|
5,28.3
<br />5.28.4
<br />protection agalnst any loss, liabilily or damage resulting from the operation of a motor vohlcle by
<br />Provider, Provider's employees or agents.
<br />Malntaln workers' compensation insurance for Provider's employees. Said insurance shall be
<br />obtained from a carrier authorized to conduct business in the jurisdictlon in which Provlder operates
<br />and shall provide such limits of coverage as required by Regulatory Requirements.
<br />Provide Wellpoint with evldence of Provider's compliance with the foregolng insurance requirements
<br />as reasonably requested by Wellpoint from tims to time during the term of this Agreoment, but ln no
<br />event less than annually, Provider shall provide Wellpoint with at least thirty (30) days prior written
<br />notice of any cancellation or non-renewal of any requlred coverage or any reduction in the amount
<br />of Provlder's coverags, and shall secure replacement coverage meeting the requirements hereunder
<br />so as to ensure no lapse in coverage. Provider shall furnlsh Wellpoint with a certificate of insurance
<br />evidencing such replacement coverage. Provider shall also furnish a certificate of insurance to a
<br />requesting Agency upon request. Provider may maintain coverage hereunder through a self-funded
<br />insurance plan, provided that Provider malntains actuarially sound reeerves related to such self-
<br />funded plan and provldes to Wellpoint on a semi-annual basis an opinion letter from an independent
<br />actuarial firm or other proof reasonably acceptable to Wellpolnt attesting lo the flnancial adequacy of
<br />such reserves.
<br />5.29
<br />5.30
<br />5.31
<br />5.32
<br />Washlnglon Enterpriss Provtder Agreement Dledlcald Atlschment
<br />92024 July - Wsllpolnl Wastington, lnc.
<br />Pischarge Planninq. ln a twenty-four (24) hour settlng, Provider shall provide discharge plannlng servlces that
<br />meet the standard set forth below:
<br />Provider shall coordlnale, as needed with HCA andior Divlsion of Behavioral Health and Recovery (DBHR)
<br />prevention services, vocalional services, housing services and supports, and other community resources and
<br />services that may be appropriate, including, but not limited to Department of Children, Youth, and Families
<br />(DCYF) services for children and families, includlng but not limited to, DCYF-contracled home visiting, Early
<br />Support for lnfants and Toddlers (ESIT), Early Childhood lnterventlon and Prevention Servlces (ECLIPSE),
<br />Early Childhood Educatlon and Asslstance Program (ECEAP) and Head Start programs uslng the information
<br />letter template jointly developed by the DCYF and HCA.
<br />Superviqiqn bv Behavloral Health Provider, As applicable, Provider will receive payment for the supervlsion of
<br />behavioral heatth providers whose llcense or certification restricts them to work under supervislon.
<br />Data Use. Securitv and Gonfldentialily. Provider shall comply wlth all data use, security, and confidentiality
<br />terms and conditions applicable to the provlder, as referenced in the applicable provider manual(s) or as
<br />required by Regulatory Requirements.
<br />Telemedicine. lf Provider is a telemediclne provider, jn accordance with Regulatory Requirements:
<br />5.e2.1 Provlder must obtain the Medlcald Member's consent for billing in advance of the service being
<br />delivered, if Provider intends to bill the Medlcaid Member or Plan for audio-only telemedicine
<br />services, and;
<br />5.32,2 As of January 1,2023, for audio-only telemedicine services, Provider must have an established
<br />relatlonship with the Medicaid Member, as defined by Washington law
<br />As deflned ln RGW 48.43.735(9Xd), "Established relationship" m6ans the provider providing audio-
<br />only telemedicine has access to suflicient health records to ensure safe, effective, and appropriate
<br />care servlces and: (i) The covored person has had, within the pastthree years, at least one in-person
<br />appointment, or at least one rea[-time lnteractive appointment using both audio and video technology,
<br />with the providor providing audio-only telemedicine or with a provider employed at the same medical
<br />group, at the same clinic, or by the same lntegrated delivery system operated by a carrler licensed
<br />under chapter 48.44 or 48.46 RCW as the provider providing audio-only telemedicine; or (ii) The
<br />covered person was referred to tho provider provldlng audio-only telemedicine by another provider
<br />who has had, within the past three years, at least one ln-person appointment, or at least one real-
<br />time interactive appolntment using both audio and video technology, with the covered person and
<br />has provided relevant medical lnformatlon to the provider providing audio-only telemedicine.
<br />5.32.3 Wellpoint will reimburse Provider for a Medlcatd Covered Service provided to a Medicaid Member
<br />through telemedicine or store and forward technology lf:
<br />1 1839321 56
<br />06105lm26
<br />26
|