SHJ25-008 COORDINATED CARE CONTRACT - PARTIALLY EXECUTED

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3.38. Provider Appeal Rights. If Provider provides physician services, Provider may exercise any appeal rights pursuant to Chapters 284-43 and 284-170 WAC to challenge Health Plan's failure to cover a service. 3.39. Health Plan Oversight and Corrective Action. Provider acknowledges and agrees that Health Plan shall conduct ongoing monitoring and periodic formal review that is consistent with applicable industry standards and the regulations of the Washington State Office of the Insurance Commissioner, if any. Such formal review shall be completed no less than once every three years or more often if specified, and will identify any deficiencies or areas of improvement and provide for corrective action of any such deficiencies. Such review shall include an evaluation to ensure that services furnished by Provider to individuals with special health care needs are appropriate to the Covered Person's needs. Inadequate performance under the Agreement will be subject to the revocation of delegation or imposition of sanctions in accordance with the dispute resolution process detailed in the Agreement. 3.40. Covered Person Self -Referral. Provider acknowledges that Covered Persons have a right to self -refer for: (a) Family planning services and supplies, and sexually -transmitted disease screening and treatment services provided at participating or non -Participating Providers, including but not limited to family planning agencies; (b) Immunizations, sexually -transmitted disease screening and follow-up, immunodeficiency virus (HIV) screening, tuberculosis screening and follow-up, and family planning services through and if provided by a local health department; (c) Immunizations, sexually transmitted disease screening, family planning and behavioral health services through and if provided by a school -based health center; (d) All services received by American Indian or Alaska Native Covered Persons under the Special Provisions for American Indians and Alaska Natives subsection of the State Contract; and (e) Crisis Response Services, including crisis intervention; crisis respite; investigation and detention services; and, evaluation and treatment services. Self -referrals can also be made for assessment and intake for behavioral health services. 3.41. Delegated Administrative Services Agreement. In the event that the Agreement delegates administrative functions to Provider, including essential behavioral health administrative functions, the Parties agree that they shall enter into a delegated administrative services agreement that contains all provisions required pursuant to the State Contract. 3.42. Confidential Member Information. Provider shall keep information about Covered Persons, including their medical records, confidential in a manner consistent with Applicable Law. 3.43. Medicaid NCCI Files. Provider may disclose only non -confidential information that is also available to the general public about the Medicaid NCCI edit files on the Medicaid NCCI webpage. 3.44. Member Rights. Provider shall comply with any Applicable Law that pertain to Covered Persons' rights and shall protect and promote those rights when furnishing services to Covered Persons. Provider shall guarantee each Covered Person the rights set forth below. Each Covered Person must be free to exercise these rights and the exercise of these rights must not adversely affect the way Health Plan or Provider treats the Covered Person. These rights include: (a) To be treated with respect and with consideration for Covered Person's dignity and privacy; (b) To receive information on available treatment options and alternatives, presented in a manner PPA WA - Kittitas County Public Health - 05.07.2025-1CMPraviderAgreement_360268 Page 8 of 12