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ATTACHMENT
<br />REQUIRED PROVISIONS
<br />(Health Care Authority)
<br />This attachment sets forth applicable Laws and Government Program Requirements, or other provisions necessary
<br />to reflect compliance for the Medicaid Products. This attachment will be automatically modified to conform to
<br />subsequent changes to Laws or Government Program Requirements. All provisions of the Agreement not
<br />specifically modified by this attachment remain unchanged and will control. In the event of a conflict between
<br />this attachment and any other provision in the Agreement, the provisions in this attachment will control for the
<br />Medicaid Products. Capitalized terms used in this attachment will have the same meaning ascribed to them in the
<br />Agreement unless otherwise set forth in this attachment. Any purported modification or any provision in this
<br />attachment that is inconsistent with a Law or Government Program Requirement will not be effective and will be
<br />interpreted in a manner that is consistent with the applicable Law and Government Program Requirement. This
<br />attachment only applies to Medicaid Products.
<br />1. Provider shall provide reasonable access to facilities and financial and medical records, computers or other
<br />electronic systems where Medicaid -related activities or work is conducted at any time, for duly authorized
<br />representatives of the CMS, HCA, Department of Social & Health Services ("DSHS") or the Department of
<br />Health & Human Services ("DHHS") for audit purposes and immediate access for Medicaid fraud
<br />investigators. The Provider must comply with behavioral health supplemental data reporting requirements,
<br />including the requirements outlined in SERI and the Behavioral Health Data Guide (BHDG). The BHDG
<br />describes the content of the supplemental data for each transaction, requirements for frequency of reporting,
<br />required data fields, valid values for data fields, and timeliness reporting guidelines.
<br />2. Provider shall completely and accurately report encounter data to Health Plan. Provider shall have the
<br />capacity to submit all required data to enable Health Plan to meet the requirements in the Encounter Data
<br />Transaction Guide published by HCA.
<br />3. Provider shall comply with Health Plan's fraud and abuse policies and procedures. Provider shall permit the
<br />State of Washington, including HCA, the Medicaid Fraud Control Division ("MFCD") and State auditor,
<br />and federal agencies, including but not limited to: CMS, Government Accountability Office, Office of
<br />Management and Budget, Office of the Inspector General, Comptroller General, and their designees to
<br />access, inspect, evaluate, and audit any records, books, contracts, documents, computers or other electronic
<br />systems of Provider, at any time, and shall permit inspection of the premises, physical facilities, equipment,
<br />books, records, contracts, computers, or other electronic systems where Medicaid -related activities or work
<br />is conducted, at any time.
<br />4. As applicable, Provider shall adhere to the WISe (Wraparound with Intensive Services) Manual and
<br />participate in all WISe-related quality activities.
<br />5. Provider shall not assign this Agreement without HCA's written agreement.
<br />6. Provider shall comply with any term or condition of Health Plan's contracts with HCA that is applicable to
<br />the services to be performed by Provider.
<br />7. Provider shall accept payment from the Health Plan as payment in full and shall not request payment from
<br />HCA or any enrollee for Covered Services performed under this Agreement.
<br />8. Provider agrees to hold harmless HCA and its employees, CMS and its employees, and all enrollees served
<br />under the terms of this Agreement in the event of non-payment by Health Plan. Provider further agrees to
<br />indemnify and hold harmless HCA and its employees against all injuries, deaths, losses, damages, claims,
<br />suits, liabilities, judgments, costs and expenses which may in any manner accrue against HCA or its
<br />employees through the intentional misconduct, negligence, or omission of Provider, its agents, officers,
<br />employees or contractors.
<br />9. Provider agrees to comply with the HCA appointment wait time standards. Provider agrees to Health Plan's
<br />regular monitoring of timely access to Provider's services, and agrees to corrective action up to and
<br />including termination for cause in the event that Provider fails to comply with the appointment wait time
<br />standards.
<br />MHWPROV22.3 MHWPSA/Revised Jan 2024 Page 22 of 25
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