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

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availability of review by an IRO; and (e) a Covered Person's right to a hearing, how to obtain a hearing, and representation rules at a hearing. 5.6 Termination, Revocation and Sanctions. In addition to Carrier's termination rights under the Agreement, Carrier shall have the right to revoke any functions or activities Carrier delegates to Provider under the Agreement or impose other sanctions consistent with the State Contract if in HCA's or Carrier's reasonable judgment Provider's performance under the Agreement is inadequate. Carrier shall also have the right to suspend, deny, refuse to renew or terminate Provider in accordance with the terms of the State Contract and applicable law and regulation. The administrative guide located at www.uhcprovider.com describes applicable provider policies and procedures, including specific criteria for termination pursuant to this provision. SECTION 6 OTHER REQUIREMENTS 6.1 Compliance with State Contract. All tasks performed under the Agreement shall be performed in accordance with the requirements of the State Contract, as set forth in this Appendix, applicable provider manuals, and protocols, policies and procedures that Carrier has provided or delivered to Provider. The applicable provisions of the State Contract are incorporated into the Agreement by reference. Nothing in the Agreement relieves Carrier of its responsibility under the State Contract. If any provision of the Agreement is in conflict with provisions of the State Contract as it relates to the State Programs, the terms of the State Contract shall control and the terms of the Agreement in conflict with those of the State Contract will be considered waived. Carrier agrees to comply with the State Contract provisions relating to providing a reasonably accessible on-line location of policies and procedures. For this purpose, the administrative guide and other information is located at www.uhcprovider.com. 6.2 Monitoring. Carrier shall perform ongoing monitoring (announced or unannounced) of services rendered by Provider under the Agreement and shall perform periodic formal reviews of Provider at least every three (3) years and according to any other schedule established by the State, consistent with industry standards or State managed care organization laws and regulations or requirements under the State Contract. As a result of such monitoring activities, Carrier shall identify to Provider any deficiencies or areas for improvement mandated under the State Contract and Provider and Carrier shall take appropriate corrective action. Provider shall comply with any corrective action plan initiated by Carrier and/or required by the State Program. In addition, Provider shall monitor and report the quality of services delivered under the Agreement and initiate a plan of correction where necessary to improve quality of care, in accordance with that level of care which is recognized as acceptable professional practice in the respective community in which Carrier and Provider practice and/or the performance standards established under the State Contract. 6.3 Delegation. The parties agree that, prior to execution of the Agreement, Carrier evaluated Provider's ability to perform any duties delegated to Provider under the Agreement. Any delegated duties and reporting responsibilities shall be reduced to writing and set forth in the Agreement or other written delegation agreement or addendum between the parties. In addition to Carrier's termination rights under the Agreement, Carrier shall have the right to revoke any functions or activities Carrier delegates to Provider under the Agreement or impose other sanctions consistent with the State Contract if in Carrier's reasonable judgment Provider's performance under the Agreement is inadequate. Carrier shall also have the right to suspend, deny, refuse to renew or terminate Provider in accordance with the terms of the State Contract and applicable law and regulation. UHUSTATE PROGRAMS REGAPX. WA. 02.25 42