COMPLIANCE: FEDERAL REGULATIONS Sample Clauses

COMPLIANCE: FEDERAL REGULATIONS. For all Title XIX delegated program and administrative activities included in this agreement, DOH is responsible for maintaining compliance with Medicaid federal regulations and any overpayments requested as a result of audit findings. (42 CFR, Parts 430-433). DOH will reference the Title XIX regulations (42 CFR, Parts 430-433) in all DOH contracts which include Title XIX administrative activities. The following criteria must be met to claim 75 percent FFP for activities performed by skilled professional medical personnel (SPMP): ß The expenditures are for activities that are directly related to the administration of the Medicaid program and as such do not include expenditures for direct medical services or activities which are extensions of a direct medical service. ß The activity must require the medical expertise of the SPMP in order to be performed effectively. If the activity can be performed effectively without SPMP expertise, the match rate is 50 percent regardless of the qualifications of the person performing the activity. ß The skilled professional medical personnel have professional education and training in the field of medical care or appropriate medical practice. "Professional education and training" means the completion of a two-year or longer program leading to an academic degree or certificate in a medically related profession. This is demonstrated by possession of a medical license, certificate, or other document issued by a recognized National or State medical licensure or certifying organization or a degree in a medical field issued by a college or university certified by a professional medical organization. Experience in the administration, direction, or implementation of the Medicaid program is not considered the equivalent of professional training in a field of medical care. ß The skilled professional medical personnel are in positions that have duties and responsibilities that require those professional medical knowledge and skills. ß The directly supporting staff are secretarial, stenographic, and copying personnel and file and records clerks who provide clerical services that are directly necessary for the completion of the professional medical responsibilities and functions of the skilled professional medical staff. The skilled professional medical staff must directly supervise the supporting staff and the performance of the supporting staff's work. ß An employer-employee relationship must exist between the Contractor and the ski...