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HomeMy WebLinkAboutAgreements/Contracts - GRIS (003)M P7 ^rt!\ r 1 77` 7- ewnn7 r—N XVI 1-064 Name According to W-9 Form with d/b/a: Grant County dba Grant County Integrated Service0y: Dat0: AMERIGROUP WASHINGTON, INC. PROVIDER AGREEMENT This Provider Agreement (hereinafter "Agreement") is made and entered into by and between Amerigroup Washington, Inc. (hereinafter "Amerigroup") and the undersigned Provider (hereinafter "Provider"), effective as of the date next to Amerigroup's signature (the "Effective Date"). In consideration of the mutual promises and covenants herein contained, the sufficiency of which is acknowledged by the parties, the parties agree as follows: ARTICLE I DEFINITIONS "Affiliate" means any entity that is: (i) owned or controlled, either directly or through a parent or subsidiary entity, by Amerigroup, or any entity which controls or is under common control with Amerigroup, and/or (ii) that is identified as an Affiliate on a designated web site as referenced in the provider manual(s). Unless otherwise set forth in this Agreement, an Affiliate may access the rates, terms and conditions of this Agreement. "Agency" means a federal, state or local agency, administration, board or other governing body with jurisdiction over the governance or administration of a Health Benefit Plan. "Amerigroup Rate" means the lesser of one hundred percent (100%) of Eligible Charges for Covered Services, or the total reimbursement amount that Provider and Amerigroup have agreed upon as set forth in the Plan Compensation Schedule ("PCS"). The Amerigroup Rate includes applicable Cost Shares, and shall represent payment in full to Provider for Covered Services. "Audit" means a post -payment review of the Claim(s) and supporting clinical information reviewed by Amerigroup to ensure payment accuracy. The review ensures Claim(s) comply with all pertinent aspects of payment including, but not limited to, contractual terms, Regulatory Requirements, Coded Service Identifiers (as defined in the PCS) guidelines and instructions, Amerigroup medical policies and clinical utilization management guidelines, reimbursement policies, and generally accepted medical practices. Audit does not include medical record review for quality and risk adjustment initiatives, or activities conducted by Amerigroup's Special Investigation Unit ("SIU"). "Claim" means either the uniform bill claim form or electronic claim form in the format prescribed by Plan submitted by a provider for payment by a Plan for Health Services rendered to a Member. "CMS" means the Centers for Medicare & Medicaid Services, an administrative agency within the United States Department of Health & Human Services ("HHS"). "Cost Share" means, with respect to Covered Services, an amount which a Member is required to pay under the terms of the applicable Health Benefit Plan. Such payment may be referred to as an allowance, coinsurance, copayment, deductible, penalty or other Member payment responsibility, and may be a fixed amount or a percentage of applicable payment for Covered Services rendered to the Member. "Covered Services" means Medically Necessary Health Services, as determined by Plan and described in the applicable Health Benefit Plan, for which a Member is eligible for coverage. "Government Contract" means the contract between Amerigroup and an applicable party, such as an Agency, which governs the delivery of Health Services by Amerigroup to Member(s) pursuant to a Government Program. "Government Program" means any federal or state funded program under the Social Security Act, and any other federal, or state, county or other municipally funded program or product in which Amerigroup maintains a contract to furnish services as designated by Amerigroup. For purposes of this Agreement, Government Program does not include the Federal Employees Health Benefits Program ("FEHBP"), or any state or local government employer program. "Health Benefit Plan" means the document(s) that set forth Covered Services, rules, exclusions, terms and conditions of coverage. Such document(s) may include but are not limited to a Member handbook, a health certificate of coverage, or evidence of coverage. "Health Service" means those services, supplies or items that a health care provider is licensed, equipped and staffed to provide and which he/she/it customarily provides to or arranges for individuals. Washington Enterprise Provider Agreement 1 1508596321 © 2020 Nov — V4 Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. "Medically Necessary" or "Medical Necessity" means the definition as set forth in the applicable Participation Attachment(s). "Member" means any individual who is eligible, as determined by Plan, to receive Covered Services under a Health Benefit Plan. For all purposes related to this Agreement, including all schedules, attachments, exhibits, provider manual(s), notices and communications related to this Agreement, the term "Member" may be used interchangeably with the terms Insured, Covered Person, Covered Individual, Enrollee, Subscriber, Dependent Spouse/Domestic Partner, Child, Beneficiary or Contract Holder, and the meaning of each is synonymous with any such other. "Network" means a group of providers that support, through a direct or indirect contractual relationship, one or more product(s) and/or program(s) in which Members are enrolled. "Other Payors" means persons or entities, pursuant to an agreement with Amerigroup or an Affiliate, that access the rates, terms or conditions of this Agreement with respect to certain Network(s), excluding Government Programs unless otherwise set forth in any Participation Attachment(s) for Government Programs. Other Payors include, without limitation, employers or insurers providing Health Benefit Plans pursuant to partially or wholly insured, self- administered or self-insured programs. "Participating Provider" means a person, including but not limited to, a physician or other health care professional or entity, including but not limited to a hospital, health care facility, a partnership of such professionals, or a professional corporation, or an employee or subcontractor of such person or entity, that is party to an agreement to provide Covered Services to Members that has met all applicable required Plan credentialing requirements, standards of participation and accreditation requirements for the services the Participating Provider provides, and that is designated by Plan to participate in one or more Network(s). Unless otherwise specifically delineated, all references herein to "Provider" may also mean and refer to "Participating Provider". "Participation Attachment(s)" means the document(s) attached hereto and incorporated herein by reference, and which identifies the additional duties and/or obligations related to Network(s), Government Program(s), Health Benefit Plan(s), and/or Plan programs such as quality and/or incentive programs. "Plan" means Amerigroup, an Affiliate, and/or an Other Payor. For purposes of this Agreement, when the term "Plan" applies to an entity other than Amerigroup, "Plan" shall be construed to only mean such entity (i.e., the financially responsible Affiliate or Other Payor under the Member's Health Benefit Plan). "Plan Compensation Schedule" and "Plan Compensation Schedule Attachment" (collectively "PCS") means the document(s) attached hereto and incorporated herein by reference, and which set forth the Amerigroup Rate(s) and compensation related terms for the Network(s) in which Provider participates. The PCS may include provider type, additional Provider obligations and specific Amerigroup compensation related terms and requirements. "Regulatory Requirements" means any requirements, as amended from time to time, imposed by applicable federal, state or local laws, rules, regulations, guidelines, instructions, Government Contract, or otherwise imposed by an Agency or government regulator in connection with the procurement, development or operation of a Health Benefit Plan, or the performance required by either party under this Agreement. The omission from this Agreement of an express reference to a Regulatory Requirement applicable to either party in connection with their duties and responsibilities shall in no way limit such party's obligation to comply with such Regulatory Requirement. ARTICLE II SERVICES/OBLIGATIONS 2.1 Member Identification. Amerigroup shall ensure that Plan provides a means of identifying Member either by issuing a paper, plastic, electronic, or other identification document to Member or by a telephonic, paper or electronic communication to Provider. This identification need not include all information necessary to determine Member's eligibility at the time a Health Service is rendered, but shall include information necessary to contact Plan to determine Member's participation in the applicable Health Benefit Plan. Provider acknowledges and agrees that possession of such identification document or ability to access eligibility information telephonically or electronically, in and of itself, does not qualify the holder thereof as a Member, nor does the lack thereof mean that the person is not a Member. 2.2 Provider Non-discrimination. Provider shall provide Health Services to Members in a manner similar to and within the same time availability in which Provider provides Health Services to any other individual. Provider will not differentiate, or discriminate against any Member as a result of his/her enrollment in a Health Benefit Washington Enterprise Provider Agreement 2 1508596321 © 2020 Nov — V4 Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. Plan, or because of race, color, creed, national origin, ancestry, religion, sex, marital status, age, disability, payment source, state of health, need for Health Services, status as a litigant, status as a Medicare or Medicaid beneficiary, sexual orientation, gender identity, or any other basis prohibited by law. Provider shall not be required to provide any type, or kind of Health Service to Members that he/she/it does not customarily provide to others. Additional requirements may be set forth in the applicable Participation Attachment(s). 2.3 Publication and Use of Provider Information. Provider agrees that Amerigroup, Plans or their designees may use, publish, disclose, and display, for commercially reasonable general business purposes, either directly or through a third party, information related to Provider, including but not limited to demographic information, information regarding credentialing, affiliations, performance data, Amerigroup Rates, and information related to Provider for transparency initiatives. 2.4 Use of Symbols and Marks. Neither party to this Agreement shall publish, copy, reproduce, or use in any way the other party's symbols, service mark(s) or trademark(s) without the prior written consent of such other party. Notwithstanding the foregoing, the parties agree that they may identify Provider as a participant in the Network(s) in which he/she/it participates. 2.5 Submission and Adjudication of Claims. Provider shall submit, and Plan shall adjudicate, Claims in accordance with the applicable Participation Attachment(s), the PCS, the provider manual(s) and Regulatory Requirements. If Provider submits Claims prior to receiving notice of Amerigroup's approval pursuant to section 2.13, then such Claims must be submitted in accordance with prior authorization requirements, and shall be processed as out of network. Amerigroup shall not make retroactive adjustments with respect to such Claims. 2.6 Payment in Full and Hold Harmless. 2.6.1 Provider agrees to accept as payment in full, in all circumstances, the applicable Amerigroup Rate whether such payment is in the form of a Cost Share, a payment by Plan, or a payment by another source, such as through coordination of benefits or subrogation. Provider shall bill, collect, and accept compensation for Cost Shares. Provider agrees to make reasonable efforts to verify Cost Shares prior to billing for such Cost Shares. In no event shall Plan be obligated to pay Provider or any person acting on behalf of Provider for services that are not Covered Services, or any amounts in excess of the Amerigroup Rate less Cost Shares or payment by another source, as set forth above. Consistent with the foregoing, Provider agrees to accept the Amerigroup Rate as payment in full if the Member has not yet satisfied his/her deductible. 2.6.2 Except as expressly permitted under Regulatory Requirements, Provider agrees to abide by the provisions of WAC 182-502-160, and agrees that in no event, including, but not limited to non- payment by Amerigroup, Amerigroup insolvency, or breach of this Agreement, shall Provider bill, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from or have any recourse against a Member, any person acting on behalf of a Member, or HCA for services provided pursuant to this Agreement and Provider shall accept payment from Amerigroup as payment in full. This provision shall not prohibit collection of nominal cost-sharing or supplemental charges made in accordance with the terms of applicable Government Contracts or Agency requirements. Provider further agrees that this section shall survive the termination of this Agreement regardless of the cause giving rise to such termination and shall be construed to be for the benefit of Member, and that this provision supersedes any oral or written contrary agreement now existing or hereafter entered into between Provider and a Member or persons acting on such Member's behalf. Provider agrees and understands that willfully collecting or attempting to collect an amount from a Member knowing that collection to be in violation of the participating provider or facility contract constitutes a class C felony under RCW 48.80.030(5). Provider agrees, in the event of Amerigroup's insolvency, to continue to provide the services promised in this Agreement to Members of Amerigroup for the duration of the period for which premiums on behalf of the Member were paid to provider or until the Member's discharge from inpatient facilities, whichever time is greater. Provider shall not hold Member liable for payment of any fees that are the legal obligation of Amerigroup. Notwithstanding any other provision of this Agreement, nothing in this Agreement shall be construed to modify the rights and benefits contained in the Member's health plan. Provider may not bill the Member for Covered Services (except for deductibles, copayments, or coinsurance) where Amerigroup denies payments because the provider has failed to comply with the terms or conditions of this Agreement. Provider further agrees that the provisions of WAC 284- 170-421(a), (b), (c), and (d) shall survive termination of this contract regardless of the cause giving rise to termination and shall be construed to be for the benefit of Provider's Members. If Provider Washington Enterprise Provider Agreement 3 1508596321 © 2020 Nov — V4 Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. enters into agreements with other providers who agree to provide Covered Services to Members of Amerigroup, with the expectation of receiving payment directly or indirectly from Amerigroup, then such providers must agree to abide by the provisions of WAC 284-170-421 (a), (b), (c), (d), and (e). 2.7 Recoupment/Offset/Adjustment for Overpayments. Except as expressly permitted under Regulatory Requirements, Amerigroup shall be entitled to request a refund in an amount equal to any overpayments made by Amerigroup to Provider provided that any refund requests by Amerigroup shall be made in conformance with RCW 48.43.600 timelines for notice and objection, as such section may be amended or recodified from time to time. Upon determination that an overpayment is due from Provider to Amerigroup, Amerigroup shall first give Provider notice of overpayment and request reimbursement via check for such an overpayment. If Provider fails to contest the request in writing within thirty (30) days following the date of Provider's receipt of such notice, the request is deemed accepted. Provider then must submit a check to Amerigroup for such overpayment, or Amerigroup shall be entitled to offset such overpayment against other amounts due and payable by Amerigroup to Provider. Except in the case of fraud by the Provider, payments made by Amerigroup shall be considered final and not subject to adjustment twenty-four (24) months after such payment is received by Provider. If Provider determines that Amerigroup has made an underpayment to Provider for Covered Services rendered to a Member, Provider shall make a written request for additional payment from Amerigroup only in accordance with RCW 48.43.605, as such section may be amended or recodified from time to time. Such written request must specify the reasons for such underpayment request and must be submitted within twenty-four (24) months after the date that the claim was denied by Amerigroup or payment intended to satisfy the claim was made by Amerigroup. 2.8 Use of Subcontractors. Provider and Plan may fulfill some of their duties under this Agreement through subcontractors. For purposes of this provision, subcontractors shall include, but are not limited to, vendors and non -Participating Providers that provide supplies, equipment, staffing, and other services to Members at the request of, under the supervision of, and/or at the place of business of Provider. Provider shall provide Amerigroup with thirty (30) days prior notice of any Health Services subcontractors with which Provider may contract to perform Provider's duties and obligations under this Agreement, and Provider shall remain responsible to Plan for the compliance of his/her/its subcontractors with the terms and conditions of this Agreement as applicable, including, but not limited to, the Payment in Full and Hold Harmless provisions herein. 2.9 Compliance with Provider Manual(s) and Policies, Programs and Procedures. Provider agrees to cooperate and comply with, Amerigroup's provider manual(s), and all other policies, programs and procedures (collectively "Policies") established and implemented by Plan applicable to the Network(s) in which Provider participates. Amerigroup or its designees may modify the provider manual(s) and its Policies by making a good faith effort to provide notice to Provider at least thirty (30) days in advance of the effective date of material modifications thereto. 2.10 Referral Incentives/Kickbacks. Provider represents and warrants that Provider does not give, provide, condone or receive any incentives or kickbacks, monetary or otherwise, in exchange for the referral of a Member, and if a Claim for payment is attributable to an instance in which Provider provided or received an incentive or kickback in exchange for the referral, such Claim shall not be payable and, if paid in error, shall be refunded to Amerigroup. 2.11 Networks and Provider Panels. Provider shall be eligible to participate only in those Networks designated on the Provider Networks Attachment of this Agreement. Provider shall not be recognized as a Participating Provider in such Networks until the later of: 1) the Effective Date of this Agreement or; 2) as determined by Plan in its sole discretion, the date Provider has met Plan's applicable credentialing requirements, standards of participation and accreditation requirements. Provider acknowledges that Plan may develop, discontinue, or modify new or existing Networks, products and/or programs. In addition to those Networks designated on the Provider Networks Attachment, Amerigroup may also identify Provider as a Participating Provider in additional Networks, products and/or programs designated in writing from time to time by Amerigroup. The terms and conditions of Provider's participation as a Participating Provider in such additional Networks, products and/or programs shall be on the terms and conditions as set forth in this Agreement unless otherwise agreed to in writing by Provider and Amerigroup. In addition to and separate from Networks that support some or all of Plan's products and/or programs (e.g., HMO, PPO and Indemnity products), Provider further acknowledges that certain Health Services, including by way of example only, laboratory services, may be provided exclusively by designated Participating Providers (a "Health Services Designated Network"), as determined by Plan. Provider agrees to refer Members to such designated Participating Providers in a Health Services Designated Network for the Washington Enterprise Provider Agreement 4 1508596321 © 2020 Nov — V4 Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. provision of certain Health Services, even if Provider performs such services. Notwithstanding any other provision in this Agreement, if Provider provides a Health Service to a Member for which Provider is not a designated Participating Provider in a Health Services Designated Network, then Provider agrees that he/she/it shall not be reimbursed for such services by Amerigroup, Plan or the Member, unless Provider was authorized to provide such Health Service by Plan. 2.12 Change in Provider Information. Provider shall immediately send written notice, in accordance with the Notice section of this Agreement, to Amerigroup of: 2.12.1 Any legal, governmental, or other action or investigation involving Provider which could affect Provider's credentialing status with Plan, or materially impair the ability of Provider to carry out his/her/its duties and obligations under this Agreement, except for temporary emergency diversion situations; or 2.12.2 Any change in Provider accreditation, affiliation, hospital privileges (if applicable), insurance, licensure, certification or eligibility status, or other relevant information regarding Provider's practice or status in the medical community. 