SHJ25-007 Kittitas County and Wellpoint Agreement - PARTIALLY EXECUTED

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2.2 Provider's Duties and Obligations to Medicaid Members. All of Provider's duties and obligations to Members set forth in the Agreement shall also apply to Medicaid Members unless otherwise specifically set forth in this Attachment. Provider shall not discriminate in the acceptance of Medicaid Members for treatment, and shall provide to Medicaid Members the same access to services, including but not limited to, hours of operation, as Provider gives to all other patients. Provider shall furnish Wellpoint with at least ninety (90) days prior written notice if Provider plans to close its practice to new patients or ceases to continue in Provider's current practice. 2.2.1 To the extent mandated by Regulatory Requirements, Provider shall ensure that Medicaid Members have access to twenty-four (24) hour -per -day, seven (7) day -per -week urgent and Emergency Services, as defined in the PCS. 2.2.2 Unless otherwise required under Regulatory Requirements, a PCP, as defined in the PCS, shall provide Medicaid Covered Services or make arrangements for the provision of Medicaid Covered Services to Medicaid Members on a twenty-four (24) hour -per -day, seven (7) day -per -week basis to assure availability, adequacy, and continuity of care to Medicaid Members. If Provider is unable to provide Medicaid Covered Services, Provider shall arrange for another Participating Provider to cover Provider's patients in accordance with Wellpoint's Policies. Provider and any PCPs employed by or under contract with Provider may arrange for Medicaid Covered Services to Medicaid Members to be performed by a Specialist Physician only in accordance with Wellpoint's Policies. 2.2.3 If Provider is furnishing Specialist Physician services under this Attachment, Provider and the Specialist Physician(s) employed by or under contract with Provider, shall accept as patients all Medicaid Members and may arrange for Medicaid Covered Services to Medicaid Members to be performed by Specialist Physician only in accordance with Wellpoint's Policies. 2.2.4 If Provider is a mental health care practitioner and providers Health Services to a Medicaid Member during an appeal or adverse certification process, the Provider must provide to the Medicaid Member written notification that the Medicaid Member is responsible forthe payment of these Health Services, unless the health carrier elects to pay for the Health Services provided. 2.3 Provider Responsibility. Welipoint shall not be liable for, nor will it exercise control or direction over, the manner or method by which Provider provides Health Services to Medicaid Members. Provider shall be solely responsible for all medical advice and services provided by Provider to Medicaid Members. Provider acknowledges and agrees that Wellpoint may deny payment for services rendered to a Medicaid Member which it determines are not Medically Necessary, are not Medicaid Covered Services under the applicable Medicaid Program(s), or are not otherwise provided or billed in accordance with the Agreement and/or this Attachment. A denial of payment or any action taken by Wellpoint pursuant to a utilization review, referral, discharge planning program or claims adjudication shall not be construed as a waiver of Provider's obligation to provide appropriate Health Services to a Medicaid Member under applicable Regulatory Requirements and any code of professional responsibility. Provider may discuss treatment or non -treatment options with Medicaid Member irrespective of whether such treatment options are Medicaid Covered Services. However, this provision does not require Provider to provide Health Services if Provider objects to such service on moral or religious grounds. 2.3.1 No health carrier subject to the jurisdiction of the state of Washington may in any way preclude or discourage their providers from informing patients of the care they require, including various treatment options, and whether in their view such care is consistent with Medical Necessity, medical appropriateness, or otherwise covered by the patient's service agreement with the health carrier. No health carrier may prohibit, discourage, or penalize a provider otherwise practicing in compliance with the law from advocating on behalf of a patient with a health carrier. Nothing in this section shall be construed to authorize Provider to bind health carriers to pay for any service. 2.3.2 No health carrier may preclude or discourage Members or those paying for their coverage from discussing the comparative merits of different health carriers with their providers. This prohibition specifically includes prohibiting or limiting providers participating in those discussions even if critical of a carrier. 2.4 Reporting Fraud and Abuse. Provider shall cooperate with Wellpoint's anti -fraud compliance program. If Provider identifies any actual or suspected fraud, abuse or misconduct in connection with the services rendered hereunder in violation of Regulatory Requirements, Provider shall promptly report such activity directly to the compliance officer of Wellpoint orthrough the compliance hotline in accordance with the provider manual(s). In addition, Provider is not limited in any respect in reporting other actual or suspected fraud, Washington Enterprise Provider Agreement Medicaid Attachment 18 1183932156 ® 2024 July - Wellpoint Washington, Inc. 05/05/2025