Common use of Respective Responsibilities Clause in Contracts

Respective Responsibilities. DSS agrees to: 1. Reimburse the School District the Title XIX and Title XXI federal share of actual and allowable costs for EPSDT administration provided by staff based upon a time accounting system which is in accordance with the provisions of OMB Circular A-87 and 45 CFR parts 74 and 95; other expense and equipment costs necessary to collect data, disseminate information and carry out the staff functions outlined in this agreement. The rate of reimbursement for eligible administrative costs will be 50%. Changes in federal regulations affecting the matching percentage and/or costs eligible for enhanced or administrative match, which become effective subsequent to the execution of this agreement, will be applied as provided in the regulations. 2. Provide the School District access to any public information necessary to properly provide the EPSDT Administrative Outreach and Case Management. 3. Develop and conduct periodic quality assurance and utilization reviews in cooperation with the School District. Federal oversight staff may also conduct reviews. 4. Provide initial training and technical assistance to staff of the School Districts regarding the responsibilities assumed within the terms of this agreement. 5. Conduct in-service training sessions for participating School Districts on a periodic basis. 6. Provide necessary consultation to the School District on issues related to this agreement as needed. The School District agrees to: 1. Provide, to the greatest extent possible, EPSDT Administrative Outreach and Case Management as an instrument for DSS to aid in assuring the availability, accessibility and coordination of required health care resources to Medicaid eligible children and their families residing within the district's boundaries. The School District shall develop and retain in its records an internal process for measuring the progress of the district toward attainment of the Program goals. The following list of activities has been identified as appropriate for providing the Administrative Case Management function. a. Provide outreach activities: Informing eligible or potentially eligible individuals about Medicaid and how to access Medicaid, describing the range of services covered under Medicaid and explaining how to obtain Medicaid preventative services. b. Assist children and families to establish Medicaid eligibility: Making referrals to the appropriate local Department of Social Services Office for eligibility determination, and, when designated by DSS, assisting the applicant in the completion of the Medicaid application forms, collecting information, and assisting in reporting any required changes affecting eligibility. 2. Provide, to the greatest extent possible, assistance to eligible children and their families in establishing a medical home as defined in the South Dakota Medicaid Program. A medical home is a coordinated, comprehensive, continuous health care program to address the child’s primary health needs. The medical home should provide or make arrangements for after hours care, and coordinate a child's specialty needs. The medical home should follow the screening periodicity schedule and perform interperiodic screens when medically necessary. Coordination activities include, but are not limited to: a. Making referrals and providing related activities for EPSDT screens in accordance with the periodicity schedule set out in South Dakota Medicaid Program. EPSDT screens include comprehensive health and developmental, mental health, vision, hearing and dental screens. b. Making referrals and providing related activities for evaluations that may be required as the result of a condition identified during the child’s screen. c. Provide case planning and coordination. This activity includes assistance to the client and the family in facilitating a case or service plan, including Individual Education Program (IEP) and Individualized Family Service Plan (IFSP) activities related to health needs. Activities include, but are not limited to: • Identifying and providing assistance for medically necessary and educationally relevant services required as the result of any regular, periodic, or interperiodic, EPSDT screen; • Assisting children and families in accessing immunization services and scheduling appointments; • Making referrals, arranging and coordinating prenatal, post-partum, and newborn medical services; • Arranging and coordinating nutritional counseling or medical services for children with medical needs including, but not limited to, gross obesity, diabetes, anorexia, or bulimia; and • Arranging for and coordinating transportation for children and families to obtain medical screenings and services. • Provide anticipatory guidance to caretakers relating to specific medical needs of a child. • Follow procedures in methodology related to monitoring and financial management. It is understood by both parties that the ability of each School District to carry out the above provisions will vary, and that each School District will endeavor to continually improve access to needed health care services for children within its boundaries. 3. Maintain the confidentiality of client records and eligibility information received from DSS and use that information only for administrative, technical assistance and coordination. 4. Accept responsibility for disallowances and incur the penalties of same resulting from the activities associated with this agreement. Return to DSS any federal funds which are deferred and/or ultimately disallowed arising from the administrative claims submitted by DSS on behalf of the School District. 5. Consult with DSS on issues arising out of this agreement. 6. Conduct all activities recognizing the authority of DSS in the administration of the State Medicaid Plan on issues, policies, rules and regulations on program matters. 7. Complete time studies, including the use of Activity Codes required in the South Dakota Public Schools Medicaid Administrative Claiming Guide, under requirements contained in the Guide. Maintain all necessary cost, time study and claim information for a minimum of five (5) years to support the claims and provide DSS or federal representatives any necessary data for auditing purposes. 8. Complete claims under approved DSS and federal methodology. Submit claims on a quarterly basis. 9. Allow DSS to ▇▇▇▇ a quarterly Consortium claim preparation fee of $87,500, prorated to each District member of the Consortium on the basis of their respective federal claim amount.

