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5.16
<br />5.17
<br />5.18
<br />5.19
<br />5.20
<br />5.22
<br />5.23
<br />5.24
<br />5.21
<br />Mo.nitorlnq. Provlder agrees to Wellpoint monitoring Provider's performance on an ongoing basis and subject
<br />to formal review, whlch review shall be accordance with a periodic schedule establlshed by HCA consisient
<br />with industry standards and Regulatory Requirements. Formal review must be completed no less than once
<br />every three years and must identiff deficiencies or areas for improvement and provide for corrective action ln
<br />accordance with 42 CFR 438.230(b),
<br />ProYider to Monitpr Qualltv. Provider shall maintain a quality assurance system to monitor the quality of
<br />servlces delivered under this Attachment and initlate corrective action where necessary to lmprove quality of
<br />care, ln accordance wlth that level of care which is rec-ognized as acceptable professional practice in the
<br />respective community in which the Provider practices and/or the standards ostablished by the Medicaid
<br />Program or its designee.
<br />Medlcaid Member Riohts. Notwlthstanding anything to the contrary in this Agreement, Provlder agrees to
<br />observe, protect and promote all rights of Medicaid Members as patients in accordance with all applicablo
<br />laws, Govemment Contract and Agency requirements. Provider shall provide any information that a Medicaid
<br />Member needs in order to decide among all relevant treatment options.
<br />Proofam lntegdiv Requirements. Provider shall comply with Wellpoint's HCA approved program integrlty
<br />policies and procedures and tho program integrlty requirements of the Government Contract, including but not
<br />limited to compliance with section 1902(a[68) of the Social Security Act,42 C.F.R. S 438.610, 42 C.F.R, 5455,
<br />42 C.F.R. $1000 through 1008 and Chapter 182-502A WAC. lf Provider is defined as a subcontractor under
<br />the Govemment Contract, Provider shall veriflr that servlces bllled by Provider were aclually provided to
<br />Medicaid Members and shall conduct ongoing analysis of utillzation, claims, billing and/or encounter data to
<br />detect overpayments and lncluding audits and investlgations of Provider's subcontractors and downstream
<br />entities.
<br />Enrollee SglJ Determinatio_[, Provider shall obtain informed consent prior to treatment from Medicaid
<br />Members, or persons authorized to consent on behalf of a Medicaid Member, and shall comply with the
<br />provisions of the Natural Death Act (RCW 70,122) and state and federal Medicaid rules concerning advance
<br />dlrectlves, and, when appropriate, inform Medicaid Members of lheir right to rnake anatomical gifts.
<br />Enrollee Self-Referral, Provider understands and agrees that Medicald Members have the right to self-refer
<br />for certain ssrvlces to partlclpating or non-partlcipating local health departments and particlpating or non-
<br />participating family planning clinics paid through separate arrangements with the State of Washlngton, The
<br />sorvlces to which a Medicaid Member may self refer include: (i) including family planning seruices and
<br />sexually-lransmitted disease screening and treatment servlces provided at participating or nonparticipating
<br />providers, including but not llmited to family ptanning agencies, such as Planned Parenthood; (ii)
<br />immunizalions, sexuallytransmitted diseass screening and follow-up, immunodeficiency virus (HlV)
<br />screening, tuberculosis screenlng and follow-up, and family planning services through and if provided by a
<br />local health department; (iii) immunizations, sexually transmitted disease $creening, family planning and
<br />menlal health seMces through and if provided by a school-based health center; and (iv) all services received
<br />by Amerlcan lndian or Alaska Native enrollees under the Special Provisions for American lndians and Alaska
<br />Natives subsection as set forth in the Government Contract.
<br />Sqlv. q-ncy Requiremqnts. If Provider is at financial risk, as defined in the Government Contract, Wellpoint shall
<br />establlsh, enforce and monitor solvency requirements that provide assurance of Provider's ability to meet its
<br />obligations. Furthermore, Provider acknowledges that Wellpoint shall annually conduct surveys of Medicaid
<br />Members' satisfaction with Provider in accordance wlth Government Contract requirements, which surveys
<br />shall to be provided to HCA or Medicaid Members upon request.
<br />Subrogation. ProMder acknowledges and agrees that it shall subrogate to the State of Washington for all
<br />crlminal, clvll and administrativo action recoveries undertaken by any government entity, including, but not
<br />limited to, all claims Wellpoint or Provider have or may have agalnst any entity that directly or indlrectly
<br />recelves funds under the Government Contract including, but not limited to, any health care provldei,
<br />manufacturer, wholesale or retail ouppller, salo.s representative, laboratory, or olher provider in the design,
<br />manufacture, marketing, pricing, or quality of drugs, pharmaceuticals, medical supplles, modlcal devlces,
<br />durable medlcal equlpment, or other health care related products or services.
<br />Assionmont. Notwithstanding Section 9.2 of the Agreement, this Agreement may not be assigned by either
<br />pa(y without the consent of HCA.
<br />Washlngton Enterprlss Provld€a Agreemenl. Med:cald Attachment
<br />@2024 July - W€llpdnt Washlngton, lnc.1 183932156
<br />05/05/2025
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