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2.2 2.3 2-4 Washlngton Enlerprlse Provld€r Agreemont Medlcsid Altachment I2024 July - Wellpoint Wasnngton, lnc. Provldgj's Duties and Ohliqations to Medicaid Members. All of Provlder's duties and obligations to Members set forth tn the Agreement shall also apply to Medicaid Members unless otherwiso specifically set forth in this Aftachment. Provider shall not discriminate in the acceptance of Medicaid Members for treatment, and shall provide to Medicaid Members the same access to seMces, including but not llmited to, hours of operation, as Provlder gives to all other pationts. Provider shall furnish Wellpoint with at least ninety (90) days prior written notice if Provider plans to close its practice to now patients orc€ases to conlinue in Provider's current practice. 2,2,1 To the extent mandated by Regulatory Requirements, Provider shall ensure that Medicaid Members have access to twenty-four (24) hour-per-day, seven (7) day-por-week urgent and Emergency Serviceg, as defined in the PCS. 2,2,2 Unless othena/se required under Regulatory Requirernents, a PCP, as deflned in the PCS, shall provlde Medicaid Covered Servlces or make arrangements for the provlsion of Medicaid Covered Services to Medicaid Members on a twenty-four (24) hour-per-day, seven (7) day-per^week basis to a$$ure avallabillty, adequacy, and contlnuity of care to Medicaid Members. lf Provider is unable to provide Medicaid Covered Servicos, Provider shall arrange for another Participating Provlder to cover Provlder's patlents in accordance with Wellpoint's Pollcies. Provlder and any PCPs employed by or under contract with Providor may arange for Medlcaid Covered Services to Medicald Members lo be performed by a Specialist Physician only in accordance wlth Wellpoint's Pollcies. 2.2.3 lf Provider is furnishing Specialist Physician sorvices under thls Attachmont, Provider and the Speclalist Physician(s) emptoyed by or under contract wilh Provider, shall accept as patients all Medicaid Members and may arrange for Medlcald Covered Services to Medicaid Members to be performed by Specialist Physician only in accordance with Wellpoint's Policles. 2.2,4 lf Provider is a mental health care practltioner and providers Health Services to a Medicaid Member during an appeal or adverse certification proc€ss, the Provlder must provide to the Medicaid Member written notification thatthe Medicaid Mernberls responsible forthe paymentofthese Health Services, unless the health carrier elects to pay for tho Health Services provided. Provider Responsibility, Wellpoint shall not be liable for, nor will it exercise control or direction over, the manner or method by which Provider provides Health Services to Medlcaid Members. Provider shall be solely responsible for all medical advice and services provlded by Provider to Medlcald Members. Provlder acknowledges and agrees that Wellpoint may deny payment for services rendered to a Medicald Member which it determlnes are not Medically Necessary, are not Medicaid Covered Services under the applicable Medlcaid Program(s), or are not otheruvise provided or bllled in accordance with the Agreement and/or this Attachment, A denlal of payment or any action taken by Wellpoint pursuant to a utilization review, referral, discharge planning program or claims adjudication shall not be construed as a walver of Provider's obligation to provide appropriate Health Servlces to a Medicaid Member under applicable Regulatory Requirements and any code of professional responsibillty. Provider may discuss treatment or non-treatment options with Medicaid Member irrospective of whether such treatment options are Medicaid Covered Services. However, thls provision does not require Provider to provide Health Services lf Provider objects to such service on moral or religious grounds. 2.3.1 No health carrier subject to the jurlsdiction of the state of Washington may ln any way preclude or discourage thelr providers from lnformlng patients of the care they requlre, including various treatment options, and whether in their vlew such care is consistent with Medical Necesslty, medical approprlateness, or otherwise covered by the patient's service agreement with the health carrier, No health carrier may prohibit, discourage, or penalize a provider otherwise practicing in compliance with the law from advocating on behalf of a patient with a health carrier. Nothing in thls section shall be construed to authorlze Provider to bind health carriers to pay for any service. 2.3.2 No health carrier may preclude or discourage Members or those paying for their coverage from discussing the comparatlve merits of different health carriers with their providers. This prohibition specifically includes prohibiting or limlting providers participating in thoso dlscussions even If critical of a carrier. Beportinq Fraud..and Abusq. Provider shall cooperate with Wellpoint's anti-fraud compliance program. lf Provider identifles any actual or suspected fraud, abuse or misconduct in connection with the seryices rendered hereunder in violation of Regulatory Requirements, Provider shall promptly report such activity directly to the cornpliance officer of Wellpoint or through the compliance hotline in accortance with the provider manual(s). ln addition, Provider is not limlted in any respect in reportlng other actual or suspected fraud, 18 1 1 83932156 05i05/2025