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

Home Browse Search

services related to a Covered Person's ability to achieve age -appropriate growth and development. 3.2 Medicaid Eligibility. Provider must be enrolled with the State as a Medicaid or CHIP provider, as applicable to participate in Carrier's Medicaid or CHIP network. Upon notification from the State that Provider's enrollment has been denied or terminated, Carrier must terminate Provider immediately and will notify affected Covered Persons that Provider is no longer participating in the network. Carrier will exclude from its network any provider who is on the State's exclusion list or has been terminated or suspended from the Medicare, Medicaid or CHIP program in any state. 3.3 Primary Care Provider (PCP) Requirements. Providers who are PCPs shall comply with the PCP requirements of the State Contract, as set forth in the applicable provider manuals, protocols, policies and procedures that Carrier has provided or delivered to Provider. 3.4 Accessibility Standards. Provider shall provide for timely access for Covered Person appointments in accordance with the appointment availability and wait time standard requirements established under the State Contract, as further described in the applicable provider manual. Provider also agrees to report accurately the information required for the Carrier's provider directory and any changes thereto. Carrier shall regularly monitor Provider's compliance with timely access and wait time standards and Provider shall implement appropriate corrective action in the event Provider fails to comply with the appointment wait time requirements under the State Contract. 3.5 Hours of Operation. Provider shall offer hours of operation that are no less than the hours of operation offered to commercial beneficiaries or comparable to Medicaid fee -for -service if Provider serves only Medicaid beneficiaries. As applicable, Provider will make Covered Services available 24 hours a day, 7 days a week when medically necessary. 3.6 Hold Harmless. Except for any applicable cost -sharing requirements under the State Contract, Provider shall accept payment from Carrier as payment in full and shall not request payment from the HCA or any Covered Person for Covered Services provided pursuant to the Agreement and the State Contract. Provider shall hold the State, HCA and its employees, the U.S. Department of Health and Human Services (DHHS) and Covered Persons harmless in the event that Carrier cannot or will not pay for such Covered Services. In accordance with 42 CPR Section 447.15, as may be amended from time to time, the Covered Person is not liable to Provider for any services for which Carrier is liable and as specified under the State's relevant health insurance or managed care statutes, rules or administrative agency guidance. Provider shall not require any copayment or cost sharing for Covered Services provided under the Agreement unless expressly permitted under the State Contract. Provider shall also be prohibited from charging Covered Persons for missed appointments if such practice is prohibited under the State Contract or applicable law. Neither the State, the HCA nor Covered Persons shall be in ally manner liable for the debts and obligations of Carrier and under no circumstances shall Carrier, or any providers used to deliver services covered under the terms of the State Contract, charge Covered Persons for Covered Services. Pursuant to Washington Administrative Code (WAC) 182-502-0160, if the medical assistance services are not Covered Services, prior to providing the services, Provider shall inform the Covered Person of the non -covered service and have the Covered Person acknowledge the information. If the Covered Person still requests the service, Provider shall obtain such acknowledgment in writing prior to rendering the service and report to Carrier any instances where a Covered Person is charged for the types of services identified under WAC 182-502- UHUSTATE PROGRAMS REGAPX WA.02.25 30