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investigations of Provider. To the extent that Provider is delegated authority for authorization of services, Provider
<br />shall comply with all utilization management requirements described in the State Contract.
<br />3.5. Debarment Certification. Provider represents and warrants that it is not presently debarred,
<br />suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any State or federal department
<br />or agency from participating in transactions. Provider shall immediately notify Health Plan in writing if, during the
<br />term of the Agreement, (a) Provider becomes debarred, suspended, proposed for debarment, declared ineligible or
<br />voluntarily excluded, or (b) Provider or any of Provider's employees are subject to disciplinary action against
<br />accreditation, certification, license and/or registration. Further, Provider shall not pay for goods and services
<br />furnished by an excluded person, at the medical direction, or on the prescription of an excluded person.
<br />3.6. Records. Provider shall maintain all financial, billing, medical and other records pertinent to the
<br />Agreement, including but not limited to records related to services rendered, quality, appropriateness, and timeliness
<br />of service, any administrative, civil or criminal investigation or prosecution. All financial records shall follow
<br />generally accepted accounting principles. Other records shall be maintained as necessary to clearly reflect all actions
<br />taken by Provider related to the Agreement. All records and reports relating to the Agreement shall be retained by
<br />Provider for a minimum of 10 years after final payment is made under the Agreement. However, when an inspection,
<br />audit, litigation, or other action involving records is initiated prior to the end of said period, records shall be
<br />maintained for a minimum of 10 years following resolution of such action.
<br />3.7. Inspection. Provider shall fully cooperate with and permit State, including HCA, Medicaid Fraud
<br />Control Units (MFCU) and state auditor, CMS, auditors from the federal Government Accountability Office, federal
<br />Office of the Inspector General, federal Office of Management and Budget, the Office of the Inspector General, the
<br />Comptroller General, and their designees, to access, inspect and audit any books, records, contracts, or documents of
<br />Provider that pertain to any aspect of services and activities performed, including any computerized data stored by
<br />Provider, and shall permit inspection of the premises, physical facilities, and equipment where Medicaid -related
<br />activities or work is conducted, at any time whether such visit is announced or unannounced. Provider shall make
<br />staff available to assist in such inspection, review, audit, investigation, monitoring or evaluation, including the
<br />provision of adequate space on the premises to reasonably accommodate HCA, MFCD or other state or federal
<br />agency. Provider shall make copies of records and shall deliver them to the requestor, without cost, within 30 calendar
<br />days of request. The right for the parties named above to audit, access and inspect under this section exists for 10
<br />years from the final date of the contract period or from the date of completion of any audit, whichever is later. If the
<br />State, CMS or the federal Office of the Inspector General determines that there is a reasonable possibility of fraud or
<br />similar risk, the State, CMS, or the federal Office of the Inspector General may inspect, evaluate, and audit the
<br />subcontractor at any time.
<br />3.8. Intemreter Services. Provider shall provide interpreter services, free of charge, for all interactions
<br />with Covered Persons or potential Covered Persons, including but not limited to: (a) customer service, (b) all
<br />appointments with any provider for any Covered Service, (c) emergency services, and (d) all steps necessary to file
<br />grievances and appeals including requests for Independent Review of Health Plan decisions.
<br />3.9. Marketing Materials. All information to be provided to Covered Persons, e.g. marketing materials,
<br />must be accurate, not misleading, comprehensible to its intended audience, designed to provide the greatest degree
<br />of understanding, and written at a sixth grade reading level, in addition to any other requirements imposed by Health
<br />Plan based on the nature of the materials. Such materials must generally be approved by Health Plan prior to use,
<br />and must comply with the State Contract.
<br />3.10. Coordination of Benefits. Services and benefits available under the Agreement shall be secondary to
<br />any other medical coverage, except in accordance with Chapter 284-51 WAC, as applicable. Health Plan shall not
<br />refuse or reduce services provided under the Agreement solely due to the existence of similar benefits under any other
<br />health care contract, except in accord with applicable coordination of benefits rules in WAC 284-51. Health Plan
<br />shall provide prenatal care and preventive pediatric care and then seek reimbursement from third parties. Provider
<br />shall comply with all applicable Third -Party Liability and Coordination of Benefits provisions of Section 17 of the
<br />PPA WA - Kittitas County Public Health - 05.07.2025 - ICMProviderAgreement_360268 Page 3 of 12
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