Document:

Exhibit 10.52  

CLIENT SERVICE CONTRACT

NURSING FACILITY SERVICES  

	 	DSHS CONTRACT NUMBER

AASA CONTRACT NUMBER

	This Contract is between the State of Washington Department of Social and Health Services (DSHS) and the Contractor identified below
	

	CONTRACTOR NAME (Must be same as Nursing Facility licensee)

	 	CONTRACTOR DBA (Facility's Name, if different)
	
	 	 
	

	CONTRACTOR MAILING ADDRESS	 	FACILITY SITE ADDRESS

	WASHINGTON UNIFORM BUSINESS IDENTIFIER (UBI)

	 	CONTRACTOR'S DSHS INDEX NUMBER	 	NURSING FACILITY LICENSE NUMBER
	
	 	 	 	 
	

	CONTRACTOR TELEPHONE

	 	CONTRACTOR FAX	 	CONTRACTOR E-MAIL ADDRESS
	
	 	 	 	 
	

	DSHS ADMINISTRATION	 	DSHS DIVISION	 	DSHS SERVICE CODE
	

Aging & Adult Services	
 	

Management Services	
 	

 
	

	DSHS CONTACT NAME AND TITLE

	 	DSHS CONTACT ADDRESS
	
	 	 	 	 
	

	DSHS CONTACT TELEPHONE

	 	DSHS CONTACT FAX	 	DSHS CONTACT E-MAIL ADDRESS
		 	 	 	 
	

	IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT

	 	CFDA NUMBERS
		 	 	 	 
	

	CONTRACT START DATE	 	CONTRACT END DATE	 	MAXIMUM CONTRACT AMOUNT
	

 	
 	

As provided by law or this contract	
 	

Fee for service
	

This
Contract, including the attached Terms and Conditions and any other documents incorporated by reference, contains all of the terms and conditions agreed upon by the parties. No other
understandings or representations, oral or otherwise, regarding the subject matter of this Contract shall be deemed to exist or bind the parties. The parties signing below warrant that they have read
and understand this Contract and have the authority to enter into this Contract. 

	CONTRACTOR SIGNATURE

	 	PRINTED NAME AND TITLE	 	DATE SIGNED
	
	 	 	 	 
	

	DSHS REPRESENTATIVE SIGNATURE

	 	PRINTED NAME AND TITLE	 	DATE SIGNED
	
	 	 	 	 
	

1

 
NURSING FACILITY SERVICES

TERMS AND CONDITIONS  

	1.
	Definitions. As used throughout this Contract, words shall have their plain, ordinary meaning if not defined in this Contractor by
applicable law or regulation.

	a.
	"Assignee"
means the new owner of the Nursing Facility identified on Page 1 of this Contract when there is a Change of Ownership triggering automatic assignment of this Contract as
provided for in 42 CFR 442.14 and by RCW 74.46.680.

	b.
	"Authorized
Services" means the services that have been approved by DSHS.

	c.
	"CFR"
means the Code of Federal Regulations. All references to CFR titles, parts, and sections shall include any successor or replacement regulation.

	d.
	"Change
of Ownership" means the occurrence of a transfer of the Nursing Facility to a New Contractor/Assignee by the Contractor which is provided for in 42 CFR 442.14, RCW 74.46.680,
and WAC 388-96-010.

	e.
	"Client"
means an individual that DSHS determines financially and programmatically eligible for payment of services provided by a licensed nursing home that has a Client Service
Contract for Nursing Facility Services with DSHS.

	f.
	"Client
participation" means the amount of the Client's nonexempt income, if any, that the Contractor shall collect directly from the Client and apply to the cost of the Client's
authorized care.

	g.
	"Contract"
means this Client Service Contract for Nursing Facility Services.

	h.
	"Contracting
Officer" means the Contracts Administrator, or successor, of DSHS Central Contract Services or successor section or office.

	i.
	"Contractor"
means the individual or entity performing services pursuant to this Contract as defined in RCW 74.46.020. Upon transfer of ownership of the Nursing Facility identified on
Page 1, "Contractor" includes the Assignee.

	j.
	"DSHS"
or "the department" or "the Department" means the Department of Social and Health Services of the State of Washington and its employees and authorized agents.

	k.
	"Nursing
Facility" or "NF" means a nursing facility as defined in WAC 388-97-005 and RCW 74.46.020 and as defined in Section 1919(a) of the federal
Social Security Act [42 U.S.C. 1396r] and regulations promulgated thereunder, as now or hereafter amended.

	l.
	"Nursing
Facility Services" means the services the Contractor shall provide to meet the needs of the Client according to WAC 388-97 and federal regulations.

	m.
	"Personal
Information" means information identifiable to any person, including but not limited to, information that relates to a person's name, health, finances, education, business,
use or receipt of governmental services or other activities, addresses, telephone numbers, social security numbers, driver license numbers, other identifying numbers, and any financial identifiers.

	n.
	"RCW"
means the Revised Code of Washington. All references to RCW chapters or sections shall include any replacement or successor statute. DSHS Central Contract Services

	o.
	"Resident"
means an individual residing in a Nursing Facility.

	p.
	"U.S.C."
means the United States Code. All references to titles and sections shall include any successor or replacement statute. 

