2021-350-EMS-E-WellCare Health Plans of NC Inc-Medicaid managed care

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Page 24 of 48 Statutes of North Carolina or is owned or operated by the State of North Carolina in which health care services are provided to patients. 1.6. “Medicaid Product” refers to those programs and health benefit arrangements offered by WellCare or other Company pursuant to a State Contract. The Medicaid Product does not apply to any Coverage Agreements that are specifically covered by another Product Attachment to the Agreement. 1.7. “Medically Necessary Service” or “Medically Necessary” means those Covered Services that are within general accepted standards of medical care in the State community, as verified by independents Medicaid Consultants, and not experimental in nature. 1.8. “Objective Quality Standards” means the objective standards for quality determinations identified by WellCare that assess a provider’s ability to deliver care; include specific defined thresholds for adverse quality determinations; meet standards established by the National Committee on Quality Assurance (NCQA); and are not discriminatory. 1.9. “Primary Care Provider” or “PCP” means the participating physician, physician extender (e.g. physician assistant, nurse practitioner, certified nurse midwife) or group practice/center selected by or assigned to the Covered Person to provide and coordinate the Covered Person’s health care needs and to initiate and monitor referrals for specialized services when required. Includes family practitioners, pediatricians, obstetricians, and internal medicine physicians. 1.10. “State” means North Carolina. 1.11. “State Contract” means a contract between WellCare or other Company and one or more state Medicaid agency(ies), or any successors thereto, to provide specified services and goods to covered beneficiaries under state Medicaid-funded program(s) and to meet certain performance standards while doing so. 2. Medicaid Product. 2.1. Medicaid and/or CHIP Product. This Product Attachment constitutes the “Medicaid Product Attachment” and is incorporated into the Agreement between Provider and WellCare. It supplements the Agreement by setting forth specific terms and conditions that apply to the Medicaid Product with respect to which a Participating Provider has agreed to participate, and with which a Participating Provider must comply in order to maintain such participation. This Attachment applies only to the provision of health care services, supplies or accommodations (including Covered Services) to Covered Persons enrolled in the Medicaid Product. 2.2. Participation. Except as otherwise provided in this Product Attachment or the Agreement, Provider and all Contracted Providers under the Agreement will participate as Participating Providers in the Medicaid Product and will provide to Covered Persons enrolled in the Medicaid Product, upon the same terms and conditions contained in the Agreement, as supplemented or modified by this Product Attachment, those Covered Services that are provided by Contracted Providers pursuant to the Agreement. In providing such services, Provider shall, and shall cause Contracted Providers to, comply with and abide by the provisions of this Product Attachment and the Agreement (including the Provider Manual). 2.3. Attachment. This Attachment constitutes the Product Attachment and Compensation Schedule for the Medicaid Product. 2.4. Construction. This Product Attachment supplements and forms a part of the Agreement. Except as otherwise provided herein or in the terms of the Agreement, the terms and conditions of the Agreement will remain unchanged and in full force and effect as a result of this Product Attachment. In the event of a conflict between the provisions of the Agreement and the provisions of this Product Attachment, this Product Attachment will govern with respect to health care services, supplies or accommodations (including Covered Services) rendered DocuSign Envelope ID: 2EC1F0FD-FAF9-4B42-B52E-D419F55A6210