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42 CFR Part 2, and the EPSDT requirements of the Medicaid Act at 42 U.S.C. § 1396a(a)(43) and
<br />1396d(r).
<br />2.3 Recordkeeping.
<br />a. Confidentiality of Member Health Information. Provider shall comply with all Laws, Health
<br />Plan's policies and procedures, and government sponsored program requirements regarding privacy
<br />and confidentiality of Members' health information and medical records, including mental health
<br />records. Provider shall not disclose or use Member names, addresses, social security numbers,
<br />identities, other personal information, treatment modalities, or medical records without obtaining
<br />appropriate authorization to do so. This provision shall not affect or limit Provider's obligation to
<br />make available medical records, encounter data and information concerning Member care to Health
<br />Plan, any authorized state or federal agency, or other Providers of health care upon authorized
<br />referral.
<br />b. HIPAA. To the extent Provider is considered a covered entity under the Health Insurance Portability
<br />and Accountability Act of 1996 ("HIPAA!'), Provider shall comply with all provisions of HIPAA
<br />including, but not limited to, provisions addressing privacy, security, and confidentiality.
<br />c. Delivery of Patient Care Information. Provider shall promptly deliver to Health Plan, upon request
<br />and/or as may be required by Laws, Health Plan's policies and procedures, applicable government
<br />sponsored health programs, Health Plan's contracts with the government agencies or third party
<br />payers, any information, statistical data, encounter data, or patient treatment information pertaining to
<br />Members served by Provider, including but not limited to, any and all information requested by
<br />Health Plan in conjunction with utilization review and management, grievances, peer review, HEDIS
<br />Studies, Health Plan's quality improvement program, Consumer Assessment of Health Plans
<br />("CAHPS"), or Claims payment. Health Plan will not pay copying fees when records are requested
<br />for any of the above listed programs. Provider shall further provide direct access to said patient care
<br />information as requested by Health Plan and/or as required by any governmental agency or any
<br />appropriate state and federal authority having jurisdiction over Health Plan.
<br />d. Member Access to Health Information. Provider shall give Health Plan and Members access to
<br />Members' health information including, but not limited to, medical records and billing records, in
<br />accordance with Laws, applicable government sponsored health programs, and Health Plan's policies
<br />and procedures.
<br />2.4 Program Participation.
<br />a. Participation in Grievance Program. Provider shall participate in Health Plan's Member grievance
<br />program and shall cooperate with Health Plan in identifying, processing, and promptly resolving all
<br />Member complaints, grievances, or inquiries.
<br />b. Provider Manual. Provider will follow the terms set forth in Health Plan's Provider Manual, which
<br />may be amended from time to time at Health Plan's sole discretion. Provider shall comply and render
<br />Covered Reentry Initiative Services in accordance with the contents, instructions and procedures set
<br />forth in Health Plan's Provider Manual and any additional operating procedures and policies for
<br />Providers which are communicated to Provider in writing by Health Plan. Provider acknowledges it
<br />received Health Plan's Provider Manual.
<br />c. Government Contracts. Provider acknowledges that Health Plan has entered into contracts with
<br />state and federal agencies for the arrangement of health care services for Members through
<br />government sponsored programs. Provider shall comply with any term or condition of those
<br />government sponsored program contracts that are applicable to the services to be performed under
<br />this Agreement.
<br />d. Supplemental Materials. Health Plan may periodically issue bulletins or other written materials in
<br />order to supplement the Provider Manual or to give additional instruction, guidance, or information
<br />("Supplemental Materials"). Health Plan may issue Supplemental Materials in an electronic format,
<br />MFIWCBHSSCA.082025 Revised Aug 2025 (MH W) Page 3 of 12
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