itedicaid aSency perforaung clerical functions an not necessary for the proper and o iaeat
ban.c
tracts fur ldministration of the elixible for 75 pomant FFP as"tfirectfy adtrtfnfstratmn Of flu Madfaeid State
nis liedivat phases of the Medicaid tuppo:tiztg stall'.'• plan.Expenditures for the usual
The changes is FFP lirast atians furnishing of medical servkm by skilled
r The tntrnt us th:se provtaians is to ,lddressed iia this dot tIment do nor apply professional medical passonnoi do not
''no i`cncaurzte Sate agencies to empiov to mawbing rates for Slate*personnel quaiify for Frdaml matching at 75
.law personrim mo nave the arciessinnai wife are involved in the survey and percent.
eteasuu 1=n.se neussary to devriop Certification of facilities participating to -Snit:ed faruiessuciial medicalnjve and ar.Z::u+rr!,t.dscasd rrrfgrams that %lodicaui T'hs FFP malich tg rates for personnel must note pt'a/azttwwi
ems err,mcasca::: +unn as wait as these survey personnel will be edutcanon c.td trainum in a medical
n"t &duan: tr:.:. •t•.titcicrt. rrofessinnai -addressed in a separate docunteut. iVd.Skiii4d proicassoaal medical
N meax.as r.nr.,.,ettue is neeued to shape We have revised the restuiations personrset are required to have
the ni:sic... ..rrr-s at the program. :'!arena to 7S percert FFP for sasiied �jeatson ansa training at a proiesasonat
incsuni-a:-..nrrr•:ration of winch nrotessionat meuicai personnel ant i:Vcl i11.ire itetd ut meaicai care or
meuic_-cr*::•s :nauid be in-citit:en to a •ircc.iv supcortinit arab. otner inin iopropr:au,meoscai oractiee:afore r Ft?
'1i to we+i•ttai.rr c:mt:ntc;ai benefit troaram. •:t.sie oersnnnet involved in the sum•ev ':sn ne ci_:med at 73 perceuL
..tis. coorcinaucn.: vovi-ibie nieaical inti certification at btedica,id f:c uucs. The:ieciai Security Amendments of
•:cut• resaurcrs.......no%.staoiishmpnt of worxinit t t.lartiv which personnel are ehCiate IWS writcn creates it.:Medicare and
I tris retttir nimn;r.ai1 inr nrniestmn.al 't•r the higher mater.:-it rate. VVP have %ledic:isu ernitrams wd rot define
eieusc:u u.-::n:;nric. Althouc:n the :dulled the defiritiors of "skilled '-rolessu•uai meoscai cersonnet.'
i hieosc:::i:a.t.'... . nes !-s.iiied essionat muaic:i«crsonnet'.fru Noweever. the Senate Finance repnrt
its protrssu•-.a ':•,rrrJsd im-"ri tnei to t!;reet:7 suopart:nit talf.' "Skilled vilieh accomuznaca rise Isgrslaunn.cued
vanutm r.:_ac :c:.not oil of:hem nre ;•'otesslunat mea:cat personnel • miter. tt lits that the"staff will inciuuc
skill.•j r:r. --..n.it rilrnstai rersornnt nQuat:only protessionzis in me acid :10tvswwns..:icumzi utisninistrators.
:nr'S oerrPnl meoscai care. 'Directly suaporrtni! newcat suciet viorit personnel.avid
Feucras r.::r., t•,. •calf" 'includes only those clerical no .ither spectuiized oersonnei necessary to
t.%rr trr- . ,:;.mere nal oern -a aoonsfotiuies that directly suction issure in aucquate number of persons
scat dicer_•rt in -•c•-:rcuna arta acaiviti2 Killed protesstonat metrical personnel i ao 4 ntlullty too. . ` `"
tn:it the r.-::rnl _._::�urtrrtrtne Nn:it �+=•::• \1!etanotes of skilled proiessiun:sa
_t} tyllim t•: -^:tai: rs anu :ea f_zetlons 'A'r also n:i%r incurocratea in rite •:cuicai oersonnet eivcn in the
t:FP.:s sa.liInd ^_tatinrs unser 6 432.510 the crit.ria .oncresssonat Committee teaort ana it
Pitt-... :cat orrtennet 4A.s t•rniru tsrlow in c: rtry tsirincr wnicn v'tt. -*,;introns nnti;r one ct•ment in
stztt. '.''tis has :,.is for!Killed orosessionat M1.111cal immon: .%It inateatc that these ttatt
resus:cn. rases. in aiifPrt7^.t •Sonnet anu alreutty st!oportmc sten j%,e ccut::tttUr unu training at a
rM nti j.itc to statrt irr :„tlfv for-5 orrrPnt F710 All "ojessional Icvet in the field of ncutcai
nr:s its $1411. ooncaole criteria must be satisfieu to .:re or aerannate meoir•.ai practice.
'6 O1 -=n t-:e".• •~r taw tt to nrovic- -t iul+th wi-iner tr.e zersonnet Ana Education and tratnina at a
incream-u r-- ^^+esczt stair.jai :_t:c tutanortine tintt nuauiv 1nr at ssinr.a w%,e+ mrnns tic
46658 Federal Rettister t Vol. So. No. -la i Tuesaay. Novernner i:. :985 1 Rules anct Reitttiauons
comoietion of a:.-.ear or longer program It should be noted that none of the "Clerical staff' is interpreted to mean
leadinc to an ac:aemic decree or functions listed above includes the secretarial,stenoeraphic.and copying
3 rrtiftcate in a rreatcaily related provision of medirai care ana services. personnel.ana file and reecrns clerks
;.roinssion.This-av be demonstrated Provision of mea cal care ana services that provide d:reci support... :bo akflled
by possession of a medical License or would always be considered medicai professional medical person_-tci.It does
Certificate tssueo ov a recognized assistance rather than administration. not include the cost of other
Nat►onai or State treatcal licensure or When the function of skilled subprofessionai staff not pc• ming
Ccrttfving orgaruxation or a degree in a professional medical personnei is the clerical functions.
rnctileni field issuea by a college or application of administrative practices Eligibility for increased Fr for
university certified by a professional and procedures unrelated to the directly supporting stag is based on the
medical arganizauam Experience in the specialised field of medical care and concept in the law of"direct eappart-
amin►stration.duection.or requires no skilled medical tratning.the "Direct support" means the limn cm of
implementation of the Medicaid costs are matched at So percent FFP.For clerical services which are dk"dy
program will-not*a considered the example.the tmsts of a physician in necessary to the completion of the
equivalent of proiesstonal training in a charge of an accounting operauon are professional medical,rtspoearbWtfes
field of medical rare. eligible for FFP only at 50 percent. and functions of skilled ptaiipia;> ►
3.Professionoi medical expertise 4.Air empioyer-empioyee relationship medical personnel. fledTbametal o
must be neitessarp to fulfill the must exist between the State agency documentation a rion showing that clerical
be
resaansrbllirits of the slullyd and the chilled profrssianal medicol services provided by the supporting sufl
limirssionai meaic:l persannel's personnel and directly supporting staff.
rasrrton.The intent of section 1903(al(2; As evidenced by the statutory language are directly related and necessary to the
xecution of the skilled professional
ref the Act is to ensure the interitrity of and legislative history of section e
ncc many diverse a:catczi aspects at the t903fatt2l.the 7S percent FFP rate is medical personnel's responsibilities.In
order for the clerical sertmcas to be
,.ted►eald program ov provtdinc an applicable to costs of sperafie aerstonnei direet:tfv related to skilled prafessiatial
,ncuntive to State agencies to emmov and staff of the Medicaid agency or any medical Personnel's responsibilities.rite
,killed professionai meatczi personnci other puoiic agency.We have skilled professional r epons genies.t
:. in respect to those medically-related consistently interpreted this provision to must be immediately r dicu peersble far the
onnel
Program activities.The law did not authorize the 75 percent FFP rate only must performed be the clerss:sl stool and
intend to protide:5 percent FFP merely for personnel who are employed by the workmust dentary d by
(ieriW to first.
to any staff person who has qualifying agency.Therefore.in most cases.FFP at levet directly
the supervise(i--gappa staffr
medical education and training and 75 percent is not authorized for and the performance of tics
r%penerice.without regard to his actual contracts with private organizations or staffs work. supporting
responsibilities.Rather.the function independent contractors.There are g,Skilled prafrssionoleirdlcal
performed by the smiled professional instances in which the agency contracts
tnedicai personnet must be one that for personnel services as a common Personnel ante direciry supporting staff
requires that levet of medical expertise method of securing the services of of Other public ageneses eruct most oil of
to order to be pe^or-led effecttveiv. skilled professional medical personnet the applicable c.metra included items i
Consnauently.7:oement FFP is only without Roinq through the formalities of through S aria:his must be rerrffed in a
.evadable for d=ose sositions that require merit hiring.if a Medicaid agency claims LYntten atrretmtnt ivirh the Medicaid
I rnit•xsu3nni nicei=knowiedec ana FrP at 75 percent for these personnel.it cgehcy. Skilled crofessional medical
atils..ts nviacnceu cat•posttton must demonstrate that a documentea personnel and directly supporting staff
,,,• cncttnns. Loll inn ntincrmertts. or luu +•molovar-emaiovee retationsnip a Kists tmoiovea by puoiic aeenaes other inan
�.uir:ttinna. betwourt tncm anu the Itectcutu:iaenc•:. 'he Sleaicata azenev lor.in the case of
:�ar..DteT of t.'_::w^S t.`.at wtuud It is funcamental to contract law tr.ae separate proeram divisions housed
:•:rut t;:cse crur-.x=.uue. taut.ire not the substance tit a transaction.rather within an 'umoretia"agency,empicyto
:.rntlru to. the fotiotr tie. than its forret, is cantratllntt.1 iCFA may in other than the Stedu:a►d componenti
• •\runs 3s a t:.vson on tea mruicil conuum an etarntnat,on of the acivai often assist the aurninistration of the
.isrrcts of the Zr:4r3m with provmvrs of Buttes pertarmed.resconsibilIties Medicaid prouram. FFP at 75 percent is
•t•rviers ano o:ner::i:ncies th.ti Prot tuc tsstimco..tllu manner of oeriarminc:'L -•vattdbie for the costs of compensation.
:nrincal care. duties and resoonstodi ties that hat•r, travel.ana traintric of these personnel
• titmisninL t:ecrrtmecir ii atitnions iteen estabf►sheu to determine it the ana directly supportinq staff if there is a
fnr the:imudirati on of w1minisi r.,live facts.inciudinc int.State % written tnterz2cnev or inieragent y
••gT+C:iis. iluctimenintion at the emptovr..rnt aererment that scec►ficaily
• 4t+•vtPtytnC:_-cacti +nt'su:i;ui retatinnsnia. inalcate me entsirnce ci:in tiunionstruies mat non-Medicaid staff
:line. cmalovrr-emptovee retat►onsnia.it is ine ..not their functions meet all the
• Vrtivttiin_ ennn cai assistants, anu substantive reiationsnic octwpen the aooncable critema.and that they assist
tic:utu�e*crcC_'.en L`. air-.tcv ;,artirs tinder Math taty Mat to t:r.t:cat in •':e ktealraid .,eencv.or the Medicaid
!vterminine.on 1 talar-at'-,.,st tinsis. icenry•: .kdit ti nrotessionai meatcal
ioat:n::' -Cuirui revi+•w ter .viielner an cmDtu%,cr-Pmoiu%,r." ;rr.sonnel to acn%ines that are airectiv
::rttr7t3Ctit n.x:ast:onni rrv:t•w i--ani `••t.ifltinsnia exists, tint the rt:rrr 'ciatea in the itimini3tration of the
::r•. >u nee^.l .i ,ir.::raL:. tediraza urt3r:ram. Directiv retatea
t..r.vi _ . . -r�sut a► r:frrt::r.,.:ntrur::• ....
