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Pursuant to RCW 48.43.735(9)(d)(i)-(ii) "Established relationship" means the provider providing audio -only
<br />telemedicine has access to sufficient health records to ensure safe, effective, and appropriate care services, and: (i)
<br />for health care services included in the essential health benefits category of mental health and substance use disorder
<br />services, including behavioral health treatment: (A) The Covered Person has had, within the past three years, at least
<br />one in -person appointment, or at least one real-time interactive appointment using both audio and video technology,
<br />with the provider providing audio -only telemedicine or with a provider employed at the same medical group, at the
<br />same clinic, or by the same integrated delivery system operated by a carrier licensed under chapter 48.44 or 48.46
<br />RCW as the provider providing audio -only telemedicine; or (B) The Covered Person was referred to the provider
<br />providing audio -only telemedicine by another provider who has had, within the past three years, at least one in -person
<br />appointment, or at least one real-time interactive appointment using both audio and video technology, with the
<br />Covered Person and has provided relevant medical information to the provider providing audio -only telemedicine;
<br />(ii) For any other health care service: (A) The Covered Person has had, within the past two years, at least one in -
<br />person appointment, or, until January 1, 2024, at least one real-time interactive appointment using both audio and
<br />video technology, with the provider providing audio -only telemedicine or with a provider employed at the same
<br />medical group, at the same clinic, or by the same integrated delivery system operated by a carrier licensed under
<br />chapter 48.44 or 48.46 RCW as the provider providing audio -only telemedicinc; or (B) The Covered Person was
<br />referred to the provider providing audio -only telemedicine by another provider who has had, within the past two
<br />years, at least one in -person appointment, or, until January 1, 2024, at least one real-time interactive appointment
<br />using both audio and video technology, with the covered person and has provided relevant medical information to
<br />the provider providing audio -only telemedicine.
<br />2.8. Treatment Decisions. No Company or Payor is liable for, nor will it exercise control over, the manner
<br />or method by which a Contracted Provider provides items or services under this Agreement. Provider and Contracted
<br />Providers understand that determinations of Company or Payor that certain items or services are not Covered Services
<br />or have not been provided or billed in accordance with the requirements of this Agreement are administrative
<br />decisions only. Such decisions do not absolve the Contracted Provider of its responsibility to exercise independent
<br />judgment in treatment decisions relating to Covered Persons. Nothing in this Agreement (i) is intended to interfere
<br />with Contracted Provider's relationship with Covered Persons, or (ii) prohibits or restricts a Contracted Provider from
<br />disclosing to any Covered Person any information that the Contracted Provider deems appropriate regarding health
<br />care duality, medical treatment decisions or alternatives.
<br />2.8.1. Withdrawal Management Services: In accordance with RCW 48.43.761 and WAC 284-43-
<br />2000, the Agreement may not specify timeframes for substance abuse disorder treatment less than what is specified
<br />in RCW 48.43.761(12(a)(i), nor specify timeframes for withdrawal management services less than what is specified
<br />in RCW 48.43.761(2)(a)(ii), nor contain language that prevents a seamless transfer to an appropriate level of care.
<br />2.9. Drug Utilization Management Exceptions. Provider drug utilization management exceptions are
<br />available on the Health Plan website: www.coordinatedearehcalth.com.
<br />2.10. Carve -Out Vendors. Provider acknowledges that Company may, during the term of this Agreement,
<br />carve -out certain Covered Services from its general provider contracts, including this Agreement, for one or more
<br />Products as Company deems necessary or appropriate. Provider and Contracted Providers shall cooperate with and,
<br />when medically appropriate, utilize all third party vendors designated by Company for those Covered Services
<br />identified by Company from time to time for a particular Product.
<br />2.11. Disparagement Prohibition. Provider, each Contracted Provider and the officers of Company shall
<br />not disparage the other during the term of this Agreement or in connection with any expiration, termination or non -
<br />renewal of this Agreement. Neither Provider nor Contracted Provider shall interfere with Company's direct or
<br />indirect contractual relationships including, but not limited to, those with Covered Persons or other Participating
<br />Providers. Nothing in this Agreement should be construed as Iimiting the ability of Health Plan, Company, Provider
<br />or a Contracted Provider to inform Covered Persons that this Agreement has been terminated or otherwise expired
<br />or, with respect to Provider, to promote Provider to the general public, or to limit Contracted Providers from
<br />participating in discussions with a patient or someone paying for their coverage regarding the comparative merits of
<br />PPA WA - Kittitas County Public Health - 05.07.2025 - ICMProviderAgreement 360268 Page 6 of 24
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