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2025-06-17 10:00 AM - Commissioners' Agenda
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Last modified
6/30/2025 2:49:56 PM
Creation date
6/30/2025 2:49:37 PM
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Meeting
Date
6/17/2025
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Fully Executed Version
Supplemental fields
Item
Request to Approve Agreement SHJ25-007 WELLPOINT - 1115 Medicaid Re-Entry Initiative
Order
14
Placement
Consent Agenda
Row ID
132242
Type
Contract
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6,4 <br />7.1 <br />7.2 <br />7.3 <br />7.4 <br />Continuation of Care provision(s) and applicable Regulatory Requirements, any references to servlcos, <br />reimbursement, or participatlon ln Networks related to the Medlcaid Program are hereby terminated in full and <br />shall have no furtherforce and effect. <br />Qontlnuation of Care, ln addition to the Continuation of Care Upon Termination provlslon of the Agreement, in <br />the evoni of lhe termination of this Attachment for any reason oxcept termlnatlon of this Attachment for cause <br />by Wellpoint any Medicaid Member who is suffering from and receivlng active health care services or who ls <br />an inpatient shall have the right to continue to receive health care services from Provider for a period of up to <br />sixty (60) days from the date of the terminatlon of this Attachment or until the Medicaid Member's discharge <br />from inpatient facilities up to ninety (90) days, whichever time is greater. Any Medicaid Member who-is <br />pregnant and receiving treatment in connectlon with that pregnancy at the tlmo of termlnation of this <br />Agreement may continue to receive health caro services from Provider for tlre remalnder of her pregnancy <br />and six (6) weeks post-partum. <br />6.4.1 During the continuity of care provlsion described in this section above, Provider shall continue to <br />provide services in accordance with the terms of this Atlachment applicablo lmmediately prior to the <br />terminatlon of this Attachment, and Wellpoint shall continue to meet all of the obligations of this <br />Attachment. Provider will maintaln and share, as approprlate, records for Medicaid Members ln <br />accordance wlth professional standards. Provider shall comply with 42 CFR S438,20S(bX5). <br />6.4.2 A Medicaid Member shall not have the right to contlnuation of care if the termination of this <br />Attachment ls for loss of Provider license, or if the terminalion of this Agreement ls due to reasons <br />related to quality of health care services rendered, health, safety or welfare of Medicaid Members. <br />ARTICLE VII <br />GENERAL PROVISIONS <br />lnconslstencies. ln the event of an inconsistency between terms and conditions of this Attachment and the <br />lerms and conditions as set forth in the Agreement, the terms and conditlons of this Attachment shall govern. <br />Except as set othenruise forth herein, all other terms and condltions of the {greement rsmain in full foice and <br />effect, Notwithstanding the Entire Agreement provision of the Agreemenl, the parties acknowledge and agree <br />that the provider manual is nol lncorporated by reference into thls Attachment as it relates Provider's <br />partlcipation in Wellpoint's Medicaid Network and it not deemed part of the entire Attachment. ln the event of <br />a) a conflict between the provisions of this Attachment and the Agreement, or b) any inconsistency or <br />gmbigtllty lnlhis Aftachment, such conflict, inconsistency or amblguity shall be resolved by giving precedence <br />in the following order: l) state or federal law, rule, regulation or ordinance (Regulatory Requirement); ii) this <br />Aftachment; and iii) the Agreement. <br />Disclosure Requirements. ln accordance with Regulatory Requirements, and Stato Agency requlrements, if <br />applicable, Provider agrees to disclose to Wellpolnt complete ownership, control and relatlonship information <br />fDisclosures") in accordance wlth 42 CFR 455.100 thror.rgh 455.106. Provider shall prwide required <br />Disclosuresto Wellpoint at the time of initial contrect, upon conlract renewal, and/orupon request by Wellpoint. <br />Providerfurther agrees to notifi7 Wellpoint within fourteen (14) days of any changes to the Disclosures. Fbiture <br />to provide Disclosures as requlred under Regulatory Requlrements shall be deemed a material breach of this <br />Altachment and the Agreement. <br />Survival of Attachment Provider fufther agrees that: (1 ) lhe hold harmless and continuation of care sections <br />shall survive the termination of thls Attachment or disenrollment of the Medicaid Member; and (2) these <br />provisions eupersede any oral or written contrary agreement now existing or hereafter entered into between <br />Provider and a Medicaid Member or persons acting on their behalf that relates to llability for payment for, or <br />continuation of, Medicaid Covered Services provided under the terms and conditions of lhese provisions, <br />Provider Education <br />7.4.1 Provider shall participate in training when requested by HCA, Provider's requests for HCA to allow <br />an exception to participation ln required tralning must be in writing and include a plan for how the <br />required lnformation wlll be provided to Provider's targeted staff, <br />7,4,2 lf Provider has community behavioral health employees who work directly with Medicaid Members, <br />Provlder shall provide such employees with annual training on safety and violence preventlon topics <br />described in RCW 49,19.030. <br />Woshington Enterprise Providsr Agreomenl. Medlcaid Altachmenl <br />@2024 July - Wellpolot Washlnglon, Inc.1 1 83932156 <br />05105!2023 <br />28
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