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SHJ25-007 Kittitas County and Wellpoint Agreement - PARTIALLY EXECUTED
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SHJ25-007 Kittitas County and Wellpoint Agreement - PARTIALLY EXECUTED
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Last modified
6/12/2025 12:53:35 PM
Creation date
6/12/2025 12:49:58 PM
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Meeting
Date
6/17/2025
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Supporting documentation
Supplemental fields
Item
Request to Approve Agreement SHJ25-007 WELLPOINT - 1115 Medicaid Re-Entry Initiative
Order
14
Placement
Consent Agenda
Row ID
132242
Type
Contract
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5.1 Indemnification of State. In addition to the Indemnification provision of the Agreement, Provider shall indemnify <br />and hold harmless the State, its agencies, officers, and employees from all claims and suits, including court <br />costs, attorney's fees, and other expenses, brought because of injuries or damages received or sustained by <br />any person, persons, or property that is caused by any act or omission of Provider. <br />5.2 This provision intentionally left blank <br />5.3 State Agency Government Contract. Provider shall comply with the terms applicable to providers set forth in <br />the Government Contract, including incorporated documents, between Plan and the applicable State Agency, <br />which applicable terms are incorporated herein by reference. Nothing in this Attachment shall be construed to <br />terminate or reduce the legal responsibility of Wellpoint to State Agency to ensure that all activities under the <br />Government Contract are carried out. Wellpoint shall afford Provider access to all necessary training and <br />information to enable Provider to carry out its responsibilities under the Government Contract. Documents, <br />procedures, and other administrative policies and programs referenced in the Government Contract must be <br />available for review by the Provider prior to contracting. <br />5.4 Performance Within the U.S. Provider agrees that all services to be performed herein shall be performed in <br />the United States of America. Breach, or anticipated breach, of the foregoing shall be a material breach of <br />this Attachment and, without limitation of remedies, shall be cause for immediate termination of the Agreement <br />and this Attachment. <br />5.5 No Payment Outside the United States. Provider agrees that Wellpoint shall not provide any payments for <br />items or services provided under the Agreement to any financial institution or entity located outside the United <br />States of America. <br />5.6 Americans with Disabilities Act Compliance. Provider shall make reasonable accommodation for Medicaid <br />Members with disabilities, in accord with the Americans with Disabilities Act, for all services and shall assure <br />physical and communication barriers shall not inhibit Medicaid Members with disabilities from obtaining such <br />services. <br />5.7 Interpreter Services. In compliance with 42 CFR 438.10(c)(4), Provider shall assure that interpreter services <br />are provided for Medicaid Members with a primary language other than English, free of charge. Provider shall <br />also provide interpreter services for all interactions between such Medicaid Members and Provider including, <br />but not limited to: all appointments, emergency services, and all steps necessary to file grievances and <br />appeals. <br />5.8 Readability. Provider shall ensure that all written information provided to Medicaid Members is accurate, is not <br />misleading, is comprehensible to its intended audience, is designed to provide the greatest degree of <br />understanding, and is written at the sixth grade reading level. All such written materials must have the written <br />approval of Wellpoint prior to use. <br />5.9 Coordination of Benefits/Third Party Liability. In addition to the Coordination of Benefits/Subrogation provision <br />of the Agreement, Provider understands and agrees thatwhen a Medicaid Member is covered by two or more <br />plans, the primary plan must pay or provide its benefits as if the Medicaid Program did not exist. Provider <br />acknowledges and agrees that claims payments made by Wellpoint pursuant to Medicaid Program <br />requirements are subject to Medicaid Program requirements regarding third party liability. Provider shall <br />cooperate with Wellpoint's policies and procedures related to third party liability recovery in the event claims <br />for services rendered by Provider to a Medicaid Member are related to an illness or injury for which a third <br />party may be liable, including, without limitation, claims that may be covered by automobile insurance, workers' <br />compensation coverage, other health insurance, or otherwise give rise to a claim for third party liability, <br />coordination of benefits or subrogation (to the extent permitted by Regulatory Requirements). Provider shall <br />take all reasonable actions required by Wellpoint to assist Wellpoint in obtaining such recoveries, including <br />executing any appropriate documents reasonably requested by Wellpoint to enforce such claims or to assign <br />any payments to Wellpoint. However Provider and Wellpoint shall not refuse or reduce services provided <br />under this agreement solely due to the existence of similar benefits under any other health care contract. In <br />addition Wellpoint shall pay claims for prenatal care and preventive pediatric care and shall seek <br />reimbursement from such third parties. <br />5.10 Appointment Waiting Times. Provider shall offer hours of operation that are no less than the hours of operation <br />offered to patients with other insurance coverage, including but not limited to commercial health plans. If <br />Provider is a primary care physician, Provider is encouraged to offer after-hours office care to Medicaid <br />Washington Enlerprlse Provider Agreement Medicaid Attachment 22 1183932156 <br />0 2024 July— Wellpoint Washington, Inc. 05/05/2025 <br />
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