2.13 Provider Credentialing, Standards of Participation and Accreditation. Provider warrants that he/she/it meets all applicable Plan credentialing requirements, standards of participation, and accreditation requirements for the Networks in which Provider participates. A description of the applicable credentialing requirements, standards of participation, and accreditation requirements, are set forth in the provider manual(s) and/or in the PCS. Provider acknowledges that until such time as Provider has been determined to have fully met Plan's credentialing requirements, standards of participation, and accreditation requirements, as applicable, Provider shall not be entitled to the benefits of participation under this Agreement, including without limitation the Amerigroup Rates set forth in the PCS attached hereto. 2.14 Provider Staffinq and Staff Privile_ es. Provider agrees to maintain professional staffing levels to meet community access standards and where applicable, agrees to facilitate and to expeditiously grant admitting privileges to Participating Providers who meet facility's credentialing standards. 2.15 Adiustment Requests. If Provider believes a Claim has been improperly adjudicated for a Covered Service for which Provider timely submitted a Claim to Plan, Provider must submit a request for an adjustment to Plan in accordance with the provider manual(s). 2.16 Provision and Supervision of Services. In no way shall Amerigroup or Plan be construed to be providers of Health Services or responsible for, exercise control, or have direction over the provision of such Health Services. Provider shall be solely responsible to the Member for treatment, medical care, and advice with respect to the provision of Health Services. Provider agrees that all Health Services provided to Members under this Agreement shall be provided by Provider or by a qualified person under Provider's direction. Provider warrants that any nurses or other health professionals employed by or providing services for Provider shall be duly licensed or certified under applicable law. In addition, nothing herein shall be construed as authorizing or permitting Provider to abandon any Member. 2.17 Coordination of Benefits/Subrogation. Subject to Regulatory Requirements, Provider agrees to cooperate with Plan regarding subrogation and coordination of benefits, as set forth in Policies and the provider manual(s), and to notify Plan promptly after receipt of information regarding any Member who may have a Claim involving subrogation or coordination of benefits. 2.18 Cost Effective Care. Provider shall provide Covered Services in the most cost effective, clinically appropriate setting and manner. In addition, in accordance with the provider manual(s) and Policies, Provider shall utilize Participating Providers, and when Medically Necessary or appropriate, refer and transfer Members to Participating Providers for all Covered Services, including but not limited to specialty, laboratory, ancillary and supplemental services. 2.19 Facility -Based Providers. Provider agrees to require its contracted facility -based providers or those with exclusive privileges with Provider to obtain and maintain Participating Provider status with Amerigroup. Until such time as facility -based providers enter into agreements with Amerigroup, Provider agrees to fully cooperate with Amerigroup to prevent Members from being billed amounts in excess of the applicable Amerigroup non -participating reimbursement for such Covered Services. Facility -based providers may include, but are not limited to, anesthesiologists, radiologists, pathologists, neonatologists, hospitalists and emergency room physicians. Washington Enterprise Provider Agreement 5 1508596321 © 2020 Nov — V4 Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. ARTICLE III CONFIDENTIALITY/RECORDS 3.1 P_roprietaN and Confidential Information. Except as otherwise provided herein, all information and material provided by either party in contemplation of or in connection with this Agreement remains proprietary and confidential to the disclosing party. This Agreement, including but not limited to the Amerigroup Rates, is Amerigroup's proprietary and confidential information. Neither party shall disclose any information proprietary or confidential to the other, or use such information or material except: (1) as otherwise set forth in this Agreement; (2) as may be required to perform obligations hereunder; (3) as required to deliver Health Services or administer a Health Benefit Plan; (4) to Plan or its designees; (5) upon the express written consent of the parties; or (6) as required by Regulatory Requirements. Notwithstanding the foregoing, either party may disclose such information to its legal advisors, lenders and business advisors, provided that such legal advisors, lenders and business advisors agree to maintain confidentiality of such information. Provider and Amerigroup shall each have a system in place that meets all applicable Regulatory Requirements to protect all records and all other documents relating to this Agreement which are deemed confidential by law. Any disclosure or transfer of proprietary or confidential information by Provider or Amerigroup will be in accordance with applicable Regulatory Requirements. Provider shall immediately notify Amerigroup if Provider is required to disclose any proprietary or confidential information at the request of an Agency or pursuant to any federal or state freedom of information act request. 3.2 Confidentiality of Member Information. Both parties agree to comply with the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and the Health Information Technology for Economic and Clinical Health Act ("HITECH Act"), and as both may be amended, as well as any other applicable Regulatory Requirements regarding confidentiality, use, disclosure, security and access of the Member's personally identifiable information ("PII") and protected health information ("PHI"), (collectively "Member Information"). Provider shall review all Member Information received from Amerigroup to ensure no misrouted Member Information is included. Misrouted Member Information includes but is not limited to, information about a Member that Provider is not currently treating. Provider shall immediately destroy any misrouted Member Information or safeguard the Member Information for as long as it is retained. In no event shall Provider be permitted to misuse or re -disclose misrouted Member Information. If Provider cannot destroy or safeguard misrouted Member Information, Provider must contact Amerigroup to report receipt of misrouted Member Information. 3.3 Network Provider/Patient Discussions. Notwithstanding any other provision in this Agreement and regardless of any benefit or coverage exclusions or limitations associated with a Health Benefit Plan, Provider shall not be prohibited from discussing fully with a Member any issues related to the Member's health including recommended treatments, treatment alternatives, treatment risks and the consequences of any benefit coverage or payment decisions made by Plan or any other party. In addition, nothing in this Agreement shall be construed to, create any financial incentive for Provider to withhold Covered Services, or prohibit Provider from disclosing to the Member the general methodology by which Provider is compensated under this Agreement, such as for example, whether Provider is paid on a fee for service, capitation or Percentage Rate basis. Plan shall not refuse to allow or to continue the participation of any otherwise eligible provider, or refuse to compensate Provider in connection with services rendered, solely because Provider has in good faith communicated with one or more of his/her/its current, former or prospective patients regarding the provisions, terms or requirements of a Health Benefit Plan as they relate to the health needs of such patient. Nothing in this section shall be construed to permit Provider to disclose Amerigroup Rates or specific terms of the compensation arrangement under this Agreement. 3.4 Plan Access to and Requests for Provider Records. Provider and its designees shall comply with all applicable state and federal record keeping and retention requirements, and, as set forth in the provider manual(s) and/or Participation Attachment(s), shall permit Plan or its designees to have, with appropriate working space and without charge, on-site access to and the right to perform an Audit, examine, copy, excerpt and transcribe any books, documents, papers, and records related to Member's medical and billing information within the possession of Provider and inspect Provider's operations, which involve transactions relating to Members and as may be reasonably required by Plan in carrying out its responsibilities and programs including, but not limited to, assessing quality of care, complying with quality initiatives/measures, Medical Necessity, concurrent review, appropriateness of care, accuracy of Claims coding and payment, risk adjustment assessment as described in the provider manual(s), including but not limited to completion of the Encounter Facilitation Form (also called the "SOAP" note), compliance with this Agreement, and for research. In lieu of on-site access, at Plan's request, Provider or its designees shall submit records to Plan, or its designees via photocopy or electronic transmittal, within thirty (30) days, at no charge to Plan from Washington Enterprise Provider Agreement 6 1508596321 © 2020 Nov — V4 Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. either Provider or its designee. Provider shall make such records available to the state and federal authorities involved in assessing quality of care or investigating Member grievances or complaints in compliance with Regulatory Requirements. Provider acknowledges that failure to submit records to Plan in accordance with this provision and/or the provider manual(s), and/or Participation Attachment(s) may result in a denial of a Claim under review, whether on pre -payment or post -payment review, or a payment retraction on a paid Claim, and Provider is prohibited from balance billing the Member in any of the foregoing circumstances. 3.5 Transfer of Medical Records. Following a request, Provider shall transfer a Member's medical records in a timely manner, or within such other time period required under applicable Regulatory Requirements, to other health care providers treating a Member at no cost to Amerigroup, Plan, the Member, or other treating health care providers. 3.6 Clinical Data Sharing. Amerigroup and Provider desire to collaborate by sharing data, including Member Information, to enhance certain health care operations activities, primarily to help improve quality and efficiency of health care. Each party's access to better clinical and administrative data is critical to the mutual goal of Amerigroup and Provider improving health care quality as it relates to their respective Members and patients. Therefore and upon request, Provider agrees to provide data to Amerigroup for treatment purposes, for payment purposes, for health care operations purposes consistent with those enumerated in the first two paragraphs of the health care operations definition in HIPAA (45 CFR 164.501), or for purposes of health care fraud and abuse detection or compliance. Provider shall provide data as set forth in Policies or the provider manual(s), as applicable. ARTICLE IV INSURANCE 4.1 Amerigroup Insurance. Amerigroup shall self -insure or maintain insurance as required under applicable Regulatory Requirements to insure Amerigroup and its employees, acting within the scope of their duties. 4.2 Provider Insurance. Provider shall self -insure or maintain insurance acceptable to Amerigroup as set forth in the provider manual(s), Participation Attachment(s), PCS, or as required under applicable Regulatory Requirements. ARTICLE V RELATIONSHIP OF THE PARTIES 5.1 Relationship of the Parties. For purposes of this Agreement, Amerigroup and Provider are and will act at all times as independent contractors. Nothing in this Agreement shall be construed, or be deemed to create, a relationship of employer or employee or principal and agent, partnership, joint venture, or any relationship other than that of independent entities contracting with each other for the purposes of effectuating this Agreement. 5.2 Provider Representations and Warranties. Provider represents and warrants that it has the corporate power and authority to execute and deliver this Agreement on its own behalf, and on behalf of any other individuals or entities that are owned, or employed or subcontracted with or by Provider to provide services under this Agreement. Provider further certifies that individuals or entities that are owned, employed or subcontracted with Provider agree to comply with the terms and conditions of this Agreement. ARTICLE VI INDEMNIFICATION AND LIMITATION OF LIABILITY 6.1 Indemnification. Amerigroup and Provider shall each indemnify, defend and hold harmless the other party, and his/her/its directors, officers, employees, agents, Affiliates and subsidiaries ("Representatives"), from and against any and all losses, claims, damages, liabilities, costs and expenses (including without limitation, reasonable attorneys' fees and costs) arising from third party claims resulting from the indemnifying party's or his/her/its Representative's failure to perform the indemnifying party's obligations under this Agreement, and/or the indemnifying party's or his/her/its Representative's violation of any law, statute, ordinance, order, standard of care, rule or regulation. The obligation to provide indemnification under this Agreement shall be contingent upon the party seeking indemnification providing the indemnifying party with prompt written notice of any claim for which indemnification is sought, allowing the indemnifying party to control the defense and settlement of such claim, provided however that the indemnifying party agrees not to enter into any settlement or compromise of any claim or action in a manner that admits fault or imposes any restrictions or Washington Enterprise Provider Agreement 7 1508596321 © 2020 Nov — V4 Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. obligations on an indemnified party without that indemnified party's prior written consent which will not be unreasonably withheld, and cooperating fully with the indemnifying party in connection with such defense and settlement. 6.2 Limitation of Liability. Regardless of whether there is a total and fundamental breach of this Agreement or whether any remedy provided in this Agreement fails of its essential purpose, in no event shall either of the parties hereto be liable for any amounts representing loss of revenues, loss of profits, loss of business, the multiple portion of any multiplied damage award, or incidental, indirect, consequential, special or punitive damages, whether arising in contract, tort (including negligence), or otherwise regardless of whether the parties have been advised of the possibility of such damages, arising in any way out of or relating to this Agreement. Further, in no event shall Plan be liable to Provider for any extracontractual damages relating to any claim or cause of action assigned to Provider by any person or entity. ARTICLE VII DISPUTE RESOLUTION 7.1 Complaints of Members. Amerigroup shall notify the Provider concerning any complaint by a Member involving that Provider or a Participating Provider of that Provider in accordance with procedures set forth in the provider manual. The provisions of this Article shall only apply to disputes that have complied fully with all grievance and appeal procedures set forth in the provider manual. 7.2 Negotiation of Disputes. In the event of a dispute arising out of this Agreement that is not resolved by, or is not within the scope of relationship management set forth in the Agreement, or that is not resolved by informal discussions among the parties, the parties shall negotiate the dispute. Any party may initiate negotiation by sending a written description of the dispute to the other parties by certified or registered mail or personal delivery. The description shall explain the nature of the dispute in detail and set forth a proposed resolution, including a specific time frame within which the parties must act. The party receiving the letter must respond in writing within thirty (30) days with a detailed explanation of its position and a response to the proposed resolution. Within thirty (30) days of the initiating party receiving this response, principals of the party who have authority to settle the dispute will meet to discuss the resolution of the dispute. The initiating party shall initiate the scheduling of this negotiating session. 7.2.1 In the event the parties are unable to resolve the dispute following the negotiation, a party shall have the right to pursue all available remedies at law or equity, including injunctive relief. 7.3 Dispute Resolution. Except as expressly permitted under Regulatory Requirements or regulations governing dispute resolution, no process for the resolution of disputes arising out of a participating provider contract shall be considered fair under RCW 48.43.055 unless the process meets all the provisions of WAC 284-170- 440. 7.3.1 A dispute resolution process may include an initial informal process but must include a formal process for resolution of all contract disputes. 7.3.2 Amerigroup may have different types of dispute resolution processes as necessary for specialized concerns such as provider credentialing or as otherwise required by law. For example, disputes over Government Program coverage of Covered Services are subject to the grievance procedures established for Members. 7.3.3 Amerigroup must allow not less than thirty (30) days after the action giving rise to a dispute for providers to complain and initiate the dispute resolution process. 7.3.4 Amerigroup may not require alternative dispute resolution to the exclusion of judicial remedies; however, Amerigroup may require alternative dispute resolution prior to judicial remedies. 7.3.5 Amerigroup must render a decision on provider complaints within a reasonable time for the type of dispute. In the case of billing disputes, Amerigroup must render a decision within sixty (60) days of the complaint. 