|
a. Provider's "license or certificate to render health care services is limited, suspended or revoked, or
<br />disciplinary proceedings are commenced against Provider by the state licensing authority;
<br />b. Health Plan determines that Provider's facility and/or equipment is insufficient to render Covered
<br />Reentry Initiative Services to Members;
<br />c. Provider is excluded from participation in Medicare and/or any state health care program t or
<br />otherwise is terminated as a provider by any state or federal health care program;
<br />d. Provider engages in fraud or deception, or knowingly permits fraud or deception by another in
<br />connection with Provider's obligations under this Agreement; or
<br />e. Health Plan determines that health care services are not being properly provided, or arranged for, and
<br />that such failure poses a threat to Members' health and safety.
<br />2.13 Termination Notification to Members. Upon receipt of termination by either Health Plan or Provider,
<br />Health Plan will inform affected Members of such termination notice in accordance with the process set
<br />forth in the Provider Manual. Health Plan will make a good faith effort to ensure that such notice is
<br />provided at least thirty (30) days prior to the effective date of the termination or immediately for a
<br />termination for cause that results in less than thirty (30) days' notice to all Members. Members may then
<br />be required to select another provider contracted with Health Plan prior to the effective date of
<br />termination of this Agreement.
<br />2.14 Indemnification. Each party shall indemnify and hold harmless the other party and its officers, directors,
<br />shareholders, employees, agents, and representatives from any and all liabilities, losses, damages, claims,
<br />and expenses of any kind, including costs and attorneys' fees, which result from the duties and
<br />obligations of the indemnifying party and/or its officers, directors, shareholders, employees, agents, and
<br />representatives under this Agreement.
<br />2.15 Entire Agreement. This Agreement, together with Attachments, Exhibits, Amendments and incorporated
<br />documents or materials, contains the entire agreement between Health Plan and Provider relating to the
<br />rights granted and obligations imposed by this Agreement. Additionally, as to the Medicaid products
<br />offered by Health Plan, the contract between HCA and the Health Plan shall be the guiding and
<br />controlling document when interpreting the terms of this Agreement. Any prior agreements, promises,
<br />negotiations, or representations, either oral or written, relating to the subject matter of this Agreement are
<br />of no force or effect.
<br />2.16 Amendments.
<br />a. Regulatory Amendments. Health Plan may, without Provider's consent, immediately amend this
<br />Agreement to maintain consistency and/or compliance with any state or federal law, policy, directive,
<br />or government sponsored program requirement.
<br />b. Non -Regulatory Amendments. Notwithstanding the Regulatory Amendments section, Health Plan
<br />may otherwise amend this Agreement upon sixty (60) days prior written notice to Provider. If
<br />Provider does not deliver to Health Plan a written notice of rejection of the amendment within that
<br />sixty (60) day period, the amendment shall be deemed accepted by and shall be binding upon
<br />Provider. In the event that the amendment is considered a "material amendment" as defined in RCW
<br />48.39.005, Provider shall have the right to reject the amendment and such rejection will not affect the
<br />existing terms of the Agreement.
<br />2.17 Assignment. Provider may not assign, transfer, subcontract or delegate, in whole or in part, any rights,
<br />duties, or obligations under this Agreement without the prior written consent of Health Plan. Subject to
<br />the foregoing, this Agreement is binding upon and inures to the benefit of the Health Plan and Provider
<br />and their respective successors in interest and assigns. Neither the acquisition of Health Plan nor a change
<br />of its legal name shall be deemed an assignment.
<br />2.18 Dispute Resolution Process.
<br />a. Submission of Non -Claims Payment Related Disputes
<br />MHWCBHSSCA.082025 Revised Aug 2025 (MHW) Page 6 or 12
<br />
|