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3,4.2 Provider shall make all records, including, but not llmited to, flnancial, admlnlstratlve and medical
<br />records avaihble at Provlder's expsnse, includlng computerlzed data stored by Provider, to any duly
<br />authorized govemment agency, including, but not limited to, HCA, CMS, OlG, MFCU, HHS, DOJ and
<br />the Offlce of the Comptroller of the Treasury, upon any authorlzed government agency's request for
<br />administrative, civil and/or crlmlnal review, audit, evaluation, inspection, investigation' and/or
<br />prosecution . HCA, GMS, OlG, MFCU, HHS, DOJ and the Office of the Comptrollerof the Treasury,
<br />as well as any authorized stat€ or fedenal agency or entity shall have the right to evaluate throujh
<br />inspeclion, evaluation, review or request, whether announced or unannounced, or other means, any
<br />record pertinent to this Attachment, including but not limited to medical records, bllllng records,
<br />financial records, andlor any records related to services rendered, quality, appropriateness and
<br />timeliness of services andlor any records relevant to an adminlstratlve, civil and/or criminal
<br />investigation andlor prosecution, and such evaluation, inspection, revlew or request, when performed
<br />or requested, shall be performed with the lmmedlate cooperation of the Provider. Requested records
<br />shall be providod at no expense to Agency personnel, including representatives from HCA, OlG, the
<br />MFCU, DOJandthe HHS,oranydulyauthorizedstateorfederal agency. Upon request,theProvider
<br />shall assist in such review$, and provide complete copies of medlcal records. Any authorized
<br />govemment agency, includlng but not llmited to, HCA, CMS, OlG, MFCU, HHS, DOJ and the Oflice
<br />of the Comptroller of the Treasury, may use these records to cany out their authorized duties,
<br />roviews, audits, admlnlstrative, civil andior mlmlnal investigations and/or prosocutions. Provlder shall
<br />cooperate fully in any audit, investigation or revlew by Wellpoint, State Agency, MPl, MFCU, or other
<br />state or federal entity and ln any subsequent legal action that may result ftom such an audit,
<br />investlgation or review involvlng this Attachment, including promptly supplying all data and
<br />information requested for such investigalion; provided that nothing ln this section shall be construed
<br />to llmlt a Provider's right to defend ils actions in any legal proceeding ln accordance wlth its rlghts
<br />under the law.
<br />3.4.3 The right for the parties named above to audit, access and inspect undor this sectlon exlsts for ten
<br />(10) years fmm the final date of the Aftachment perlod or from the date of completion of any audit,
<br />whichever is later, or any othor tlmeframe authorized by law
<br />3.4.4 Provider will have the rlght to audit Wellpoint records relating to Medicaid Covered Services rendered
<br />by Provider to Medicaid Members.
<br />3.5 Encounter Datq. lf Provider is paid on a capitated basis, Provider shall timely submit complete and accunate
<br />encounter data for capitated services rendered to Medicald Members, including, without llmitation, statistical
<br />and descriptive medical, diagnostic and patient data for Medicaid Covered Services rendered to Medicaid
<br />Members, to meet the encounter data reporting requiremonts set forth ln the Govemment Contract.
<br />ARTIGLE IV
<br />COMPLIANCE WITH FEDERAL REGU LATORY REQUIREMENTS
<br />4,1 Fedgral Funds. Provider acknowledges that payments Provider receives from Plan to provide Medicaid
<br />Covered Services to Medicaid Members are, in whole or part, from federal funds. Therefore, Provider and any
<br />of his/herlits subcontractors are subject to certain laws that are applicable to indlviduals and entities receiving
<br />federal funds, which may include but are not limited to, Title Vl of the Civil Rights Act of 1964 as implementod
<br />by 45 CFR Part B0; the Age Discrlmination Act of 1975 as implemented by 45 CFR Part 91; the Americans
<br />with Disabllities Act as implemented by 28 CFR Part 35; the Rehabilltation Act of 1973 as implemented by 45
<br />CFR Part 84, lobbying restrictions as lmplemented by 45 CFR Part g3 and 31 USC 1352, Title lX of the
<br />Education Amendments o11972, as amended (20 U,S.C. sections 1681, 1685-1686, and 1783) and any other
<br />regulations appllcable to recipients of federal funds.
<br />4.2 Surety BQnd Requirement. lf Provider provides home health seMces or durable medical equlpment, Provider
<br />shall comply with all applicable provisions of Section 4724(b) of the Balanced Budget Act of 1997, including,
<br />without limitation, any applicabte requirements related to the posting of a surety bond.
<br />4.3 Laboratorv Compliance. lf Provider renders lab services in tho offlce, it must maintain a valid Cllnical
<br />Laboratory Improvement Amendments ("CLlA") certlficate for all laboratory testing sites and comply with CLIA
<br />regulatlons at 42 CFR Part 493 for all laboratory testing sites performing Health Services pursuant to this
<br />Attachment.
<br />ARTIGLE V
<br />COMPLIANCE WITH STATE REGULATORY REQUIREMENTS
<br />Washlngton Enteprlse Provlder Agreem6nl Medlcald Attactynenl
<br />@ 2024 July - Wollpoint Washlngton, lnc.1 1 839321 56
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