SHJ25-008 COORDINATED CARE CONTRACT - PARTIALLY EXECUTED

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calendar days of the request, including the following transactions: (1) Any sale or exchange, or leasing of any property between Provider and such a party; (2) Any furnishing for consideration of goods, services (including management services), or facilities between Provider and such a party but not including salaries paid to employees for services provided in the normal course of their employment; and (3) Any lending of money or other extension of credit between Provider and such a party. 3.55. Information on Persons Convicted of Crimes. If the Provider is not an individual practitioner or a group of practitioners, Provider shall investigate and disclose to Health Plan, at Agreement execution or renewal, and upon request by Health Plan of the identified person who has been convicted of a criminal offense related to that person's involvement in any program under Medicare, Medicaid, or the Title XX services program since the inception of those programs and who is: (a) A person who has an ownership or control interest in Provider; (b) An agent or person who has been delegated the authority to obligate or act on behalf of Provider; and (c) An agent, managing employee, general manager, business manager, administrator, director, or other individual who exercises operational or managerial control over, or who directly or indirectly conducts the day-to-day operation of, Provider. 3.56. Maternity Newborn Length of Stay; Sterilizations and Hysterectomies. All hospital delivery maternity care provided under the Agreement shall be in accord with RCW 48.43.115. All sterilizations and hysterectomies provided raider the Agreement shall be in compliance with 42 C.F.R. § 441 Subpart F, and Provider shall use a "Consent for Sterilization" form (HH8-687) or its equivalent in connection therewith. A hysterectomy requires the "Hysterectomy Consent and Patient Information" form (HCA 13-365). 3.57. Grievance and Appeals. Health Plan shall maintain a grievance and appeals system in accordance with the requirements of the State Contract, and Health Plan shall provide the following information regarding Health Plan's grievance and appeal system to Provider: (a) The toll -free numbers to file oral grievances and appeals; (b) The availability of assistance in filing a grievance or appeal; (c) The Covered Person's right to request continuation of Medicaid benefits during an appeal or hearing and, if the Health Plan's adverse benefit determination is upheld, that the Covered Person may be responsible to pay for the continued benefits; (d) The Covered Person's right to file grievances and appeals and their requirements and timeframes for filing; (e) The Covered Person's right to a hearing, how to obtain a hearing and representation rules at a hearing; and (f) Provider may file a grievance or request an adjudicative proceeding on behalf of a Covered Person in accordance with the State Contract. PPA WA - Kittitas County Public Health - 05.07.2025 - ICMProviderAgreement_360268 Page I I of 12