7.4 Period of Limitations. Unless otherwise provided for in this Agreement or a Participation Attachment(s), neither party shall commence any action at law or equity against the other to recover on any legal or equitable claim arising out of this Agreement ("Action") more than two (2) years after the events which gave rise to such Action; provided, however, this two (2) year limitation shall not apply to Actions by Amerigroup Washington Enterprise Provider Agreement 8 1508596321 © 2020 Nov — V4 Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. against Provider related to fraud, waste or abuse which shall be subject to the period of limitations set forth in applicable Regulatory Requirements. In the situation where Provider believes that Amerigroup underpaid a Claim, the Action arises on the date when Amerigroup first denies the Claim or first pays the Claim in an amount less than expected by Provider. In the situation where Amerigroup believes that it overpaid a Claim, the Action arises when Provider first contests in writing Amerigroup's notice to it that the overpayment was made. The deadline for initiating an Action shall not be tolled by the appeal process, provider dispute resolution process or any other administrative process. To the extent an Action is timely commenced, it will be administered in accordance with Article VII of this Agreement. ARTICLE VIII TERM AND TERMINATION 8.1 Term of Agreement. This Agreement shall commence at 12:01 AM on the Effective Date for a term of one (1) year, and shall continue automatically in effect thereafter for consecutive one (1) year terms unless otherwise terminated as provided herein. 8.2 Termination Without Cause. Either party may terminate this Agreement without cause at any time by giving at least one hundred eighty (180) days prior written notice of termination to the other party. Notwithstanding the foregoing, should a Participation Attachment(s) contain a longer without cause termination period, the Agreement shall continue in effect only for such applicable Participation Attachment(s) until the termination without cause notice period in the applicable Participation Attachment(s) ends. 8.3 Breach of Agreement. Except for circumstances giving rise to the Immediate Termination section, if either party fails to comply with or perform when due any material term or condition of this Agreement, the other party shall notify the breaching party of its breach in writing stating the specific nature of the material breach, and the breaching party shall have thirty (30) days to cure the breach. If the breach is not cured to the reasonable satisfaction of the non -breaching party within said thirty (30) day period, the non -breaching party may terminate this Agreement by providing written notice of such termination to the other party. The effective date of such termination shall be no sooner than sixty (60) days after such notice of termination. 8.4 Immediate Termination. 8.4.1 This Agreement or any Participation Attachment(s) may be terminated immediately by Amerigroup if: 8.4.1.1 Provider commits any act or conduct for which his/her/its license(s), permit(s), or any governmental or board authorization(s) or approval(s) necessary for business operations or to provide Health Services are lost or voluntarily surrendered in whole or in part; or 8.4.1.2 Provider commits fraud or makes any material misstatements or omissions on any documents related to this Agreement which Provider submits to Amerigroup or to a third party; or 8.4.1.3 Provider files a petition in bankruptcy for liquidation or reorganization by or against Provider, if Provider becomes insolvent, or makes an assignment for the benefit of its creditors without Amerigroup's written consent, or if a receiver is appointed for Provider or its property; or 8.4.1.4 Provider's insurance coverage as required by this Agreement lapses for any reason; or 8.4.1.5 Provider fails to maintain compliance with Plan's applicable credentialing requirements accreditation requirements or standards of participation; or 8.4.1.6 Amerigroup reasonably believes based on Provider's conduct or inaction, or allegations of such conduct or inaction, that the well-being of patients may be jeopardized; or 8.4.1.7 Provider has been abusive to a Member, an Amerigroup employee or representative; or 8.4.1.8 Provider and/or his/her/its employees, contractors, subcontractors, or agents are ineligible, excluded, suspended, terminated or debarred from participating in a Government Program, and in the case of an employee, contractor, subcontractor or Washington Enterprise Provider Agreement 9 1508596321 © 2020 Nov — V4 Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. agent, Provider fails to remove such individual from responsibility for, or involvement with, the Provider's business operations related to this Agreement, or if Provider has voluntarily withdrawn his/her/its participation in any Government Program as the result of a settlement agreement; or 8.4.1.9 Provider is convicted or has been finally adjudicated to have committed a felony or misdemeanor, other than a non -DUI related traffic violation. 8.4.2 This Agreement may be terminated immediately by Provider if: 8.4.2.1 Amerigroup commits any act or conduct for which its license(s), permit(s), or any governmental or board authorizations) or approval(s) necessary for business operations are lost or voluntarily surrendered in whole or in part; or 8.4.2.2 Amerigroup commits fraud or makes any material misstatements or omissions on any documents related to this Agreement which it submits to Provider or to a third party; or 8.4.2.3 Amerigroup files for bankruptcy, or if a receiver is appointed. 8.5 Partial Termination of Participating Providers. Amerigroup shall be entitled to terminate this Agreement as it applies to one or a number of Participating Providers under the terms of this Article VIII, without terminating the Agreement in its entirety, and in such case, the Agreement shall continue in full force and effect in connection with Provider and/or any and all Participating Providers as to which the Agreement has not been terminated. Notwithstanding the foregoing, Amerigroup reserves the right to terminate Participating Provider(s) from any or all Network(s) under the terms of this Article VIII while continuing the Agreement for the remaining Participating Provider(s). 8.6 Transactions Prior to Termination. Except as otherwise set forth in this Agreement, termination shall have no effect on the rights and obligations of the parties arising out of any transaction under this Agreement occurring prior to the date of such termination. 8.7 Continuation of Care Upon Termination. If this Agreement or any Participation Attachment terminates for any reasons other than one of the grounds set forth in the "Immediate Termination" section, then Provider shall, at Amerigroup's discretion, continue to provide Covered Services to all designated Members under this Agreement or any terminating Participation Attachment, as applicable, in accordance with Regulatory Requirements. During such continuation period, Provider agrees to: (i) accept reimbursement from Amerigroup for all Covered Services furnished hereunder in accordance with this Agreement and at the rates set forth in the PCS attached hereto; and (ii) adhere to Amerigroup's Policies, including but not limited to, Policies regarding quality assurance requirements, referrals, pre -authorization and treatment planning. 8.8 Survival. The provisions of this Agreement set forth below shall survive termination or expiration of this Agreement or any Participation Attachment(s): 8.8.1 Publication and Use of Provider Information; 8.8.2 Payment in Full and Hold Harmless; 8.8.3 Recoupment/Offset/Adjustment for Overpayments; 8.8.4 Confidentiality/Records; 8.8.5 Indemnification and Limitation of Liability; 8.8.6 Dispute Resolution; 8.8.7 Continuation of Care Upon Termination; and 8.8.8 Any other provisions required in order to comply with Regulatory Requirements. ARTICLE IX GENERAL PROVISIONS Washington Enterprise Provider Agreement 10 1508596321 © 2020 Nov — V4 Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. 9.1 Amendment. Except as otherwise expressly permitted under Regulatory Requirements, this Agreement may be amended by the mutual agreement of the parties as evidenced in a writing signed by the parties. In addition, Amerigroup shall be entitled to amend this Agreement as follows without the written agreement of Provider: 9.1.1 Upon thirty (30) days prior written notice to Provider, if the amendment is being effected by Amerigroup to comply with a Regulatory Requirement, such amendment shall be effective as of the effective date set forth in the amendment. Notwithstanding the above, Amerigroup shall be entitled to amend the Agreement upon less than thirty (30) days prior written notice if a shorter notice period is required in order to comply with such Regulatory Requirement. 9.1.2 Upon sixty (60) days prior written notice to Provider, to the extent the amendment is being effected by Amerigroup for a purpose other than compliance with a Regulatory Requirement. Provider shall be entitled to object to the amendment, by written notice provided to Amerigroup within sixty (60) days following Provider's receipt of such amendment. If a timely objection is received by Amerigroup, then the amendment shall take effect until the parties mutually agree on a resolution to the objection or this Agreement is terminated in accordance with the terms hereof. 9.1.3 An amendment to the Agreement may not be made retroactive without the consent of the Provider. 9.2 Assignment. This Agreement may not be assigned by Provider without the prior written consent of Amerigroup. Any assignment by Provider without such prior consent shall be voidable at the sole discretion of Amerigroup. Amerigroup may assign this Agreement in whole or in part. In the event of a partial assignment of this Agreement by Amerigroup, the obligations of the Provider shall be performed for Amerigroup with respect to the part retained and shall be performed for Amerigroup's assignee with respect to the part assigned, and such assignee is solely responsible to perform all obligations of Amerigroup with respect to the part assigned. The rights and obligations of the parties hereunder shall inure to the benefit of, and shall be binding upon, any permitted successors and assigns of the parties hereto. 9.3 Scope/Change in Status. 9.3.1 Amerigroup and Provider agree that this Agreement applies to Health Services rendered by Provider at the Provider's location(s) on file with Amerigroup. Amerigroup may, in its discretion, limit this Agreement to Provider's locations, operations, business or corporate form, status or structure in existence on the Effective Date of this Agreement and prior to the occurrence of any of the events set forth in subsections 9.3.1.1 — 9.3.1.5. Unless otherwise required by Regulatory Requirements, Provider shall provide at least ninety (90) days prior written notice of any such event. 9.3.1.1 Provider (a) sells, transfers or conveys his/her/its business or any substantial portion of his/her/its business assets to another entity through any manner including but not limited to a stock, real estate or asset transaction or other type of transfer; (b) is otherwise acquired or controlled by any other entity through any manner, including but not limited to purchase, merger, consolidation, alliance, joint venture, partnership, association, or expansion; or 9.3.1.2 Provider transfers control of his/her/its management or operations to any third party, including Provider entering into a management contract with a physician practice management company or with another entity which does not manage Provider as of the Effective Date of this Agreement, or there is a subsequent change in control of Provider's current management company; or 9.3.1.3 Provider acquires or controls any other medical practice, facility, service, beds or entity; or 9.3.1.4 Provider changes his/her/its locations, business or operations, corporate form or status, tax identification number, or similar demographic information; or 9.3.1.5 Provider creates or otherwise operates a licensed health maintenance organization or commercial health plan (whether such creation or operation is direct or through a Provider affiliate). Washington Enterprise Provider Agreement 1 1 1508596321 © 2020 Nov — V4 Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. 9.3.2 Notwithstanding the termination provisions of Article VIII, and without limiting any of Amerigroup's rights as set forth elsewhere in this Agreement, Amerigroup shall have the right to terminate this Agreement by giving at least sixty (60) days written notice to Provider if Amerigroup determines, that as a result of any of the transactions listed in subsection 9.3.1, Provider cannot satisfactorily perform the obligations hereunder, or cannot comply with one or more of the terms and conditions of this Agreement, including but not limited to the confidentiality provisions herein; or Amerigroup elects in its reasonable business discretion not to do business with Provider, the successor entity or new management company, as a result of one or more of the events as set forth in subsection 9.3.1. 9.3.3 Provider shall provide Amerigroup with thirty (30) days prior written notice of: 9.3.3.1 Addition or removal of individual provider(s) who are employed or subcontracted with Provider, if applicable. Any new individual providers must meet Plan's credentialing requirements or other applicable standards of participation prior to being designated as a Participating Provider; or 9.3.3.2 A change in mailing address. 9.3.4 If Provider is acquired by, acquires or merges with another entity, and such entity already has an agreement with Amerigroup, Amerigroup will determine in its sole discretion which Agreement will prevail. 9.4 Definitions. Unless otherwise specifically noted, the definitions as set forth in Article I of this Agreement will have the same meaning when used in any attachment, the provider manual(s) and Policies. 9.5 Entire Agreement. This Agreement, exhibits, attachments, appendices, and amendments hereto, and the provider manual(s), together with any items incorporated herein by reference, constitute the entire understanding between the parties and supersedes all prior oral or written agreements between them with respect to the matters provided for herein. If there is an inconsistency between any of the provisions of this Agreement and the provider manual(s), then this Agreement shall govern. In addition, if there is an inconsistency between the terms of this Agreement and the terms provided in any attachment to this Agreement, then the terms provided in that attachment shall govern. 9.6 Force Majeure. Neither party shall be deemed to be in violation of this Agreement if such party is prevented from performing any of his/her/its obligations hereunder for any reason beyond his/her/its reasonable control, including without limitation, acts of God, natural or man-made disasters, acts of any public enemy, statutory or other laws, regulations, rules, orders, or actions of the federal, state, or local government or any agency thereof. 9.7 Compliance with Regulatory Requirements. Amerigroup and Provider agree to comply with all applicable Regulatory Requirements, as amended from time to time, relating to their obligations under this Agreement, and maintain in effect all permits, licenses and governmental and board authorizations and approvals as necessary for business operations. Provider warrants that as of the Effective Date, he/she/it is and shall remain licensed and certified for the term of this Agreement in accordance with all Regulatory Requirements (including those applicable to utilization review and Claims payment) relating to the provision of Health Services to Members. Provider shall supply evidence of such licensure, compliance and certifications to Amerigroup upon request. If there is a conflict between this section and any other provision in this Agreement, then this section shall control. 9.7.1 In addition to the foregoing, Provider warrants and represents that at the time of entering into this Agreement, neither he/she/it nor any of his/her/its employees, contractors, subcontractors, principals or agents are ineligible, excluded, suspended, terminated or debarred from participating in a Government Program ("Ineligible Person"). Provider shall remain continuously responsible for ensuring that his/her/its employees, contractors, subcontractors, principals or agents are not Ineligible Persons. If Provider or any employees, subcontractors, principals or agents thereof becomes an Ineligible Person after entering into this Agreement or otherwise fails to disclose his/her/its Ineligible Person status, Provider shall have an obligation to (1) immediately notify Amerigroup of such Ineligible Person status and (2) within ten (10) days of such notice, remove such individual from responsibility for, or involvement with, Provider's business operations related to this Agreement. Washington Enterprise Provider Agreement 12 1508596321 © 2020 Nov — V4 Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. 9.8 Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington, unless such state laws are otherwise preempted by federal law. However, coverage issues specific to a Health Benefit Plan are governed by the state laws where the Health Benefit Plan is issued, unless such state laws are otherwise preempted by federal law. 9.9 Intent of the Parties. It is the intent of the parties that this Agreement is to be effective only in regards to their rights and obligations with respect to each other; it is expressly not the intent of the parties to create any independent rights in any third party or to make any third party a third party beneficiary of this Agreement, except to the extent specified in the Payment in Full and Hold Harmless section of this Agreement, or in a Participation Attachment(s). 9.10 Non -Exclusive Participation. None of the provisions of this Agreement shall prevent Provider or Plan from participating in or contracting with any provider, preferred provider organization, health maintenance organization/health insuring corporation, or any other health delivery or insurance program. Provider acknowledges that Plan does not warrant or guarantee that Provider will be utilized by any particular number of Members. 9.11 Notice. Any notice required to be given pursuant to the terms and provisions of this Agreement shall be in writing and shall be delivered by hand, facsimile, electronic mail, or mail. Notice shall be deemed to be effective: (a) when delivered by hand, (b) upon transmittal when transmitted by facsimile transmission or by electronic mail, (c) upon receipt by registered or certified mail, postage prepaid, (d) on the next business day if transmitted by national overnight courier, or (e) if sent by regular mail, five (5) days from the date set forth on the correspondence. Unless specified otherwise in writing by a party, Amerigroup shall send Provider notice to an address that Amerigroup has on file for Provider, and Provider shall send Amerigroup notice to Amerigroup's address as set forth in the provider manual(s). Notwithstanding the foregoing, and unless otherwise required by Regulatory Requirements, Amerigroup may post updates to its provider manual(s) and Policies on its web site. 9.12 Severability. In case any one or more of the provisions of this Agreement shall be invalid, illegal, or unenforceable in any respect, the remaining provisions shall be construed liberally in order- to effectuate the purposes hereof, and the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby. If one or more provisions of the Agreement are invalid, illegal or unenforceable and an amendment to the Agreement is necessary to maintain its integrity, the parties shall make commercially reasonable efforts to negotiate an amendment to this Agreement and any attachments or addenda to this Agreement which could reasonably be construed not to contravene such statute, regulation, or interpretation. In addition, if such invalid, unenforceable or materially affected provision(s) may be severed from this Agreement and/or attachments or addenda to this Agreement without materially affecting the parties' intent when this Agreement was executed, then such provision(s) shall be severed rather than terminating the Agreement or any attachments or addenda to this Agreement. 9.13 Waiver. Neither the waiver by either of the parties of a breach of any of the provisions of this Agreement, nor the failure of either of the parties, on one or more occasion, to enforce any of the provisions of this Agreement, shall thereafter be construed as a waiver of any subsequent breach of any of the provisions of this Agreement. 9.14 Construction. This Agreement shall be construed without regard to any presumption or other rule requiring construction against the party causing this Agreement to be drafted. 9.15 Counterparts and Electronic Signatures. 