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	q.
	"WAC"
means the Washington Administrative Code. All references to WAC chapters or sections shall include any successor or replacement rule.

	2.
	Statement of Work. The Contractor shall in all respects operate the NF and business in accordance with applicable federal and state laws
and regulations, as now existing or hereafter adopted or amended, and as may be finally interpreted by courts of competent jurisdiction from time to time, including but not limited to 42 U.S.C.
§ 1396; 42 CFR Parts 440, 442,447, 483 and 488; chapters 18.51, 74.09, 74.42 and 74.46 RCW; and WAC 388-96,388-97 and
388-98.

	3.
	Billing and Payment. 
	a.
	Billing
and payment for Contractor's services shall be in accordance with chapter 74.46 RCW.

	b.
	DSHS
shall mail the Contractor's payment for services to the Contractor's mailing address specified on Page 1 of this Contract unless a different payment address is requested in
writing by the Contractor.

	c.
	The
Contractor shall not bill DSHS for services performed under this Contract, and DSHS shall not pay the Contractor, if the Contractor has charged or will charge the State of
Washington or any other party under any other contractor agreement for the same services. DSHS shall not pay any claims for payment for services submitted more than 12 months after the date of
service, except as provided in WAC Chapter 388-502 or any other applicable federal or state laws or regulations.

	4.
	Assignment of Contract. 
	a.
	Pursuant
to 42 CFR 442.14, RCW 74.46.680, and WAC 388-96-010, when there is a Change of Ownership and the Contractor's NF is transferred to
another individual or entity, this Contract shall be automatically assigned to that individual or entity, except as limited by those provisions. That individual or entity shall be known as the
Assignee. The Assignee shall assume and be bound by all of the terms and conditions of this Contract as of the effective date of the Change of Ownership. The Assignee shall complete a DSHS Contractor
Intake within thirty (30) days of the date of transfer.

	b.
	Except
as provided in this Paragraph 4, the Contractor or Assignee shall not otherwise assign any of this Contract's rights or obligations to a third party.

	5.
	Administrative Appeal and Dispute Resolution Options. 
	a.
	Disputes
regarding the Contractor's failure to comply with chapters 18.51 and 7.4.42 RCW and WAC 388-97, WAC 388-98, and/or with
federal requirements described in 42 CFR Part 483 and 488, shall be handled in accordance with procedures described therein and in 42 CFR Part 431 and Part 498.

	b.
	If
administrative dispute resolution is authorized by statute or regulation, then disputes that arise in connection with payment or a related matter under Chapter 74.46 RCW or
WAC 388-96 shall be handled in accordance with the provisions of chapter 74.46 RCW or WAC 388-96.

	6.
	Compliance with Applicable Law. At all times during the term of this Contract, the Contractor shall comply with all applicable federal
and state and local laws, regulations and rules, including without limitation all applicable ethics, nondiscrimination, worker's compensation, occupational disease and occupational health and safety
laws, statutes and regulations.

	7.
	Confidentiality. The Contractor may only use Personal Information or other information gained by reason of this Contract for the purpose
of this Contract, and shall not disclose, transfer, or sell any Personal Information or other information to any party, except by prior written consent of the person or as provided by law. The
Contractor shall safeguard such information and shall return or certify destruction of the information upon Contract expiration or termination. 

3

 
	8.
	Contractor Certifications. The Contractor acknowledges and certifies as follows:

	a.
	The
Contractor shall not accept any Client or other person in excess of the Contractor's licensed capacity as stated in the Contractor's Nursing Home License.

	b.
	If
applicable, the Contractor and the Contractor's owners, members, directors, officers, partners, agents and any employees who will provide services under this Contract shall comply
with chapter 42.52 RCW, Ethics in Public Service, at all times during the performance of this Contract. The Contractor shall immediately notify the DSHS Contact identified on Page 1 of this Contract
in the event that the Contractor accepts employment with the State of Washington or if the Contractor hires an employee who is a current or former State of Washington employee.

	c.
	The
Contractor shall not hold the Contractor or the Contractor's owners, members, directors, officers, partners, agents or employees out as, nor claim to be, an officer, employee or
agent of DSHS or the State of Washington by reason of this Contract. The Contractor shall not claim for the Contractor or the Contractor's employees any rights, privileges or benefits which would
accrue to a civil service employee under chapter 41.06 RCW, or its successor or replacement statute. DSHS shall not pay federal taxes, social security taxes, or Department of Labor and
Industries contributions for the Contractor or the Contractor's employees.

	d.
	If
the Contractor has reason to know that a Resident is likely to become financially eligible for Medicaid benefits within one hundred eighty (180) days, the Contractor shall
immediately notify the Resident and the' Department, and the Contractor shall comply with chapter 74.42 RCW.