•:�sr -c:+ns nt:rrora::nc duties that are
.ri!•:.ii Y t.i moi••::'..r....r .tni3 •• •t:c rS "ta"aA•t'tr'lt•C!srr:^rr:t'rC:
C.-:. :-1 t•Yc:iry in :nt: oneration of the
i •.:.ii•U. .is .r. .. . .:,:.uu it % i A -err••:• •:r•CrSShi't''. •r.;r:••••,r•:i ,..:: '.a t:-ii_airt nro_r:im for which the State
• ••+teeth•:. ' '•::1 L..c•' ...ter•r.•tfOnr7l:::rC;t'�::'C'��Uli�::J::rlfr:5 %Uinnitarcttur n3 the hledieatd ororrum
nazt:nrnt .a:... .•�. ti.r:err:.etst t,,r ;r;rwt r•:11.1`of rnr S:,rurrr!t�n•�9.Crrr Cr +!.rountnole. Ice uttreement must
•n••.l i..: . . ..,t... •,i .. ..r::r ..}..r. ,t.ii.t! r ..err. 1r :err.iC:':::a's tnr other iaiutic
..t.t. :... .ri•t .. ..:a',: :.. i1 It tit 1:::....... .Q.11sist in iti^
_. :t.u,c:,:u n::i_.•it:3.
Federai Register t VoL SIX No. Z28 J Tuesday. November 2=. 2985 1 Rules and Remi1atiaas . 46W
7.FFF mast be crarated for strict donations made by a proprietary agenctcs to seek reunbmiemmt troth
(unctions of skilled arafessionot medical organs:anon such as a long-terra care third parties who are liable to pay far
personnel and direrw 7r4upporun_q staff facility or data ptoce sing company.in medical care and services in taimpients.
If the skilled professional medical return for Medicaid business.Therefore. is broad enough to permit a Stats to.
personnel or dLwiy supporting staff the regulations permitted use of public seek reimbursement from&illaiest3s4f.-
time is split among az$esent funcuonm and private fiords as the sources of the insurance.We have not wade my
some of which do not qualify for 75 State's share of financial participation additional change in the of
percent FFP, the skilled professional only for ane category of coats—•ttainin`8 private insurer because we believe that
medical personnel and directly expenditures.
supporting staff costa trust be allocated Ezpen--has show no abuse of the specific early age quavkunder vibe ats�tg
among the varsaus funcacass.The public and privets funds through -�already sdegturatt e?mrtie= s
allocation mast be basad as either the caaditiosnal doaatic ns or kickbacks. tammefiter's coaaefa-•" . r. 4�-+.::-
spent within Canerady donated funds are organization idrniaist
acsual peruxatage of rima °� �beslt�W.
eacb fuactioa or another methodalta commingied vntb all other Medicaid casualty insurance pians for.
that is approved by HCFA. fiords ands r the State agency's Professional assoaatiaes.
sources Of State's Share of F7nancial administrative control.By limiting the fraternal,groups,ernpioyas+atatp n?"
Paruciptftfon we of ticrostiarnsa as Stats Eustis only to benefit plans.and any sstmitt.:.�.:.,r. :
0 can offering
Section 2907taif2l of the Social �p sed an admisistratt&burden �including self Wenn d ''sad aelt'
Security Aa requires States to than in on the States in terms of coat allocation. funded plass:'
tins cast of naecucal assi&tance Furthexmam if a State we..to receive Comment:One ccs-measetabocied to
expenditures.but permrra both State and donations in an amount greater than its the et'tect that the apphcanaaat test
local goventments to Participate in the total eammtig expenditures.the excess revised definition.of third party amt
finanang of the non-Federal portion of fluids could riot be used as the Stats have on liability of an eids:}Tispoose d a
the Medicaid pragnm.This section share of other Medicaid
specties the perceciage of tike State's expenditures. State ttapiemetits the regmssirs�mt for
We have revised the requirements use of the cast avoidance ttistisesd of
share of these casts and regiiires that under;43Z.s0 to permit publfe and
this share be sufficient to assure that private dcnatsaas to be used as a State's paying cleisis involving tmaotr ti7itd
ffi
lack of adeouate funds from local share of ffasnaal paracipanon in the per liability.The canunemag batiitsved
sources will not purest the furnishing entire Medicaid program.rather than that an elderty spouse could be
of services equal in amistmL duration. considered a liable third parir t-
scope.and quality ticoogisauau
perStates t the State. lusts permits s Stat aspaaditsrtsa.Thetaa mar!fleuibititp is.ravtaion deteranming probable vdaManoW ddrd'
As State fiscal budgets have became adminsstsrirsg their prop me and Pty liability on a claim.aubd stat#hitt
mare susters•,State legislatures naverecuse&the could resuiit in withholding of '• .
looked increasiagfy to alternative necessary to reimbursement for services p>evrWed to
sources for relate donated funds exclusively to h,. .
funding a forger tions h of an institutionalized spouse. .
the Medicaid ptvg:am.Questions have ��expenditures—Section 43Z.,tiO U • •
is p 4=—SLate Perianal Resronse:The revised dei3attloa of
arisen regarding the use of public and Administration of the Code of Federal third party has not changed fr tm tate
private donations as sources of State's Reguiations.Because the revised previous definition in reistioa to the
shire of fin definition
o"Slate non. requirements are no longer limited to canurtenter s obiection.The revised
The detinitiaa pf tater ens training costs we have redesignated definition.as well as the previous
generally used by States means funds them as ; 433.4S of Parr 433—,State definition.includes "any individual.
unrestricted power of
g
over which the State to appropriations.has an Fiscal Adminisiration. entity. or program tr
that is or may be
Therefore.m orcer for donations from liable to pay ait or part. . . :'The aniy
public or prvate sources to be Sutnasary of Public Comments on difference in the definition is the scope
considered as the State's share of Propaseo Rules ono Dispairtment of services for which collection can be
finanaal participation at Medicaid.we Responses made-which not includes any medical
issued regulations it 432501 for assistance furnished beyond that
Definitions of Private insurer and T.'tird
determining when donations ceased relating to the diagnosis or treatment of
beinu local or private funds and became Pam' an injury.disease.or disability.such as
State funds for pursoses of a Federal Comment:Nine commenters prenatal care.well-baby visits.rauttre
.e program.In deveiopus;the regulations. supported the broadened definition&. physical examinations.eta Th*
we wanted to ensure that tf a Medicaid One commenter expressed concern approveu practices that a State applied
i agencv mainsainea atimtmittrative about the absence to the definition of a under the previous definition of third
control and unrestricted power of private insurer of a specific reference to party may continue under the revised
allocation of ill donated funds.Section self-insurance that meets the definition.The revised section 433.239
432.50 outtines the cannitions under requirements pubiiahed by the U.S. nertmts States to have the requum
ecnt
i which public ano onvate funds may be Department of tabor under title t of the to use the cost avoidance method
consideree as the State s snare of Fasotovee Retirement Income Security waive*if they are using.as of the
t Medicaid excenmtures. Act of 19"74 iERISAi.ERISA provines for
puoticatson tiate of thcse reltiiations. the
At the time the reinuations were seif-insurance neanh benefit plans "netnod of caving tic entire claim and
r
.ormulutea.there was some concern througn unions and seif-funded then seeking reimnunement from any
about potential for cause. We wanted to mptayer peneiit plana in some latae sable thud party.if they can doeuntert
prevent zonations trat cauid be publicly ano privately owneu business ghat their method is as cost effective as
conditional on some aenein to the entities.
donor.For exampte.we were Resaonse:The provision under :he cost avoidance meutod.and if they
'C particularly concerneo that a "kickback" section t9oZIa11Z51 of the Social Security '=ceive the soorovai of the HCFA
t situation couta result f ac private ?kct that recuires State Medicaid• Rocionat Off:ce.
A
i
a
46658 Federal newusr t Vol. 50. No. ::3 / Tuesa.:. Novernoer 1=. :385 i Rules anti Reguianishe
Fovinent of Claim i.vativiny T&rd requirement for use of the cost recovery is logical for hesits insutriance
Parry L.tobdiry avoidance method waived, but does not apply to noel-no fault
Comment:While ennt commenters Comment!Two commenters personai injury cisims.ants that it is
generally supporters Sze overall third recbmmenbed that pharmacy uaims always "cost effecuve"to seek payment
party liability caa=aL lour of these and involving third party liability be to the full extent in available setdement
six other cotttmeaters objected to the excluded it=being paid under the cost money.The commenter suggested
requirement that States use the cost avoidance method.They pomteta out revised ianiguage that would delineate
avoidance method to paying claims that these individual claims are usually suspension or termination Frocemcret
viten the agency oat established the small dollar amounts and.therefore.the for third parry liability artg*in
probable existetstr vii third party cost of recovery will usually exceed the contractual situations(typically health
liability.They believed that the actual amount of the ciaim.They instsrancaej or no-fault cases and those
requirement would rat be Sonat effective asserted that the alternate method of that arise out of tort or mesion
for=at States and would in=asa the paying the claim and then seeking compensauon.
administrative burden on providers_ reimbursement was snots pracaeal and Response-Section ISM&X=of the
Three commenters pointed out that just as cost effective.One of these Att requires that in uses where kmw `
States should be allowed the flexibility commenters also recommended third party liability is found so esin
to make third parry coilacnons in a excinswo of nursing home cialusis from after medical assistance is mad to
manner most cost-effective for them and the cast avoidance method requi etnent. a recipient.and where the amouast the
suggested that States wnh'"pay-and- Response:As discussed earlier in this State can reasonably es;efet to recover
chase'methods in Kiace be granted document under"Diseussiota and exceeds the cost of rename?the State
waivers of the mumnent to use the Provisions of the Relt"do Third must seek retmbursemus to the etrnnt
cost avoidance mrinod if they can party Uabiiity."under the provision that of any liability.This section cootaim no
provide evidence mat their methods are a State agency trust use the cost exceptions.hence all third party
cost effective. avoidance method to pay claims resources.including workers'
Response:We have retained the involving probable third party liability, compensation and tort liability,taust be
reautrement that States use the cast we will allow the State agency to use pursued to the limit of iiab$ity.
.+voicance meutoo oecause procrar n procedures for determining the Comment Five commenters objected
experience demonstrates that the likelihood of third parry liability and to the responsibility that the proposed
method is cost eiieruve.hevemeiess. subsequent payment that take into reguiations under !+fib)places out
we recognize that:titre an some State account the type of medical expense and a State to predeter==w atsttzlma:s the
agencies with effticatx methods of type of insurance an a particular claimamount the third parry wWky iZ►
mak-nit full payment with subsequent These procedures apply to ail claims situations whets probable d*d party
recovery and that an immediate involving third party liability.including liability exssu.Two comnessen
required change to t.a cost avoidance pharmacy and nursing home daima.if suggested that"probable liability"be
method would itarose on them the State determines that the use of the cfeariy defined otherwise►dsdicaid
unnecessary delays and costs because cost avoidance method is not agencies will.in most case plam the
of system changes and implementation appropriate for paying a claim using burden of this daterminatietn on the
time.Therefore.we nave revised these critens.the State would have to provider.
a33.237 to petritt;sates to have the use the alternate method of payirrq the Resaonse:The proposed requlations
ri-cuirrment to use tie cost avoidance riaim and then seeking reimbursement. did not inciude a requirement to pay
metnoowaivrd if:Lev are using, as of However. the existing reinitianons at rlaims on an estimated basis when
tn,oiication cafe ni these rrtruiations. : 433.1391ci tnow redesianated as 2robabie third party tiability is known
C treMoo of aavt-z t.^.e entire rintm ; 133.137tf11 allow a State to ter-n—ate •c exist.insieac. t.hev woaid have
:o tier aee+tine re-ot:rsement from :r suscerta recovery efforts on c:ainis requuec payment to the extent that the
..-v itauie inira ca-c ono if they can `ur which:t determines that the amount payment tinder the agmt�s payment
icumeai that toric-rthod is as cost t reasonably expects to rtrcpveT 14Ri1 be schedule exceeds the expected amount
!fmnve as ine c:st avotbance r-ti-mod. ...ss tnan the cost of rccovery. Tl-.;s of the third party liability.We have
A Stale s request:2 r.3ye the section also allows a State to revised the rettuiations to clarify the
^.ssirrmcni wmvea atony with iccurnuiate billings with respect :a s procedure under tvnich a State will
•�,icumentjuon a% :-.e cost eifectiycness ;-articular liable third party lover a +stablish the amount of third party
..i the exmuns me:-aa must be boecified oeriod of time and to a duflar ,ability. The regulations spaafrr that.if
-tium!tted to ine r.CFA Reittbnai Office :mount rnosen by the Statel in mating- :he Medicaid agents has established the
linin tit:aays at:-a zumicatiun u.tte tit •':e dectsiun whether to seen recavory of :trobable existence of third party
eie final rreu:a::cns.Administr-mve -aimbursement.This accuntulation of liability(that is. during the eligibility.