9.15.1 This Agreement and any amendment hereto may be executed in two (2) or more counterparts, each of which shall be deemed to be an original and all of which taken together shall constitute one and the same agreement. 9.15.2 Either party may execute this Agreement or any amendments by valid electronic signature, and such signature shall have the same legal effect of a signed original. Washington Enterprise Provider Agreement 13 1508596321 © 2020 Nov — V4 Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. Each party warrants that it has full power and authority to enter into this Agreement and the person signing this Agreement on behalf of either party warrants that he/she has been duly authorized and empowered to enter into this Agreement. Provider shall be designated as a Participating Provider in the Networks set forth on the Provider Network Attachment on the later of: (1) the Effective Date of this Agreement or; (2) as determined by Plan in its sole discretion, the date Provider has met applicable credentialing requirements, standards of participation and accreditation requirements. PROVIDER NAME AQPqRQING TO W-9 FORM WITH D/B/A: Grant County dba Grant County Integrated ervil s -17 By: LI+ Signature, Authordod Wepr-ese n ---- t-Tti-veof Provider(s) Date Printed:aa& Cindy Carter, Chair Name Title Address PO Box 37 Street Tax Identification Number (TIN): 916001319 (Note, if any of the following is not applicable, please leave blank) Phone Number: Amerigroup Washington, Inc. E2hrata WA 98823 City State Zip AMERIGROUP INTERNAL USE ONLY By*- Signature, Authorized 4 -hive of Amengroup Date 7.2.2021 Printed: Preston W. Cody., .... Director Network Management Name Title Washington Enterprise Provider Agreement 14 1508596321 * 2020 Nov — V4 Grant County dba Grant County Integrated Services 04/1412021 Arnerigroup Washington, Inc. PROVIDER NETWORKS ATTACHMENT Provider shall be designated as a Participating Provider in the following Networks on the later of: 1) the Effective Date of this Agreement or; 2) as determined by Plan in its sole discretion, the date Provider has met applicable credentialing requirements, standards of participation and accreditation requirements: Government Proarams: Health Benefit Plans issued pursuant to an agreement between Plan and Agency in which Members have access to a network of providers and receive an enhanced level of benefits when they obtain Covered Services from Participating Providers regardless of product licensure status. Provider participates in one or more of the following Networks which support such Health Benefit Plans: 0 Amerigroup Medicaid Network Other Proarams: Wraparound with Intensive Services (WISe) Program (Medicaid) Washington Enterprise Provider Agreement 15 1508596321 © 2020 Nov — V4 Grant County dba Grant County Integrated Services Amerigroup 04/14/2021 Washington, Inc. MEDICAID PARTICIPATION ATTACHMENT TO THE AMERIGROUP WASHINGTON, INC. PROVIDER AGREEMENT This is a Medicaid Participation Attachment ("Attachment") to the Amerigroup Provider Agreement ("Agreement"), entered into by and between Amerigroup and Provider and is incorporated into the Agreement. ARTICLE I DEFINITIONS The following definitions shall apply to this Attachment. Terms not otherwise defined in this Attachment shall carry the meaning set forth in the Agreement. "Clean Claim" means a claim that can be processed without obtaining additional information from the provider of the service or from a third party and has no defect or impropriety, including any lack of any required substantiating documentation, or particular circumstances requiring special treatment that prevents timely payments from being made on the claim. "Medicaid Program(s)" means, for purposes of this Attachment, a medical assistance program provided under a Health Benefit Plan approved under Title XVI, (Supplemental Security Income), Title XIX (Medicaid) and/or Title XXI (Children's Health Insurance Program "CHIP Program(s)") of the Social Security Act or any other federal or state funded program or product as designated by Amerigroup. "Medicaid Covered Services" means, for purposes of this Attachment, only those Covered Services provided under Plan's Medicaid Program(s); health care services that HCA determines are covered for enrollees, those health care services (including Behavioral Health Care Services) that a Medicaid Member is entitled to receive through Amerigroup pursuant to Regulatory Requirements, and for which a PCS is attached hereto setting forth the Providers' reimbursement under one or more Programs. Medicaid Covered Services do not include the preventable adverse events as set forth in the provider manual(s). "Medicaid Member" means, for purposes of this Attachment, a Member who is enrolled in Plan's Medicaid Program(s). "Medically Necessary/Medical Necessity" means services that are "medically necessary" as is defined in WAC 182- 500-0070 those services, based upon generally accepted medical practices in light of the Medicaid Covered Member's condition at the time of treatment, that are: (i) appropriate and consistent with the diagnosis of the treating provider and the omission of which could adversely affect the Medicaid Member's medical condition; (ii) compatible with the standards of acceptable medical practice in the community; (iii) provided in a safe, appropriate, and cost- effective setting given the nature of the diagnosis and the severity of the symptoms; (iv) not provided solely for the convenience of the Medicaid Member or the convenience of the provider or hospital; (v) not primarily custodial care unless custodial care is a Medicaid Covered Service; and (vi) there are no other effective and more conservative or substantially less costly treatment, service and setting available. "State Agency" means the Washington Health Care Authority ("HCA") or other duly authorized state agency. ARTICLE II SERVICES/OBLIGATIONS 2.1 Participation -Medicaid Network. As a participant in Amerigroup's Medicaid Network, Provider will render Medicaid Covered Services to Medicaid Members in accordance with the terms and conditions of the Agreement and this Attachment consistent with the provisions of 42 CFR 434.6. Such Medicaid Covered Services provided shall be within the scope of Provider's licensure, expertise, and usual and customary range of services pursuant to the terms and conditions of the Agreement and this Attachment, and Provider shall be responsible to Amerigroup for his/her/its performance hereunder. Provider shall release to Amerigroup any information necessary for Amerigroup to perform any of its obligations under the Agreement or under the Government Contract. Except as set forth in this Attachment or the Plan Compensation Schedule ("PCS"), all terms and conditions of the Agreement will apply to Provider's participation in Amerigroup's Medicaid Network. The terms and conditions set forth in this Attachment are limited to the provision of and payment for Health Services provided to Medicaid Members. Washington Enterprise Provider Agreement Medicaid Attachment 16 1508596321 © 2020 Nov— Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. 2.2 Provider's Duties and Obligations to Medicaid Members. All of Provider's duties and obligations to Members set forth in the Agreement shall also apply to Medicaid Members unless otherwise specifically set forth in this Attachment. Provider shall not discriminate in the acceptance of Medicaid Members for treatment, and shall provide to Medicaid Members the same access to services, including but not limited to, hours of operation, as Provider gives to all other patients. Provider shall furnish Amerigroup with at least ninety (90) days prior written notice if Provider plans to close its practice to new patients or ceases to continue in Provider's current practice. 2.2.1 To the extent mandated by Regulatory Requirements, Provider shall ensure that Medicaid Members have access to twenty-four (24) hour -per -day, seven (7) day -per -week urgent and Emergency Services, as defined in the PCS. 2.2.2 Unless otherwise required under Regulatory Requirements, a PCP, as defined in the PCS, shall provide Medicaid Covered Services or make arrangements for the provision of Medicaid Covered Services to Medicaid Members on a twenty-four (24) hour -per -day, seven (7) day -per -week basis to assure availability, adequacy, and continuity of care to Medicaid Members. If Provider is unable to provide Medicaid Covered Services, Provider shall arrange for another Participating Provider to cover Provider's patients in accordance with Amerigroup's Policies. Provider and any PCPs employed by or under contract with Provider may arrange for Medicaid Covered Services to Medicaid Members to be performed by a Specialist Physician only in accordance with Amerigroup's Policies. 2.2.3 If Provider is furnishing Specialist Physician services under this Attachment, Provider and the Specialist Physician(s) employed by or under contract with Provider, shall accept as patients all Medicaid Members and may arrange for Medicaid Covered Services to Medicaid Members to be performed by Specialist Physician only in accordance with Amerigroup's Policies. 2.3 Provider Responsibility. Amerigroup shall not be liable for, nor will it exercise control or direction over, the manner or method by which Provider provides Health Services to Medicaid Members. Provider shall be solely responsible for all medical advice and services provided by Provider to Medicaid Members. Provider acknowledges and agrees that Amerigroup may deny payment for services rendered to a Medicaid Member which it determines are not Medically Necessary, are not Medicaid Covered Services under the applicable Medicaid Program(s), or are not otherwise provided or billed in accordance with the Agreement and/or this Attachment. A denial of payment or any action taken by Amerigroup pursuant to a utilization review, referral, discharge planning program or claims adjudication shall not be construed as a waiver of Provider's obligation to provide appropriate Health Services to a Medicaid Member under applicable Regulatory Requirements and any code of professional responsibility. Provider may discuss treatment or non -treatment options with Medicaid Member irrespective of whether such treatment options are Medicaid Covered Services. However, this provision does not require Provider to provide Health Services if Provider objects to such service on moral or religious grounds. 2.3.1 No health carrier subject to the jurisdiction of the state of Washington may in any way preclude or discourage their providers from informing patients of the care they require, including various treatment options, and whether in their view such care is consistent with Medical Necessity, medical appropriateness, or otherwise covered by the patient's service agreement with the health carrier. No health carrier may prohibit, discourage, or penalize a provider otherwise practicing in compliance with the law from advocating on behalf of a patient with a health carrier. Nothing in this section shall be construed to authorize Provider to bind health carriers to pay for any service. 2.3.2 No health carrier may preclude or discourage Members or those paying for their coverage from discussing the comparative merits of different health carriers with their providers. This prohibition specifically includes prohibiting or limiting providers participating in those discussions even if critical of a carrier. 2.4 Reportinq Fraud and Abuse. Provider shall cooperate with Amerigroup's anti -fraud compliance program. If Provider identifies any actual or suspected fraud, abuse or misconduct in connection with the services rendered hereunder in violation of Regulatory Requirements, Provider shall promptly report such activity directly to the compliance officer of Amerigroup or through the compliance hotline in accordance with the provider manual(s). In addition, Provider is not limited in any respect in reporting other actual or suspected fraud, abuse, or misconduct to Amerigroup. Provider shall also refer all potential allegations of fraud to HCA and the Medicaid Fraud Control Division (MFCD) as described in 42 C. F. R § 455.23. Washington Enterprise Provider Agreement Medicaid Attachment 17 1508596321 © 2020 Nov — Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. 2.5 Plan Marketing/Information Requirements. Provider agrees to abide by Plan's marketing/information requirements. Provider shall forward to Plan for prior approval all flyers, brochures, letters and pamphlets Provider intends to distribute to Amerigroup's Medicaid Members concerning its payor affiliations, or changes in affiliation or relating directly to the Medicaid population. Provider will not distribute any marketing or recipient informing materials without the consent of Plan or the applicable State Agency. 2.6 Schedule of Benefits and Determination of Medicaid Covered Services. Amerigroup shall make available upon Provider's request schedules of Medicaid Covered Services for applicable Medicaid Program(s), and will notify Provider in a timely manner of any material amendments or modifications to such schedules. 2.7 Medicaid Member Verification. Provider shall establish a Medicaid Member's eligibility for Medicaid Covered Services prior to rendering services, except in the case of an Emergency Condition, as defined in the PCS, where such verification may not be possible. In the case of an Emergency Condition, Provider shall establish a Medicaid Member's eligibility as soon as reasonably practical. Plan shall provide a system for Providers to contact Plan to verify a Medicaid Member's eligibility twenty-four (24) hours a day, seven (7) days per week. Nothing contained in this Attachment or the Agreement shall, or shall be construed to, require advance notice, coverage verification, or pre -authorization for Emergency Services, as defined in the PCS, provided in accordance with the federal Emergency Medical Treatment and Active Labor Act ("EMTALA") prior to Provider's rendering such Emergency Services. 2.8 Hospital Affiliation and Privileges.. To the extent required under Plan's credentialing requirements, Provider or any Participating Providers employed by or under contract or subcontract with Provider shall maintain privileges to practice at one or more of Amerigroup's participating hospitals or furnish documentation to Amerigroup that referral arrangements have been made with another Amerigroup contracted provider to assume the Participating Provider admission responsibilities of Provider. In addition, in accordance with the Change in Provider Information Section of the Agreement, Provider shall immediately notify Amerigroup in the event any such hospital privileges are revoked, limited, surrendered, or suspended at any hospital or health care facility. 2.9 Participating Provider Requirements. If Provider is a group provider, Provider shall require that all Participating Providers employed by or under contract or subcontract with Provider comply with all terms and conditions of the Agreement and this Attachment. Notwithstanding the foregoing, Provider acknowledges and agrees that Amerigroup is not obligated to accept as Participating Providers all providers employed by or under contract or subcontract with Provider. 2.10 Coordinated and Managed Care. Provider shall participate in utilization management and care management programs designed to facilitate the coordination of services as referenced in the applicable provider manual(s). 2.11 Representations and Warranties. Provider represents and warrants that all information provided to Amerigroup is true and correct as of the date such information is furnished, and that Provider is unaware of any undisclosed facts or circumstances that would make such information inaccurate or misleading. Provider further represents and warrants that Provider: (i) is legally authorized to provide the services contemplated hereunder; (ii) is qualified to participate in all applicable Medicaid Program(s); (iii) is not in violation of any licensure or accreditation requirement applicable to Provider under Regulatory Requirements; (iv) has not been convicted of bribery or attempted bribery of any official or employee of the jurisdiction in which Provider operates, nor made an admission of guilt of such conduct which is a matter of record; (v) is capable of providing all data related to the services provided hereunder in a timely manner as reasonably required by Amerigroup to satisfy its internal requirements and Regulatory Requirements, including, without limitation, data required under the Health Employer Data and Information Set ("NEDIS") and National Committee for Quality Assurance ("NCQA") requirements; and (vi) is not, to Provider's best knowledge, the subject of an inquiry or investigation that could foreseeably result in Provider failing to comply with the representations set forth herein. In accordance with the Change in Provider Information Section of the Agreement, Provider shall immediately provide Amerigroup with written notice of any material changes to such information. ARTICLE III COMPENSATION AND AUDIT 3.1 Submission and Adiudication of Medicaid Claims. Unless otherwise instructed, or required by Regulatory Requirements, Provider shall submit Claims to Plan, using appropriate and current Coded Service Identifier(s), within three hundred sixty-five (365) days from the date the Health Services are rendered or Washington Enterprise Provider Agreement Medicaid Attachment 18 1508596321 © 2020 Nov — Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. Plan may refuse payment. If Plan is the secondary payor, the three hundred sixty-five (365) day period will not begin until Provider receives notification of primary payor's responsibility. 3.1.1 Provider agrees to submit Claims in a format consistent with industry standards and acceptable to Plan either (a) electronically through electronic data interchange ("EDI"), or (b) if electronic submission is not available, utilizing paper forms as defined by the National Uniform Claim Committee ("NUCC"). 3.1.2 Provider agrees to provide to Amerigroup, unless otherwise instructed, at no cost to Amerigroup, Plan or the Medicaid Member, all information necessary for Plan to determine its payment liability. Such information includes, without limitation, accurate and Clean Claims for Medicaid Covered Services. If Amerigroup or Plan asks for additional information so that Plan may process the Claim, Provider must provide that information within sixty (60) days, or before the expiration of the three hundred sixty-five (365) day period referenced in section 3.1 above, whichever is longer. 3.1.3 Once Amerigroup determines Plan has any payment liability, all Clean Claims will be adjudicated in accordance with the terms and conditions of a Medicaid Member's Health Benefit Plan, the PCS, the provider manual(s), and the Regulatory Requirements applicable to Plan's Medicaid Program(s). 3.1.4 Amerigroup shall meet the timeliness of payment standards specified for Medicaid fee-for-service in Section 1902(a)(37)(A) of the Social Security Act, 42 C.F.R. § 447.46 and specified for health carriers in WAC 284-170-431. To be compliant with both payment standards, Amerigroup shall pay ninety-five percent (95%) of the monthly volume of Clean Claims within thirty (30) calendar days of receipt and shall pay or deny ninety-five percent (95%) of the monthly volume of all Claims within sixty (60) days of receipt. Notwithstanding the foregoing, Amerigroup and Provider may agree to a different payment requirement in writing on a claim by claim basis. 3.1.5 Amerigroup shall pay Provider interest at the rate of one percent (1%) per month, as set forth in WAC 284-170- 431 (d) which section may be amended or recodified from time to time, on the unpaid or undenied portion of Clean Claims not adjudicated within the time periods discussed above, as required under applicable prompt pay requirements. 3.1.6 Provider agrees to accept payments or appropriate denials made in accordance with this Agreement as payment in full for all Medicaid Covered Services provided to Medicaid Members. Provider shall be responsible for collecting co -payments from Medicaid Members to the extent required by Regulatory Requirements. 3.2 This provision intentionally left blank. 