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icientifioation of such safety issue. @xamples of safety issues are set forth in the Health Plan Policies and <br />Procedures.) <br />6.5.6 Provider or the applicable Contracted Provider shall notiff Health Plan of any <br />change in Provider's or Contracted Provider's key personnel, within 24 hows of suoh change. <br />6.6 Minimum Data Set. If Conhacted Provider is a nursing facility, Provider or such Contracted <br />Provider shall submit to llealth Plan or its designee the Minimum Data Set as defined by CMS and required under <br />federal law and Health Plan policy as it relates to all Covered Persons who are residents in Contracted Provider's <br />facility. Such submission shall be via electronio mail, facsimile transmissioq or olher mannel and format reasonably <br />requested by Health Plan. <br />.6.7 Quality Improveqlent Plan. Each Contracted Provider shall participate in Health Plan's <br />LTSS qriality improvement plan Each Contracted Provider shall permit Health Plan to ascess such Contracted <br />Providers' assessment and quality data upon reasonable advance notice, which may be givenby elechonic mail. <br />6.8 Electronic Visit Verification If Contrasted Provider provides in-home services, Contraoted <br />ProvidEr shall comply with 21't Century Cures Act and Health Plan's electronic visit verifi.oation system requirements <br />where applicable and accessible. <br />6,9 Criminal Backeround Checks. Provider shall conduct a criminal background check on each <br />Contracted Provider prior to the commencement of services under this Agreement and as requested by Health Plan <br />thsreafter. Provider shall provicle the results of such baokground shecks to Health Plan and member, if self-directed, <br />upon request. Provider agrees to immediately notify Health Plan of any oriminal convictions of any Contracted or <br />zub-oontracted Provider. Provider shall pay any costs associated with such criminal background checks. <br />7. Person-Centered Planning. Care/Servigp Plan" and Services (."PCSP"). Provider shall comply with <br />all state and federal regulatory requAements related to person-centered planning, cardservice plans, and services <br />including, but not limited 1;o: <br />7.1 Covered Persons shall lead the person-centered planning prooess and can elect to include, <br />and/or consult with, any of their LTSS providers in the care/service plan development prccess. <br />7.2 The carelservice plan must be finalaed and agreed to, with the informed consent of the <br />individual in writing and signed by all individuals and providers responsible for its implementation through the <br />mechanism recluired by state and federal requirements, Non-medical service providers (such as meals or assistive <br />technolory) can signify their agreement through fhis contraot or writtsr agresment in lieu of directiy in the plan, if <br />permitted by the Covered Persons. <br />7,3 LTSS provider shall be aware o{ respect, and adhere to a Covered Person's prefsrences for <br />the delivery ofservices and supports, <br />7.4 LTSS provider shall ensure services and zuppods are culturally appropriate, provided in <br />plain language (whero applicable), and accessible to Covered Persons and the person(s) supporting them srho have <br />disabilities and/or are limited English proficient. <br />7.5 I{ealth Plan agrees to complete the care/service plan in a timely manner (within at least 120 <br />days of enrollment orannually, or less ifstaterequirements differ) andprovidea copyto LTSS provider(s)responsible <br />for implementation. <br />PPA WA - I(ttitas County Public FIealth - 05.01.2025 - ICMProviderAgreeurent 360268 Page22of24