	9.
	Death of Clients. The Contractor shall report all deaths of DSHS Clients residing in the Contractor's NF within twenty-four
(24) hours to the appropriate regional office of the DSHS Home and Community Services Division and shall comply with WAC 388-96-384 and
388-97-047.

	10.
	Debarment Certification. At the request of DSHS, the Contractor shall complete the DSHS Certification regarding Federal Debarment,
Suspension, Ineligibility, and Voluntary Exclusion. The certification, if any, is incorporated into this Contract by reference.

	11.
	Drug-Free Workplace. The Contractor shall maintain a drug-free workplace, as defined by and in accordance with
41 U.S.C. § 701.

	12.
	Effective Date, Amendment, and Waiver. This Contract shall be binding on DSHS only upon signature of an authorized DSHS Representative.
This Contract may be amended only by a written amendment signed by DSHS and the Contractor. Only the DSHS Contracting Officer has the authority to waive any term or condition of this Contract on
behalf of DSHS.

	13.
	Governing Law and Venue. This Contract shall be governed by the laws and regulations of the State of Washington. In the event of a
lawsuit involving this Contract, venue shall be proper only in Thurston County, Washington.

	14.
	Inconsistency in This Contract. In the event of. any inconsistency in this Contract or between its terms and'. any applicable statute
or rules, unless otherwise provided herein, the inconsistency shall be resolved by giving precedence In the following order: a) applicable federal laws and regulations; b) applicable
state laws and regulations; c) this Contract, including the Statement of Work; and d) any other document incorporated by reference.

	15.
	Indemnification and Hold Harmless. The Contractor shall be responsible for and shall indemnify and hold DSHS harmless from all
liability resulting from the acts or omissions of the Contractor and any subcontractor. 

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	16.
	Insurance. The Contractor and any agent shall have and maintain insurance in the amounts and types as may be required by federal or
state law or regulation.

	17.
	Inspection. During the term of this Contract and for one (1) year following termination of this Contract, the Contractor shall
give reasonable access to the Contractor's place of business and Client and Contractor records to DSHS and to any other employee or agent of the State of Washington or the United States of America for
the purpose of inspecting the Contractor's place of business and Its records, and monitoring, auditing, and evaluating Contractor performance and compliance with applicable laws, regulations, rules,
and this Contract.

	18.
	Maintenance of Records. 
	a.
	Clinical Records of Residents. The Contractor shall maintain records required by, but not limited to, 42 U.S.C. 1396a, 42 CFR
483.75(l), RCW 18.51.300, and WAC 388-97-180 for a period of no less than eight (8) years following the most recent discharge of a Resident, except that the
records of minors must be retained for no less than three (3) years following the attainment of eighteen (18) years, or ten (10) years following their most-recent
discharge, whichever is longer. In the event of a change of ownership, the Contractor shall provide for the orderly transfer of clinical records to the Assignee, and the Assignee shall maintain those
records as required by this section and applicable statute and regulation.

	b.
	All Records. During the term of this Contract and for eight (8) years following termination of this Contract, the Contractor
shall maintain records sufficient to: (1) document performance of all acts required by statute, regulation, rule, or this Contract; (2) substantiate the Contractor's statement of its
organization's structure, tax status, capabilities, and performance; and (3) demonstrate accounting procedures, practices, and records which sufficiently and properly document the Contractor
invoices to DSHS and all expenditures made by the Contractor to perform as required by this Contract. The Contractor shall maintain and retain cost reports and supporting records, and trust accounts
established pursuant to RCW 74.46.700, as provided by RCW 74.46.060 and 74.46.080.

	19.
	Ownership of Material. Material created by the Contractor and paid for by DSHS as a part of this Contract shall be owned by DSHS, and
shall be "works for hire" as defined by the U.S. Copyright Act of 1976.

	20.
	Severability; Conformity. The provisions of this Contract are severable. If any provision of this Contract, including any provision of
any document incorporated by reference, is held invalid by any court of competent jurisdiction, that invalidity shall not affect the other provisions of this Contract and the invalid provision shall
be considered modified to conform to existing law.

