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requesting that he or she not receive futile emergency medical treatment, in accordance with RCW
<br />43.70.480.
<br />Primary Care Provider or PCP: a Participating Provider who has the responsibility for supervising,
<br />coordinating, and providing primary health care to Members, initiating referrals for specialist care,
<br />and maintaining the continuity of Member care. PCPs include, but are not limited to pediatricians,
<br />family practitioners, general practitioners, internists, naturopathic physicians, medical residents
<br />(under the supervision of a teaching physician), physician assistants (under the supervision of a
<br />physician), or advanced registered nurse practitioners (nurse practitioners), as designated by
<br />CHPW. The definition of PCP is inclusive of primary care physician as it is used in 42 C.F.R. §
<br />438. All Federal requirements applicable to primary care physicians will also be applicable to
<br />PCPs as the term is used in this Exhibit.
<br />State: the state of Washington
<br />State Contract(s): the applicable contract(s) between HCA and CHPW under which CHPW agrees
<br />to provide or arrange for services related to the Apple Health Program, including any exhibits,
<br />attachments, documents, or materials incorporated by reference.
<br />Facility Agreement Requirements. The parties agree to the following terms and conditions:
<br />1. CHPW Remains Legally Responsible. Nothing herein shall be construed to delegate
<br />legal responsibility to HCA for any work performed under the Agreement, nor for oversight of
<br />any functions and/or responsibilities delegated to Facility.
<br />2. Compliance with Applicable Law. Facility shall comply with all Applicable Law. For
<br />purposes of this Exhibit, Applicable Law shall specifically include those laws and regulations as
<br />set forth in the State Contract, including but not limited to the Health Insurance Portability and
<br />Accountability Act of 1996 ("HIPAA"), the Mental Health Parity and Addiction Equity Act
<br />("MHPAEA") and final rule, state laws and regulations regarding mental and behavioral health
<br />and substance use disorder services, the Federal Drug and Alcohol Confidentiality Laws in 42
<br />C.F.R. Part 2, 42 U.S.C. §§ 1396a(a)(43) (early and periodic screening, diagnostic, and treatment
<br />services ("EPSDT")), 1396d(r) (definition of EPSDT), and 42 C.F.R. § 438.3(1) (choice of
<br />network provider).
<br />3. Compliance with State Contract. Facility shall comply with any term or condition of the
<br />State Contract that is applicable to the services to be performed under the Agreement, including
<br />but not limited to the Performance Improvement Project requirements of the State Contract and
<br />the prohibition on direct and/or indirect door-to-door, telephonic, or other cold -call marketing.
<br />4. Policies and Procedures. Facility shall comply with CHPW's policies and procedures,
<br />including, but not limited to, credentialing and recredentialing, utilization management, fraud
<br />and abuse, authorization of services, quality improvement activities and provider payment
<br />suspensions. Facility shall comply with the Program Integrity requirements of the State
<br />Contract, as well as CHPW's program integrity policies and procedures. Without limiting the
<br />generality of the foregoing, Facility shall comply with the Program Integrity requirements in
<br />Section 1902(a)(68) of the Social Security Act, 42 C.F.R. § 438.610, 42 C.F.R. § 455, 42 C.F.R.
<br />§ 1000 through 1008, and Chapter 182-502A WAC. Further, Facility shall be subject to ongoing
<br />analysis of utilization, claims, billing and/or encounter data to detect overpayment, which
<br />2020 Facility Exh BIB - McaidProv Page 31 of 51 Contract #{Contract #}-{PRC Agreement ID}
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