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<br /> <br /> Page 17 of 48 <br />activities; ii) maintain the confidentiality of a Covered Persons information and records pursuant to the Agreement; <br />and iii) allow the Company to use facility’s performance data. <br /> <br />6 Long Term Services and Supports (“LTSS”) and Home and Community-Based Services (“HCBS”) <br />Providers. If Provider or a Contracted Provider is a provider of LTSS and/or HCBS services, the following provisions <br />apply. <br /> <br />6.1 Definition. LTSS generally includes assistance with daily self-care activities (e.g., walking, <br />toileting, bathing, and dressing) and activities that support an independent lifestyle (e.g., food preparation, <br />transportation, and managing medications). The broad category of LTSS also includes care and service coordination <br />for people who live in their own home, a residential setting, a nursing facility, or other institutional setting. Home <br />and community-based services (“HCBS”) are a subset of LTSS that functions outside of institutional care to maximize <br />independence in the community. Long-term care (“LTC”) is another subset of LTSS which provides benefits as <br />specified through the SMMC LTC Program. <br /> <br />6.2 HCBS Waiver Authorization. Provider shall not provide HCBS Covered Services to <br />Covered Person without the required HCBS waiver authorization. <br /> <br />6.3 Conditions for Reimbursement. No payment shall be made to the Provider unless the <br />Provider has strictly conformed to the policies and procedures of the HCBS Waiver Program, including but not <br />limited to not providing HCBS Covered Services without prior authorization of WellCare. For the purposes of this <br />Exhibit, “HCBS Waiver Program” shall mean any special Medicaid program operated under a waiver approved by <br />the Centers for Medicare and Medicaid Services which allows the provision of a special package of approved services <br />to Covered Person. <br /> <br />6.4 Acknowledgement. WellCare acknowledges that Provider is a provider of LTSS and is not <br />necessarily a provider of medical or health care services. Nothing in this Agreement is intended to require Provider <br />to provide medical or health care services that Provider does not routinely provide, but woul d not prohibit providers <br />from offering these services, as appropriate. <br /> <br />6.5 Notification Requirements. Provider or the applicable Contracted Provider shall provide the <br />following notifications to WellCare, via written notice or via telephone contact at a numbe r to be provided by <br />WellCare, within the following time frames: <br /> <br />6.5.1 Provider or the applicable Contracted Provider shall notify WellCare of a Covered <br />Person’s visit to urgent care or the emergency department of any hospital, or of a Covered Person’s hospitali zation, <br />within twenty-four (24) hours of becoming aware of such visit or hospitalization. <br /> <br />6.5.2 Provider or the applicable Contracted Provider shall notify WellCare of any change <br />to the designated/assigned services being provided under a Covered Person’s plan of care and/or service plan, within <br />24 hours of becoming aware of such change. <br /> <br />6.5.3 Provider or the applicable Contracted Provider shall notify WellCare if a Covered <br />Person misses an appointment with Provider, within 24 hours of becoming aware of such missed appointment. <br /> <br />6.5.4 Provider or the applicable Contracted Provider shall notify WellCare of any change <br />in a Covered Person’s medical or behavioral health condition, within 24 hours of becoming aware of such change. <br />(Examples of changes in condition are set forth in the Provider Manual.) <br /> <br />6.5.5 Provider or the applicable Contracted Provider shall notify WellCare of any safety <br />issue identified by Provider or Contracted Provider or its agent or subcontractor, within 24 hours of the identification <br />of such safety issue. (Examples of safety issues are set forth in the Provider Manual.) <br /> <br />DocuSign Envelope ID: 2EC1F0FD-FAF9-4B42-B52E-D419F55A6210