SHJ25-008 COORDINATED CARE CONTRACT - PARTIALLY EXECUTED

Home Browse Search

prospective (newly enrolling) home health agencies and prospective (newly enrolling) durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) suppliers or such other categories of providers as defined under 42 C.F.R. §424.518, shall be enrolled in and screened by Medicare, in addition to complying with Health Plan's policies and procedures regarding credentialing and recredentialing. Such providers shall revalidate Medicare enrollment every five years in compliance with 42 C.F.R. §424.515. Notwithstanding the foregoing, infant in -home phototherapy providers that meet Health Plan's certification requirements are not required to be enrolled in Medicare. 3.30. HCA Approval Required. To the extent that the Agreement is considered a "Subcontract" requiring HCA approval under the State Contract, the Agreement will not take effect prior to HCA's review and written approval, or failure to approve or deny within 45 calendar days of filing. 3.31. HCA Approval for Assignment. Provider acknowledges and agrees that no assignment of the Agreement shall take effect without the prior written agreement of HCA. 3.32. Quality Improvement System. Provider shall maintain a quality improvement system tailored to the nature and type of Covered Services provided hereunder, which affords quality control for such services, including but not limited to the accessibility of Medically Necessary services, and which provides for a free exchange of information with Health Plan to assist Health Plan in complying with the requirements of the State Contract. Providers that are PCPs or specialty care providers shall comply with all quality improvement activities of the Health Plan. 3.33. Records of Delegated Activities. As applicable to services rendered under the Agreement, Provider shall have a means to keep records necessary to adequately document services provided to Covered Persons for any and all delegated activities including quality improvement, utilization management, Covered Person's rights and responsibilities, health homes, and credentialing and re-credentialing. 3.34. Behavioral Health Provider Supervision. Provider agrees that, if applicable, it will receive payment for the supervision of behavioral health providers whose license or certification restricts them to working under supervision. 3.35. Payment in Full and Covered Person Charges. Provider agrees to accept payment from Health Plan as payment in full. Provider shall not request payment from HCA or any Covered Person for Covered Services provided under the Agreement, and shall comply with WAC 182-502-0160 requirements applicable to providers. Provider shall report to Health Plan any instance in which a Covered Person is charged for services. Provider shall repay to a Covered Person any inappropriate charges paid by such Covered Person, or shall reimburse Health Plan to the extent Health Plan repays such inappropriate charges to the Covered Person. 3.36. HCA and Covered Person Hold Harmless. Provider agrees to hold harmless HCA and its employees, and all Covered Persons in the event of non-payment by Health Plan. Provider further agrees to indemnify and hold harmless HCA and its employees against (a) all injuries, deaths, losses, damages, claims, suits, liabilities, judgments, costs and expenses which may in any manner accrue against HCA or its employees through the intentional misconduct, negligence, or omission of Provider, its agents, officers, employees or contractors, and (b) any damages related to Provider's unauthorized use or release of Personal Information (PI) or Protected Health Information (PHI) of Covered Persons. 3.37. Termination Provision. Either Party to this Attachment may terminate this Attachment upon 90 days advance written notice to the other Party. Notwithstanding the foregoing, in the event that (a) Provider is excluded from participation in the Medicaid program, Health Plan may immediately terminate the Agreement or this Attachment upon written notice to Provider, and may immediately recover any payments for goods or services that benefit excluded individuals or entities; or (b) HCA or Medicare has taken any action to revoke Provider's privileges for cause, and Provider has exhausted all applicable appeal rights or the timeline for appeal has expired. "For cause" may include but is not limited to reasons related to fraud, integrity or quality. PPA WA - Kittitas County Public Health - 05.07.2025 - 1CMProviderAgreement_360268 Page 7 of 12