	21.
	Subcontracting. If the Contractor subcontracts out for any services relating to this Contract (including any management agreement), the
Contractor shall be responsible for the acts and omissions of any subcontractor. The Contractor shall ensure that any subcontractor (including any contracted NF manager) complies with the terms and
conditions of this Contract.

	22.
	Survivability. The terms and conditions contained in this Contract that by their sense and context are intended to survive the
expiration or termination of this Contract shall so survive. Surviving terms include but are not limited to: Confidentiality, Disputes, Indemnification and Hold Harmless, Inspection, Maintenance of
Records, Notice of Overpayment, Ownership of Material, Termination for Default, Termination and Expiration Procedure, Treatment of Assets Purchased by Contractor, and Treatment of DSHS Assets.

	23.
	Termination for Convenience. The Contractor may terminate this Contract for convenience by giving DSHS at least sixty
(60) calendar days' written notice addressed to the DSHS Contact identified on Page 1 of this Contract. However, if the Contractor continues to provide the type of sevices that are provided by
NFs, the termination shall be subject to federal law prohibiting the discharge 

5

 

of
residents who are residing in the NF on the day before the effective date of termination of this Contract per 42 U.S.C. 1396r(c). DSHS may terminate this Contract if Contractor refuses to
sign the Updated Contract under the terms of Paragraph 28. 

	24.
	Termination Due to Change in Funding. If the funds DSHS relied upon to establish this Contract are withdrawn or reduced, or if
additional or modified conditions are placed on such funding, DSHS may immediately terminate this Contract by providing written notice to the Contractor. The termination shall be effective on the date
specified in the notice of termination.

	25.
	Termination for Good Cause. The federal government or the DSHS Contracting Officer may terminate this Contract for good cause, in whole
or in part, by written notice to the Contractor. If this Contract is terminated for good cause, DSHS shall be entitled to all remedies available at law or in equity, including consequential damages,
incidental damages, and costs.

	26.
	Termination Procedure. If this Contract is terminated for any reason, the termination procedure shall be in accordance with Title XIX
of the Social Security Act (42 U.S.C. 1396); 42 C.F.R. Chapters 431, 442, 488, 489 and 498; and chapter 74.46 RCW. The Contractor shall immediately deliver to the DSHS
Contact named in this Contract, or to his or her successor, all DSHS assets in the Contractor's possession, including any material produced under this Contract and any Personal Information.

	27.
	Treatment of Contractor Assets. Title to all assets (property) purchased or furnished by this Contractor is vested in the Contractor
and DSHS waives all claim of ownership to such property.

	28.
	Updated Contract. DSHS may propose that the providers execute an updated version (Updated Contract) of this Contract. DSHS shall
provide the Updated Contract to the Contractor at least 90 calendar days prior to the start date of the Updated Contract. The Statement of Work in the Updated Contract will not impose operating
requirements on the Contractor that are in addition to those that exist in Medicare/Medicaid certification requirements, state licensing or other requirements of the Washington Administrative Code.
Execution of an Updated Contract shall not affect the existing liabilities and obligations of DSHS and the contractor under this Contract. If the Updated Contract makes changes in the liabilities and
obligations of DSHS and the contractor, the changes shall apply only to services provided on or after the effective date of the Updated Contract. If the Contractor refuses to sign the Updated Contract
by the end of the 90-day period, DSHS may terminate this Contract by giving the Contractor written notice at least 60 days in advance of the effective date of termination.

	29.
	Waiver of Default. Waiver of any default on one occasion shall not be deemed to be a waiver of any subsequent default. Waiver of any
breach or default of any provision of this Contract shall not be deemed to be a, waiver of any subsequent breach, and shall not be construed to be a modification of the terms and conditions of this
Contract. 

APPROVED AS TO FORM BY THE OFFICE OF THE ATTORNEY GENERAL  

6Exhibit 10.53  

UTAH DEPARTMENT OF HEALTH

DIVISION OF HEALTH CARE FINANCING

PROVIDER AGREEMENT FOR MEDICAID AND UMAP  

        This is a Provider Agreement for participation in both Title XIX of the Social Security Act (Medicaid) and the state funded medical assistance program known as
the Utah Medical Assistance Program (UMAP). 

        This
agreement is between the Utah Department of Health, Division of Health Care Financing, hereafter referred to as DEPARTMENT, and
                                        
(Provider Name), hereafter referred to as PROVIDER. 

	
 (Billing Address for PROVIDER)

City                                State        
                        Zip	 	
 (Practice Address, if different)

City                                State        
                        Zip

PROVIDER
is (mark one): 

	        Individual	 	        Partnership	 	        Corporation	 	        Other (specify)

Billed charges: The usual and customary charges for the services rendered to the general public. 

