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Docusign Envelope lD: CEBC6B3C-DFA1-486C-AFE8-6A4A634400B6 <br />51.3.3 Any lending of money or other extension of credit between Facility and <br />such a party <br />52. Information on Persons Convicted of Crimes. Facility shall investigate and disclose to <br />CHPW, at Agreement execution or renewal, and upon request by CHPW of the identified person <br />who has been convicted of a criminal offense related to that person's involvement in any <br />program under Medicare, Medicaid, or the title XX services program since the inception of those <br />programs and who is: <br />52.1 A person who has an ownership or control interest in Facility; <br />52.2 An agent or person who has been delegated the authority to obligate or act on <br />behalf of Facility;and <br />52.3 An agent, managing employee, general manager, business manager, <br />administrator, director, or other individual who exercises operational or managerial control over, <br />or who directly or indirectly conducts the day-to-day operation of, Facility. <br />53. Maternity Newborn Length of Stoy; Sterilizations and Hysterectomies. All hospital <br />delivery matemity care provided under the Agreement shall be in accord with RCW 48.43.115. <br />All sterilizations and hysterectomies provided under the Agreement shall be in compliance with <br />42 C.F.R. $ 441 Subpart F, and Facility shall use a Consent for Sterilization form (HHS-687) or <br />its equivalent in connection therewith. A hysterectomy requires the Hysterectomy Consent and <br />Patient Information form (HCA 13-365). <br />54. Grievance and Appeals. CHPW shall maintain a grievance and appeals system tn <br />accordance with the requirements of the State Contract, and CHPW shall provide the following <br />information regarding CHPW's grievance and appeal system to Facility: <br />54.1 The toll-free numbers to file oral grievances and appeals; <br />54.2 The availability of assistance in filing a grievance or appeal, including informing <br />the Member about ombuds services and how to access those services; <br />54.3 The Member's right to request continuation of Medicaid benefits during an appeal <br />or hearing and, if the CHPW's Adverse Benefit Determination is upheld, that the Member may <br />be responsible to pay for the continued benefits; <br />54.4 The Member's right to file grievances and appeals and their requirements and <br />timeframes for filing; <br />54.5 The Member's right to a hearing, how to obtain a hearing and representation rules <br />at a hearing; and <br />54.6 Facility may file a grievance or request an adjudicative proceeding on behalf of a <br />Member in accordance with the State Contract. <br />2020 Facility Exh BIB - McaidProv Page 41 ofSl Conhact #5908-662684