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Docusign Envelope lD: 7 4E827C5-FAB8-8084-827C-41 4AD59920A0 19. Upon termination of this Agreement without cause, Provider will continue to render Covered Services to Members until the earliest of the following: (1) the date Covered Services being rendered to Member by Provider arc oompleted or medically appropriate provisions have been made by Health Plan for another provider to assume responsibility for providing such Covered Sewices; or (2) sixty (60) days following notice to the Member of Provider's contract termination. The provision of such Covered Seryices and the reimbursement to Provider for such Covered Services shall be subject to all applicable terms of this Agreement on the same basis as Covered Services provided during the term of this Agreement. Provider will satisfy and be in compliance with all of the requirements in WAC 284-170-421(5). Provider will ensure that all of its subcontractors witl satisfy and be in compliance with all of the requirements in WAC 284-170-421(5>. Telemedicine Services. i. Pursuant to RCW 48.43.135(8) and its irnplementing rcgulations, if Provider intends to bill a Member or Health Plan for an audio-only telemedicine service, Provider must obtain Member consent for the billing in advance ofservice being delivered. ii, Beginning January 1,2023, Provider must have an established relationship with the Member to be eligible for reimbursement for audio-only telemedicine (RCW 48,43.735). iii. "Established Relationship" means the provider providing audio-only telemedicine has access to sufflcient health records to ensure safq effective, and appropriate care services and: (A) The Member has had, within the past three years, at least one in-person appointment, or at teast one real-time interactive appointment using both audio and video technology, with the provider providing audio-only telemedioine or with a provider employed at the same medical group, at the same clinic, or by the same integrated delivery systern operated by a carrier licensed under chapter 48.44 or 48.46 RCW as the provider providing audio-only telemedicinei ot (B) The Member was referred to the provider providing audio-only telemedicine by another provider who has had, within the past three years, at least one in-person appointment, or at least one real- time interactive appointment using both atrdio and video technology, with the Member and has provided relevant medical informalion to the provider providing audio-only telemedicine. Drug Utilization Review. Health Plan maintains documented drug utilization rnanagement criteria to align with RCW 48.43,42A and WAC 284-43-2020(2) and can be found on Health Plan's website, http_s://wr:vw.molinamarketplace.com/m?rketplace/wa/en-us/Providels/Drug-List. 2A 2L 22 23 MHWpROV22.3 MHWPSA/Revised Jan 2024 Page 2 I of25