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5.11 5.12 5.13 5.',|4 Members on evenings and weekends. Provider agrses that it wlll provide for regular monitoring of flmely access and corrective action by Wellpoint if Provider fails to comply with ffre appointment wait time-standard6 as stated in 42 CFR a38.206(c)(1). Provider shall comply with 42 CFR g438.206(c)(1). Provider sflall comply with appointment standards that are no longer than the following: (a) Transltional healthcare servlces by i primary care provider shall be available for clinical assessment and care planning within seven (Z) caleniar days of discharge from inpatient or institutional care for physlcal or behavioral health dlsorders or'discharge from a subslance use disorder treatment program; (b) Transitional healthcare services by a homo care nurco or horne care registered counselor within sevsn (7) calendar days of discharge from inpatient or institutional garefor physlcal or behavioral health dlsorders ordischarge from a substance use disordbrtneatment program, lf ordered by the enrollee'q prlmary care provider or as part of the discharge plan; (c) Non-symptoniaflc (1.e.; prevel_tlve care) oflice visits shall be available from the Medlcald Member's PCP or another pioviOer within thirty (30)calendar days. A non-symptomatic office visit may include, but is not limited to, wellfireventive care such as physical examinations, annual gynecological examinatlons, or chlld and adult immunizbtions; (d) Non- urgent, symptomatic (i.e., routine care) office visits shall be availabte from the Medicaid Member's'pbp or another provider within ten (10) calendar days, A non-urgent, symptomatic offlce visit is associated wlth the presentatlon of medical signs not requirlng immediate aftentlon; (e) Urgent, symptomatic office visits shall be available from the Medicaid Member's PCP or another provider within twenty-four (24) hours. An urgent, symptomatic vlsit is assoclated with the presentation of medical spns that require immediate aftentionl but are not life threatening; and (f) Emergency medical care shall be available twenty-four (24) hours per day, seven (7) days per week, frohibited Practices. Nothing in thls Agreement shall be construed as prohibiting any Participating provider from: 5.1 1.1 Discussing treatment or non-treatment options with Medicaid Members irrespective of Wellpoint's posltion on such treatment or non-treatment options or whether suci treatment options are Medicaid Covered Servlces; 5.11,2 Acting wlthln the lawful scope of such provide/s practice, advising or advocating on behalf of a Medicaid Member for such Medicaid Member's health status, medical care, or treatment or non- lrgalmqnf opfions, including any allernative treatments that might be self-adminlstered by the Medicald Member; 5.11.3 Advocating on behalf of a Medicaid Member within the utilization review or grievance processes established by Welipoint or individual authorization process to obtain Medically'Necessary Medicaid Covered SeMces; or 5"11,4 Dlscouraging Medicaid Members or those paying for their coverage from discussing the comparative merits of different health carriers with their providers. This prohibition specifically inLludes proniniting or limiting providers participating in those dlscussions even if critlcal of a carrler. 9u,ltural C,ompelency Plan. Provjder shall participate wlth the State of Washington's efforts to promote the delivery of servlces in a culturally competent manner to all Medicaid Mernbers, including thosawith llmited Eryli"l proficiency and diverse cultuial ethnic backgrounds. To that end, Provider agreei to comply wlth all Wellpoint 0glicies and procedures deslgned to ensure that culturally competent services, including but not limited to effective, equitable, understandable, and respectful quality care and servlces that are resp6nslve to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs, are provided by Wellpoint both directly and through its health care providers and subcontractors. Authorizations. Provider shall comply wlth Wellpolnt's preauthorization and authorlzation processes and procedures applicable to Provider as more fully set forth ln the provider manual(s). ElgIibiled Referrals. ln accordence with federal and state law, Provider is prohibited from referring any Medicaid Members for designated health services to any entlty in which Provider, or a member of provlder's immedlate family, has a llnanclal relatlonship. Itclsfel9--ailUgnbclg. Without otheruvise limiting Wellpoint's rights pursuant io this Agreement, upon Wellpoint's determinatlon made in good faith and with reasonable belief that a Medicaid Member's health or gafety i9 in jeopardy, Wellpoint may requlre that such Medicald Member be transferred immediately for careto another provlder at Wellpoint's direction, and Provider shall fully cooperate with any such transfer requ.irement. Additionally, Provider shall cooperate in all respects with provlder of other health plans to assure maximum health outcomes with regard to transitioning Medicaid Members. 5.15 Washington Entsrprlse Pbvlder Agrooment Medicaid Attachm€nt @2024 July - Wellpoint Washlmton, lnc, 'l'18393215623 0510512025