SHJ25-011 UNITED HEALTHCARE & KCJ Carceral 2025 Medicaid Contract - PARTIALLY EXECUTED

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thereafter for changes, amendments, supplements and replacements. You must be given reasonable notice of not less than sixty days of changes that affect your compensation and that affect health care service delivery unless changes to federal or state law or regulations make such advance notice impossible, in which case notice shall be provided as soon as possible. Subject to any termination and continuity of care provisions of the agreement between you and us, you may terminate that agreement without penalty if you do not agree with the changes. No change to that agreement may be made retroactive without your express written consent. H. Participating Entities. Participating entities as defined in paragraph 2 of Appendix 2 of the agreement have access to our agreement. L Prescription Drug Exception Process. Our process to request exceptions to our drug utilization management process can be found at.www.UHCProv i der. com. J. Customer Consent for Telemedicine. Patient consent is required for telemedicine services prior to rendering such services. Failure to obtain consent could result in disciplinary action pursuant to RCW 48.43.735. in addition, audio only telemedicine services may only be billed when provided to established patients. "Established relationship" means the provider providing audio -only telemedicine has access to sufficient health records to ensure safe, effective, and appropriate care services and: (i) The covered person has had, within the past three years, at least one in -person appointment, or at least one real-time interactive appointment using both audio and video technology, with the provider providing audio -only tclemedicine or with a provider employed at the same medical group, at the same clinic, or by the same integrated delivery system operated by a carrier licensed under chapter 48.44 or 48.46 RCW as the provider providing audio -only telemedicine; or (ii) The covered person was referred to the provider providing audio -only telemedicine by another provider who has had, within the past three years, at least one in -person appointment, or at least one real-time interactive appointment using both audio and video technology, with the covered person and has provided relevant medical information to the provider providing audio -only telemedicine. 3. The following provision replaces, in its entirety, paragraph 8 of section "What you will do" of the agreement: Denial of Claims for Not Following Protocols, Not Filing Timely, or Lack of Medical Necessity. You will not charge our customers anything for the services you provide, if those services are covered services under their benefit contract, but the applicable co -pay, coinsurance, payments for non -Covered Services or deductible amount. If the services you provide are denied or otherwise not paid, or an administrative sanction is imposed, due to your failure to notify us, to fie a timely claim, to submit a complete claim, to respond to our request for information, or based on our reimbursement policies and methodologies, you may not charge our customer. If the services you provide are denied for reason of not being medically necessary, you may not charge our customer unless our customer has, with knowledge of our determination of a lack of medical necessity, agreed in writing to be responsible for payment of those charges. If the services you provide are not covered under our customer's benefit contract, you may, of course, bill our customer directly. You will not require a customer to pay a "membership fee" or other fee in order to access you for covered services (except for co -payments, coinsurance and/or UHC/5MGA.REGAPY 09.24. WA -21-