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HCA Contract No. K7759-01 Page 5 of 8 <br />2.10.4.1 Wraparound health services and referrals, including referrals to appropriate <br />clinical and non-clinical services <br />2.10.4.2 Medical and psychosocial case management, <br />2.10.4.3 Provision of life necessities as able (providing free materials such as <br />hygiene supplies, food/water and some clothing), <br />2.11 The contractor will ensure that SM teams will be held to the same standards as any healthcare <br />facility delivering medical care and includes clinical record keeping and licensing requirements. In <br />addition, the contractor will establish a quality assurance (QA) and quality improvement (QI) plan <br />for SM teams. <br />2.12 Contractor to meet with HCA on a quarterly schedule to discuss progress on contract work, <br />including successes and challenges. Additional meetings as needed by the contractor. <br />2.13 The contractor will set up billing systems and bill for services eligible for Medicaid reimbursement <br />and include details in final report. <br />3. Reporting: <br /> <br />The contractor will submit quarterly reports due the last business day of the month after end of quarter to <br />include the following: <br />3.1 Individuals on SM teams who attended quarterly training during the reporting period and report <br />the training on an attendance sheet to include date/time and duration of time, type of training <br />involved, name of personnel attending the training, and instructor/title providing the training. <br />3.2 Data collection. The contractor will collect and report on the following data elements on a <br />quarterly basis. <br />3.2.1 Program information <br />3.2.1.1 Quarterly staffing report including number and type of providers. <br />3.2.1.2 Total number of sites visited to include date/time/location and participating <br />staff. <br />3.2.1.3 Any manner of deaths (natural, accident, homicide, undetermined and <br />pending) if possible. <br />3.2.2 Billable services <br />3.2.2.1 Total number of patients seen, including: <br />3.2.2.1.1 Client demographics to include age, racial, ethnic and <br />gender. <br />3.2.2.1.2 Number and type of treatments/services performed on <br />individuals and outcomes such as testing and overdose <br />Docusign Envelope ID: BA5A7EFA-772A-4417-9B4B-83C72073A952