SHJ25-009 KCJ AND CHPW - PARTIALLY EXECUTED

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51.3.3 Any lending of money or other extension of credit between Facility and such a party. 52. Information on Persons Convicted of Crimes. Facility shall investigate and disclose to CHPW, at Agreement execution or renewal, and upon request by CHPW 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: 52.1 A person who has an ownership or control interest in Facility; 52.2 An agent or person who has been delegated the authority to obligate or act on behalf of Facility; and 52.3 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, Facility. 53. Maternity Newborn Length of Stay; Sterilization 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 under the Agreement shall be in compliance with 42 C.F.R. § 441 Subpart F, and Facility shall use a Consent for Sterilization form (HHS-687) or its equivalent in connection therewith. A hysterectomy requires the Hysterectomy Consent and Patient Information form (HCA 13-365). 54. Grievance and Appeals. CHPW shall maintain a grievance and appeals system in accordance with the requirements of the State Contract, and CHPW shall provide the following information regarding CHPW's grievance and appeal system to Facility: 54.1 The toll -free numbers to file oral grievances and appeals; 54.2 The availability of assistance in filing a grievance or appeal, including informing the Member about ombuds services and how to access those services; 54.3 The Member's right to request continuation of Medicaid benefits during an appeal or hearing and, if the CHPW's Adverse Benefit Determination is upheld, that the Member may be responsible to pay for the continued benefits; 54.4 The Member's right to file grievances and appeals and their requirements and timeframes for filing; 54.5 The Member's right to a hearing, how to obtain a hearing and representation rules at a hearing; and 54.6 Facility may file a grievance or request an adjudicative proceeding on behalf of a Member in accordance with the State Contract. 2020 Facility Exh BIB - McaidProv Page 41 of 51 Contract #{Contract #1-(PRC Agreement ID)