,is:nut ue tic-s..;trec in a !)tilincs cotta apply to pnarmacv claims. ,iaims orocessina.medicai support
imputatwn ai:La nasi etiec:iyeness of Comment.One commenter woo .;oiiection.or third parry recovery
-c 5t;;tc s netriac-erre we wt-.i •..•;jive ••,3rported the overall third pariv process or any other third party related
:r recui._ment t.-,:3e of the cast +abtitty chances suggested that tre ictivitti. :he State asencYmust select
:Ccuest m -:ivy zulatinrs.parucuiarly 4 4311:31cl vie claim ane return it to the'Provtder.
r rrnm:cent .-:mien also wi•i not UL 'ow reoestanated as E ;33.133If11 We interoret orocable liability to mean
.,:ru,r-t ice:a a -rat noes no: -...e .•i.iting to susbensiona or termination nt ":e presence of an indicator in the case
-!.,t.c .ii w :-e:_.::aa::on CJ:d Ct ••_overy trtton.could not be cornoteteiv -scarp tr.3t suggests a cossible third
ese ttr.ui re.uia:;t r.s ine methoc ci ,opueo to liabilities amine in matters vii -3rry resource that is or may be iiable
rnitre ants then :aextnz n or wnrxers compensation or,it ur a recipients mebicai expenses.The
rrpurtiemezt:-_r:.try stable intra uottect. wriuid be counterprocua:ive in ••stabitshment of third parry liability
iriv i*-r. NCFA-citorat Office !veil •-:fecttvp program onerat;on. The takes otace when the State seen"
:vetnin in t`.sys rpt •mme•mpr nennteo out innt re•ating trip •rrtves contirrnation from the provider
pi -r rrC_es:' -1yft tri -,:rt*rust tit rPcovrry in ine amotint fit r tnet inirp parry resoutct tncticatine ine
y. Federal Rei ister i Vol. 50. No. :13 t Tuesciav, November i 1:185 1 Rules and Reauiarimm 4usg
oil
extent of liabilim available.The attencv is a condition of tt#igibi:ity and We also have revised the re Wations
must then pay t;.e claim aniv to the requested revision of the remsiations to to emphasize that the terms of specific
extent tl%at payment ailowed under the incorporate this requirement. cooperative agreements may be
agency s payment schedule exceeds the Response;The Deficit Reduction Act. developed at the discrepoa of each
payment of the third party payer, which was enacted after we issued the agency to account for tntuvidual
Commend Severat cotamenters proposed regulations.now requires circumstances.
emphasizea that if the requirement for applicants and recipients to assign their
use of the cost avoidance method is rights to medical support or other third Rates of FFP far C-inVensatran and
maintained.reasonable timeframes for party payments as a condition of Training of SOW Froiecuaaai
impiementauan ae allowed. y. .Medica/Personnel and D
Response:We reaiiza that States that Medicaid tiigsbff91Z o(Sectionsthe Supporting Staff �y
do not have a cau avoidance method in 1' ta#i441 and itRZ ad the Social
place wtil r equate teas to deveico the tea
Sutty A.ei►We have made Comment.Ten coramsaneea objected
conforming in these final to the mare restrictive dafmitka of
method at modify a tmrrent method to regulatiaoa.SSA is also reeking
comply with these regulations. supporbaq staff.These omits
Therefatt,we ars applying the confarmi g referetttes to regulations recommended that the dewed be
regturemenu to claims tnvoiring third governing SSI eligibility detetrntinatioa broadened to include the ctiogory of
Pam liability that are processed 180 under 20 CFR Pact 416 and is developing ••subprafessionai staff"as dafised and
days after the trualiestion of the administrative p4ace dures to obtain the allowed in current retptlatiame tttndsr
mguiatioas.We feel that making these applicanva response and signature to sl 432,2,In addition.rheas aomzdtanters
requirements eiiecuve 188 days niter the assst;ttment of tithes during the efigibility pointed out that the commoWy Used
date of publication provides ample time process in States where SSA determines definition of"r,#erical parstsonai".
for States to came into compliance with Medicaid eligibility. includes copying.file:and records clerks
the reoumments,in addition.States Caaaerarnve Agreemenr3 far Third Forty ds well as the secretarial and .
have oven given previous notice of the Collections stencittaontc oersonnet spared in the
proposed recuirements throusth the proposeu regulations.The caramtenters
notice of proposea miematctn Comment Two commenters supported
s;published the proposal to delete the detailed :rcarnmcnucd revising that dsSaition to
in file Federal Resister an Ione 4. 1984. the proposal,
for cooperative include ail of these types of clerical
Comment Two commenter objected requi; cinerea with title IV-0 a tentaes and personnel. .
to the absence to the preamble to the 8 Response:The Senate nuamoe
proposed reguiaucas of a quantification other 4"maes and officials under
433.182.However.the Committee report that accompanied the
of savings as a rod.T e use of the cast Y quiriutd out 1965 Social Security Ameadse cat&cited
avoidance method.They also pointed that the deletion of the requiretstent far
out that the inflationary impact on reimbursement by the State Stedicaid earlier.clearly defuus"s Ming staff°
"clerical staff
providers was not prapariy addressed. agency to title IV-0 agencies for as the dIrsedY associated
services performed has created a with the professional staff."Tia
Response;In this preamble we have discrepancy with child support legislative intent.as reflected lit this
fisted the areas in which scares should �
be increased throutth use of the cost regulations at 45 CFR tart 106 which report.does not indicate that tete costs
of other"subprofessiasul staff"net
avoidance memod.We believe our logic require title IV-0 agencies to be f other
clerical font ti staff"
are o he
' is sound and acoLrate because the reimbursed by Medicaid for activities p
maionty of States are now uninit cost performed under optionat cooperative ?Iigible for 75 percent FFP as
avoidance to some extent. We recognize tttreements. •'tupportime staff:'Therefam we are
that there will be some instances in ltesnonse: Wo have rrvisec the onaule to accent the commenters'
which the i,,u;:a-of cotlecurz trnm 'causations in specisv that the recommenuation to broaden the
third oariv pavers will be transferred to rr-qufr".ents of the Uffice of Child definition sit supporting stiff to include
the provider or service and increase its Support Enforcement under 45 CFR Put icher noncwrirai subproiessionai
administrative cost However. in inane 308 are still aopucabie and to provide personnel.i fuwever.we agree with the
cases the provider s biflinst of third party 'hat cooperative agreements entered cummrnters tn.it our interpretation of
sources will stmDty tie a substitutiva for eta with a title IV-D acencv must the torn"cirncai staff'to mean only
its biding of :.t.0:ca:a. Oecir4 that the title LV-D agency s -weretanai and stt:nocrlphic personnel
reimbursement from the Medicaid was unduly retstnctive as to the common
Issie.-client of R:;=rs to aeneri., .titencv will be iirruted to costs of use and uruerstanding of the terns.
Cammrnr:Y.vo commenters suacested Nervices that Are necessary for Medk=id Therrfore. to the final rettulations we
that wmie ine cr000sea rrausauuns collection ono meatcal support activities `ave brnanrneo our definitton ni
,illow a Mate to recuire.US 3 ca:tuictaa •!tat aro to addition to those roquired to itioporting scarf to mean secretarial.
of eifctowty,t=t eacn iestatiy auto be pertormea by the title IV-0 ogenty . enoerapnic..,iui copying personnel.
applicant ane recsotent assien hts riehts inder the Child Support F.rifomement and file ante records clerics that directly
to meotrai sucpori or other third party \menoments of t933 iPub. L o3-3'Ai. support tho -*snonsdbdlities of skilled
resources to tre%ledieaid agencies.this Section to of flub.L 33-3:3 authorizes nroiessfunat mcas=i personnel.
rrnudrement ca_-ot be met in triose -tie becretary to issue reautations to (.'javrien::Fite commenters obfectod
s Stites wn.re aa:r:ementas Securiv +•outs::tie iV-D agenrses to petition in '.i the reauirement that the supporttne
income oiSii d:.momtt iq aetermineu uv :cduut:meuicar support as part of t.hdid tail trust ue uirectiy supervised by the
the Social Securer Administrrstinn ,upoort oruers and to provide fur ikilled orotesstonal measatl persc i
iSSAI.Thry Vnntea out that a5,X has morovpa information enchanee -n artier to ouaufv for 75 percent
mace no orovivans for aopivine three )!ttvc!n Mate IV-0 agencies and State 'unudne. the commenters suggested that
regusauons to aSI recipients. Une at cite `.tedticaid asenctes rrgarafnsr ine this reattirement aid not reflect
two commenters sutrttested that the .tvatlabutty tit health insurance h•Kislative intent ana that there should
State nas a ricni to mcutrn mrurmnt:on a ire^_r.. .vttn ririmoursement frac ton C rn rrryu:renCnt Gnat int supaucuns
iuncerntnit possiote tetra onr v pavers tffice of t.h.id Suoport tnforrernent. •,,,f be L;;;ctiv suoervtsea ov or
I
46660 Fede ai Remster r Vol. 50. No. 419 / Tuesnay. Novemoer 1= 1985 i Rules and Retwationa
=mtuiateiv resrponsitue to the skilled qualify for 75 percent FFP as siulled Cammerry Commenters maommended
-ainstonat meotcaa cersonnet. proiesstoi:u medical personnel or that the rezuiaoons be reto
Response.The iespis,auve iustory and ,ilrectiv suoporung staff.However. the ;ravine that State Niedicad Olrecters r
:he warning in the su;ute co not support regulations citany reflect congressional automancasiv quaitfv in ad instaacas as t
Ime commenters ootttslans.The Senate and statutory intent as to what skilled protessiond memeal personnel.
Report it).831 refers to the supporting - . personnel qualify for 75 percent fu:tding Responsier We disagree mewit that
staff fcr the skilled crofessionai medical and thele is no other authority to commenters' re•commendanee twmw e
personnel as-direcxiv suppotttnR such provide 75 percent funding for these there is no support in tt»at"*or in
personnel'and"d:recrty associated personnel if they do not qualify unrser the legislative histary to aerosomily
with the prafesaatsat staff."Also. these reguiatioaa, allow any persanneL inelodesg Stant
section 19031a 1(21 refers to"staff directly It is diffi—it for us to assess whether Wedicaid Directors.to gtadify as sidllsd
supporting such personnel."The or not screali State staff reductions will professional medical persoasai.An
legislative history ares the statute result from the impleaaentation of these personnel of State Medieseid arpeoes
consistently indicatea that a direcz regulations suxx State staffing and including State Medical Disiaesera.mtnst
relationship mast exist between the claiming practices and Stats budgetary satisfy the applicable astssta"mcdled,,,
,;uppartiria staff ane itt skilled constraints vary front State to Starts. in the regulations to estabisin whatber
rrofessionef medical pemannei in order Some States may restructure their they qualify as skilled prefouked
fur FFP to be allowatite at 75 pent L staffia;patterns to accommodate the medical personnel or dimcey voppoert
I his airrm reiationsntu is best chan"s in these regulations but we do staff before being claimed at 73 pereent
evidertrra by the suvocrting staff being not know what specdit State staffing Fly'.
