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

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process for their complaints, grievances, appeals, fair hearings or requests for external review of adverse decisions made by Cagier or Provider. Provider shall adhere to the quality assurance and utilization review standards of the State Programs and shall monitor quality and initiate corrective action to improve quality consistent with the generally accepted level of care. 3.30 Continuity of Care. Provider shall cooperate with Carrier to provide newly enrolled Covered Persons with continuity of treatment, including coordination of care to the extent required under law or required to ensure that ongoing care is not disrupted or interrupted. Provider shall also coordinate with Carrier to ensure continuity of treatment in the event Provider's participation with Carrier terminates during the course of a Covered Person's treatment by Provider. 3.31 Informed Consent; Information for Covered Persons. To the extent applicable to Provider in performance of the Agreement, Provider shall obtain informed consent prior to treatment, or from persons authorized to consent on behalf of a Covered Person as described in RCW 7.70.065. Providers that are hospitals, nursing facilities, home health agencies, hospices, or organizations responsible for providing personal care, as well as PCPs that contract with any of the above entities, shall comply with federal and State law (WAC 182-501-0125 and 42 CFR 438.6(m)) and Carrier's policies regarding advance directives for adult Covered Persons. Provider shall also comply with the provisions of the Natural Death Act (RCW 70.122), and when appropriate, inform Covered Persons of their right to make anatomical gifts (RCW 68.50.540). 3.32 Special Health Care Needs. As applicable, Provider shall identify Covered Persons with special health care needs in the course of contact, or a Covered Person initiated health care visit, and report such identification to Carrier. 3.33 Termination. In the event of termination of the Agreement, Provider shall promptly supply to Carrier all information necessary for the reimbursement of any outstanding Medicaid claims. 3.34 Health Information Systems. Provider shall maintain a health information system that complies with the requirements of 42 CFR 438.242 and provides the information necessary to meet Provider's obligations under the Agreement and this Appendix. 3.35 Clinical Laboratory Improvements Act (CLIA) certification or waiver. As applicable, if Provider performs any laboratory tests on human specimens for the purpose of diagnosis and/or treatment, Provider agrees to acquire and maintain the appropriate CLIA certification or waiver for the type of laboratory testing performed. Provider further agrees to provide a copy of the certification if requested by Carrier. A State authorized license or permit that meets the CLIA requirements may be substituted for the CLIA certificate pursuant to State law. Medicare and Medicaid programs require the applicable CLIA certification or waiver for the type of services performed as a condition of payment. Provider must include the appropriate CLIA certificate or waiver number on claims submitted for payment for laboratory services. 3.36 Encounter Data. Provider agrees to cooperate with Carrier to comply with Carrier's obligation to prepare timely encounter data submissions, reports, and clinical information including, without limitation, child and adolescent health check-up reporting, EPSDT encounters, and cancer screening encounters, as applicable, and such other reporting regarding Covered Services as may be required under the State Contract. Encounter data must be accurate and include all services furnished to a Covered Person, including capitated provider's data and rendering provider information. Encounter data must be provided within the timeframes specified and in a form that meets Carrier and State requirements. By submitting encounter data to Carrier, Provider represents to Carrier that the data is accurate, and upon Carrier's request Provider shall certify in UHCSTATE PROGRAMS REGAPX WA.02.25 38