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limitations. Provider is free to communicate any and all treatment options to Members regardless of
<br />benefit coverage limitations.
<br />2.3 Promotional and Marketing Activities. At the request of Health Plan, Provider shall (1) display Health
<br />Plan promotional materials in its offices and facilities as practical, and (2) shall cooperate with and
<br />participate in all reasonable Health Plan's marketing efforts. Provider shall not use Health Plan's name in
<br />any advertising or promotional materials without the prior written permission of Health Plan.
<br />As applicable, Provider shall not directly or indirectly conduct door-to-door telephonic, or other cold -call
<br />marketing of enrollment (42 CFR 438.104(b)(1)(v)).
<br />2.4 Nondiscrimination.
<br />a. Enrollment. Provider shall not differentiate or discriminate in providing Covered Services to
<br />Members because of race, color, religion, national origin, ancestry, age, sex, marital status, sexual
<br />orientation, physical, sensory, or mental handicap, socioeconomic status, or participation in publicly
<br />financed programs of health care services. Provider shall render Covered Services to Members in the
<br />same location, in the same manner, in accordance with the same standards, and within the same time
<br />availability regardless of payer.
<br />b. Employment. Provider shall not differentiate or discriminate against any employee or applicant for
<br />employment, with respect to their hire, tenure, terms, conditions or privileges of employment, or any
<br />matter directly or indirectly related to employment, because of race, color, religion, national origin,
<br />ancestry, age, sex, height, weight, marital status, physical, sensory, or mental disability unrelated to
<br />the individual's ability to perform the duties of the particular job or position.
<br />2.5 Recordlceeping.
<br />a. Maintaining Member Medical Record. Provider shall maintain a medical record for each Member
<br />to whom Provider renders health care services. Provider shall open each Member's medical record
<br />upon the Member's first encounter with Provider. The Member's medical record shall contain all
<br />information required by Laws, generally accepted and prevailing professional practice, applicable
<br />government sponsored health programs, and all Health Plan policies and procedures. Provider shall
<br />retain all such records for at least ten (10) years.
<br />b. 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 />c. 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 />d. 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 />MH WPROV22.3 MHWPSA/Revised Jan 2024 Page 6 of 25
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