,iimcttv suaern3ed fimmeniate first- decisions emit acualhy be made. Comment T wenry-three conamatet
Ic:vri:supesvisiont by the skilled Commerce Two commmters indicated objected to the fact that tht repintians
miesiminni medial oersonnei. We note that the HCFA regional offices were would not allow States to tis=an £
**,at a tri,same intere-etanon we nave airesoy"retroactively"applying the individual's on-the-iob tttatsag and
een unotving unaer s-e current proposed retulations to current financial :writ experience as quaiftmaa for the
vuial,,,ns. rnanasteme:nt reviews and were reouesng skilled prttiessratial meditalparsarmel
t'o;;tccvt the co::-enters funding to the States accordingiy. designanon.They oefieve dist this
-,•rontmrnnation wowa be contrary to Response:Tba application of the training and experience roar be more
to rr:rc r_tslaute•n:ent of direct proposed solations before they are relevant and important in daing a
uopurc:mu couta result in a situation duly promuigated as final regulations is quality job than the expeatse pitted
where it i surfed proinsionai menial imp=CL However:we know of no through professional ednapi a tittsd
personnel posiuon nestled the Medicaid instances whets disallowances or training before working is a sid3lsd
1 a t ail ata the reeve ea at 5 staff t financed adiustmeats have been taken professional medical persoaaai function.
ilii attt•eiCY were c;aiIIted at:5 percent against any State using policy changes in addition. the commentars
FFP.There is no mcliauon that included in the proposed regulations. recommended that we ca*our
Congress intended to reimburse the Any disallowances issued before the meaning of"professional edneatica and
,•ntu•e c:.are of suzoontnit staff in the effective date of these final resnsiations raininit' to provide Tor t•year programs
Medicut.i aaencr:::3 oerccnt F FP. reflect law.restttiations.and poiiev then that lead to a certificate.
In order to ensure:nat there wail be no in effect and States are provided Rvsponse:We do not agtea entirely
~isinti,mrriation.we nate soucitied in
::s un::-cite that _-:ectly suoervtse upporttuuty for an aaproanate appeal of .vich the catnmentets ntatamenta.we
.,cs 11ic t a:e::• ecti et a disallowance to the Oepartmentat believe that it was clearly the origsasi
;a•n,s, :n. .:c ... ,ate ciarsisrsi sn ;rant Aopesis Boom :nterlt at the skilled profesitond meau:ai
(:.immenr:One commencer ontectea to •:crsonnci Provision in the statute that
nirs�,ur.si inch:• must ine reaulrctnent in the proposers :t:e ennancea funaing for thaw
rerun s„aem•sse.._. -'rzonvuuponencl t scat£ -eruiations inat an emotaver-emntovee personnel was io provide.an saittsauve to
the sunourtinc retationanio exist between the Medicaid Mates to mire personnel who had
itis ,+.,rK. In a.....:n.vve ha+r iaencv ana the smiled oroiesssorai professional education and trauung in a
incl.+,^1{v r*ir--r^ a suonnrtin•:Taff "eoicai Personnel.Tt:a commenter medicci field before being claimed at 75
.s:. auca -." stark' i`. utrtaui ,Cgestea that individuals unaer aerccnt i'FP.These oersonnai wouid
eel,,^.nle arc -r^ ratio to t-;mie 'onsuitant contracts for aaminsstrative :nen Prima this meutcat expertise to beer
• c i.incuarc c--:-.-:P'ht!statute. Aervitcs automatieatly be eonstueme un the oevetottment and administration
--r..rnenlers Mate emmotees for FFP purposes and if the htedic:aid timitram.
-- atinns vsnu,d hat auca contracts not be reviewea on a We can tend noinsng in the ortional
c a r.r,,mvv a-n=,.i tmaact nn ine .ase-OV-case basis. ;eRisiatcon nutorz of this man that
ates...S Mates Nn•:sd be tvanirea to Response: We disagree with the suggests that ine Contra=intended to
-n.inr ::rite tunas :n :.nuke ommenter since the iettniatsve nisiorv, mcourate ine States to hire pemonnei
:i inr: a of Fv:'-:.:i:-as tar:-use ,t section i--U3la1lZ1 of the Act cmariv alth venous oocicarounds who would
::i:: _ .•.{•._..n=ed;tt '; • autres trial 75 Percent FFP?s ataiiabhe =omenow train menicsl ea<oernse on the
that oc runu4:tl .,t ) niv for%me costs at specific cersonnei no ana oecome sidled Proiesatonai t
rcrr. ". ,rr sn±:-':=SCC rrvitt.i:.nns. no.stall that are e.r,.c:otra by inr. i,edical Personnel.Also.there re no
:Pasaccatra I••.,t ,: %teusca,a acencv.if the Mea:ca-u ricication tnat ti4naress intended to ,
a at,:e+ +•are ::._:.c to orovi" the :cncv hiatals is percent FFP for sauien aunt an InCIVIC kat s oo-tbe-wb trauunx i
-mtessionai ineatcat Personnel wnritina ars worK experience trained in seine e
tui t:t^.s:vou,P :r re state asency unaer contract.a -ther loo Pumice ineState asenew as
•,;r: vi,.a,-ee min tine oust aucurnent the existence of an 4uauncauon for the sculled tiratesafonac {}
:rnrner.iers inat s:.e i-vutations r..av rnoiavPr•cmofovee i•etanonsrua r•seaicai Personnei aesionsuaa.
• Sit:::r.t`meet:---•aeitranai -:etc ^tvvern ire.'btecicato xaencv anu sues -he:eitim, inese rettutations moutre that c}
tics nese vmruns tial no. ;onizer --►sonnet. n inaivsouai nave orsieastonat c}
reQ3= f Vail 50. No. :g 1 Tuesaay. Vovetntaer 1.... :9E5 r 2uies and Recuiatitmv 4MI
education and training in a medical field Prafesstonai medical knowiedi a is Medicatid of donor s facditv¢-•tfae we.
befbre hems csatmea as axtiled needed to shape the medical asaeuis of •:tolanon' shouid be-volitios•':
proiesatanat ouirs t oersannet. the program and it is the intent of the R,esparue:We have corree ed the
However.we have reused the skilled professional medical personnel ypographtcai error to q 4M.45(b)(41.
regulations to provide that"professional funding to encourage States to place Carmment:One commentervaggested
education and u2intng•cleans the such professional medical persionnei in that the proposed change air Wntpea
'comtoieuon of a Z•vear or longer prolamin jobs when their medical background wouid prr:ciude a for-profit prrmte
lean-it to an acaaenuc degree or and expernse wowd result in ktewcaid organization from participating to
Certificate in a memcaili related programs that am medically sound and Medicaid if it donates fonds tithe
proiession:' administratively efficient Medicaid aaercy bet:rass a domteWn
Canivient:Six commenters Comsssenr Thirtsm constaentets could result in the facilitrunbeft
tmphasized that the regmanons would indicated that we were-sat foii*w1A4 allowed to treat Medicaidrem
have a siauficant negative imps=on enrigresaionai intent because we Response:Section 4=5(b)of the
Ilse FPSDT prograta tar ttdnong the alirninsted apemfic reference to various regulations does not prohibit a�ofit'
!level of funding provided for F3513T types of aitilis,i prafeuional msdicasl facility from participating l;Iftdiesfd It-
'personnel and that this accon indicates personnel(e.g-medical adminisrtatom serves only to define what tso"tsts
pini increasing lack of support for the medical social woriaml in the fonds may be considered part of tilt
SDT program. regWations.The cammenters believe State's share of financial partldpstiaa.
Response:We do not intend for these that these types of personnel shouid be Our Inter.!Is to preclude"tddthst3c
.regulations to have a negative impact on explicitly defined as skilled professional situations'that could ri suit private
'the EPSDT program or any other medical personnei is the reguiations. donations made by proprttw7
Medicaid program ares.and we went to Response:We have removed some mrganiz.tions in return for Madimid
iempnastzse our=nuauea stronu support references to specific jab titles(e.g.. business.
of ane=rruiuuatnt to tae EPSDT medical administrators.medicai soctai Comment--One commenter expressed
iprogrs=However.tae statute son Its workersl in the definition of skilled Concert tnat opportutunss fns ttiS.. will
tlestistauve hsstory co not autoraaticaiiv ;,rofessional mecicai persanaci because resuit If %v a allow private sad publlo
proviae for ennzncea funuina for of the varying and sometimes
personnel woriuna m soecai Meuicaid contradictory use of these titles among unconrlses to malts can edict ons
p"e uncondttianatiy to the Madirali
proitraw areas sura u EPSDT.We the States. in some personnel praaraat The commenter behow4 that
ui
believe that these oenctei must who did not have professional educauon pfts to the State should be rwsarletsd to
tquaiify as skilled prainuanal metrical and training in the field of medical care gifts to the whole State anrktb•dbte Skate
!personnel or direr<ty supportintt staff as or appropriate medial!practice were General funds and that gifts m that
•would any other personnel in the simply given a medicallyrelated job Medical program:should be prtaiafbited.
;Medicaid agencv.We beiieve that the title.This resulted in inconsistent and a
regulatioill ns whave minimRrsapnse:Donated finds wtlQ tesosoe
al uffecL if differing claiming practices around the under the administrativeedfuhof*a`any.on
the health reiaud professionals country.We believe that the Medi=d aitencv.The regaletlaen
tiinvoived in the piar».::;t. rongresstonai intent is to prtmde:5 M
Imaiurncntatto :z supervision of the . Fercent FF? for personnel who have clearer prnhit the rcvetttttg of private
'EPUST protean.Addiuonady,we proiessionai education and tratninst in funds to the donor s facility of train
•behevr seat tiny ins:o:revenue the Grid of nuc=le=i tare or approont:nless the donor is a nonprofitate ,Irt:an:zatlan and the Medicaid agency.with US=:ersonnct cu:its :-culz;l practice and who are tri
tl:dt IL iii ra icr.:sr itched.at 7: ;iosmons that :cave duties diid f I:t own vr+tition. decides to ins,the
prier-: :IV tri :he inCrCJ3CLt saontlntltttr.s rust require praicsslonal iunor s :,ctun. til'"'nil be sail to
%VC:-:�r. El'SDT -:s:nic:i t,nowtodre :roll skills LL,tnout :e. I,Iv::nv niaior Lnoiations of this
pen¢-i-7:^rel '': :etv EPS?7T :rcarz :a spelt::t lob ar poaitwn title. ;rov:,lain inrouvn the HCFA financial
t -taniccment rcv,rw. The regulations are
rr_t:te::tens ouc.:s-.::•.::L,ct,.ul:r -.. 'hart::ore. we have mintttuzeti rrterencc
t'R 116311. 'o st;ecific lob lilies 1n the resutations ntenrc%! to zcnnit States as=
'•chi=c at the sdme time vrnvt:1mw for 'extr.:::: aurrun:sterinc their
rrrumn,enucl^. ::-::'3:,rrc tt fu^11tt tt br. !ilii-ret:aitt Cd personnci•' L•:nn havo, `tcdlt:.,&a oroararn. :\ithou;h public and
1....:.lbi_ :,r s• ,.c::--• s-tile,= 'tiu rc•.;L;irea education anct tnitnir.V. _r11':1 t: C3nauons t:an he used as a
zr ;t:ICn +.iit mil ennole us to review Inc Stjte s -+!arc tit financial paracipatton.
tl:rinlr. ::.e tea:e::;a a:r:ncv. r1*n :2 :l.:it 't•rnitCattnna 0t etcft Indivitilini on 1 '•Yr me not manuat;:ta the States tic this.
