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5.32.4 <br />5.32.5 <br />(a) The Health Servlce is a Medlcaid Covered Service when provided ln person by Provider; <br />(b) The Medlcaid Covered Service ls Medically Necessary; <br />(c) The Medicald Covered Servico is a service recognized as an essential health benefit <br />under section 1302(b) of the federal Patient Protection and Affordable Care Act in effect <br />on January 1,2015, RCW 48,43.005 and 48.43,71b; <br />(d) Ths Medicald Covered Service is determined to be safelyand effectivoly provided through <br />telemedicine or store and forward technology according to generally accepted health care <br />practices and standards, and the technology used to provide tho Medicald Covered <br />Service meels_ the standards reguired by state and federal laws governing the privacy <br />and security of protected health informatlon; and <br />ln accordance with subsection 5.32,3 abovo, Wellpoint will reimburse Provider for a Medlcaid <br />Covered Service provided to a Medicald Member through telemediclne as provided by Washington <br />law, the same amount of compensation Wellpoint would pay Provider under this Agreement, f the <br />Medicaid Covered Service was provlded in person by Provider. <br />An originating site for a telemedicine Health Servlce subject to subsection 5.32.3 above includes a: <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />(f) <br />(g) <br />Hospital; <br />RuralHealth Gllnic; <br />Federally Qualifled Health Center; <br />Physlcian's or other pncvider's offlce; <br />Llcensed or Certifled Behavioral Health Agency; <br />Skllled Nursing Facility; <br />6,1 <br />6.2 <br />Washlngton Enlerprise Prcvlder Agreement Medlcald Ailachmenl <br />@2024 July- Wollpolnt Washlnglan, lnc, <br />6.3 <br />Home or any location determlned by the individual receiving the service including, but not <br />limited to, a pharmacy licensed under chapter 18.64 RCW or a school-based health <br />center a$ deflned ln RCW 43.70,825.lf the slte chosen by the indlvldual receiving service <br />is in a state other than the state of washington, a providefs ability to conduct a <br />telemedlcine encounter ln that state is determlned by the licensure status of the provider <br />and the provider licensure laws of the other state; or <br />(h) Renal dialysis center, except an independent renal dialysls center. <br />5.32.6 Provider shall ensure that access to telemedicine Health Servicos is lnclusive for Medicaid Members <br />who may have disabilities or limited English proficiency and for whom the use of telemedicine <br />technology may be more challenging, in accordance with Regulatory Requiroments. <br />ARTICLE VI <br />TERMINATION <br />Tqlmination of Medicald Participation Attachtnent. Either party may terminate this Attachment without cause <br />by giving at least one hundred eighty (180) days prior wriften notice of termination to the other party, <br />fermination oi Oov . lf a Government Contract between the applicable State Agency and <br />Wellpoint termlnates, expires or ends for any reason or is modifled to ellmlnate a Medicaid erogram, ttris <br />Aftachment shall have no further force or effect with respect to the applicable Medicaid Program. ln the event <br />of termlnation of the Government Contract between Wellpolnt and State Agency, Provider shall immediately <br />make avallable to State Agency, or its designated representalive, ln a usable form, any or all records, whether <br />medical or financial, related to Provider's actlvities undertaken pursuant to this Agreement. The provision of <br />such records shall be at no expense to Wellpoint or State Agency. <br />Eftestsflqnilg!9!. Following tenninatlon of this Attachment, the romainder of the Agreement shall continue <br />in full force and effoct, if applicable, In addition, upon termination of fris Attachment but subJect to the <br />1 183932156 <br />06106t202s <br />27