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Participating Providers to provide the Covbred Service for whioh the Covered Person is referred. Except as required by applicable law, failwe of Provider and Contracted Providers to follow suoh procedures may result in denial of payment for unauthorized treatment. Preauthorizattonis not required prior to provision of Covered Services in the event of an emergsncy. 2.1.1. PriQf Authorization: In accordance with RCW 48.43.016(2)(a), the Agreement does not require utilization management or review of any kind for an initial evaluation and management visit, and up to six treatment visits with a Contracted Provider in a new episode of eare for each of the following: . Chiropractic o Physicaltherapy o Occupational therapy . AcupunctureandEasternmedicine r Massage therapy . Speechtherapy Visits where utilization management or review is prohibited are stil1 zubject to quantitative treatment limits of the Health P1an. With the exception of RCW 48.43.515(5), the Health Plan can require a referal or prescription for the therapists listed. For visits where utilization management or review is prohibited, Health Plan will not deny or limit coverage on the basis of medioal necessity or appropriat€ness; or retroactively deny care or refuse payment for the visits in accordance with RCW 48.43.016(2Xb). 2.7.2, Tglemedicine Payrnent Parity. In accordance with RCW 48.43.735, providers for telemedicine services shall be oompensaied at the same rate (to be defined by the Legislahue) as in-person services. Provider can negotiate a telemedicine reimbursemer( rate that differs from in-person services for: o hospitals, r hospital s)'stems, r telemedicine companies, and o provider groups consisting of l1 or more providers. Provider cannegotiate payment of facility fees for telemedicine services that originate at: . a hospital, . aruralhealthclinig r a federally qualified health center (FQHC), . a physician/health care provider's office, . community msntal health center, skilled nursing facility, orr a renal dialysis center (except an internal renal dialysis center). Any other site may not charge a facility fee. Health Plan shall not distinguish between originating sites that are rura1 and urban when providing coverage. Health Plan is not required to reimburse: . an originating site for professional fees, . services not covered under the plan, or o an originating siteorproviderthat isnotcontracted underthe plan. Audio-Only Telemedisine: In accorclance with RCW 48,43.735(1)(a)(v) and WAC 284-17A433(1)(b), the covered person must have an established relationship with the provider. PPA WA - Kittitas County Public Health -05.07.7V25 - ICMPr.oviderAgreemenl36026S Page! of24