+,art-- tttL`t:Int-•^::75' :-^aa t .r•t,1•1'151 1:.'.513 Lv,rntlul rrzsrd :n tura •`:i Stair!tvttnrs til continue to use
b.aUtt,.•t!� Sett .t::: ':::r^ter 1 Lr r--,•;%un wid mute rat+.•,L' Iona. f_:SY tar tr;1ntn4ptirattaeS
*L,, r't rrrttl•<r- en:lt '',limn in mr-nrivirnt cnn,tri•at:gin:1t :nit'. '.::s r*tutation aiso allows the
a•nr:•.i UlaCr•rnr: •^'r r .'ileal int gnu Lt'ai faCllilJlC .^„ore Fo.
l~ nd :,1 .. -': ::= =: ;.tits:titins ::nticv.toanrarlan by t iCF':\ .I sir Waiver tit Notice at Propottrted
t.,•n:.. 1tr•r - _.. .,tn:.._;.-.,_.:ills :titian.,tr.r. �r ,i•-.r. riUtl:rrtaAin7,
',' 4rC t•i• • •f-n• •trttrL'r '^'t .,:! t•
o notice of
5'.,L.. ::.. !r:�..,°cr- tilrt• 'tt•,. rt
--^vu: ^^ `n'"" .'r'=t ir"i mr•,••c C`:iriern rnmmrntt•ra : tat .: r..rm:1►..r._on the oravtsrnns
: t _ r� nrnnmaal t„ rr, nt•,1 _. ....... ^.tt tntOtZ?Ot1tC Thr
1a lir. nwu .1;r1 ... ..•.:.•.
> :::^. .. . ... . • . .• . . . ,:+: . . r•_r.nt :or 3sitiou. ent at
r....,.•r- ^r i•t•,+, -. ..s;:•,1+.tt tt.1.1s1C.:l .,:e N %n,;re vii nnarlriat n-ttttr:-:•tine' . -art :;,crnr-nts and other
,,-, ,•.. ..r•i•.•.... .ts.+, 'iv. it WAS nt)t .L ` wix:.t. Croerain ocoenu,.. r:CB .ir,i " ,L`:C:iti .rtiQ C000eratlan in
:t t itis .t A^Cutin t':r 1 ,,r.::r :-r1r::,� to ltain:n2 ,'.1:':.•: .._ :l:crnt-v ono obtalnirls
}:,rs,•- ^,r,-at'a.A. 'f_til n ut,r•m-n,n •tAnctu:r,r. tine of ttrse cimrt•ntera c^z-- i. t ,::nni:ion of ehobility anti
aril.-. _• ,•a •♦r ..•rc to 1 a t •^n4rantttrnl •,�
............. _cnn^r7tivr
L:'..1•. .•-tt.-... ......., S ,i t!•+i:i irri.•tlnc to .iia•I CY
46662 Fedor Register ! Vol. So. No. vie / Tuesday. November 1.. 1985 / Rules and Requianans
agency and other agencies for obtaining the impact of these regulations wtil be supporting staff as only sectetnsisiL
medical support These requirements. enhanced through the intemcuve effects stenographic.and copymgpe:soaatei
watch were opoonai provisions under of other Hurd party liability initiatives. and file and records dents that provide
previous legislation.are mandated We are unable to develop a precise direct support to the skilled pm(aaatonal
under the Deficit Reduction Act of 1951. actuarial esuttsate for these tn=d party medical personnel:and(3)an
We do not believe that it would be in liability provisions.We protect that inestimable savings generated by not
the best interest of the public of delay these regiiiations with other third party paying 75 percent enhanced funding for
these regulations to obtain public initiatives will allow recovery of 80 skilled professional meduW ommonsiei
comment.as these provisions are percent of the amounts that are who do not have the regtmti
mandated by statute and:here is little or currently uncollected.We believe that professional educarsoo and ttt&iaiag in a
no leeway in appiying the requtreattents. between im percent and=percent of medical field related is*Arptondnn is
Revised procedures for implementing current Medicaid expenditures could be the Medicaid program.Than pwoosmel
some of the previously opuanai recovered through better collection costs would be matched an VgMent.
provisions were addressed in the June practitms. We anticipates possible,in
1964 NPRM.Comments an these We anticipate that these reguiations these savings if States to katagottr claim
optional provisiotss have been will ac colzrit for 2.5 percent of the these staff at 75 percent M.Haweeer.
responded to in hese final regulations combined effects of these requiations we cannot provide savmp isegmtes
and these responses an equally and other third party liability initiatives. because we do not know who specific
applicable even taaugh the optional We have developed the following deastons States will make,
provisions were made mandatory after projection of low and high values of Sources of State's Share of Araaaciat
issuance of the MIRM.Therefore.we potential Federal savings:
find that there is good cause to waive Faruc:patran
public rulemaLms procedures and issue t ins i irsr t Ives i"w'IM We expect tittle change ben current
these requirements as final regulations. to.to•WEE.W• ars levels of donations to State Medicaid
urs g iso i iso i sn
Regulatory impact Statement �.»+'^�• .. sot rs g ftp t tso i i+s pr'ograms as a result of thsM pvvv cions.
To the extent that donations itumase.
C.tecutive Order):'Sl °°""""°" "" ""'" the individual State picip ma veil
Executive Order 1=1 requires us to Each State's savings.while not readily benefit but we believe that thw extent of
prepare and puoush a regulatory impact estimable.would bear the same the incremental increase will not be
analysis for any major reguiauons—that relationship to the Federal savings that great enough to benefit affacod
is.those that wtil have an annual effect their current Medicaid expenditures recipient populations.
on the economv of SIM million or mote: bear to total Federal expenditures. R,eguiatory Flexibility Act of I=(Pub,
cause a major increase in costs or prices Actual State savings will also depend L 96.354)
for consumers.irdividual industries. directly on the State's success in
government 31211=11L or geographic recovering third party liability. The Regulatory Flexibility Act
t•r.4ttons.or have sipaticant adverse requires us to prepare and polalish a
rffecis on competition.empiovment. FFP for Compensation and Training of regulatory flexibility analysis(RFA)for
investment.proaucuvity.innovation.or Skilled Professional Medical Personnel any rotgufation that wid have a
on the ability of United States-basea We also expect the changes in the significant impact on a substantial
t•nierprises m aonesttc or expdrt definition of skilled professional number of small entities.A&mail entity
markeis. We have eeternitipci that.for medical oersonnel and directs}•is a small business,a nonprofit `
:nr.reasons statea ovow. mese supporting staff to result in orogram enteronse.or a government jurisdiction
retiiutions ao r.::-etc env of the savings an the Frderas levet. isuen as a couniv or town&hial witn a
, rttcria tar a major regulation. lttioiementation of these changes viii population of less tnan 304M.The
"nereiore.it rcg:xatory impact anaivsis motice the rate of FFP from -S nereent to purpose of the analysts would be to
:s not,required. So percent for many Staten skilled anticiaote the impact and to seek
professional medical personnel claims. alternatives tent would have a less
resulting in some aaditional program significant effect.
1s noted canter.:--:morovr the expense for affected States. We We do riot expect the changes in these
..uministration c::-e medicaio oroeram estimate a program savings of at least regulations to uifect a substantia! �
..p arc uroauen:-t:Re scone of services SIS.8 million in the first furl fiscal vrar number of small entities.We expect
tar watch a State:-.st cotlert trom third :hat these rrituiations are eifeetive. larre mator health insurars and State
;,artir.s int cost o:necicai assimancr. These savings will be generated, uv Yledicaic acenc:cs. wnich are not
tttrntsnra to titec:t:::a rectotents. 11'r disaliowanre of innoorinrinte nate t•tinstat ren tented entities.to be the
.wsu arc revising:rx^etnnus of raving :iatms for ennanceu Federal inattming entities ortmuniv affected.As
t.iaims involving;r.:ra nariv lt:tfuitty. and nn r<oected reduction to the mrntioneu above in the discussion of
no mat.tng unaners to numuer tit. personnel.inn statt. :or venom vxet:utn•r Under i=i.the changes in
ncornurate a star::ore nrnvietnn mat `:t pt:rrpnt mnicntrc:r t:itmrn :gnu ,killed nrotessihnat medical personnel
rnuirr5 the assignment tit mratcai tin+ rut. \vitt rrsuit in a sntft to States of a
tt000rt runts art:c:-rr:r.trrt ii.it iv timer:tt,cnily. wr r�timaw:c t: S:ivinrs ;•tinrnn ni administrative costa that have
..t act ,r.tiuun rr,uutne tram Inc ,rvvmusw neon oorn oy the Federal
,taon%hinit ar.0 ntit.tinint: t•timinniton ht Tri orrccnt ennaneea government.
tt000rt as a of rt•_:Usiit+ tnr :.:nuine for i:f say sminrnirssionais vvp aiio emonasiie that the rules on
it•tiicatu. writ(to not nulitfv ae titrectty tniro aariv iiabthty snould have tittte '
',,:e antictaate:':i irraipmrntine :;uDoortine staff: l,,savings at 53.8 mn.ict on Medicata providers.'rhe
nese intro oartr::aautty prov%sions wilt -zithon nv corninatine tea rrsanoes to tetra aariv liability rules do
•r,7CaSe our aoi::t:•'i rrr.o+'rr stenirniu .ttiornie-minnat t_itecary tit .at mane rrvoicnts unv more liable to
•t:rncttures. V.-I a.so anticmate that jrioortin7 m:n ana tiv ti.:rinirm atrec:Y: av inr grrviccs turnianea under a State
z -"i uesti::v. Jvr i^ »tom_ ... ':S a=ulos r►tla Restuta
. . ,, . .. � ... 48563
� -.. trsara
Ian tnan utev Rasa oeen in Lhe past. Sappictrentat sectinty income iSS11.' pericrm uut►es that direcuv retests to the
le revcsea ctainti.avment system will Virstin isiands. IItimintsu•ation of the Medic"pr gresm
quire providers to We ciainis with
:e ird party payers._ ;,CFR Chapter IV is amended as set
at this system has
roved womacia to-at States that now forth below: 4. R new l.43Z S is added to subpart
C to read as follows: •t
se it.Because only 10 to 1S percent of PART 432—STATE PERSONNEL
11 Medicaid rectaients have health ADMINiSTRATION 4 432AS Aopuicaboy of aw.usaafrW
or nsurance.we beiieve that primders ran tttsboan.
i acconuoodate the new claims fi A.Part 432 is amended as follows:
� The rates of FFP specked tete titin .
