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Docusign Envelope lD: CEBCOB3C-DFA1-4BOC-AFE8-6A4A63440080 <br />Exrunlr B-1-B <br />Mrorcuo <br />Rneurnnr PRo\TsIoNs <br />Community Health Plan of Washington ("CHPW") has contracted with the Washington State <br />Health Care Authority ("HCA") to arrange for the provision of fully integrated physical and <br />behavioral health care services to Members under the Apple Health Medicaid Program. The <br />Contract between CHPW and HCA (the "State Contract") requires that specific terms and <br />conditions be incorporated into agreements between CHPW and its participating providers and <br />subcontractors. <br />This Exhibit B-1-B ("this Exhibit") is intended to supplement the Agreement by setting forth the <br />parties' rights and responsibilities related to the provision of Covered Services to Members as it <br />pertains to the Apple Health Program. In the event of a conflict between the terms and conditions <br />of the Agreement and the terms and conditions of this Exhibit, this Exhibit shall govern as to the <br />Apple Health Program. <br />Facility agrees and understands that Covered Services shall be provided in accordance with the <br />State Contract(s), Payor requirements, any applicable State handbooks or policy and procedure <br />guides, and all applicable State and federal laws and regulations. To the extent Facility is unclear <br />about Facility's duties and obligations, Facility shall request clarification from CHPW. <br />Definitions. The following definitions apply to this Exhibit B-1-B: <br />Capitalizedterms used and not otherwise defined herein shall have the meanings given to them in <br />the Agreement or the State Contract. The definitions listed below will supersede any meanings <br />contained elsewhere in the Agreement with regard to this Exhibit. <br />Apple Health Program: the Medicaid integrated managed care program known as Apple Health. <br />HCA: the State of Washington Health Care Authority and its employees and authorized agents. <br />Medically Necessary: health care services that: (a) are reasonably calculated to prevent, diagnose, <br />correct, cure, alleviate or prevent worsening of conditions in the Member that endanger life, or <br />cause suffering or pain, or result in an illness or infirmity, or threaten to cause or aggravate a <br />handicap, or cause physical deformity or malfunction; and (b) are not more costly than any other <br />equally effective or more conservative course of treatment available or suitable for the Member <br />requesting the service. Such services shall include services related to the Member's ability to <br />achieve age-appropriate growth and development. <br />Member: an individual enrolled in Apple Health and entitled to receive Covered Services pursuant <br />to that Benefit Plan. <br />Physician's Orders for Life Sustaining Treatment ("POLST"): a set of guidelines and protocols for <br />how emergency medical personnel shall respond when summoned to the site of an injury or illness <br />for the treatment of a person who has signed a written directive or durable power of attomey <br />2o20Facility Exh BIB - McaidProv Page 30 of51 Contract #5908-662684