SHJ25-009 KCJ AND CHPW - PARTIALLY EXECUTED

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EXHIBIT B-1-B MEDICAID REQUIRED PROVISIONS Conummity Health Plan of Washington ("CHPW") has contracted with the Washington State Health Care Authority ("HCA") to arrange for the provision of fully integrated physical and behavioral health care services to Members under the Apple Health Medicaid Program. The Contract between CHPW and HCA (the "State Contract") requires that specific terms and conditions be incorporated into agreements between CHPW and its participating providers and subcontractors. This Exhibit B-1-B ("this Exhibit") is intended to supplement the Agreement by setting forth the parties' rights and responsibilities related to the provision of Covered Services to Members as it pertains to the Apple Health Program. In the event of a conflict between the terms and conditions of the Agreement and the terms and conditions of this Exhibit, this Exhibit shall govern as to the Apple Health Program. Facility agrees and understands that Covered Services shall be provided in accordance with the State Contract(s), Payor requirements, any applicable State handbooks or policy and procedure guides, and all applicable State and federal laws and regulations. To the extent Facility is unclear about Facility's duties and obligations, Facility shall request clarification from CHPW. Definitions. The following definitions apply to this Exhibit B-1-B: Capitalized terms used and not otherwise defined herein shall have the meanings given to them in the Agreement or the State Contract. The definitions listed below will supersede any meanings contained elsewhere in the Agreement with regard to this Exhibit. Apple Health Program: the Medicaid integrated managed care program known as Apple Health. HCA: the State of Washington Health Care Authority and its employees and authorized agents. Medically Necessary: health care services that: (a) are reasonably calculated to prevent, diagnose, correct, cure, alleviate or prevent worsening of conditions in the Member that endanger life, or cause suffering or pain, or result in an illness or infirmity, or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction; and (b) are not more costly than any other equally effective or more conservative course of treatment available or suitable for the Member requesting the service. Such services shall.include services related to the Member's ability to achieve age -appropriate growth and development. Member: an individual enrolled in Apple Health and entitled to receive Covered Services pursuant to that Benefit Plan. Physician's Orders for Life Sustaining Treatment ("POLST"): a set of guidelines and protocols for how emergency medical personnel shall respond when summoned to the site of an injury or illness for the treatment of a person who has signed a written directive or durable power of attorney 2020 Facility Exh B lB - McaidProv Page 30 of 51 Contract #{Contract #1-{PRC Agreement ID)