Immediate access to records: When authorized DEPARTMENT employees request access to records relevant to claims submitted for services furnished under
any medical assistance programs without prior notice and without delay. Immediate access shall only be requested when the DEPARTMENT employee reasonably believes the records will be destroyed or
altered, and no other less intrusive method of obtaining the records is reasonably available. Unless the authorized DEPARTMENT employee has obtained a search warrant, PROVIDER shall have
24 hours to produce the records. 

Medical assistance: Services provided under Medicaid or the UMAP program. 

Ownership interest: Direct (or indirect) ownership or control interest totaling 5% or more (see 42 CFR 455.102 to calculate
ownership or control percentages). 

Provider: The medical professional or organization that executes this agreement as well as any of PROVIDER'S employees or other persons acting
for PROVIDER. 

Reasonable access to records: A written request from an authorized DEPARTMENT employee requesting access to records relevant to claims submitted for
services furnished under any medical assistance programs delivered during normal business hours. The request must include a statement of the authority for the request, the rights of PROVIDER in
responding to the request, the reasonable date for producing the records (not less than 5 business days after the request), and the location where access to the records is to
be allowed. 

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Recipient: A resident of the State of Utah who is eligible for and received services under medical assistance programs. 

Sanctioned individuals: Anyone on any exclusion list maintained by the state or federal government. 

Significant business transaction: Any series of transactions during one fiscal year which exceeds $25,000. 

Subcontractor: (a) an individual, agency or organization to which a disclosing entity has contracted or delegated some of its management
functions or responsibilities of providing medical care to its patients; or (b) an individual, agency or organization with which a fiscal agent has entered into a contract, agreement or
purchase order or lease (or leases of real property) to obtain space, supplies, equipment or services provided under the Medicaid agreement. 

Third party: Any insurance company, organization, corporation, program or agency which has a responsibility to pay for all or part of the services
rendered to the recipient. This specifically excludes the parents and relatives of the recipient and other parties not mentioned above. 

TERMS OF AGREEMENT  

I.    DEPARTMENT agrees to:  

	1.
	Enrollment:
Enroll PROVIDER in the Medicaid and UMAP Programs if PROVIDER has 1) submitted an application, licensure, and other supporting
documentation; 2) agreed to the terms of this contract; and 3) otherwise complies with the requirements for enrollment. Once approved, DEPARTMENT will issue a unique Medicaid Provider
Number or will assign a National Provider Identifier, if appropriate, to PROVIDER.

	2.
	Manual:
Furnish to PROVIDER, upon enrollment and on request thereafter, a current copy of the appropriate provider manuals (Utah Medicaid Provider Manual
or UMAP Provider Manual). DEPARTMENT will also include PROVIDER on the mailing list for the Medicaid Information Bulletin (MIB) and for updates to the provider manual. DEPARTMENT agrees to include
changes to this agreement in the MIB. Department shall establish a process that permits the input of providers and associations representing providers before implementing a significant policy or
practice that providers would be expected to comply with under the terms of the agreement. Fee schedules, current provider manuals, a current copy of this agreement, the agreement with the Medicaid
Fraud Unit, as well as applicable and appropriate state and federal rules and regulations, to the extent practicable, will also be available for review from the Utah Medicaid internet site
(the address at the time of this agreement was http://www.health.state.ut.us/medicaid). Copies will also be available upon request.

	3.
	Policy,
Rules and Regulations: Comply with all appropriate and applicable state and federal rules and regulations, including due process rights of PROVIDER
to be free from unreasonable search and seizure and right to counsel.

	4.
	Civil
Rights Information: Supply PROVIDER with statements about civil rights to post as public information. Statements include
non-discrimination policy, the availability of language interpretation service, and the procedure for filing civil rights complaints. DEPARTMENT agrees to pay for interpretive services,
for eligible Medicaid clients seeking Medicaid covered services in either a fee-for-service or an HMO setting (generally included in the flat fee paid to the HMO). 

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	5.
	Payment:
Pay PROVIDER for services to Medicaid/UMAP recipients in accordance with the policy and the fee schedule in effect at the time the services are
rendered. DEPARTMENT agrees to periodically review provider reimbursement rates in the Medical Care Advisory Committee and to publish the results of the review in the MIB. DEPARTMENT shall give
PROVIDER, upon request (also available on the internet as per paragraph 2), the fee schedule appropriate for the type of service rendered by PROVIDER. If DEPARTMENT learns of evidence that a
PROVIDER has under billed DEPARTMENT, DEPARTMENT shall promptly inform the PROVIDER. DEPARTMENT agrees to accept amended claims for up to three (3) years after the date of service, if provider
has initially filed the claim within the one (1) year federal time limit.