3.3 Audit for Compliance with CMS Guidelines. Notwithstanding any other terms and conditions of the Agreement, this Attachment, or the PCS, Plan has the same rights as CMS, to review and/or Audit and, to the extent necessary recover payments on any claim for Medicaid Covered Services rendered pursuant to this Attachment and the Agreement to ensure compliance with CMS Regulatory Requirements. 3.4 Records Retention. In addition to the Plan Access to and Requests for Provider Records provision of the Agreement, Provider shall maintain an adequate record system for recording services, charges, dates and all other commonly accepted information elements for Medicaid Covered Services in a manner that is current, detailed and organized, and that permits effective and confidential patient care and quality review, administrative, civil and/or criminal investigations and/or prosecutions. Provider shall maintain all medical records for Medicaid Members in accordance with applicable Regulatory Requirements. 3.4.1 In addition to and without limiting any audit rights otherwise set forth in the Agreement and immediate access for Medicaid fraud investigators, Provider agrees that agents and employees of HCA and HHS shall have the right to inspect, evaluate and audit any pertinent books, financial records, documents, papers, and records of Provider involving financial transactions related to a Government Contract. HCA representatives and authorized federal and state personnel including, but not limited to the Office of the Inspector General (OIG), the Medicaid Fraud Control Unit (MFCU), HHS, the Department of Justice (DOJ), the Comptroller of the Treasury and any other duly authorized state or federal agency, shall have immediate and complete access to all records pertaining to services provided to Medicaid Members. Washington Enterprise Provider Agreement Medicaid Attachment 19 1508596321 © 2020 Nov — Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. 3.4.2 Provider shall make all records, including, but not limited to, financial, administrative and medical records available at Provider's expense, including computerized data stored by Provider, to any duly authorized government agency, including, but not limited to, HCA, CMS, OIG, MFCU, HHS, DOJ and the Office of the Comptroller of the Treasury, upon any authorized government agency's request for administrative, civil and/or criminal review, audit, evaluation, inspection, investigation and/or prosecution . HCA, CMS, OIG, MFCU, HHS, DOJ and the Office of the Comptroller of the Treasury, as well as any authorized state or federal agency or entity shall have the right to evaluate through inspection, evaluation, review or request, whether announced or unannounced, or other means, any record pertinent to this Attachment, including but not limited to medical records, billing records, financial records, and/or any records related to services rendered, quality, appropriateness and timeliness of services and/or any records relevant to an administrative, civil and/or criminal investigation and/or prosecution, and such evaluation, inspection, review or request, when performed or requested, shall be performed with the immediate cooperation of the Provider. Requested records shall be provided at no expense to Agency personnel, including representatives from HCA, OIG, the MFCU, DOJ and the HHS, or any duly authorized state or federal agency. Upon request, the Provider shall assist in such reviews, and provide complete copies of medical records. Any authorized government agency, including but not limited to, HCA, CMS, OIG, MFCU, HHS, DOJ and the Office of the Comptroller of the Treasury, may use these records to carry out their authorized, duties, reviews, audits, administrative, civil and/or criminal investigations and/or prosecutions. Provider shall cooperate fully in any audit, investigation or review by Amerigroup, State Agency, MPI, MFCU, or other state or federal entity and in any subsequent legal action that may result from such an audit, investigation or review involving this Attachment, including promptly supplying all data and information requested for such investigation; provided that nothing in this section shall be construed to limit a Provider's right to defend its actions in any legal proceeding in accordance with its rights under the law. 3.4.3 The right for the parties named above to audit, access and inspect under this section exists for ten (10) years from the final date of the Attachment period or from the date of completion of any audit, whichever is later, or any other timeframe authorized by law 3.4.4 Provider will have the right to audit Amerigroup records relating to Medicaid Covered Services rendered by Provider to Medicaid Members. 3.5 Encounter Data. If Provider is paid on a capitated basis, Provider shall timely submit complete and accurate encounter data for capitated services rendered to Medicaid Members, including, without limitation, statistical and descriptive medical, diagnostic and patient data for Medicaid Covered Services rendered to Medicaid Members, to meet the encounter data reporting requirements set forth in the Government Contract. ARTICLE IV COMPLIANCE WITH FEDERAL REGULATORY REQUIREMENTS 4.1 Federal Funds. Provider acknowledges that payments Provider receives from Plan to provide Medicaid Covered Services to Medicaid Members are, in whole or part, from federal funds. Therefore, Provider and any of his/her/its subcontractors are subject to certain laws that are applicable to individuals and entities receiving federal funds, which may include but are not limited to, Title VI of the Civil Rights Act of 1964 as implemented by 45 CFR Part 84; the Age Discrimination Act of 1975 as implemented by 45 CFR Part 91; the Americans with Disabilities Act; the Rehabilitation Act of 1973, lobbying restrictions as implemented by 45 CFR Part 93 and 31 USC 1352, Title IX of the Educational Amendments of 1972, as amended (30 U.S.C. sections 1681, 1783, and 1685-1686) and any other regulations applicable to recipients of federal funds. 4.2 Surety Bond Requirement. If Provider provides home health services or durable medical equipment, Provider shall comply with all applicable provisions of Section 4724(b) of the Balanced Budget Act of 1997, including, without limitation, any applicable requirements related to the posting of a surety bond. 4.3 Laboratory Compliance. If Provider renders lab services in the office, it must maintain a valid Clinical Laboratory Improvement Amendments ("CLIA") certificate for all laboratory testing sites and comply with CLIA regulations at 42 CFR Part 493 for all laboratory testing sites performing Health Services pursuant to this Attachment. ARTICLE V COMPLIANCE WITH STATE REGULATORY REQUIREMENTS Washington Enterprise Provider Agreement Medicaid Attachment 20 1508596321 © 2020 Nov — Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. 5.1 Indemnification of State. In addition to the Indemnification provision of the Agreement, Provider shall indemnify and hold harmless the State, its agencies, officers, and employees from all claims and suits, including court costs, attorney's fees, and other expenses, brought because of injuries or damages received or sustained by any person, persons, or property that is caused by any act or omission of Provider. 5.2 This provision intentionally left blank. 5.3 State Agency Government Contract. Provider shall comply with the terms applicable to providers set forth in the Government Contract, including incorporated documents, between Plan and the applicable State Agency, which applicable terms are incorporated herein by reference. Plan agrees to provide Provider with a description of the applicable terms upon request. Nothing in this Attachment shall be construed to terminate or reduce the legal responsibility of Amerigroup to State Agency to ensure that all activities under the Government Contract are carried out. Amerigroup shall afford Provider access to all necessary training and information to enable Provider to carry out its responsibilities under the Government Contract. Documents, procedures, and other administrative policies and programs referenced in the Government Contract must be available for review by the Provider prior to contracting. 5.4 Performance Within the U.S. Provider agrees that all services to be performed herein shall be performed in the United States of America. Breach, or anticipated breach, of the foregoing shall be a material breach of this Attachment and, without limitation of remedies, shall be cause for immediate termination of the Agreement and this Attachment. 5.5 No Payment Outside the United States. Provider agrees that Amerigroup shall not provide any payments for items or services provided under the Agreement to any financial institution or entity located outside the United States of America. 5.6 Americans with Disabilities Act Compliance. Provider shall make reasonable accommodation for Medicaid Members with disabilities, in accord with the Americans with Disabilities Act, for all services and shall assure physical and communication barriers shall not inhibit Medicaid Members with disabilities from obtaining such services. 5.7 Interpreter Services. In compliance with 42 CFR 438.10(c)(4), Provider shall assure that interpreter services are provided for Medicaid Members with a primary language other than English, free of charge. Provider shall also provide interpreter services for all interactions between such Medicaid Members and Provider including, but not limited to: all appointments, emergency services, and all steps necessary to file grievances and appeals. 5.8 Readability. Provider shall ensure that all written information provided to Medicaid Members is accurate, is not misleading, is comprehensible to its intended audience, is designed to provide the greatest degree of understanding, and is written at the sixth grade reading level. All such written materials must have the written approval of Amerigroup prior to use. 5.9 Coordination of Benefits/Third Party Liability. In addition to the Coordination of Benefits/Subrogation provision of the Agreement, Provider understands and agrees that when a Medicaid Member is covered by two or more plans, the primary plan must pay or provide its benefits as if the Medicaid Program did not exist. Provider acknowledges and agrees that claims payments made by Amerigroup pursuant to Medicaid Program requirements are subject to Medicaid Program requirements regarding third party liability. Provider shall cooperate with Amerigroup's policies and procedures related to third party liability recovery in the event claims for services rendered by Provider to a Medicaid Member are related to an illness or injury for which a third party may be liable, including, without limitation, claims that may be covered by automobile insurance, workers' compensation coverage, other health insurance, or otherwise give rise to a claim for third party liability, coordination of benefits or subrogation (to the extent permitted by Regulatory Requirements). Provider shall take all reasonable actions required by Amerigroup to assist Amerigroup in obtaining such recoveries, including executing any appropriate documents reasonably requested by Amerigroup to enforce such claims or to assign any payments to Amerigroup. However Provider and Amerigroup shall not refuse or reduce services provided under this agreement solely due to the existence of similar benefits under any other health care contract. In addition Amerigroup shall pay claims for prenatal care and preventive pediatric care and shall seek reimbursement from such third parties. 5.10 Appointment Waiting Times. Provider shall offer hours of operation that are no less than the hours of operation offered to patients with other insurance coverage, including but not limited to commercial health plans. If Provider is a primary care physician, Provider is encouraged to offer after-hours office care to Washington Enterprise Provider Agreement Medicaid Attachment 21 1508596321 © 2020 Nov — Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. Medicaid Members on evenings and weekends. Provider agrees that it will provide for regular monitoring of timely access and corrective action by Amerigroup if Provider fails to comply with the appointment wait time standards as stated in 42 CFR 438.206(c)(1). Provider shall comply with 42 CFR §438.206(c)(1). Provider shall comply with appointment standards that are no longer than the following: (a) Transitional healthcare services by a primary care provider shall be available for clinical assessment and care planning within seven (7) calendar days of discharge from inpatient or institutional care for physical or behavioral health disorders or discharge from a substance use disorder treatment program; (b) Transitional healthcare services by a home care nurse or home care registered counselor within seven (7) calendar days of discharge from inpatient or institutional care for physical or behavioral health disorders or discharge from a substance use disorder treatment program, if ordered by the enrollee's primary care provider or as part of the discharge plan; (c) Non -symptomatic (i.e., preventive care) office visits shall be available from the Medicaid Member's PCP or another provider within thirty (30) calendar days. A non -symptomatic office visit may include, but is not limited to, well/preventive care such as physical examinations, annual gynecological examinations, or child and adult immunizations; (d) Non -urgent, symptomatic (i.e., routine care) office visits shall be available from the Medicaid Member's PCP or another provider within ten (10) calendar days. A non -urgent, symptomatic office visit is associated with the presentation of medical signs not requiring immediate attention; (e) Urgent, symptomatic office visits shall be available from the Medicaid Member's PCP or another provider within twenty-four (24) hours. An urgent, symptomatic visit is associated with the presentation of medical signs that require immediate attention, but are not life threatening; and (f) Emergency medical care shall be available twenty-four (24) hours per day, seven (7) days per week. 5.11 Prohibited Practices. Nothing in this Agreement shall be construed as prohibiting any Participating Provider from: 5.11.1 Discussing treatment or non -treatment options with Medicaid Members irrespective of Amerigroup's position on such treatment or non -treatment options or whether such treatment options are Medicaid Covered Services; 5.11.2 Acting within the lawful scope of such provider's practice, advising or advocating on behalf of a Medicaid Member for such Medicaid Member's health status, medical care, or treatment or non- treatment options, including any alternative treatments that might be self-administered by the Medicaid Member; 5.11.3 Advocating on behalf of a Medicaid Member within the utilization review or grievance processes established by Amerigroup or individual authorization process to obtain Medically Necessary Medicaid Covered Services; or 5.11.4 Discouraging Medicaid Members or those paying for their coverage from discussing the comparative merits of different health carriers with their providers. This prohibition specifically includes prohibiting or limiting providers participating in those discussions even if critical of a carrier. 5.12 Cultural Competency Plan. Provider shall participate with the State of Washington's efforts to promote the delivery of services in a culturally competent manner to all Medicaid Members, including those with limited English proficiency and diverse cultural ethnic backgrounds. To that end, Provider agrees to comply with all Amerigroup policies and procedures designed to ensure that culturally competent services, including but not limited to effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs, are provided by Amerigroup both directly and through its health care providers and subcontractors. 5.13 Authorizations. Provider shall comply with Amerigroup's preauthorization and authorization processes and procedures applicable to Provider as more fully set forth in the provider manual(s). 5.14 Prohibited Referrals. In accordance with federal and state law, Provider is prohibited from referring any Medicaid Members for designated health services to any entity in which Provider, or a member of Provider's immediate family, has a financial relationship. 5.15 Transfers of Members. Without otherwise limiting Amerigroup's rights pursuant to this Agreement, upon Amerigroup's determination made in good faith and with reasonable belief that a Medicaid Member's health or safety is in jeopardy, Amerigroup may require that such Medicaid Member be transferred immediately for care to another provider at Amerigroup's direction, and Provider shall fully cooperate with any such transfer Washington Enterprise Provider Agreement Medicaid Attachment 22 1508596321 © 2020 Nov — Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. requirement. Additionally, Provider shall cooperate in all respects with provider of other health plans to assure maximum health outcomes with regard to transitioning Medicaid Members. 5.16 Monitoring. Provider agrees to Amerigroup monitoring Provider's performance on an ongoing basis and subject to formal review, which review shall be accordance with a periodic schedule established by HCA consistent with industry standards and Regulatory Requirements. Formal review must be completed no less than once every three years and must identify deficiencies or areas for improvement and provide for corrective action in accordance with 42 CFR 438.230(b). 5.17 Provider to Monitor Quality. Provider shall maintain a quality assurance system to monitor the quality of services delivered under this Attachment and initiate corrective action where necessary to improve quality of care, in accordance with that level of care which is recognized as acceptable professional practice in the respective community in which the Provider practices and/or the standards established by the Medicaid Program or its designee. 5.18 Medicaid Member Rights. Notwithstanding anything to the contrary in this Agreement, Provider agrees to observe, protect and promote all rights of Medicaid Members as patients in accordance with all applicable laws, Government Contract and Agency requirements. Provider shall provide any information that a Medicaid Member needs in order to decide among all relevant treatment options. 5.19 Program Integrity Requirements. Provider shall comply with Amerigroup's HCA approved program integrity policies and procedures and the program integrity requirements of the Government Contract, including but not limited to compliance with section 1902(a)(68) of the Social Security Act, 42 C. F. R. § 438.610, 42 C. F. R. §4557 42 C.F.R. §1000 through 1008 and Chapter 182-502A WAC. If Provider is defined as a subcontractor under the Government Contract, Provider shall verify that services billed by Provider were actually provided to Medicaid Members and shall conduct ongoing analysis of utilization, claims, billing and/or encounter data to detect overpayments and including audits and investigations of Provider's subcontractors and downstream entities. 5.20 Enrollee Self Determination. Provider shall obtain informed consent prior to treatment from Medicaid Members, or persons authorized to consent on behalf of a Medicaid Member, and shall comply with the provisions of the Natural Death Act (RCW 70.122) and state and federal Medicaid rules concerning advance directives, and, when appropriate, inform Medicaid Members of their right to make anatomical gifts. 5.21 Enrollee Self -Referral. Provider understands and agrees that Medicaid Members have the right to self -refer for certain services to participating or non -participating local health departments and participating or non- participating family planning clinics paid through separate arrangements with the State of Washington. The services to which a Medicaid Member may self refer include: (i) including family planning services and sexually -transmitted disease screening and treatment services provided at participating or nonparticipating providers, including but not limited to family planning agencies, such as Planned Parenthood; (ii) immunizations, sexually -transmitted disease screening and follow-up, immunodeficiency virus (HIV) screening, tuberculosis screening and follow-up, and family planning services through and if provided by a local health department; (iii) immunizations, sexually transmitted disease screening, family planning and mental health services through and if provided by a school-based health center; and (iv) all services received by American Indian or Alaska Native enrollees under the Special Provisions for American Indians and Alaska Natives subsection as set forth in the Government Contract. 