SHJ25-008 COORDINATED CARE CONTRACT - PARTIALLY EXECUTED

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(b) Transitional healthcare services by a home care nurse, a home care mental health professional or other behavioral health professional shall be available within seven calendar days of discharge from inpatient or institutional care for physical or behavioral health care, if ordered by the Covered Person's PCP or as part of the discharge plan; (c) Non -symptomatic (i.e., preventive care) office visits shall be available from the Covered Person's PCP or another provider within 30 calendar days. A non -symptomatic visit may include, but is not limited to, well/preventive care such as physical examinations, annual gynecological examinations, or child and adult immunizations. (d) Non -urgent, symptomatic (i.e., routine care) office visits, shall be available from the Covered Person's PCP or another provider within 10 calendar days, including behavioral health services from a behavioral health provider. A non -urgent, symptomatic visit is associated with the presentation of medical signs not requiring immediate attention. (e) Urgent, symptomatic office visits shall be available from the Covered Person's primary care, behavioral health or another provider within 24 hours. An urgent, symptomatic visit is associated with the presentation of medical or behavioral health signs that require immediate attention, but are not emergent. (f) Emergency medical care shall be available 24 hours per day, 7 days per week; and (g) Second opinion appointments described in Subsection 16.2.1 of the State Contract must occur within 30 calendar days of the request, unless the Covered Person requests a postponement of the second opinion to a date later than 30 calendar days. Health Plan shall monitor Provider's compliance with this section. In the event Provider fails to comply with the applicable appointment wait time standards set forth in this section, Provider shall comply with Health Plan's procedures for corrective action. Nothing in this section prohibits Provider from conducting assessments in alternate settings, such as the Covered Person's home or within an institutional setting. [Source: § 6.9 of the 2022 Apple Health IMC Agreement] 3.21. 24/7 Availability. To the extent applicable, Provider shall make the following services available 24 hours per day, 7 days per week, 365 days a year by a toll -free telephone number: (a) Medical and behavioral health advice for Covered Persons from licensed health care professionals; (b) Triage concerning the emergent, urgent or routine nature of medical and behavioral health conditions by licensed health care professionals; and (c) The toll -free line staff must be able to make a warm handoff to the regional crisis line. 3.22. Health Information Systems. Provider shall maintain a health information system that complies with the requirements of 42 C.F.R. §438.242 and provides the information necessary to meet Health Plan's obligations under the State Contract. Provider shall: (a) Collect, analyze, integrate, and report data. The system must provide information on areas that include but are not limited to utilization, grievance and appeals, and terminations of enrollment for other than loss of Medicaid eligibility; and (b) Ensure data provided to IIealth Plan is accurate and complete by: (a) verifying the accuracy and timeliness of reported data; (b) screening the data for completeness, logic, and consistency; and (c) collecting service information on standardized formats to the extent feasible and appropriate. PPA WA - Kittitas County Public Health - 05.07.2025 - ICMProviderAgreement_360268 Page 5 of 12