CONTRACTING FOR MEDI-CAL SERVICES. As a government entity, Contractor may itself contract for Medi-Cal Services. As such, it may enter into contracts with community based organizations or other provider agencies for the provision of Medi- Cal services and/or MAA. Contractor may claim the costs of contract administration for allowable MAA, such as Outreach, or claim the costs under contract administration. Accordingly, Contractor must elect which type of claim to submit as it is precluded from claiming under both. Finally, contracting for Medi-Cal services may only be claimed under contract administration. Contracting for MAA and/or Medi-Cal services is claimable as MAA when the administration of those contracts meets all of the following criteria: • The contract administration is performed by an identifiable unit of one or more employees, whose tasks officially involve contract administration, according to the duty statements or job descriptions of the employees being claimed. • The contract administration involves contractors that provide MAA and/or Medi- Cal services. • The contract administration must be directed to one or more of the following goals: (1) providing technical assistance to Medi-Cal Subcontractors/Grantees regarding County, State and Federal regulations; monitoring provider agency capacity and availability; and (3) ensuring compliance with the terms of the contract. • The contract administration costs being claimed are not for Subcontractors/Grantees who are service providers under managed care arrangements.
CONTRACTING FOR MEDI-CAL SERVICES. This activity involves entering into agreements with community based organizations or other provider agencies for the provision of Medi-Cal services other than TCM and/or MAA. The costs of TCM subcontract administration should be included in the TCM rate. Contracting for Medi-Cal services and/or MAA is claimable as an administrative activity when the administration of those agreements meets all of the following criteria:
a. The contract administration is performed by an identifiable unit of one or more employees, whose tasks officially involve contract administration, according to the duty statements or job descriptions of the employees being claimed.
b. The contract administration involves contractors that provide Medi-Cal services and/or MAA. The costs of contracting for TCM services with non-LGA providers should be claimed as part of the TCM rate. These costs cannot be separately claimed as MAA.
c. TCM case managers and LGA subcontractors cannot claim for contract management. It is claimable only when performed by an LGA.
d. The administrative costs of contracting by LGAs as service providers under managed care arrangements may not be claimed administratively and are considered to be in the managed care capitation payment to the LGA.
e. The contract administration must be directed to one or more of the following goals:
(1) Identifying, recruiting, and contracting with community agencies as Medi-Cal service contract providers;
(2) Providing technical assistance to Medi-Cal subcontractors regarding County, State and Federal regulations;
(3) Monitoring provider agency capacity and availability; and
(4) Ensuring compliance with the terms of the agreement. The contracts being administered must be for Medi-Cal services and/or MAA and may involve Medi-Cal populations only or may be general medical service agreements involving Medi-Cal and other indigent, non-Medi-Cal populations. When the contract involves a Medi-Cal and non-Medi- Cal population, the costs of contract administration shall be discounted by the Medi-Cal percentage.