5.22 Solvency Requirements. If Provider is at financial risk, as defined in the Government Contract, Amerigroup shall establish, enforce and monitor solvency requirements that provide assurance of Provider's ability to meet its obligations. Furthermore, Provider acknowledges that Amerigroup shall annually conduct surveys of Medicaid Members' satisfaction with Provider in accordance with Government Contract requirements, which surveys shall to be provided to HCA or Medicaid Members upon request. 5.23 Subrogation. Provider acknowledges and agrees that it shall subrogate to the State of Washington for all criminal, civil and administrative action recoveries undertaken by any government entity, including, but not limited to, all claims Amerigroup or Provider have or may have against any entity that directly or indirectly receives funds under the Government Contract including, but not limited to, any health care provider, manufacturer, wholesale or retail supplier, sales representative, laboratory, or other provider in the design, manufacture, marketing, pricing, or quality of drugs, pharmaceuticals, medical supplies, medical devices, durable medical equipment, or other health care related products or services. Washington Enterprise Provider Agreement Medicaid Attachment 23 1508596321 © 2020 Nov — Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. 5.24 Assignment. Notwithstanding Section 9.2 of the Agreement, this Agreement may not be assigned by either party without the consent of HCA. 5.25 Pharmacy Preauthorization and Emergency Fill Requirements. Provider and Amerigroup shall each comply with all applicable pharmacy preauthorization and emergency requirements of the Government Contract and WAC 284-170-470, including but not limited to compliance with the following: (a) Disclose if the provider or pharmacy has the right to make a prior authorization request; and (b) Provide that if Amerigroup or Provider requires the authorization number to be transmitted on a pharmaceutical claim, the issuing party will provide the authorization number to the billing pharmacy. The authorization number will be communicated to the billing pharmacy after approval of a prior authorization request and upon receipt of a claim for that authorized medication. (c) The prior authorization determination must be transmitted to the requesting party and must include the information about whether a request was approved and if the request was made by the pharmacy, notification will additionally be made to the prescriber. (d) Amerigroup and Provider acknowledge and agree that Amerigroup shall authorize an emergency fill by the dispensing pharmacist and approve the claim payment. An emergency fill is only applicable when: (1) The dispensing pharmacy cannot reach Amerigroup's prior authorization department by phone as it is outside of that department's business hours; or (2) Amerigroup is available to respond to phone calls from a dispensing pharmacy regarding a covered benefit, but Amerigroup cannot reach the prescriber for full consultation. 5.26 Potentially Preventable Readmissions. If applicable, to facilitate care transitions for Medicaid Members, Provider and Amerigroup shall comply with all Potentially Preventable Readmission ("PPR") requirements, as set forth in the Government Contract and WAC 182-550-2900 and 182-550-3000. Consistent with the PPR provisions of the Government Contract, Amerigroup and Provider shall work together to facilitate care transitions for Medicaid Members and Provider shall be responsible for ensuring completion of the following: (a) discharge screenings, (b) discharge/care plans, (c) discharge education, and (d) follow up care after discharge, including for mental health services, as applicable. In addition, for high risk members, Provider will allow Amerigroup or Amerigroup's designee to assist with the coordination of planning, including visiting the Medicaid Member. 5.27 Reporting. Provider shall submit to Amerigroup all reports and clinical information required by Regulatory Requirements or otherwise reasonably requested by Amerigroup. 5.27.1 If Provider is a Certified Behavioral Health Agency (BHA), Provider must comply with behavioral health reporting requirements, including Service Encounter Reporting Instructions ("SERI"). Provider must report behavioral health supplemental transactions to Amerigroup as set forth in the provider manual(s), or as required under applicable Regulatory Requirements. 5.28 Provider Insurance Coverage. In addition to the Provider Insurance provision in the Agreement, Provider, at all times during the term of this Agreement, shall: 5.28.1 Maintain professional liability insurance; including maintaining such tail or prior acts coverage necessary to avoid any gap in coverage for claims arising from incidents occurring during the term of this Agreement. Such insurance shall (i) be obtained from a carrier authorized to conduct business in the jurisdiction in which Provider operates; (ii) maintain minimum policy limits equal to $5,000,000.00 per occurrence and $10,000,000.00 in the aggregate for acute care hospitals and $1,000,000.00 per occurrence and $3,000,000.00 in the aggregate for other providers; and (iii) include coverage for the professional acts and omissions of Provider and any employee, agent or other person for whose acts or omissions Provider is responsible. 5.28.2 Maintain general comprehensive liability insurance from a carrier authorized to conduct business in the jurisdiction in which Provider operates, in amounts required under Regulatory Requirements. Said insurance shall cover Provider's premises, insuring Provider against any claim of loss, liability, Washington Enterprise Provider Agreement Medicaid Attachment 24 1508596321 © 2020 Nov — Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. or damage caused by or arising out of the condition or alleged condition of said premises, or the furniture, fixtures, appliances, or equipment located therein, together with the standard liability protection against any loss, liability or damage resulting from the operation of a motor vehicle by Provider, Provider's employees or agents. 5.28.3 Maintain workers' compensation insurance for Provider's employees. Said insurance shall be obtained from a carrier authorized to conduct business in the jurisdiction in which Provider operates and shall provide such limits of coverage as required by Regulatory Requirements. 5.28.4 Provide Amerigroup with evidence of Provider's compliance with the foregoing insurance requirements as reasonably requested by Amerigroup from time to time during the term of this Agreement, but in no event less than annually. Provider shall provide Amerigroup with at least thirty (30) days prior written notice of any cancellation or non -renewal of any required coverage or any reduction in the amount of Provider's coverage, and shall secure replacement coverage meeting the requirements hereunder so as to ensure no lapse in coverage. Provider shall furnish Amerigroup with a certificate of insurance evidencing such replacement coverage. Provider shall also furnish a certificate of insurance to a requesting Agency upon request. Provider may maintain coverage hereunder through a self-funded insurance plan, provided that Provider maintains actuarially sound reserves related to such self-funded plan and provides to Amerigroup on a semi- annual basis an opinion letter from an independent actuarial firm or other proof reasonably acceptable to Amerigroup attesting to the financial adequacy of such reserves. 5.29 Discharge Planning. In a twenty-four (24) hour setting, Provider shall provide discharge planning services that meet the standard set forth below: Provider shall coordinate, as needed with HCA and/or Division of Behavioral Health and Recovery (DBHR) prevention services, vocational services, housing services and supports, and other community resources and services that may be appropriate, including, but not limited to Department of Children, Youth, and Families (DCYF) services for children and families, including but not limited to, DCYF-contracted home visiting, Early Support for Infants and Toddlers (ESIT), Early Childhood Intervention and Prevention Services (ECLIPSE), Early Childhood Education and Assistance Program (ECEAP) and Head Start programs using the information letter template jointly developed by the DCYF and HCA. 5.30 Supervision by Behavioral Health Provider. As applicable, Provider will receive payment for the supervision of behavioral health providers whose license or certification restricts them to work under supervision. 5.31 Data Use, Security and Confidentiality. Provider shall comply with all data use, security, and confidentiality terms and conditions applicable to the provider, as referenced in the applicable provider manual(s) or as required by Regulatory Requirements. ARTICLE VI TERMINATION 6.1 Termination of Medicaid Participation Attachment. Either party may terminate this Attachment without cause by giving at least one hundred eighty (180) days prior written notice of termination to the other party. 6.2 Termination of Government Contract. If a Government Contract between the applicable State Agency and Amerigroup terminates or expires or ends for any reason or is modified to eliminate a Medicaid Program, this Attachment shall have no further force or effect with respect to the applicable Medicaid Program. In the event of termination of the Government Contract between Amerigroup and State Agency, Provider shall immediately make available to State Agency, or its designated representative, in a usable form, any or all records, whether medical or financial, related to Provider's activities undertaken pursuant to this Agreement. The provision of such records shall be at no expense to Amerigroup or State Agency. 6.3 Effect of Termination. Following termination of this Attachment, the remainder of the Agreement shall continue in full force and effect, if applicable. In addition, upon termination of this Attachment but subject to the Continuation of Care provision(s) and applicable Regulatory Requirements, any references to services, reimbursement, or participation in Networks related to the Medicaid Program are hereby terminated in full and shall have no further force and effect. 6.4 Continuation of Care. In addition to the Continuation of Care Upon Termination provision of the Agreement, in the event of the termination of this Attachment for any reason except termination of this Attachment for Washington Enterprise Provider Agreement Medicaid Attachment 25 1508596321 © 2020 Nov — Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. cause by Amerigroup any Medicaid Member who is suffering from and receiving active health care services or who is an inpatient shall have the right to continue to receive health care services from Provider for a period of up to sixty (60) days from the date of the termination of this Attachment or until the Medicaid Member's discharge from inpatient facilities up to ninety (90) days, whichever time is greater. Any Medicaid Member who is pregnant and receiving treatment in connection with that pregnancy at the time of termination of this Agreement may continue to receive health care services from Provider for the remainder of her pregnancy and six (6) weeks post -partum. 6.4.1 During the continuity of care provision described in this section above, Provider shall continue to provide services in accordance with the terms of this Attachment applicable immediately prior to the termination of this Attachment, and Amerigroup shall continue to meet all of the obligations of this Attachment. 6.4.2 A Medicaid Member shall not have the right to continuation of care if the termination of this Attachment is for loss of Provider license, or if the termination of this Agreement is due to reasons related to quality of health care services rendered, health, safety or welfare of Medicaid Members. ARTICLE VII GENERAL PROVISIONS 7.1 Inconsistencies. In the event of an inconsistency between terms and conditions of this Attachment and the terms and conditions as set forth in the Agreement, the terms and conditions of this Attachment shall govern. Except as set otherwise forth herein, all other terms and conditions of the Agreement remain in full force and effect. Notwithstanding the Entire Agreement provision of the Agreement, the parties acknowledge and agree that the provider manual is not incorporated by reference into this Attachment as it relates Provider's participation in Amerigroup's Medicaid Network and it not deemed part of the entire Attachment. 7.2 Disclosure Requirements. In accordance with Regulatory Requirements, and State Agency requirements, if applicable, Provider agrees to disclose to Amerigroup complete ownership, control and relationship information ("Disclosures") in accordance with 42 CFR 455.100 through 455.106. Provider shall provide required Disclosures to Amerigroup at the time of initial contract, upon contract renewal, and/or upon request by Amerigroup. Provider further agrees to notify Amerigroup within fourteen (14) days of any changes to the Disclosures. Failure to provide Disclosures as required under Regulatory Requirements shall be deemed a material breach of this Attachment and the Agreement. 7.3 Survival of Attachment. Provider further agrees that: (1) the hold harmless and continuation of care sections shall survive the termination of this Attachment or disenrollment of the Medicaid Member; and (2) these provisions supersede any oral or written contrary agreement now existing or hereafter entered into between Provider and a Medicaid Member or persons acting on their behalf that relates to liability for payment for, or continuation of, Medicaid Covered Services provided under the terms and conditions of these provisions. 7.4 Provider Education 7.4.1 Provider shall participate in training when requested by HCA. Provider's requests for HCA to allow an exception to participation in required training must be in writing and include a plan for how the required information will be provided to Provider's targeted staff. 7.4.2 If Provider has community behavioral health employees who work directly with Medicaid Members, Provider shall provide such employees with annual training on safety and violence prevention topics described in RCW 49.19.030. 7.5 Mental Health Advance Directive. In accordance with 71.32 RCW, Provider shall inform all Medicaid Members who present for mental health services of their right to a Mental Health Advance Directive, and shall provide technical assistance to those Medicaid Members who express an interest in developing and maintaining a Mental Health Advance Directive. A "Mental Health Advance Directive" means a written document in which the Medicaid Member makes a declaration of instructions, or preferences, or appoints an agent to make decisions on behalf of the Medicaid Member regarding the Medicaid Member's mental health treatment. Provider shall also maintain current copies of any Medicaid Member's Mental Health Advance Directive in the Medicaid Member's record and shall inform Medicaid Members that complaints concerning noncompliance with a Mental Health Advance Directive should be referred to the Department of Health. Washington Enterprise Provider Agreement Medicaid Attachment 26 1508596321 © 2020 Nov — Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. 7.6 Compliance with 42 CFR Part 2. To the extent that in performing its services under this Attachment, Provider uses, discloses, maintains, or transmits protected health information that is protected by 42 CFR Part 2, Provider acknowledges and agrees that in receiving, storing, processing or otherwise dealing with any such records for Medicaid Members, Provider is fully bound by 42 CFR Part 2; and, if necessary will resist any efforts to obtain access to such records except as permitted under 42 CFR Part 2. Notwithstanding any other language in this Attachment, Provider acknowledges and agrees that any Medicaid Member information Provider receives that is protected by 42 CFR Part 2 is subject to protections that prohibit Provider from disclosing such information to agents or subcontractors without the specific written consent of the Medicaid Member. 7.7 Provider Subcontractors. In addition to the Provider Subcontractors provision in the Agreement, if Provider delegates or subcontracts any functions of Amerigroup delegated by Amerigroup to Provider, Amerigroup's consent to such action is required and the agreement governing such subcontract or delegation shall include all applicable requirements of the Government Contract (or any successor sections thereto). Washington Enterprise Provider Agreement Medicaid Attachment 27 1508596321 © 2020 Nov — Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. BEHAVORIAL HEALTH SERVICES WRAPAROUND WITH INTENSIVE SERVICES REQUIRED PROVISIONS ATTACHMENT TO THE AMERIGROUP WASHINGTON, INC. PROVIDER AGREEMENT This is a Wraparound with Intensive Services ("WISe") Program Attachment (this "Attachment") to the Amerigroup Provider Agreement ("Agreement"), entered into by and between Amerigroup and Provider ("Provider") and is incorporated into the Agreement. PROGRAM PROVISIONS 1. Provider must be a Health Care Authority ("HCA") approved WISe agency. 2. WISe Implementation. Provider agrees to cooperate with Amerigroup efforts in connection with development of Provider capacity and workforce development. Provider shall report WISe capacity and service intensity data to Amerigroup on a monthly basis. Such data shall be submitted to Amerigroup no later than the fifth (5th) day of each month. 3. Notifications. 3.1 Provider must notify Amerigroup if they are unable to maintain sufficient staffing levels of WISe qualified staff. 3.2 Provider will notify Amerigroup anytime a Medicaid Member is a) approved for the WISe program b) Denial of WISe services based on the CANS C) Reduction in services d) Suspension of services 4. Primary Setting. Provider agrees to provide WISe services in the home and in community locations, and at times and locations that ensure meaningful participation of youth, family members, and natural supports. Assessment, treatment, and support services are provided in the youth and family's natural setting, where needs, strengths, and challenges present themselves (such as home, school and community). 5. WISe Program Policy and Procedure Manual. Provider shall comply with all requirements of the most current Washington State WISe Program Policy and Procedure Manual, including, but not limited to, requirements related to grievances and appeals. 6. Policies and Procedures. Provider shall have in place policies and procedures applicable to the WISe Program and shall also comply with Amerigroup WISe Program policies and procedures communicated to Provider by Amerigroup. In the event of any conflict between the terms of Amerigroup's WISe policies and procedures and Provider's WISe policies and procedures, the terms of Amerigroup's policies and procedures shall govern. In the event of any conflict between the terms of the Washington State WISe Program Policy and Procedure Manual and either Amerigroup's or Provider's WISe policies and procedures, the terms of the Washington State WISe Program Policy and Procedure Manual shall govern. 7. Continuity of Care. Provider shall notify Amerigroup in the event that Medicaid Members receiving WISe services and transition age youth ("TAY") require assistance with any of the following: 7.1 WISe TAY Medicaid Members approaching discharge from WISe who may require additional assistance with housing/employment services/transitioning to a lower level of care/PH services or transition to adult services; 7.2 Other (non -TAY) Medicaid Members transitioning out of WISe who may require assistance transitioning to a lower level of care; Washington Enterprise Provider Agreement WISe Attachment 28 1508596321 © 2019 Nov — Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. 7.3 Youth Medicaid Members in WISe who are moving to other areas of the state of Washington who may require assistance with care coordination to the new region. 8. Screening. 