My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
SHJ25-008 COORDINATED CARE CONTRACT - PARTIALLY EXECUTED
>
Meetings
>
2025
>
06. June
>
2025-06-17 10:00 AM - Commissioners' Agenda
>
SHJ25-008 COORDINATED CARE CONTRACT - PARTIALLY EXECUTED
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
6/12/2025 12:53:41 PM
Creation date
6/12/2025 12:49:58 PM
Metadata
Fields
Template:
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 SHJ25-008 Coordinated Care - 1115 Medicaid Re-Entry Initiative
Order
15
Placement
Consent Agenda
Row ID
132242
Type
Contract
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
38
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
that such individual agrees to assume responsibility for providing inpatient Covered Services to Covered Persons <br />who are patients of the applicable Practitioner. <br />2.2 Acceptance of New Patients. To the extent that Practitioner is accepting new patients, such <br />Practitioner must also accept new patients who are Covered Persons with respect to the Products in which such <br />Practitioner participates. Practitioner shall notify Company in writing 45 days prior to such Practitioner's decision to <br />no longer accept Covered Persons with respect to a particular Product. In no event will an established patient of any <br />Practitioner be considered a new patient. <br />2.3 Preferred Drug List/Drug Formulary. If applicable to the Covered Person's coverage, <br />Practitioners shall use commercially reasonable efforts, when medically appropriate under the circumstances, to <br />comply with formulary or preferred drug list when prescribing medications for Covered Persons. <br />2.4 National Committee for Quality Assurance ("NCOA") Accreditation of Health Plans <br />Standards. Each Practitioner agrees to: i) cooperate with Quality Management and Improvement ("QI") activities; ii) <br />maintain the confidentiality of a Covered Persons information and records pursuant to the Agreement; and iii) allow <br />the Company to use Practitioner's performance data. <br />3. Ancillary Providers. If Provider or Contracted Provider is an ancillary provider (including but not <br />limited to a chemical dependency services provider, residential treatment facility/behavioral health agency, home <br />health agency, durable medical equipment provider, sleep center, pharmacy, ambulatory surgery center, nursing <br />facility, laboratory, correctional facilities, or urgent care center) ("Ancillary Provider"), the following provisions <br />apply: <br />3.1 Acceptance of New Patients. To the extent that Ancillary Provider is accepting new patients, <br />such Ancillary Provider must also accept new patients who are Covered Persons with respect to the Products in which <br />such Ancillary Provider participates. Ancillary Provider shall notify Company in writing 45 days prior to such <br />Ancillary Provider's decision to no longer accept Covered Persons with respect to a particular Product. In no event <br />will an established patient of any Ancillary Provider be considered a new patient. <br />3.2 National Committee for Quality Assurance ("NCOA") Accreditation of Health Plans <br />Standards. Each ancillary provider agrees to: i) cooperate with Quality Management and Improvement ("QI") <br />activities; ii) maintain the confidentiality of a Covered Persons information and records pursuant to the Agreement; <br />and iii) allow the Company to use ancillary provider's performance data. <br />4. FQHC. If Provider or a Contracted Provider is a federally qualified health center ("FQHC"), the <br />following provision applies: <br />4.1 FQHC Insurance. To the extent FQHC's employees are deemed to be federal employees <br />qualified for protection under the Federal Tort Claims Act ("FTCA") and Health Plan has been provided with <br />documentation of such status issued by the U. S. Department of Health and Human Services (such status to be referred <br />to as "FTCA Coverage"), Section 5.1 of this Agreement will not apply to those Contracted Providers with FTCA <br />Coverage. FQHC shall provide evidence of such FTCA Coverage to Health Plan at any time upon request. FQHC <br />shall promptly notify Health Plan if, any time during the term of this Agreement, any Contracted Provider is no longer <br />eligible for, or if FQHC becomes aware of any factor circumstance that would jeopardize, FTCA Coverage. Section <br />5.1 of this Agreement will apply to a Contracted Provider immediately upon such Contracted Provider's loss of FTCA <br />Coverage for any reason. <br />5. Facility Providers.. If Provider or a Contracted Provider is a facility (including but not limited to <br />clinic, FQHC, long-term acute care (LTAC), nursing home, rehabilitation, rural health clinic (RHC), skilled nursing) <br />("Facility Provider") the following provision applies: <br />PPA WA - Kittitas County Public Health - 05.07.2025 - ICMProviderAgreement_360268 Page 20 of 24 <br />
The URL can be used to link to this page
Your browser does not support the video tag.