SHJ25-008 COORDINATED CARE CONTRACT - PARTIALLY EXECUTED

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State Contract 3.11. Care Coordination. Provider shall comply with Health Plan's policies and support Health Plan's efforts regarding care coordination, transfers between levels of care and medication management. If applicable, Provider shall ensure that discharge plans and facilitation to post -discharge services are documented in a Covered Person's electronic health record. If Provider is an inpatient substance use disorder (SUD) treatment provider, then Provider shall have policies in place for prompt exchange of Covered Person information between behavioral health treatment agencies to facilitate continuity of care, consistent with the State Contract. 3.12. Subcontracting. Provider may not subcontract any services under the Apple Health Program without the prior written consent of Health Plan. Any subcontract entered into by Provider must be in writing consistent with 42 C.F.R. § 434.6, and all Provider requirements contained in this Attachment must be propagated downward into any other lower tiered subcontracts. 3.13. Reasonable Accommodations for Disabilities. Provider shall cooperate with Health Plan to make reasonable accommodation for Covered Persons with disabilities, in accordance with the Americans with Disabilities Act, for all Covered Services and shall assure physical and communication barriers shall not inhibit Covered Persons with disabilities from obtaining Covered Services. 3.14. Surgical Health and Safety. If Provider is a hospital, ambulatory care surgery center, or office -based surgery site, Provider shall endorse and adopt procedures for verifying the correct patient, the correct procedure and the correct surgical site that meet or exceed those set forth in the Universal ProtocolTM development by the Joint Commission or other similar standards. 3.15. Practice Guidelines. Provider shall comply with applicable physical and behavioral health practice guidelines adopted by Health Plan. 3.16. Timely Access to Care. Provider shall offer access comparable to that offered to commercial enrollees or if Provider serves only Medicaid enrollees, then comparable to Medicaid fee -for -service. 3.17. Hours of Operation. Provider's hours of operation for Covered Persons shall be no less than the hours of operation offered to any other of Provider's patients. 3.18. Administrative Simplification. Unless otherwise directed by Health Plan, Provider shall use and follow the most recent updated versions of: Current Procedural Terminology ("CPT"); International Classification of Diseases ("ICD"); Healthcare Common Procedure Coding System ("HCPCS"); CMS Relative Value Units ("RVUs"); CMS billing instructions and rules; The Diagnostic and Statistical Manual of Mental Disorders; NCPDP Telecommunication Standard D.O.; and Medi-Span® Master Drug Data or any other nationally recognized drug database with approval by HCA. 3.19. Claims Payment Standards. Except as otherwise allowed under Applicable Law, or unless otherwise agreed by the Parties in writing on a claim -by -claim basis, Health Plan shall meet the following minimum standards for timeliness of payment: 95% of Clean Claims shall be paid within 30 calendar days of receipt of the paper or electronic claim; 95% of all claims shall be paid or denied within 60 calendar days of receipt of the paper or electronic claim; and 99% of Clean Claims shall be paid or denied within 90 calendar days of receipt. 3.20. Appointment Wait Time Standards. As applicable, Provider shall meet the following appointment wait time standards with respect to Covered Persons: (a) Transitional healthcare services by a PCP shall be available for clinical assessment and care planning within seven calendar days of discharge from inpatient or institutional care for physical or behavioral health disorders or discharge from a SUD treatment program. PPA WA - Kittitas County Public Health - 05.07.2025 - ICMProviderAgreement_360268 Page 4 of 12