8.1 For WISe Program eligibility screens, Provider shall complete a Child and Adolescent Needs and Strengths (CANS) screen, regardless of referral source. A mental health intake must not be required to be completed to do the WISe screen. 8.2 Provider shall complete CANS screens within ten (10) business days from the date that Provider receives the referral, CANS full within thirty (30) calendar days of the WISe screen, and updated CANS full every ninety (90) days thereafter, or such other timeframes required under applicable Regulatory Requirements. CANS Screens and CANS full must be entered into the Behavioral Health Assessment System (BHAS). A WISe screen is not considered to be complete until entered into the BHAS. 8.3 Provider must notify Amerigroup in writing of all instances, regardless of the reason, where a Medicaid Member was given a CANS screen and not subsequently enrolled in the WISe Program. 9. WISe Services. 9.1 The provision of WISe services must include a Child and family Team (CFT) and, at a minimum, access to the following: 9.1.1 Intake evaluation; 9.1.2 Intensive care coordination; 9.1.3 Intensive services; 9.1.4 24/7 Crisis intervention and stabilization services. 9.2 Delivery of the full WISe service array focused on the needs and strengths and driven by youth and family voices and choice will be evaluated in accordance with HCA's WISe Quality Management ("QM") Plan and the Amerigroup WISe QM Plan. 10. WISe Collaborative. 10.1 Provider will participate in regional WISe Collaborative, Family Youth System Partner Round Table (FYSPRT) and other WISe-related meetings. 10.2 Provider will work with Amerigroup on the WISe Collaborative Action Plan. 10.3 Provider will participate in WISe Quality Improvement Review (QIRT) processes. Washington Enterprise Provider Agreement WISe Attachment 29 1508596321 © 2019 Nov — Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. PLAN COMPENSATION SCHEDULE ("PCS") ARTICLE I DEFINITIONS The definitions set forth below shall apply with respect to all of the terms outlined in this PCS. Terms not otherwise defined in this PCS and defined elsewhere in the Agreement shall carry the meanings set forth in the Agreement. "Capitation" means the amount paid by Amerigroup to a provider or management services organization on a per member per month basis for either specific services or the total cost of care for Covered Services. "Case Rate" means the all-inclusive Amerigroup Rate for an entire admission or one outpatient encounter for Covered Services. "Chargemaster" or "Charge Master" means facility's listing of facility charges for products, services and supplies. "Coded Service Identifier(s)" means a listing of descriptive terms and identifying codes, updated from time to time by CMS or other industry source, for reporting Health Services on the CMS 1500 or CMS 1450/UB-04 claim form or its successor as applicable based on the services provided. The codes include but are not limited to, American Medical Association Current Procedural Terminology ("CPT® -4"), CMS Healthcare Common Procedure Coding System ("HCPCS"), International Classification of Diseases, 10th Revision ("ICD -10"), National Uniform Billing Committee ("Revenue Code") and National Drug Code ("NDC") or their successors. "Cost to Charge Ratio" ("CCR") means the quotient of cost (total operating expenses minus other operating revenue) divided by charges (gross patient revenue) expressed as a decimal, as defined by Regulatory Requirements. "Diagnosis -Related Group" ("DRG") means Diagnosis Related Group or its successor as established by CMS or other grouper, including but not limited to, a state mandated grouper or other industry standard grouper. "DRG Rate" means the all-inclusive dollar amount which is multiplied by the appropriate DRG Weight to determine the Amerigroup Rate for Covered Services. "DRG Weight" means the weight applicable to the specific DRG methodology set forth in this PCS, including but not limited to, CMS DRG weights as published in the Federal Register, state agency weights, or other industry standard weights. "Eligible Charges" means those Provider Charges that meet Amerigroup's conditions and requirements for a Health Service to be eligible for reimbursement. These conditions and requirements include but are not limited to: Member program eligibility, Provider program eligibility, benefit coverage, authorization requirements, provider manual specifications, Amerigroup administrative, clinical and reimbursement policies and methodologies, code editing logic, coordination of benefits, Regulatory Requirements, and this Agreement. Eligible Charges do not include Provider Charges for any items or services that Provider receives and/or provides free of charge. "Emergency Condition" means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in serious jeopardy to the health of the individual, or in the case of a pregnant woman, the health of the woman or her unborn child; serious impairment to bodily functions; or serious dysfunction of any bodily organ or part. "Emergency Services" means those Covered Services furnished by a provider qualified to furnish emergency services, and which are needed to evaluate or treat an Emergency Condition. "Encounter Data" means Claim information and any additional information submitted by a provider under capitated or risk -sharing arrangements for Health Services rendered to Members. "Encounter Rate" means the Amerigroup Rate that is all-inclusive of professional, technical and facility charges including evaluation and management, pharmaceuticals, routine surgical and therapeutic procedures, and diagnostic testing (including laboratory and radiology) capable of being performed on site. "Fee Schedule(s)" means the complete listing of Amerigroup Rate(s) for specific services that is payment for each unit of service allowed based on applicable Coded Service Identifier(s) for Covered Services. Washington Enterprise Provider Agreement PCS 30 1508596321 © 2020 Nov — Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. "Global Case Rate" means the all-inclusive Amerigroup Rate which includes facility, professional and physician services for specific Coded Service Identifier(s) for Covered Services. "Inpatient Services" means Covered Services provided by a facility to a Member who is admitted and treated as a registered inpatient, is assigned a licensed bed within the facility, remains assigned to such bed and for whom a room and board charge is made. "Observation" means the services furnished on the facility's premises, including use of a bed and periodic monitoring by nursing or other staff, which are Medically Necessary to evaluate a Member's condition and determine if the Member requires an inpatient admission to the facility. Such determination shall be in compliance with Policies or Regulatory Requirements. "Outlier Rate" means the payment applied to an admission which exceeds the outlier threshold as set forth in the PCS or in compliance with Policies or Regulatory Requirements. "Outpatient Services" means Covered Services provided by a facility to a Member who is admitted and treated as a registered outpatient within the facility. "Patient Day" means each approved calendar day of care that a Member receives in the facility, to the extent such day of care is a Covered Service under the terms of the Member's Health Benefit Plan, but excluding the day of discharge. "Percentage Rate" means the Amerigroup Rate that is a percentage of Eligible Charges billed by a provider for Covered Services. "Per Diem Rate" means the Amerigroup Rate that is the all-inclusive fixed payment for Covered Services rendered on a single date of service. "Per Hour Rate" means the Amerigroup Rate that is payment based on an increment of time for Covered Services. "Per Relative Value Unit" ("RVU") means the Amerigroup Rate for each unit of service based on the CMS, State Agency or other (e.g., American Society of Anesthesiologists (ASA)) defined Relative Value Unit (RVU). "Per Service Rate" means the Amerigroup Rate that is payment for each service allowed based on applicable Coded Service Identifier(s) for Covered Services. "Per Unit Rate" means the Amerigroup Rate that is payment for each unit of service allowed based on applicable Coded Service Identifier(s) for Covered Services. "Per Visit Rate" means the Amerigroup Rate that is the all-inclusive fixed payment for one encounter for Covered Services. "Provider Charges" means the regular, uniform rate or price Provider determines and submits to Amerigroup as charges for Health Services provided to Members. Such Provider Charges shall be no greater than the rate or price Provider submits to any person or other health care benefit payor for the same Health Services provided, regardless of whether Provider agrees with such person or other payor to accept a different rate or price as payment in full for such services. "Short Stay" means an inpatient hospital stay that is less than a specified number of calendar days in compliance with Policies and/or Regulatory Requirements. ARTICLE II GENERAL PROVISIONS Billing Form and Claims Reporting Requirements. Provider shall submit all Claims on a CMS 1500 or CMS 1450/UB- 04 claim form or its successor form(s) as applicable based on the Health Services provided in accordance with Policies or applicable Regulatory Requirements. Provider shall report all Health Services in accordance with the Coded Service Identifier(s) reporting guidelines and instructions using HIPAA compliant billing codes. In addition, Plan shall not pay any Claim(s) nor accept any Encounter Data submitted using non-compliant codes. Plan audits that result in identification of Health Services that are not reported in accordance with the Coded Service Identifier(s) guidelines and instructions, will be subject to recovery through remittance adjustment or other recovery action as may be set forth in the provider manual(s). Washington Enterprise Provider Agreement PCS 31 1508596321 © 2020 Nov — Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. Claim Submissions for Pharmaceuticals. Each Claim submitted for a pharmaceutical product must include standard Coded Service Identifier(s), a National Drug Code ("NDC") number of the covered medication, a description of the product, and dosage and units administered. Unless otherwise required under Regulatory Requirements, Plan shall not reimburse for any pharmaceuticals that are not administered to the Member and/or deemed contaminated and/or considered waste. Codinq Updates. Coded Service Identifier(s) used to define specific rates are updated from time to time to reflect new, deleted or replacement codes. Amerigroup shall use commercially reasonable efforts to update all applicable Coded Service Identifiers within sixty (60) days of release by CMS or other applicable authority. When billing codes are updated, Provider is required to use appropriate replacement codes for Claims for Covered Services, regardless of whether this Agreement has been amended to reflect changes to standard billing codes. If Provider bills a revised code prior to the effective date of the revised code, the Claim will be rejected or denied and Provider shall resubmit Claim with correct code. In addition, Claims with codes which have been deleted will be rejected. Coding Software. Updates to Amerigroup's Claims processing filters, code editing software, pricers, and any edits related thereto, as a result of changes in Coded Service Identifier(s) reporting guidelines and instructions, shall take place automatically and do not require any notice, disclosure or amendment to Provider. Amerigroup reserves the right to use a code editing software as reasonably required by Amerigroup to ensure Claims adjudication in accordance with industry standards, including, but not limited to, determining which services are considered part of, incidental to, or inclusive of the primary procedure and ensuring medically appropriate age, gender, diagnosis, frequency, and units billed. Modifiers. All appropriate modifiers must be submitted in accordance with Regulatory Requirements, industry standard billing guidelines and Policies. If appropriate modifiers are not submitted, Claims may be rejected or denied. New/Expanded Service or New/Expanded Technology. In accordance with the Scope/Change in Status section of the Agreement, as of the Effective Date of this Agreement, any New/Expanded Service or New/Expanded Technology (defined below) is not reimbursable under this Agreement. Notwithstanding the foregoing, Provider may submit the following documentation to Amerigroup at least sixty (60) days prior to the implementation of any New/Expanded Service or New/Expanded Technology for consideration as a reimbursable service: (1) a description of the New/Expanded Service or New/Expanded Technology; (2) Provider's proposed charge for the New/Expanded Service or New/Expanded Technology; (3) such other reasonable data and information required by Amerigroup to evaluate the New/Expanded Service or New/Expanded Technology. In addition, Amerigroup may also need to obtain approval from applicable Agency prior to Amerigroup making determination that New/Expanded Service or New/Expanded Technology can be considered a reimbursable service. If Amerigroup agrees that the New/Expanded Service or New/Expanded Technology may be reimbursable under this Agreement, then Amerigroup shall notify Provider, and both parties agree to negotiate in good faith, a new Amerigroup Rate for the New/Expanded Service or New/Expanded Technology within sixty (60) days of Amerigroup's notice to Provider. If the parties are unable to reach an agreement on a new Amerigroup Rate for the New/Expanded Service or New/Expanded Technology before the end of the sixty (60) day period, then such New/Expanded Service or New/Expanded Technology shall not be reimbursed by Amerigroup, and the Payment in Full and Hold Harmless provision of this Agreement shall apply. a. "New/Expanded Service" shall be defined as a Health Service: (a) that Provider was not providing to Members as of the Effective Date of this Agreement and; (b) for which there is not a specific Amerigroup Rate as set forth in this PCS. b. "New/Expanded Technology" shall be defined as a technological advancement in the delivery of a Covered Service which results in a material increase to the cost of such service. New/Expanded Technology shall not include a new device, or implant that merely represents a new model or an improved model of a device or implant used in connection with a service provided by Provider as of the Effective Date of this Agreement. Non -Priced Codes for Covered Services. Amerigroup reserves the right to establish a rate for codes that are not priced in this PCS or in the Fee Schedule(s), including but not limited to, Not Otherwise Classified Codes ("NOC"), Not Otherwise Specified ("NOS"), Miscellaneous, Individual Consideration Codes ("IC"), and By Report ("BR") (collectively "Non -Priced Codes"). Amerigroup shall only reimburse Non -Priced Codes for Covered Services in the following situations: (i) the Non -Priced Code does not have a published dollar amount on the then current applicable Plan, State or CMS Fee Schedule, (ii) the Non -Priced Code has a zero dollar amount listed, or (iii) the Non -Priced Code requires manual pricing. In such situations, such Non -Priced Code shall be reimbursed at a rate established by Amerigroup for such Covered Service. Notwithstanding the foregoing, Amerigroup shall not price Non -Priced Codes that are not Covered Services under the Members Health Benefit Plan. Amerigroup may require the submission of medical records, invoices, or other documentation for Claims payment consideration. Washington Enterprise Provider Agreement PCS 32 1508596321 © 2020 Nov— Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. Reimbursement for Amerigroup Rate Based on Eligible Charges. Notwithstanding any reimbursement amount set forth herein, Provider shall only be allowed to receive such reimbursement if such reimbursement is for an Eligible Charge. In addition, if Provider reimbursement is under one or more of the following methodologies: Capitation, Case Rate, DRG Rate, Encounter Rate, Global Case Rate, Per Diem Rate, Per Relative Value Unit (RVU), and Per Visit Rate, then individual services billed shall not be reimbursed separately, unless otherwise specified in Article IV of this PCS. Reimbursement for Subcontractors. Plan shall not be liable for any reimbursement in addition to the applicable Amerigroup Rate as a result of Provider's use of a subcontractor. Provider shall be solely responsible to pay subcontractors for any Health Services, and shall via written contract, contractually prohibit such subcontractors from billing, collecting or attempting to collect from Amerigroup, Plan or Members. Notwithstanding the foregoing, if Amerigroup has a direct contract with the subcontractor, the direct contract shall prevail over this Agreement and the subcontractor shall bill Amerigroup under the direct contract for any subcontracted services, with the exception of nursing services provided for Home Infusion Therapy, or unless otherwise agreed to by the parties. Tax Assessment and Penalties. The Amerigroup Rates in this Agreement include all sales and use taxes and other taxes on Provider revenue, gross earnings, profits, income and other taxes, charges or assessments of any nature whatsoever (together with any related interest or penalties) now or hereafter imposed against or collectible by Provider with respect to Covered Services, unless otherwise required by Agency pursuant to Regulatory Requirements. Neither Provider nor Plan shall add any amount to or deduct any amount from the Amerigroup Rates, whether on account of taxes, assessments, tax penalties or tax exemptions. Updates to Amerigroup Rate(s) Based on External Sources. Unless otherwise required by Regulatory Requirements, and notwithstanding any proprietary fee schedule(s)/rate(s)/methodologies, Amerigroup shall use commercially reasonable efforts to update the Amerigroup Rate(s) based on External Sources, which include but are not limited to, i) CMS Medicare fee schedule(s)/rate(s)/methodologies; ii) Medicaid or State Agency fee schedule(s)/rate(s)/methodologies; iii) vendor fee schedule(s)/rate(s)/methodologies; or iv) any other entity's published fee schedule(s)/rate(s)/methodologies (collectively- "External Sources") no later than sixty (60) days after Amerigroup's receipt of the final fee schedule(s)/rate(s)/methodologies change from such External Sources, or on the effective date of such final fee schedule(s)/rate(s)/methodologies change, whichever is later. The effective date of such final fee schedule(s)/rate(s)/methodologies change shall be the effective date of the change as published by External Sources. Fee schedule(s)/rate(s)/methodologies will be applied on a prospective basis. Claims processed prior to the implementation of the new Amerigroup Rate(s) in Amerigroup's payment system shall not be reprocessed, however, if reprocessing is required by Regulatory Requirements, and such reprocessing could result in a potential under and/or over payment to a Provider, then Plan may reconcile the Claim adjustments to determine the remaining amount Provider owes Plan, or that Plan owes to Provider. Any resultant overpayment recoveries (i.e. Provider owes Plan) shall occur automatically without advance notification to Provider. Unless otherwise required by Regulatory Requirements, Amerigroup shall not be responsible for interest payments that may be the result of a late notification by External Sources to Amerigroup of fee schedule(s)/rate(s)/methodologies change. Washington Enterprise Provider Agreement PCS 33 1508596321 © 2020 Nov — Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. PLAN COMPENSATION SCHEDULE ("PCS") ARTICLE I DEFINITIONS The definitions set forth below shall apply with respect to all of the terms outlined in this PCS. Terms not otherwise defined in this PCS and defined elsewhere in the Agreement shall carry the meanings set forth in the Agreement. "Capitation" means the amount paid by Amerigroup to a provider or management services organization on a per member per month basis for either specific services or the total cost of care for Covered Services. "Case Rate" means the all-inclusive Amerigroup Rate for an entire admission or one outpatient encounter for Covered Services. "Chargemaster" or "Charge Master" means facility's listing of