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prospective (newly enrolling) home health agencies and prospective (newly enrolling) durable medical equipment,
<br />prosthetics, orthotics and supplies (DMEPOS) suppliers or such other categories of providers as defined under 42
<br />C.F.R. $424.518, shall be enrolled in and screenedby Medicare, in addition to complying with Health Plan's policies
<br />and procedures regarding uedentialing and recredentialing, Such providers shall revalidate Medicare enrollment
<br />every five years in cornpliance with 42 C.F.R. $424.515, Notwithstanding tlre foregoing, infant in-home phototherapy
<br />providers that meet Health Plan's certification require.rnents are not required to be enrolled in Medicare.
<br />3.30, HCA Approval Required. To the extent that the Agreement is considered aooSubcontract" requiring
<br />IICA approval under the State Contract, the Agreement will not take effest prior to HCA's review and written
<br />appmval, or failure to approve or deny within 45 calendar days of filing.
<br />3,31. HCA Approval for Assigrrment, Provider acknowledges and agrees that no assignment of the
<br />Agreement shall take effect without the prior written agreement ofHCA.
<br />3.32. Quality Improvement System, Provid.er shall maintain a quality improvement system tailored to the
<br />nature and type ofCovered Services provided hereunder, whioh affords qualrty control for such services, including
<br />but not limited to the accessibility of Medicaliy Necessary services, and whish provicles for a free exchange of
<br />information with Health Plan to assist Health Plan in complying with the requirements of the State Contract,
<br />Providers that are PCPs or specialty care providers shall comply with all quality improve,ment activities of the Health
<br />Plan.
<br />3.33. Records of Delegated Activities. As applicable to services rendered under the Agreement, Provider
<br />shall have a means to keep records necessaf,y to adequately document services provided to Covered Persons for any
<br />and all delegated activities including quality improvement, utilization management, Covered Person's rights anil
<br />responsibilities, health homes, and credentialing and re-credentialing.
<br />3.34. Behavioral Health Provider Supervisio..rl Provider agrees that, if applicable, it will receive payment
<br />for the supervision of behavioral health providers whose license or certification restricts thein to working uncler
<br />supervision.
<br />3.35. Paymeirt in Full and Cove,{ed Person Charees. Provider agrees to accept pa5ment from Health Plan
<br />as payment in full. Provider shall not request palmrent from FICA or any Covered Person for Covered Servicss
<br />provided under the Agreeme,lrt, and shall comply with WAC 182-502-Arc0 requirements applioable to providers.
<br />Provider shall report to Health Plan any instance in which a Covered Person is charged for services. Provider shali
<br />repay to a Covered Person any inappropriate oharges paid by such Covered Person, or shall reimburse HealthPlan to
<br />the extent Health Plan repays such inappropriate charges to the Covered Person.
<br />3.36. HCA and C.:overed PersonHoldHarmless. Provider agrees to hold harmless HCA and its employees,
<br />ancl all Covered Psrsons in the event of non-payment by Health Plan. Provider further agrees to indemnify and hold
<br />harmless HCA and its employees against (a) all injuries, deaths, losses, damages, claims, suits, liabilities, judgments,
<br />costs and expenses which may in any manner accrue against HCA or its employees through the intentional
<br />misconduct, negligence, or omission of Provider, its agents, ofificers, employees or contraotors, and (b) any damages
<br />related to Provider's unauthorized use or release of Personal Information (PI) or Protected Iilealth Information (PHI)
<br />ofCovered Persons.
<br />3,37 , Termination Provision. Either Party to this Attachment may terminate this Attacbment upon 90 days
<br />advance written notice to the other Party. Notwithstandrng the foregoing, in the event that (a) Provider is exclucled
<br />from participation in the Medicaid program, I-Iealth Plan may immediately tsflrrinate the Agreement or this
<br />Attachment upon writton notice to Provider, and may irnmediately recover any payments for goods or services that
<br />benefit excluded individuals or entities; or (b) HCA or Medicare has taken any action to revoke Provider's privileges
<br />for cause, and Provider has exhausted a1l appiicable appeal rights or the timeline for appeal has expired. "For cause"
<br />may include but is not limited to reasons related to fraud, integrity or quality.
<br />PPA WA - Kittitas Counly Public Ilealth - 05.07,2025 - ICMPrcvidcrAgreernent 360268 Page7 of72
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