Respective Responsibilities. DSS agrees to: 1. Reimburse the School District the Title XIX and Title XXI federal share of actual and allowable costs for EPSDT administration provided by staff based upon a time accounting system which is in accordance with the provisions of OMB Circular A-87 and 45 CFR parts 74 and 95; other expense and equipment costs necessary to collect data, disseminate information and carry out the staff functions outlined in this agreement. The rate of reimbursement for eligible administrative costs Costs will be 50%reimbursed at the eligible Medicaid rate. Changes in federal regulations affecting the matching percentage and/or costs eligible for enhanced or administrative match, which become effective subsequent to the execution of this agreement, will be applied as provided in the regulations. 2. Provide the School District access to any public information necessary to properly provide the EPSDT Administrative Outreach and Case Management. 3. Develop and conduct periodic quality assurance and utilization reviews in cooperation with the School District. Federal oversight staff may also conduct reviews. 4. Provide initial training and technical assistance to staff of the School Districts regarding the responsibilities assumed within the terms of this agreement. 5. Conduct in-service training sessions for participating School Districts on a periodic basis. 6. Provide necessary consultation to the School District on issues related to this agreement as needed. The School District agrees to: 1. Provide, to the greatest extent possible, EPSDT Administrative Outreach and Case Management as an instrument for the DSS to aid in assuring the availability, accessibility and coordination of required health care resources to Medicaid eligible children and their families residing within the district's boundaries. The School District shall develop and retain in its records an internal process for measuring the progress of the district toward attainment of the Program goals. The following list of activities has been identified as appropriate for providing the Administrative Case Management function. a. Provide outreach activities: Informing eligible or potentially eligible individuals about Medicaid and how to access Medicaid, describing the range of services covered under Medicaid and explaining how to obtain Medicaid preventative services. b. Assist children and families to establish Medicaid eligibility: Making referrals to the appropriate local Department of Social Services Office for eligibility determination, and, when designated by DSS, assisting the applicant in the completion of the Medicaid application forms, collecting information, and assisting in reporting any required changes affecting eligibility. 2. Provide, to the greatest extent possible, assistance to eligible children and their families in establishing a medical home as defined in the by South Dakota Medicaid ProgramMedicaid. A medical home is a coordinated, comprehensive, continuous health care program to address the child’s primary health needs. The medical home should provide or make arrangements for after hours care, and coordinate a child's specialty needs. The medical home should follow the screening periodicity schedule and perform interperiodic inter-periodic screens when medically necessary. Coordination activities include, but are not limited to: a. Making referrals and providing related activities for EPSDT screens in accordance with the periodicity schedule set out in South Dakota Medicaid Programschedule. EPSDT screens include comprehensive health and developmental, mental health, vision, hearing and dental screens. b. Making referrals and providing related activities for evaluations that may be required as the result of a condition identified during the child’s screen. c. Provide case planning and coordination. This activity includes assistance to the client recipient and the family in facilitating a case or service plan, including Individual Education Program (IEP) and Individualized Family Service Plan (IFSP) activities related to health needs. Activities include, but are not limited to: • Identifying and providing assistance for medically necessary and educationally relevant services required as the result of any regular, periodic, or interperiodicinter-periodic, EPSDT screen; • Assisting children and families in accessing immunization services and scheduling appointments; • Making referrals, arranging and coordinating prenatal, post-partum, and newborn medical services; • Arranging and coordinating nutritional counseling or medical services for children with medical needs including, but not limited to, gross obesity, diabetes, anorexia, or bulimia; and • Arranging for and coordinating transportation for children and families to obtain medical screenings and services. ; • Provide anticipatory guidance to caretakers relating to specific medical needs of a child. ; and • Follow procedures in methodology related to monitoring and financial management. It is understood by both parties that the ability of each School District to carry out the above provisions will vary, and that each School District will endeavor to continually improve access to needed health care services for children within its boundaries. 3. Maintain the confidentiality of client recipient records and eligibility information received from DSS and use that information only for in administrative, technical assistance and coordinationcoordination activities. 4. Accept responsibility for disallowances and incur the penalties of same resulting from the activities associated with this agreement. Return to DSS any federal funds which are deferred and/or ultimately disallowed arising from the administrative claims submitted by DSS on behalf of the School District. 5. Consult with DSS on issues arising out of this agreement. 6. Conduct all activities recognizing the authority of DSS in the administration of the Medicaid State Medicaid Plan on issues, policies, rules and regulations on program matters. 7. Complete time studies, including the use of Activity Codes required in the South Dakota Public Schools Medicaid Administrative Claiming Guide, studies under requirements contained in the Guide. Maintain all necessary cost, time study and claim information for a minimum of five seven (57) years to support the claims and provide DSS or federal representatives any necessary data for auditing purposes. 8. Complete claims under approved DSS and federal methodology. Submit claims on a quarterly basis. 9. Allow DSS to ▇▇▇▇ bill a quarterly Consortium claim preparation fee of $87,500fee, prorated to each District member of the South Dakota Medicaid Consortium (see VI. Participation in Statewide Consortium) on the basis of their respective federal claim amount.