+2uirement with iz=mal disropuon of I.The authonty citation for Past 432 Subpart C do not apply to S ar. -
`in 'lling procedures and no:reduetion in continues to reap as iollows: personnel who candua s=,rlaCqvitirs
ei emces furnished to Medicaid Aotbanry:Sec•1'1o2 ci the Sawa S—inty and certify facilities for dt-
ptents. rtet(42 USX–23021. Medicaid.as prtmded for=do an
Therefore.we have determined and Z The table of contents for Subpart C 19t12(a1(31(B)of the•Act ,...
t e Secretary certifies under S U.S.C. is amended by adding a new f 43245
;r,
r
M.that these ossa!regulations will and removing }43Z.60S.Section 4"" is ameaei-d b0 to read as �
of have a significaat economic impact follows. revising paragraphs(b)(1)aadk4 and by
in a substantial ottmber of small adding paraitrapb(d)and paramrsah(e)
tnut►es, to read as follows:
Suboart C—Staffing and Training 4S2 50 t`F►:Stan*+9 eros lsersiasfescalst:
Paperwork Reducuad Act of 29110(flub. Ezpendttures
L 964121 43245 Appitcahtlity of pruvtstnrs in
Secttans 43L=d1121.433.139.and •uttpsrt. (b) Rates of FFP. (1)For skL ad`
t 33.145 contain ttum=auon collection ' professional medical periotseai and
quircments Inat ane suateet to 43LW iReserveal directiv suoportinst staff of the Wedieaid
's pprovai of stir OfScc of!6ianasensent !.Section 43L':r amended by addin¢ carne or of other public atemcgia(as
no Suditet tOME);;.raer the Panpnvuric n introauctory phase and rrvisinc tic ::esittt►d iso 0 43.,,1,the rate u 7S Percent.
of Reduction Act We nava submitted a detfinition of"skilled ornfessicnsi
opy of these reautrements to 0,\tB for nsedmal persnnnet' and**staff of tither (c)Appilcatron a/rain.
la review and approvai. When Q.%IB pubiie aaenctes'•.removing the (1)i'FF is prorated forstas d=8 that
pprovai is outaoaest we will publish ate tirfin tion of"sopportinq staff%=d it split among functions rieimr�■rid at
ppropnate notice to the fedrerai adding a new definition of-directly different rates. - ;t4►�:
a. Register. suppunsn:staff' in alphubeticai order to (2)Rites of FFP in axe=adfi0
of Subjects rrad as follows: percent apply only to those of
the indit:duat•a workinrt tsmt *at are
CFR Fort a12 +;4x22 O.fwuans spent carrying out dunes=thropeeified
As used in this part— areas for which the higherrsevator
sr Grant-in-Aid program--nertth.tleuit4 cuthartzeti.
.Cart:l:inancin¢Acc:ntstrat►un.
suapun►nq stall
I-Medicaid.Subprc:esstonuis.Tt a:ninq ' oic:ins 1J)The allocation ai persae�eri and
t• :•proaram:s. '-olun:ecrs. secresnriai. strrtneroptitc.and co:nutr. .tatf costs must be hased an athw the
pt:rsunnci.tnu file anti::::onus c:crxs tc:u;►I p:rrcnta¢rs of time spent
X42 CFR mer: 433 ,.nu t:rovioe Clerical srrviccs that arrv:na out aut►es to the soleetfied'
ano :irecity suopnrt?he rrtoons►uilitit*%.tt •:nos.cr;-notner memodolairy appruven
�procr_ure. A:istQ--enc of roc ts. t:..i:ls, :sileu Lrts:cs3tanat ntcult:ui rcrtnn:tL:.
#Cunu•ac:s torme!"nw. Cost ailocutlon.
to.ire ntrectiv supervis?u tit :ac i) CJ;f;rr--inutatrans for FFP rate+or
Kederxt f:nanc:ai-:nicmatton. i':•ticrai -raised nrntrit,iona►inedtc:al oerm,tincl. ,r.'r .r:,n-r�rsru:ni mrdrep!personner
�matr.n:ne^raYtttCr.Crant-in-Aid no tents nrr:in an cmr.l„vr•r•.•mr: ^t l:r:cele!t':: C.•1.7t:•Or:rr.•t,staff
:pro::ram—north. '•:acnartzcdelatnts : uunsntot1UnIIC,ie'ilit:::: : .+::::+: :i41r. r!!r'ttCCCCRCYaeryonnet/arid
�proct:ssinc:inn.n ration r:irtrvai -wr. I'-.(!r.•t•tit T:,ncrcent FTP is
e
iisczi titallcti t::.:Irsstonai int tlit.i: +ati.thi.: :•Ir.ittiled praiessionai
•taysn•m�.\V.•tac..,:.::.i:2
`adrrtn:stra::on- _ •a o:tr!v 1-..htitty _t•rsonnet neans on}sittat,%, t;t:-::;rs. :wcrat nLr%nnnei and directly
ant:uther snecusimco=t:-u-.mnri nn,: staff of the!Medicaid agtenry
41 CY.1 A-.-t.4 :fill it.ivr:rntessionat situ". s;n. :•Y
r.. -.-.vin,,', .:con.x11 +ppltWbir.
1:d to ritrt:urs auI!(Jeuense•nt curb:-,a file ctrtti cif tneutuai c•.r...,r
Cali leer.. A.:::ns.i_:econra►ty nr••ny •mrnnrtatC •.nn 1'':• , ,r. nu.:.;..z.ire fur ac:tivtiscs
Contracts facrerrrents--tiitate ptani. .,,r. to 3n em0tover-emotovoe ::it Air.;+ruin• muted to the
EIi¢sbtitty.t;r.trt•!m-Atd orosram— -^iauortsnto whit the Nir-tticaltl .►crnt.t t •+::tt;trn::on tit the,Iedicztd orogram.
.heitun.tit curt:aC:::aes.,tedsc.au. ii +lues nut include ulnar ntinntt•.;.c.,t ,.:u , '1111.1 ,*..) 3): :-ciude exprnustures
tMedir.ativ neruv r".eaortinq .:.ttth oroicsstunats such a, ntittitt.
e 4recuircments.trete uown. .aminrstrutars.meatcat inaivsts. 1;:17 st,r! U arotess:onat meuieal
Sucelmnirtntat ;r•.x:: income 1a5ii. ••Itit%,srs. sentur munaQcrs or ••r;tinn,-i r ,•, -_ 'ntr'lsionai education
•:mtntstrators ui uuuucatic.: . i it I::::r: rot :nr acid at meateat care
c 4'L' ;'::: ''' roututris or me,teatcatu crocram. :r annrannatc mcatcal aractice.
t ;
i:d tai,: t=res::':n Ucoenacnt ''an r,r.trrrr�::aur:ort: i::s :-eans nfr..tun.,i ••uucatinn and trainine
Chddren. A.tans.t»_:socia •,tied prute-tsianat mcatw► eersurnet ::rangy inr romotction of a 2•yeer or
(aereementst.E::at:wty.t.rant-to-Atu .nu titre+:uv vt000rtine stall Lynn ore Qn:t:r n^izram te3ointf to an ac=oemtc
proizram--^•aitn.tram. health r:otuv.o to didie or tocat acenc:cs gree i,-rr•rtticatc in a medtealiv
C fariaat s. `.:•rite ...i�•:rrtn I+t^.ti. r.rr tran utt:1Iouicato ;iccnt:c ..no it u ; ^.t:•a,iar.. 1::i5 is demonstrairn
f
46664 Federal iZeeister i V-11. 57. No. _:8 f Tuesclay. Novernoer i:• ;965 1, Rules and Rettulacons
by possession of a medical license. t9P3trt.aria 191:of the Sona!Security Act by Federal taw to be used to match
certificate.cr otner eocutaent issued by : 42 U.S.0 13t12.1396a1a114i.1396seatt251. other Federal funds. f
3 recagnizea Nationsi or State medical 139stalt45t.1396biail3t.1396btdii,s. (bl private dattactd funds as the
licensure or cernivintt organization or a 1396k.uni ss Otherftlol. ise noted.
1]96blri and State's share. (1)Funds donated from S
1]86k.unins omerwue nosed.
degree in a meatcai field issued by a private sources may be constdtsed as
catleae or universiry certified by a Z The table of contents is amended by the State's share to daimmg FFP only if
professional meoicaf organization. adding a new$433AS to Subpart B. they meet the conditions specified in :
Experience in the anninlstration. revising the titles of 11433.137.433.145. paragraphs(b)(Z) and(3)of this section. i
direction.or imaiementation of the and 433.151.and removing 1433.149 (2)The private funds an erndarred t
Medicaid program is not considered the under Subpart 0 to read as follows: to the State or.ioeal Medicsit:agency i
equivalent of prafessional training in a and are under its admitwursti+rs ciontnol.
field of medical care. Suboan d--Ganem (3)The private funds do not mvest to
(iii)The skilled pttiiessionai medical q , s the dances facility or use ga3sss the t
personnel are in possdons that have donor is it non-profit arg ks=stU o.and
duties and responstatUties that require
those professional medical knowledge SK. the ide to use
eche dogency.of its own volition.
and skills.
41345 Sources of State share of flnancat decides to use the dodoes facility.
(iv)A State-docifinented employer- parumpauon. (S)Section 433.135 is mvwjd to read
employee reiationsaic exists between as follows:
the Medicaid agency and the skilled sybom 0—Thkd PwW LiaWYty 433.135 Balls one pistvasis.
professional mediai personnel and # .
directly suppornet staff:and This subpart impieme=sec idnis
( (The directly suaoornnt staff are 413.13+ State pian requirements. 19=a)(25).19021a)Hsi.1903td;1(21.
secretarial.stenottratnic.and canying 1903(a).1903Ep1.and 1912 of the Act by
personnel and rile and records clerks 313.St Aaan requirnt ements.
ennithes to benefits.— setting forth State pian requirements
State pian requsete+ents.
who provide clerical services trial are roneernmit—
directiv necessary for the commetion of 333.149 (Removed and reservetn( (a)The legal liability of third parties
the prafessionai mecscai responsibilities to pay for semces provided=Am the.
and functions of the smiled professional plan:
medical staff.The smiledrofessional 413.131 Caopersuve sweenvants and
p va payteteats—Stats plan (b)Aesigna:ent to the State of as
Incentive medical staff must directly supervise the Incent cetssits. individual's rights to third patty
supporting staff aria the periornlance-of payments:and
the supporting staffs work. 3.Section 433.15 is amended by (c)Cooperstive agreements between
(2)Staff of other oualic agencies.The revising paragraph(b)(5)to read as the Medicaid agency and other entities
rate of 75 percent FFP is available for follows: for obtaining third partypaymenta.
staff of other public agencies of the
requirements specified in parsttntes ph 1433.1S Roof FFP for sisnunistranon. L Section 433.135 is amended by
(dltll of this sexton are met:end the revising the definitions of"Privets
public agency has a written agreement insurer" and'Third party"to read as
with the Medicate aaencv'to verify that (b)Acttvties and tarts. Follows:
these reaulrements Are met. 433.116 Oetinnions.
frit Limitations an rFP rotes rar srcrf 151 Campensattan and training of §
:i mernanizea c=:="rocessrac aria skilled orciessionai medical personnel For purposes of this subpart--
:rnn""atran rrrr:evc:s.-steins. Fhn and staff directiv suopertinst tnose 'Private insurer'means:
personnel if the criteria specified in
'DeCIHi fiatc:iiri4 fates tar'erSOnS (1)Any commercial inatirenea
..•orxins On meenvnizea claims § 432.50 tet and tdl are met:'S Percent. comoanv offering health or casualty
^racessint;and info.=atton retries zt (Section 1903(al(Zl;42 CFR 432.501bl(Si.) insurance to individuals or groups
:vstems iparoaranns 3031.1 and 131 of (including both experience-rated
:his sectiont are acoucaate only if the 4.A new s 433.45 is added to read as insurance contracts and indemnity
desiun.deveinomeni dna installation.or allows: contracts 1:
ane operation.n ave veen aobrovea tiv §433.45 Sources of state ars"of (ZI Anv profit or nonprofit prepaid
ilio Administrator to accordance %vlth financial oaevei taxon. plan dffenne either medical services or
Part 43:1.Suboari C...i this suochnoter. (a)Public fund's as the State' s share. full or parital Payment for services
432.60 1Rtnrovea iia Aeseneel (1)Public funds may Pe considered as included in the State pian:and
Section 41-.EJ:c-efidvt P dna the States share in claiming FFP if they (3)Anv organization administering
r��rrvr tij. n 3:.'contIt:s revised ono meet the conditions sbectfied in health or casuaisv insurance pians far
-r•1esicaalea 3s.i nt: a evise,under paneraons ieil2l and 13)of this section. professional associations.unions.
