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government entity or local law enforcement to stand in the place of Facility in the collection <br />against a third party. <br />2& Limitations on Referrals. Facility referrals may be limited to Participating Providers <br />except in the following circumstances: (a) Emergency services; (b) Services provided outside the <br />Service Areas as necessary to provide Medically Necessary services; (c) When a Member has <br />other primary comparable physical and/or behavioral health coverage, as necessary to coordinate <br />benefits; and (d) Within the Service Areas, as defined in the Service Areas provisions of the <br />Enrollment Section of the State Contract, Facility shall cover Members for all physical and/or <br />behavioral health necessary services. <br />29. High Categorical Risk Providers. Providers that are deemed to be "high categorical <br />risk," including prospective (newly enrolling) home health agencies and prospective (newly <br />enrolling) durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) suppliers <br />or such other categories of providers as defined under 42 C.F.R. § 424.518, shall be enrolled in <br />and screened by Medicare, in addition to complying with CHPW's policies and procedures <br />regarding credentialing and recredentialing. Such providers shall revalidate Medicare enrollment <br />every three (3) years in compliance with 42 C.F.R. § 424.515. Notwithstanding the foregoing, <br />Infant In -Home Phototherapy Providers that meet CHPW's certification requirements are not <br />required to be enrolled in Medicare. <br />30. HCA Approval for Assignment. Facility acknowledges and agrees that no assignment of <br />the Agreement shall take effect without the prior written agreement of HCA. <br />31. Quality Improvement System. Facility shall maintain a quality improvement system <br />tailored to the nature and type of Covered Services provided hereunder, which affords quality <br />control for such services, including but not limited to the accessibility of Medically Necessary <br />services, and which provides for a free exchange of information with CHPW to assist CHPW in <br />complying with the requirements of the State Contract. Providers that are PCPs or specialty care <br />providers shall comply with all quality improvement activities of the CHPW. <br />32. Records of Delegated Activities. As applicable to services rendered under the Agreement, <br />Facility shall have a means to keep records necessary to adequately document services provided <br />to Members for any and all delegated activities including quality improvement, utilization <br />management, Member's rights and responsibilities, Health Homes, and credentialing and re- <br />credentialing. <br />33. Payment in Full and Member Charges. Facility agrees to accept payment from CHPW <br />as payment in full. Facility shall not request payment from HCA or any Member for Covered <br />Services provided under the Agreement, and shall comply with WAC 182-502-0160 <br />requirements applicable to providers. Facility shall report to CHPW any instance in which a <br />Member is charged for services. Facility shall repay to a Member any inappropriate charges paid <br />by such Member, or shall reimburse CHPW to the extent CHPW repays such inappropriate <br />charges to the Member. <br />34. HCA and Member Hold Harmless. Facility agrees to hold harmless HCA and its <br />employees, and all Members in the event of non-payment by CHPW. Facility further agrees to <br />indemnify and hold harmless HCA and its employees against (a) all injuries, deaths, losses, <br />2020 Facility Exb BIB - McaidProv Page 36 of 51 Contract #{Contract #)-(PRC Agreement ID} <br />