	6.
	Appeals
and Employee Complaint Record: Accept and process appeals in accordance with policy in the provider manual. When a PROVIDER'S billing or coding
practices have come under the scrutiny of DEPARTMENT, DEPARTMENT shall inform PROVIDER if DEPARTMENT makes a tentative finding that a billing or coding practice has resulted in an under or overpayment
to PROVIDER. A tentative finding shall be reviewed by a nationally credentialed coder employed or contracted by DEPARTMENT before the PROVIDER is notified of the finding if the total amount of
all pending overpayments against the PROVIDER is more than $500.00, or after PROVIDER notification if the total amount of all pending overpayments is less than $500.00 and the PROVIDER requests the
review within 15 days of receiving the notification. PROVIDER may respond to a tentative finding within 30 days by submitting additional verbal or written information to DEPARTMENT to
clarify PROVIDER'S billing practices or correct a possible misunderstanding. PROVIDER may include as additional information the findings and opinion of an independent coding expert retained by
PROVIDER. DEPARTMENT agrees to carefully evaluate any additional information from PROVIDER in making its written agency decision. If PROVIDER disagrees with the agency decision, PROVIDER may request
an informal conference with a DEPARTMENT representative that was not directly involved in the agency decision. PROVIDER retains all rights to request a review of the agency decision through
DEPARTMENT'S established administrative review process, including the right to request a review of an agency decision in the first place without having to either submit additional information or
request an informal conference. The Department agrees to establish a process to track provider complaints against employees and to take appropriate administrative action in the event that a pattern of
substantiated complaints are found to exist.

	7.
	Overpayment,
Civil Enforcement and Criminal Fraud: Maintain an agreement with the State Medicaid Fraud Unit (MFU) regarding allocation of responsibility
between DEPARTMENT and the MFU regarding investigation and prosecution. DEPARTMENT agrees to furnish PROVIDER with a copy of the agreement with the MFU upon request. DEPARTMENT agrees to properly
train personnel to assure that judgments about proper coding of claims are reasonable and justified. This may include participation in a national credentialing process. The Department shall also use
professional consultants to review billing practices and other information that suggests an investigation of a provider should be commenced. DEPARTMENT shall actively monitor the billing practices of
providers and offer training and technical assistance to providers on the normal and customary billing practices of other providers, to allow providers to avoid good faith mistakes in billing
practices.

	8.
	Department
Subject to Administrative Procedures Act for Dispute Resolution: All disputes, including those involving suspended payments, are subject to the
administrative procedures act (UCA 63-46b). Providers will have full rights to appeal any agency action of the Department against that Provider through an administrative hearing
process. 

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II.    PROVIDER agrees to:  

	1.
	Non-Discrimination:
Abide by the provisions of Title VI of the Civil Rights Act of 1964 as amended (42 U.S.C. 2000e) which prohibits
discrimination against any employee or applicant for employment or an applicant or recipient of services, on the basis of race, religion, color, national origin, age, or sex. In addition, PROVIDER
agrees to abide by the requirements of the Americans with Disabilities Act of 1990, as amended (42 U.S.C. Chapter 126, Section 12101 et seq.), which prohibits discrimination
against disabled persons. PROVIDER agrees to abide by Section 504 of the Rehabilitation Act, as amended (45 CFR, Part 85); the Age Discrimination Act of 1975, as amended; as well
as other state and federal laws, rules and regulations as amended.

	2.
	Civil
Rights Information: Display civil rights information provided by DEPARTMENT in a conspicuous location.

	3.
	Policy,
Rules and Regulations: Be aware of and comply with policies and procedures in the provider manual and MIBs in effect when the service was rendered.
When PROVIDER becomes aware of missing manuals or MIBs, make an immediate request for the material. PROVIDER will comply with all appropriate and applicable state and federal rules and regulations.

	4.
	Advanced
Directives: Home health agencies, hospitals, nursing homes, and hospice providers must comply with the advance directives requirements for
applicable provider types as specified in 42 CFR, subpart I.

	5.
	Services:
Provide care and services as authorized by PROVIDER'S license under the laws of the state in which the services are rendered, under the federal
regulations, and in accordance with all applicable Medicaid/UMAP regulations.

	6.
	Third
Party Liability: Seek payment for services rendered from all available third party sources prior to billing Medicaid/UMAP as per the Utah Medicaid
Provider Manual.

	7.
	Billing:
Submit claims for services in accordance with the Medicaid/UMAP policy in effect at the time of service. When used, PROVIDER will comply with
standards for electronic claims submission.