I.1 The ouatie funds are approanatea .raternat touts.emptoyer-emptoyee
Part 4:13.1 airectty in cane State or ideal Medicain uenefit Plans. and any similar
PART 433—STATE FISCAL aitencv. or transterrea from other auotic ^rganizat+on otfennit these payments or
A0164INiSTRATiON •:aencies iinctudins Indian tribest to the ervires. inciuotn t self-insured and seif-
iu
tnte nr tocat auencv and under its 'uncea sns.
t l'.iri 433 is..menceu as intiow%: administrative control.or cernfted by -Third party" -:leans any individual
file autnoriv r:•neon inr Pnrt eater is ne eontnbutina pucite agencv as entity or program that is or may be
Pt•iaed to react as le-own: represtntsnt;expenditures etigibie for !table to Pay ani or can of the
r„uhonry 7ccs.is^-..1323auii. FFP under tnis section. exoenaitures for medical assistance
n_t,u_St.1o0ztaite:,i 97�tau.it. !31 The Public funds are not Federst `urnisnea under a State plan.
ands.or are Frderat funds autnorized
Federal R"ister 1 Vol. 50. No. 2.3 / Tuesday. November 1:. :9SS l Rules and Rewitiationx 466ti�
T Section 433.137 is revised to read as of this secnon.The waiver must be in section.if the waiver request Wdemed
`follows: accordance with the prtmsious of at the waiver is restandad than State has
1433.137 Stats am requwsonents. paragraph le)of this section. 6 months from the data of that denial or
(c)Probable liability is not resasston notice to the
(a)A State titan must provide that the established or:manta Orr not ovadable method required under
PwaWsPb(b)(1)
zi requirements of It 433.138 and 433.139 at the time claim is filed If the probable of this section.
am met for catertsuung iegai liability of existence of third party liability cannot
n, third parties to pay for services trader (fl Suspension or tarrrrtaL(2) o f
e pian and for be established or third parry benefits recszvary o f rtfmbursaasttwt t2)
1 payment of claims are not available to pay the recipient's agency must seek rpt from a
lnvaiving thirst partes. medical expenses at the tame the claim liable third party an all didim iWwisch
o� (b)A State pica must provide that.for is file&the agency must pay the full it datert rift that the ow ago fa.• •-- ..
a b3edicai 4142M aoa furtaahed On Or after amount allowed imder the agency's reasonably expects to natiirm,wig be
October 1:11254-. payment schedule. greater than the cwt d te�►
(1)Tho regmrements of I t 433.145 Recovery efforts may bt faspasdad or
1 (d)Recovery of rriarburses�rasrt if the
tht000 433.148 are reset for assignment air learns of the existsmae of a liable terminated only U they tttspaot est
rights to benefits and cooperation ftd party,or benefits become available effective. ..
Ynth the agency aoi obtaining medical after a claim is paid the agency must (2)The State plan attttsw ti4idF- tha '.
t support or payments:and seek recd V e 7 of reimbursement from threshold amount or othwVddalins iiia
(2)The requtements of It 4=151 the third parry to the limit of legal the agency
thrtiit whether
ugh 433.154 are nett for cooperative liability within too days after the end of to seerecov m
agreements ana incentive payments for the month in which t is made or recovery of {tine
third PAY cotiaatotrs. ��'� a liable third party,tie daettt(t1s}eshe -
Et1 days after the end of the mcath it process by which the atfetaitgrdetanataes
v . b Section 433.132 is revised to read as learns of the existence of the liable third that seeking recovery ffi te�tpenlant
(allows: patty,watchaver is earlier.uniess it would not be cost efiaKxsrta.• -
determutes that recovery would not be
i )Ant" tenret eiacnsa. e
cost effective to accordance with the dollar amounate t orpetsodat timeorf
(a)Basic cravisions.ill For claims paragraph(f)of this secuon. whirls it will accumitiate babbW with
involving third party liability that are (e) Waiver of required us*of cost respect to a particular Habit third party
processed on or after May 17-198L the avoidance method(1)The requitsament re pact o the decfsiar itrietthes,to trash•
agency must u s the procedures to use the daims payment tstethod
pecified in paragraphs(b)through(f1 of specified tender paragraph(b)(1)of this recovery of reimbtrraatttttts jL--.:: :r- -
this section. season may be waived if— 2.Section 433.143 is.--- i tea read as.
n ' (2)The agency daunt submit (1)Tho agency is using the method of follows:
a documentauoa of the methods(e.g..coat paying the entire claim and then seeking f 43ltts xaaigetti+aae,stt4srMia le
avoidance.pay sad recover later{it uses reimbursement from any liable third bet+ases--6tst• Wr W SIA" a
ar payment of daitas involving third parry as of November 1Z 198Sc .
party tiability to the HCFA Regional (ii)The agency submits adequate For medical assistance fordabad an
Otrce. documentation that its method is as coat or after October 1.1986—
(bi Probable liability is established at effective as the method required under (a)A State pian must pnnUW that,as
the time claim is filed Unless the p4rattrsob(b)(1)of this section to the a condition of eligibility.sioak legally
agency has received approval to use an l iCFA Regional Office on or before able azipheant and rempient mutat assitri
alternative method of payment as J.nuary 13.1388 and requests approval his rights to medical support or other
specined unser aaragraph(b)(21 of this of its use iAdmmistrative costs must be thud party payments to the Medicaid
section,the agency must pav ciaims considerea in the computation of the agency and cooperate wins the agency
lnvotving procaate third party liability cost effectiveness of the State's In obtaining medical suppers payments.
as follows: alternative metnodl:and (b)A State ptan most pr wide that the
(1)if the agency has established the (iii{The HCFA Regional Office requirements for assignments and
probable existence of third party soproves the States request for a coopers tion to establishia;paternity
liability at the mme the time is tiled.the .•atver of the requirement. and obtaining support tsndat It 433.148
agency must rvect the claim and return (Z)The HCFA Regional Office will through 431.148 are met.
it to the proviaer for a deterninatien of :cview a State's request to have the (c)A State plan must provide that the
;r the amount of isabiiity.The requirement under paragraph(b)(1)of assicriment of rights to benefits obtained
establishment of third party liability this section waived and notify the State from an appimant or recipient is
takes otace-nen the ogenct receives of its determination within 30 days of effective oniv for services that are
confirmation irons the provider ar a third receipt of a request.The Reipartai Office rctmbursea by Medicaid.
party resource inaicating the extent of %nil request additional information irom
third oariv tutitisty. When the amount of the State. if necessary. 1433.142 (Removee iuw r•eearVedl
liability is deter-ined. the aaenev must (3)The HCFA Regional Office will 10.Section 433.149 is removed and
then pav the claim to the extent that grant the waiver for an indefinite period reservea.
or payment atlawoo unser the sernev s ;:niess it specifies otherwise to the 11.Section 4:13.151 is revised to read
�:i• payment scneci::e exceeaa the amount i;provai notice to the State.A State is follows:
of the third warm s oavnrent. that is aranted a waiver must notity the
(2-1 The suenc.may pay the iuil Retnonat Office of any event that occurs 143,3.151 C000entwe srsrsaW*MM and
amount aiiowee unser the aaencv s that chanties the cost effectiveness of tnce""ve osyments~61aw Man
payment scnectue icer the claim ant then :tie aoproved alternative method.The reauuv"elite.
seek reimbursement from any liable Reitionsi Oftee may rescind the waiver For medical assistance fuzntshed an
third Darty to the ttnnit of feeat liabtfity if it anv time that the State's metbod is no or after October 1.1984--
it has ootainco atiorovai of a wniver of :outer as cost effective as the metnnd (a)A State titan must provide for
Lthe rcouirement unser paraerapn tbl(i) :equirea unser parattrapn tb1(1)of this -!nterina into written cooperative
16666 Federat Reeister f Vol. 50, No. ,:S / 7 uesday. Nuvemccr 12. :05 ! Rules and rr_siaaans
agreements for e-;I=ment of rights to tb)The requirements for assignment existing passencer motor oahadte lines
and collection of gird party oeneitts of rights must be applied undo
rtaty for manufactured in 2983 add 1984,and to
with at least one of the following all groups covered corder the pian, determine the median theft rata for
entities:The State utle IV-0 agency. those 130 lines.The lines iisted hm
,iny appropriate atency of the State-and PART 438--ELiGtsit n Y IN GUAM. number t to number aS,iadaatrve„had a
appropriate courts and law enforcement PUERTO RICO,AND THE VIRGIN theft rate that exceeded the r.cdiurn
officials.The attseements must be in 151.ANOS - theft rate.and will be sabtec .a
accordance%"in the provisions of 0.Part 43L Subpart C is amended as selection for coverage cinder- :motor
s 433.151 follows: vehicle theft prevention stns` at,&
(b)A State pian must provide that the L The authority tatladon for Pari 436 Poon PUWT`U DWOPuurtoti Ca"WACr
requirements for maidng incenuve continua to read as follows: Mr.Brian McLaughlin CIA=cif 1Kasiset
payments and for diatrded g third Aufl atitr.Sec 1102 of the Salol Security ttsatrstives.NHTSA.Roost&3%L Opp
party coUecuons speatiied i s 4#433.153 Aa(42 US.0 1302)unless othisfrwise noted. Seventh Street.SW_WaaWapm DC.
and 433.154 are met. ZMW(=4254740)i. s ,
1Z Section 43LW4 is revised to read as
2 Section♦33152 is revised to read
follows: SUPP.t:saOM"t111111rifesatt M.
as fohlows: . .
4XA" AsaigettPAM W 11W.te W Background .�:
423.152 iR.etar.awits for eatoo+sr.ttr• p«1e Tithe Vi of the Motor Vel irfst
ayreetrretiaa:or trine"Meo+raeLana. For medical assistants furnished on Information and Cost Safhrgs Act(the
(al Excimt as specified in paragraph or after Ocsaber L 5904— Cost Savings Act 13U=2=e8 s".)
ib)of this secman.tits State agency may (a)As a condition of eligibility.the
requdevelop the speclit terms of agency must require legally able theft pr NHTSA to standard ipte
a bla to
+:ooverative streements with ostler their heft ca In es.Seca afppliGa II)to
applicants and recipients to as:tela high their car linea.Setaaoa a=&III)of
agencies as It cetermutes appropriate rights to medtcali support and other third the Cost Savings Act(15 U.S.C.
or individual c:==stances. parry payments to the Medicaid agency =Ial(t))specifies thatthttes type st of
IBI Aflreements wits tote IV-0 and to cooperate vath the agency in rar•tines are high theft finite will t the
Agencies must seeniy that the Medicaid obtaining aedical support at payments.
.agency will— (Part 433.Subpart 0.contains specific meaning of Title Vt.Thssas theca types
(11 Meet the rraauzments of the requirements for these asst am. .
Office of Child S 8ame "O (1)Existing lines that had a tltt#t rata
Of
Support,Eisfortxraent far (b)This rt!quitrmtmts for assigr"amtnt exceeding the memedian tbdt lata let 29m
coopersuve agreements under 45 CFR of rights must be applied unibu;Wy for
Part 305:and all groups traversed usader the pian. and 2964:
(2)Provide r!:waursement to the IV-Z? (Catafott of Federal Doasesix ASsistauice (2)New iines that aro�y to halm a
agency only for=ae child support pr�oftram Na 1171*--M.dua!wsaiatanat theft rate exceeding that--M--daft
services performea that are notrate:and
reimbursable by this Office of Child P Dido c A4rcis S 19e.L (3)Lines with theft rates biaiow the
Support Enforcement under title IV-0 of Coiy,st,IL Davi< median theft rate.but which have a
she Act and that are necessary for the .•fQrninrausmr.N'ev/tit Cors Finanumajority of major parts na fatae+r�3ant;pbre
collection of amounts for the Ntedicato -ldminizzmuan. with lines whose theft rate ertsseded or
pro-gram. :1ppro+na:Auttust t fisc. is likaiy to exceed this w"inn theft rate.
