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Exhibit A—Statement of Work <br /> 1. The Contractor shall: <br /> a) Meet the applicable requirements in Chapter 182-546 WAC; <br /> b) Bill the agency in a timely manner for covered services provided to eligible clients in accordance with <br /> Chapter 182-502-0150 WAC and the HCA Ambulance Medicaid Provider Guide. <br /> c) Maintain sufficient documentation to support and justify the billed and paid claims in accordance with <br /> Chapter182-546-0300 WAC. <br /> d) Submit annually an agency Cost Report. The Cost Report must include the contractors allocated direct <br /> and indirect costs directly related to the GEMT services and must be submitted within 150 days after the <br /> close of SFY. The allocation must be completed in accordance with the CMS approved cost identification <br /> principles and standards such as Provider Reimbursement Manual Pub. 15-1 and OMB Circular A-87 and <br /> aligned with generally accepted accounting principles. <br /> e) Agree to participate in the IGT process by transferring local matching funds to HCA. <br /> f) Bear full responsibility for all submitted billing information completed by the Contractor, or Billing Agents, <br /> where applicable. <br /> State of Washington Page 19 of 19 Contract No.K2850 <br /> Health Care Authority <br />