	8.
	Prohibition
on Billing Recipient: Not bill the recipient or otherwise attempt to collect payment for services except as specifically permitted by
Medicaid/UMAP policy. PROVIDER may obtain the advance consent of a Medicaid recipient to see the recipient as a private pay patient for a given service, and to bill the recipient, so long as the
PROVIDER does not bill Medicaid for the service. For recipients eligible for both Medicaid and Medicare, PROVIDER may make it known to the recipient that they are not a Medicaid participating provider
and bill the recipient for the Medicare coinsurance and/or deductible. PROVIDERS must not violate paragraph 1, non-discrimination when making a decision which patient to accept as a
Medicaid or Medicare recipient and which shall be private pay. PROVIDER will accept payment or claims adjudication from DEPARTMENT as payment in full for services rendered. For recipients enrolled in
a managed care plan, payment from the plan is considered payment in full.

	9.
	Records:
Maintain all records for services rendered under this agreement to fully disclose the extent of services related to billed charges or claims for a
minimum of five (5) years after the date of service (or until all audits in process are completed, whichever is later). PROVIDER certifies that all information, reports, and supporting
documents are accurate and true to the best of his/her knowledge.

	10.
	Overpayment:
Accept responsibility to substantiate all services provided to Medicaid/UMAP recipients and for correctly filing claims. If PROVIDER receives
a Medicaid/UMAP payment in excess of the allowed Medicaid reimbursement amount, PROVIDER must reimburse DEPARTMENT within 30 days of request for repayment by DEPARTMENT, regardless of who
caused the overpayment. PROVIDER may challenge any overpayment calculation through an administrative hearing, and the 30-day period will begin upon receipt of final judgment. If not paid
within 30 days of discovery, DEPARTMENT may recoup court costs, attorneys' fees, penalties, and other costs necessary to recover the overpayment. Causes of overpayment include lack of
documentation for claimed services, improper billing, payments by third parties, failure to supply requested records, failure to disclose ownership interests, failure to disclose persons convicted of
crimes associated with medical assistance programs, or failure to disclose sanctioned individuals. 

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	11.
	Ownership
Disclosure: Conform with 42 CFR 455.100 to 106, concerning disclosure of ownership and other information. This includes submitting in
writing under the following conditions: 1) with application, 2) within thirty-five (35) days of any request by DEPARTMENT or its designees, or 3) within
35 days of the date on which the following circumstances come to PROVIDER'S knowledge (or reasonably should have come to PROVIDER'S knowledge), full and complete information about:

	1.
	The
ownership of any subcontractor with whom PROVIDER has had business transactions totaling more than $25,000 during the 12-month period ending on the date of the request
or knowledge.

	2.
	Any
significant business transactions between PROVIDER and any wholly owned supplier, or between PROVIDER and any subcontractor, during the 5-year period ending on the date
of the request or knowledge.

	3.
	Any
person who has an ownership interest in PROVIDER including: the name and address of each and the name of any other disclosing entity in which they have an ownership interest; and
whether any persons named are related to another as spouse, parent, child, or sibling.

	12.
	Criminal
Disclosure: Disclose to DEPARTMENT, any person who is an agent or managing employee of PROVIDER who has been convicted of a criminal offense
related to that person's involvement in any medical assistance program since the inception of these programs. PROVIDER agrees to exclude any sanctioned individual from participation under
this agreement.

	13.
	Independent
Contractor: Accept the status of an independent contractor without authorization, express or implied, to bind DEPARTMENT or the State of Utah
to any agreement, settlement, liability or understanding whatsoever.

	14.
	Hold
Harmless: Indemnify and hold harmless DEPARTMENT for any claims arising out of work performed by PROVIDER under authority of this agreement.

	15.
	Notification
of Adverse Action on License: Notify DEPARTMENT, within thirty (30) days of any adverse action taken by state or federal regulators on
PROVIDER'S license that significantly impacts PROVIDER'S ability to provide services to Medicaid recipients. 

III.    DEPARTMENT and PROVIDER both agree:  

	1.
	Confidentiality:
That neither party will disclose information concerning the care or services given to recipients or other clients except as specifically
allowed by state and federal laws and regulations.

	2.
	Length
of Agreement: This agreement will be in effect for a period of at least one year. DEPARTMENT shall periodically (at least every three years)
notify PROVIDER that DEPARTMENT intends that this agreement remains in force and supply PROVIDER with a current copy of this agreement. The notice shall also inform PROVIDER of the option to terminate
the agreement upon thirty days written notice to the DEPARTMENT. 

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	3.
	Modifications
to Agreement: No exception, modification, change or amendment to this agreement will be valid unless set forth in a written document signed
by both parties, except as set forth in paragraph 2 above.

	4.
	Suspended
Payments: DEPARTMENT may withhold payments, in whole or in part, upon receipt of reliable evidence of fraud or willful misrepresentation as
specified in 42 CFR section 455.23. DEPARTMENT shall fully document the reliable evidence it evaluated in making a decision to withhold payment. If DEPARTMENT has evidence of fraud or
willful misrepresentation on the part of PROVIDER, DEPARTMENT may notify PROVIDER of the temporary suspension of this agreement. If PROVIDER has been notified of the temporary suspension of
this agreement, PROVIDER may not bill for services rendered to eligible individuals during the period of the suspension.