Section t�03tb(of chs Cess Savings Ac:
PART 335—eL'GiBILITY IN TME %faritam M.K°d`4r. eptstio now Inc f Lbe C u to determinet
STATES.C:STr+C'OF COLUMBIA. �ecre'on'• .vnetner etistins itues had a theft rate
AND THE NORTHERN MARIANA r"ti Doc.as-MM3 Filed 11-8-a5.8:45 amt that exceeued the median dwit rate in
ISLANDS :shwa coot sltta.os." 1903 onto Inc Section OW(b)(3)directs
NI MA to 'obtain Cron Nast s oat
Part 435.5.;.-an C.;s amended as — reliable source or saurw accurate and
'uticrw,: DEPARTMENT OF TRANSPORTATION
:.The autrxcr:citation for Pnrt 435 :imeiv theft and recoverydata and
nzu-nes to.ela ss follows: National Highway Trat"le Safety publish such data for review and
+:omment.Tu the greatest eittisnt
1Vihonty:Ser-::-.:of the scmul Sccunts Admmrattatson passiuie. Inc INHTSA(shall,utili=theft
t t I_U.S.C.::.... 42 CFR C?L V ;.ita rezortea by FedemL State.or tocai
Section 4J5.504 IS revisen to rrad as Police.1Uter Su=publication and
:Jtio.vs: tt}oe><et»a 78s-ot;ftutics at opportunity for comastat.the(NHTSAI
:1s.6o4 A Rnht TFtet+t Oats'Motor Vehicle There shall utilize the theft data to determine
isgrn+tnt at ngnta to the fneuian theft rate under this
:er+e+its. Prevention Statusatro ciosectiun.
•+ -rcuicz.�ssistanre furnisnea un AGti4t r Nationai Hichwav traffic !r aetoroanre with the Statutory
,+i;er . :;84— SAfety Administration iNHTSAI.UO'P. urective.6HTSA puoitshed a notice
;%$.I r.c-c::::-nt ciictinitty. I!tr. ACrlorv.W.ihlication of final thrft mita, c-mIe tine comments on theft data the
_c.^.c': 711-:S1"._::e: caliv JutC .:ency nal uutatned from the NCIC Intl
_ptac:ir.IS dr.a recipients to assign summAwr These ants retiect the ne National Automobile Theft Bureau
mts to-cc:jai support or oincr mird 7assenter motor ventcie thefts in 1983 `:ATUI:50 Fit 1WZ&May Z 1965.That
,rry ,4vr ie^:s::Inc Medirato acencv no 1984 that have been orovidea to tnls nonce states tit nfrencY S tettt&U"
nu to cooaera:e wain the agency in .,tencv oy the National Crime recision to use the NC1C data to
:,tairint rice:_:support or payments. :nformation Center tNC1Cl.These Gate ;etermine the mealan theft rate for 19:3
ri 4.l,1.J_:part J.contains soecitic :ave oeen usea by tine agency to ,o 1984 Ana the tneft rates for the 130
Asstanments.t etermine Inc tneit rates for ine Iso xitting unes. the a>sencv exptatnea
County of Contra Costa 93-19032
Exhibit F
INSTRUCTIONS AND DEFINITIONS FOR DISCLOSURE FORM
I Instructions: How to determine ownership and control percentages
Department of Health Services Disclosure Form must be
completed by all Contractors with the State under the Medi-Cal
program. Those Contractors which are federally qualified
health maintenance organizations must complete questions #1
through #5 and question V. Those Contractors which are state
qualified health maintenance organizations must complete all
questions on the forms (including question W .
a. Indirect Ownership Interest- - The amount of indirect
ownership interest is determined by multiplying the
percentages of ownership in each entity. For example, if A
owns 10 percent of the stock in a corporation which owns 80
percent of the stock of the Contractor, A' s interest equates
to an 8 percent indirect ownership interest in the Contractor
and must be reported. Conversely, if B owns 80 percent of the
stock of a corporation which owns 5 percent of the stock of
the Contractor, B' s interest equates to a 4 percent indirect
interest in the Contractor and need not be reported.
b. Person With an Ownership or Control Interest- - In order to
determine percentage of ownership, mortgage, deed of trust,
note, or other obligation, the percentage of interest owned in
the obligation is multiplied by the percentage of the
Contractor' s assets used to secure the obligation. For
example, if A owns 10 percent of a note secured by 60 percent
of the Contractor' s assets, A' s interest in the Contractor' s
equates to 6 percent and must be reported. Conversely, if B
owns 40 percent of a note secured by 10 percent of the
Contractor' s assets, B' s interest in the Contractor' s assets
equates to 4 percent and need not be reported.
County of Contra Costa 93-19032
. • • II Definitions
A. AGENT means any persons who have been delegated the
authority to obligate or act on behalf of a provider or
contractor.
B. CONTRACTOR means a Medi-Cal prepaid health care Contractor
or fiscal agent.
C. OTHER CONTRACTOR means any other Medi-Cal Contractor and
any entity that does not participate in Medi-Cal, but is
required to disclose certain ownership and control information
because of participation in any of the programs established
under Title V, XVIII, or XX of the Social Security Act. This
includes :
(1) Any hospital , skilled nursing facility, home health
agency, independent clinical laboratory, renal
disease facility, rural health clinic or health
maintenance organization that participates in
Medicare (Title XVIII) ;
(2) Any Medicare intermediary or carrier; and
(3) Any entity (other than an individual practitioner or
group of practitioners) that furnishes, or arranges
for the furnishing of, health related services for
which claims payment under any plan or program
established under Title V or Title XX of the Social
Security Act .
D. FISCAL AGENT means a Contractor that processes or pays
vendor claims on behalf of DHS .
E. GROUP OF PRACTITIONERS means two or more health care
practitioners who practice their profession at a common
location (whether or not they share common facilities,
common supporting staff, or common equipment) .
F. INDIRECT OWNERSHIP INTEREST means an ownership interest
in an entity that has an ownership interest in the
Contractor. This term includes and ownership interest in
any entity that has an indirect ownership interest in the
Contractor.
G. MANAGING EMPLOYEE means a general manager, business
manager, administrator, director, or other individual who
exercises operational or managerial control over, or who
directly or indirectly conducts the day-to-day operation
of, an institution, organization or agency.
H. OWNERSHIP INTEREST means the possession of equity in the
capital, the stock, or profits of the Contractor.
county of Contra Contra 93-19032
I. PERSON WITH AN OWNERSHIP OR CONTROL INTEREST means a
person or corporation that:
(1) Has an ownership interest totalling 5 percent or more
in a Contractor;
(2) Has a indirect ownership interest equal to 5 percent
or more in a Contractor;
(3) Has a combination of direct and indirect ownership
interests equal to 5 percent or more in a Contractor;
(4) Owns an interest of 5 percent or more in any
mortgage, deed of trust, note, or other obligation
secured by the Contractor if that interest equals at
least 5 percent of the value of the property or assets of
the Contractor;
(5) Is an officer or director or a Contractor that is
organized as a corporation;
(6) Is a partner of a Contractor that is organized as a
partnership
J. SIGNIFICANT BUSINESS TRANSACTION means any business
transaction or series of transactions that, during any
one fiscal year, exceed the lesser of $25, 000 or 5
percent of a Contractor' s total operating expenses .
K. SUBCONTRACTOR means:
(1) An individual, agency, or organization to which a
Contractor has contracted or delegated some of its
management functions or responsibilities of providing
medical care to its patients; or
(2) An individual, agency, or organization with which a
fiscal agent has entered into a contract, agreement,
purchase order, or lease (or leases of real property) to
obtain space, supplies, equipment, or services provided
under the Medi-Cal agreement.
L. SUPPLIER means an individual, agency, or organization
from which a Contractor purchases goods and services used
in carrying out its responsibilities under Medi-Cal
(e.g. , a commercial laundry, a manufacturer of hospital
beds, or a pharmaceutical firm) .
M. WHOLLY OWNED SUPPLIER means a supplier whose total
ownership interest is held by a Contractor or by a
person, persons, or other entity with an ownership or
control interest in a Contractor.
A
County of Contra Costa 93-19032
DISCLOSURE FORM
In compliance with
Federal Regulations 42 CFR 455.104 and 42 CFR 455.106
(Name of Contractor)
2.9-77n
(Contract Number)
The undersi;ned hereby certifies that the following information is true and
correct as of the date set forth below.
1) Name and address of each person with an ou-nership or control interest in
the contractor (add additional pages if necessary).
Contra Costa County is a political suhdivision of the State of
California governed by a five memher elected Board of Supervisors.
2) Nare and address of each person with an au-nership or control interest in
any subcontractor in-which the contractor has direct or indirect owner-
ship of 5 percent or more (add additional pages if necessary)..
-County of Contra costa
93-19032
3. Identify any relationship of the persons named in paragraphs (1) and (2)
if they are related as spouse, parent, child, a= sibling (add additional
pages if necessary) .
4. Name any ot*,*ie-- contractor with the Department of Health Services in
V.-;ch a person with an o--mership or control interest in tha: Contractor
also has an ournership and control interest in the contractor disclosing
information or. this form.
S. Name and address of all directors and officers of the contractor that is
organized as a corporation; name and address of all partners of the con-
tractor that is organized as a partnership.
• qr r
f
- County of Contra Costa 93-19032
E. This question must be answered by non-federally qualified Eeslth Hain-
tenance Organizations.
a. Report any sale or exchanges, or leasing of any property between the
contractor and a person with an ownership or control interest (add
additional pages if necessary) .
b. Report any furnishings for consideration of goods, services
(i-cluding management services) , or facilities between the cortrac-
for and a person with an ounnership or control interest, but not in-
cluding salaries paid to employees for services provided in the nor-
ral course of their employment (add additional pages if necessary) .
c. Report any lending of money or other extension of credit b2rJeen the
contractor and a person with an aurnership or control inzarest (add
additional pages if necessary) .
County of Contra costa
93-19032
7. Pame and address of any person who has ownership or control interest in
the contractor, or any subcontractor, or is an agent or managing
employee of the contractor and has been convicted of a criminal offense
related to that person's involvement in any program under Medicare,
Medicaid (Medi-Cal) , or title XX (Social Security Act} services program
since the 'inception of those programs. Also list the specific
offense(s) and the disposition of the cases (add additional pages if
necessary) .
JUL
L 12 1994.
n
N am a Data
Chairn)an, Lloa,-d of SuPeN.'sors
Title
STATE OF CALIFORNIA—HEALTH AND WELFARE AGENCY PETE WILSON, Governor
7w 10
DEPARTMENT OF HEALTH SERVICES 1994
714/744 P STREET SEP 1 q S
P.O. BOX 942732 `
SACRAMENTO, CA 94234-7320
(916) 322-6122
County of Contra Costa
Attention: Chairperson, Bd. of Supvr.
651 Pine Street
Martinez, CA 94553
Dear Contractor:
CONTRACT NUMBER 93-19032
The enclosed contract has been approved by the State and should be retained as
your record of this agreement.
For program matters and for submission of invoices, please
contact: Department of Health Services, Administrative and Support. Unit, Attn:
James Gifford, 714 P Street, Rm.1340, Sacramento, CA 95814, 657-0738.
Sincerely,
Philip Schroeder
Contract Analyst
Contract Management Section
Enclosures
cc: Admin & Support Section
cros-05 (02/91)
RECEIdED
SEP
OF SUPERVISORS
p
CLERK�O j) COSTA CO.