	5.
	Termination:
PROVIDER may terminate this agreement, with or without cause, upon thirty (30) days written advance notice. Payments will be made for
services rendered up to and including the date of termination. Termination of this agreement by the Department will be governed by Utah Admin. Code R414-22, Administrative Sanction
Procedures and Regulations. PROVIDER will promptly supply all information necessary for the reimbursement of any outstanding claims. An extension of up to 30 days may be granted by DEPARTMENT
to allow for continuity of patient care.

	6.
	Superseding
Effect: This agreement supersedes any and all previous agreements between DEPARTMENT and PROVIDER.

	7.
	Agreement
with Health Maintenance Organization (HMO): Medicaid eligible patients seen by PROVIDER under a contract with an HMO, the agreement with the HMO
governs the rights and responsibilities of PROVIDER, rather than this agreement. 

IV.    Access to Records/Appeals/Legal Rights:  

	1.
	Records
Access Authority: Federal rules require Medicaid providers to provide access to medical records upon request by any state or federal government
agency conducting a Medicaid audit or investigation. Medicaid recipients and applicants sign a waiver of privacy rights to their Medicaid records for purposes of administering the Medicaid program. By
signing this agreement, PROVIDER agrees to provide reasonable access to all requested records relevant to claims submitted for services furnished under any medical assistance programs for auditing and
investigative purposes by DEPARTMENT employees. Under extraordinary circumstances as defined in this agreement, PROVIDER agrees to furnish DEPARTMENT with immediate access to records. In such cases,
DEPARTMENT shall, at a minimum, disclose to PROVIDER that (1) a request for immediate access is an extraordinary request and (2) that the differences between reasonable access and
immediate access are explained in the Provider Agreement. In each case DEPARTMENT shall fully document the extraordinary circumstances that justify the request for immediate access and why no other
less intrusive method of obtaining the records was reasonably available. Access to records by the State Medicaid Fraud Unit (MFU) is governed by applicable state and federal law, including
42 CFR 1001.1301 which sets forth (1) the information that must be included in a reasonable, written request for documents and (2) defines immediate access for the MFU and
the circumstances under which it must be given. DEPARTMENT may not permit a member of the MFU to state, suggest, or imply that the member is acting on behalf of DEPARTMENT in conducting an audit or
investigation unless the audit or investigation is in fact at the request and under the direct supervision and oversight of DEPARTMENT.

	2.
	Limitation
on Authority: This agreement does not confer any authority to search, detain, interrogate, or subpoena records or employees of PROVIDER. Rules
regarding subpoenas and search warrants are governed by state and federal law and by the terms stated in each particular warrant or subpoena. 

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	3.
	Legal
Counsel: Legal counsel may be obtained in responding to a request for records under this agreement or pursuant to a civil, administrative, or
criminal subpoena. However, neither an attorney, nor any other person may obstruct or delay a law enforcement officer in serving a signed and valid search warrant.

	4.
	Failure
to Produce Records: Failure to produce or make records available for copying pursuant to a valid reasonable or immediate request for access
according to the terms of the request may result in punitive administrative measures against PROVIDER.

	5.
	Right
to Appeal: PROVIDER has the right to appeal to the Division of Health Care Financing any claim arising out of a request for records under this
agreement, including disputing any alleged overpayment or non-compliance with Medicaid rules.

	6.
	Criminal
Proceedings: All claims involving criminal allegations will be prosecuted by the State Medicaid Fraud Unit (MFU). Objections to subpoenas, search
warrants, or investigative tactics, behavior, and procedures may be handled in court.

	7.
	Effect
of Criminal Sanctions: Criminal prosecutions which result in a conviction, including a plea bargain, may serve as a basis to terminate a Medicaid
provider agreement. 

PROVIDER  

	

 Type or Print PROVIDER Name	
 	

 	

 
	 	 	 	 
	

 Type or Print Name of Corporation	
 	

 	

 
	 	 	 	 
	

 PROVIDER Signature	
 	

Date:	

Page
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DEPARTMENT  

        PROVIDER is hereby accepted and is assigned the following Medicaid/UMAP Provider Number or National Provider Identification number: 

	

 Medicaid/UMAP Provider Number	
 	

 	

 
	 	 	 	 
	

 Type or Print Title of Authorized Party	
 	

 	

 
	 	 	 	 
	

 Signature of Authorized Party	
 	

Date:	

        Division
of Health Care Financing—Utah State Department of Health 

Page
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