facility charges for products, services and supplies. "Coded Service Identifier(s)" means a listing of descriptive terms and identifying codes, updated from time to time by CMS or other industry source, for reporting Health Services on the CMS 1500 or CMS 1450/UB-04 claim form or its successor as applicable based on the services provided. The codes include but are not limited to, American Medical Association Current Procedural Terminology ("CPT® -4"), CMS Healthcare Common Procedure Coding System ("HCPCS"), International Classification of Diseases, 10th Revision ("ICD -10"), National Uniform Billing Committee ("Revenue Code") and National Drug Code ("NDC") or their successors. "Cost to Charge Ratio" ("CCR") means the quotient of cost (total operating expenses minus other operating revenue) divided by charges (gross patient revenue) expressed as a decimal, as defined by Regulatory Requirements. "Diagnosis -Related Group" ("DRG") means Diagnosis Related Group or its successor as established by CMS or other grouper, including but not limited to, a state mandated grouper or other industry standard grouper. "DRG Rate" means the all-inclusive dollar amount which is multiplied by the appropriate DRG Weight to determine the Amerigroup Rate for Covered Services. "DRG Weight" means the weight applicable to the specific DRG methodology set forth in this PCS, including but not limited to, CMS DRG weights as published in the Federal Register, state agency weights, or other industry standard weights. "Eligible Charges" means those Provider Charges that meet Amerigroup's conditions and requirements for a Health Service to be eligible for reimbursement. These conditions and requirements include but are not limited to: Member program eligibility, Provider program eligibility, benefit coverage, authorization requirements, provider manual specifications, Amerigroup administrative, clinical and reimbursement policies and methodologies, code editing logic, coordination of benefits, Regulatory Requirements, and this Agreement. Eligible Charges do not include Provider Charges for any items or services that Provider receives and/or provides free of charge. "Emergency Condition" means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in serious jeopardy to the health of the individual, or in the case of a pregnant woman, the health of the woman or her unborn child; serious impairment to bodily functions; or serious dysfunction of any bodily organ or part. "Emergency Services" means those Covered Services furnished by a provider qualified to furnish emergency services, and which are needed to evaluate or treat an Emergency Condition. "Encounter Data" means Claim information and any additional information submitted by a provider under capitated or risk -sharing arrangements for Health Services rendered to Members. "Encounter Rate" means the Amerigroup Rate that is all-inclusive of professional, technical and facility charges including evaluation and management, pharmaceuticals, routine surgical and therapeutic procedures, and diagnostic testing (including laboratory and radiology) capable of being performed on site. "Fee Schedule(s)" means the complete listing of Amerigroup Rate(s) for specific services that is payment for each unit of service allowed based on applicable Coded Service Identifier(s) for Covered Services. Washington Enterprise Provider Agreement PCS 34 1508596321 © 2020 Nov —Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. "Global Case Rate" means the all-inclusive Amerigroup Rate which includes facility, professional and physician services for specific Coded Service Identifier(s) for Covered Services. "Inpatient Services" means Covered Services provided by a facility to a Member who is admitted and treated as a registered inpatient, is assigned a licensed bed within the facility, remains assigned to such bed and for whom a room and board charge is made. "Observation" means the services furnished on the facility's premises, including use of a bed and periodic monitoring by nursing or other staff, which are Medically Necessary to evaluate a Member's condition and determine if the Member requires an inpatient admission to the facility. Such determination shall be in compliance with Policies or Regulatory Requirements. "Outlier Rate" means the payment applied to an admission which exceeds the outlier threshold as set forth in the PCS or in compliance with Policies or Regulatory Requirements. "Outpatient Services" means Covered Services provided by a facility to a Member who is admitted and treated as a registered outpatient within the facility. "Patient Day" means each approved calendar day of care that a Member receives in the facility, to the extent such day of care is a Covered Service under the terms of the Member's Health Benefit Plan, but excluding the day of discharge. "Percentage Rate" means the Amerigroup Rate that is a percentage of Eligible Charges billed by a provider for Covered Services. "Per Diem Rate" means the Amerigroup Rate that is the all-inclusive fixed payment for Covered Services rendered on a single date of service. "Per Hour Rate" means the Amerigroup Rate that is payment based on an increment of time for Covered Services. "Per Relative Value Unit" ("RVU") means the Amerigroup Rate for each unit of service based on the CMS, State Agency or other (e.g., American Society of Anesthesiologists (ASA)) defined Relative Value Unit (RVU). "Per Service Rate" means the Amerigroup Rate that is payment for each service allowed based on applicable Coded Service Identifier(s) for Covered Services. "Per Unit Rate" means the Amerigroup Rate that is payment for each unit of service allowed based on applicable Coded Service Identifier(s) for Covered Services. "Per Visit Rate" means the Amerigroup Rate that is the all-inclusive fixed payment for one encounter for Covered Services. "Provider Charges" means the regular, uniform rate or price Provider determines and submits to Amerigroup as charges for Health Services provided to Members. Such Provider Charges shall be no greater than the rate or price Provider submits to any person or other health care benefit payor for the same Health Services provided, regardless of whether Provider agrees with such person or other payor to accept a different rate or price as payment in full for such services. "Short Stay" means an inpatient hospital stay that is less than a specified number of calendar days in compliance with Policies and/or Regulatory Requirements. ARTICLE II GENERAL PROVISIONS Billing Form and Claims Reporting Requirements. Provider shall submit all Claims on a CMS 1500 or CMS 1450/UB- 04 claim form or its successor form(s) as applicable based on the Health Services provided in accordance with Policies or applicable Regulatory Requirements. Provider shall report all Health Services in accordance with the Coded Service Identifier(s) reporting guidelines and instructions using HIPAA compliant billing codes. In addition, Plan shall not pay any Claim(s) nor accept any Encounter Data submitted using non-compliant codes. Plan audits that result in identification of Health Services that are not reported in accordance with the Coded Service Identifier(s) guidelines and instructions, will be subject to recovery through remittance adjustment or other recovery action as may be set forth in the provider manual(s). Washington Enterprise Provider Agreement PCS 35 1508596321 © 2020 Nov — Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. Claim Submissions for Pharmaceuticals. Each Claim submitted for a pharmaceutical product must include standard Coded Service Identifier(s), a National Drug Code ("NDC") number of the covered medication, a description of the product, and dosage and units administered. Unless otherwise required under Regulatory Requirements, Plan shall not reimburse for any pharmaceuticals that are not administered to the Member and/or deemed contaminated and/or considered waste. Coding Updates. Coded Service Identifier(s) used to define specific rates are updated from time to time to reflect new, deleted or replacement codes. Amerigroup shall use commercially reasonable efforts to update all applicable Coded Service Identifiers within sixty (60) days of release by CMS or other applicable authority. When billing codes are updated, Provider is required to use appropriate replacement codes for Claims for Covered Services, regardless of whether this Agreement has been amended to reflect changes to standard billing codes. If Provider bills a revised code prior to the effective date of the revised code, the Claim will be rejected or denied and Provider shall resubmit Claim with correct code. In addition, Claims with codes which have been deleted will be rejected. Coding Software. Updates to Amerigroup's Claims processing filters, code editing software, pricers, and any edits related thereto, as a result of changes in Coded Service Identifier(s) reporting guidelines and instructions, shall take place automatically and do not require any notice, disclosure or amendment to Provider. Amerigroup reserves the right to use a code editing software as reasonably required by Amerigroup to ensure Claims adjudication in accordance with industry standards, including, but not limited to, determining which services are considered part of, incidental to, or inclusive of the primary procedure and ensuring medically appropriate age, gender, diagnosis, frequency, and units billed. Modifiers. All appropriate modifiers must be submitted in accordance with Regulatory Requirements, industry standard billing guidelines and Policies. If appropriate modifiers are not submitted, Claims may be rejected or denied. New/Expanded Service or New/Expanded Technology. In accordance with the Scope/Change in Status section of the Agreement, as of the Effective Date of this Agreement, any New/Expanded Service or New/Expanded Technology (defined below) is not reimbursable under this Agreement. Notwithstanding the foregoing, Provider may submit the following documentation to Amerigroup at least sixty (60) days prior to the implementation of any New/Expanded Service or New/Expanded Technology for consideration as a reimbursable service: (1) a description of the New/Expanded Service or New/Expanded Technology; (2) Provider's proposed charge for the New/Expanded Service or New/Expanded Technology; (3) such other reasonable data and information required by Amerigroup to evaluate the New/Expanded Service or New/Expanded Technology. In addition, Amerigroup may also need to obtain approval from applicable Agency prior to Amerigroup making determination that New/Expanded Service or New/Expanded Technology can be considered a reimbursable service. If Amerigroup agrees that the New/Expanded Service or New/Expanded Technology may be reimbursable under this Agreement, then Amerigroup shall notify Provider, and both parties agree to negotiate in good faith, a new Amerigroup Rate for the New/Expanded Service or New/Expanded Technology within sixty (60) days of Amerigroup's notice to Provider. If the parties are unable to reach an agreement on a new Amerigroup Rate for the New/Expanded Service or New/Expanded Technology before the end of the sixty (60) day period, then such New/Expanded Service or New/Expanded Technology shall not be reimbursed by Amerigroup, and the Payment in Full and Hold Harmless provision of this Agreement shall apply. a. "New/Expanded Service" shall be defined as a Health Service: (a) that Provider was not providing to Members as of the Effective Date of this Agreement and; (b) for which there is not a specific Amerigroup Rate as set forth in this PCS. b. "New/Expanded Technology" shall be defined as a technological advancement in the delivery of a Covered Service which results in a material increase to the cost of such service. New/Expanded Technology shall not include a new device, or implant that merely represents a new model or an improved model of a device or implant used in connection with a service provided by Provider as of the Effective Date of this Agreement. Non -Priced Codes for Covered Services. Amerigroup reserves the right to establish a rate for codes that are not priced in this PCS or in the Fee Schedule(s), including but not limited to, Not Otherwise Classified Codes ("NOC"), Not Otherwise Specified ("NOS"), Miscellaneous, Individual Consideration Codes ("IC"), and By Report ("BR") (collectively "Non -Priced Codes"). Amerigroup shall only reimburse Non -Priced Codes for Covered Services in the following situations: (i) the Non -Priced Code does not have a published dollar amount on the then current applicable Plan, State or CMS Fee Schedule, (ii) the Non -Priced Code has a zero dollar amount listed, or (iii) the Non -Priced Code requires manual pricing. In such situations, such Non -Priced Code shall be reimbursed at a rate established by Amerigroup for such Covered Service. Notwithstanding the foregoing, Amerigroup shall not price Non -Priced Codes that are not Covered Services under the Members Health Benefit Plan. Amerigroup may require the submission of medical records, invoices, or other documentation for Claims payment consideration. Washington Enterprise Provider Agreement PCS 36 1508596321 © 2020 Nov — Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. Reimbursement for Amerigroup Rate Based on Eligible Charges. Notwithstanding any reimbursement amount set forth herein, Provider shall only be allowed to receive such reimbursement if such reimbursement is for an Eligible Charge. In addition, if Provider reimbursement is under one or more of the following methodologies: Capitation, Case Rate, DRG Rate, Encounter Rate, Global Case Rate, Per Diem Rate, Per Relative Value Unit (RVU), and Per Visit Rate, then individual services billed shall not be reimbursed separately, unless otherwise specified in Article IV of this PCS. Reimbursement for Subcontractors. Plan shall not be liable for any reimbursement in addition to the applicable Amerigroup Rate as a result of Provider's use of a subcontractor. Provider shall be solely responsible to pay subcontractors for any Health Services, and shall via written contract, contractually prohibit such subcontractors from billing, collecting or attempting to collect from Amerigroup, Plan or Members. Notwithstanding the foregoing, if Amerigroup has a direct contract with the subcontractor, the direct contract shall prevail over this Agreement and the subcontractor shall bill Amerigroup under the direct contract for any subcontracted services, with the exception of nursing services provided for Home Infusion Therapy, or unless otherwise agreed to by the parties. Tax Assessment and Penalties. The Amerigroup Rates in this Agreement include all sales and use taxes and other taxes on Provider revenue, gross earnings, profits, income and other taxes, charges or assessments of any nature whatsoever (together with any related interest or penalties) now or hereafter imposed against or collectible by Provider with respect to Covered Services, unless otherwise required by Agency pursuant to Regulatory Requirements. Neither Provider nor Plan shall add any amount to or deduct any amount from the Amerigroup Rates, whether on account of taxes, assessments, tax penalties or tax exemptions. Updates to Amerigroup Rate(s) Based on External Sources. Unless otherwise required by Regulatory Requirements, and notwithstanding any proprietary fee schedule(s)/rate(s)/methodologies, Amerigroup shall use commercially reasonable efforts to update the Amerigroup Rate(s) based on External Sources, which include but are not limited to, i) CMS Medicare fee schedule(s)/rate(s)/methodologies; ii) Medicaid or State Agency fee schedule(s)/rate(s)/methodologies; iii) vendor fee schedule(s)/rate(s)/methodologies; or iv) any other entity's published fee schedule(s)/rate(s)/methodologies (collectively "External Sources") no later than sixty (60) days after Amerigroup's receipt of the final fee schedule(s)/rate(s)/methodologies change from such External Sources, or on the effective date of such final fee schedule(s)/rate(s)/methodologies change, whichever is later. The effective date of such final fee schedule(s)/rate(s)/methodologies change shall be the effective date of the change as published by External Sources. Fee schedule(s)/rate(s)/methodologies will be applied on a prospective basis. Claims processed prior to the implementation of the new Amerigroup Rate(s) in Amerigroup's payment system shall not be reprocessed, however, if reprocessing is required by Regulatory Requirements, and such reprocessing could result in a potential under and/or over payment to a Provider, then Plan may reconcile the Claim adjustments to determine the remaining amount Provider owes Plan, or that Plan owes to Provider. Any resultant overpayment recoveries (i.e. Provider owes Plan) shall occur automatically without advance notification to Provider. Unless otherwise required by Regulatory Requirements, Amerigroup shall not be responsible for interest payments that may be the result of a late notification by External Sources to Amerigroup of fee schedule(s)/rate(s)/methodologies change. Washington Enterprise Provider Agreement PCS 37 1508596321 © 2020 Nov— Grant County dba Grant County Integrated Services 04/14/2021 Amerigroup Washington, Inc. PLAN COMPENSATION SCHEDULE ("PCS") ATTACHMENT MEDICAID For purposes of determining the Amerigroup Rate, the total reimbursement amount that Provider and Amerigroup have agreed upon for the applicable provider type(s) for Covered Services provided under this Agreement in effect on the date of service shall be as set forth below. The parties acknowledge and agree that the Medicaid Fee Schedule is subject to modification by Amerigroup at any time during the term of this Agreement and will be applied on a prospective basis. Program: -11", --- Amerigroup Medicaid Nefiniork . Behavioral;Health Facility Service Descri tion Ball.n Code ,,- - =RatelMethodolo Rate Descri tion` Crisis intervention mental S9484 $63.98 Per Hour health services, per hour stabilization Crisis Intervention mental S9485 $625.00 Per Diem health services, per diem up to 14 days Mental Health Assessment, H0031 $156.65 Per Encounter by non physician Nursing assessment/ T1001 $20.52 Per Encounter evaluation Psychiatric diagnostic 90792 $149.52 Per Encounter evaluation with medical services Behavioral health, short H0018 $312.00 Per Diem term residential, without room and board, per diem Behavioral Health, long term H0019 $290.00 Per Diem residential, without room and board, per diem Crisis Intervention Service H201 $35.10 Per Unit 1. Provider agrees to reference SERI coding guidelines, available through Amerigroup's Web portal, to ensure the proper billing and reimbursement. Medicaid Affiliate Services. Provider acknowledges that Amerigroup is affiliated with health plans that offer similar benefits under similar programs as the programs covered hereunder ("Medicaid Affiliates"). The parties acknowledge that Provider is not a Participating Provider in Medicaid Affiliate's Network for purposes of rendering services to Medicaid Members. However, in the event Provider treats a Medicaid Member of a Medicaid Affiliate, subject to Regulatory Requirements, Provider shall accept as payment in full the rates established by the Medicaid Affiliate's state program governing care to Medicaid Members. Such services must be Medicaid Covered Services under the Medicaid Affiliate's state program, and shall require prior authorization, except for Emergency Services and services for which a Medicaid Member is entitled to self -refer. Upon request, Amerigroup shall coordinate and provide information as necessary between Provider and Medicaid Affiliate for services rendered to Medicaid Member. Reimbursement Specific to Provider Type The following will be reimbursed for facility services only: Acute Care Hospital, ASC, Behavioral Health Facility, Free Standing Birthing Center, Rehabilitation Facility and SNF. Professional services are excluded. Ambulance Provider Air and/or Ground shall be reimbursed in accordance with Regulatory Requirements for the applicable methodology based on the referenced fee schedule. If such reimbursement is based on an Amerigroup Rate, the applicable state methodology on which such fee schedule is based, shall be used to determine the appropriate level of reimbursement. Washington Enterprise Provider Agreement PCS Attachment 38 1508596321 Medicaid " Behavioral Health Facility 04/14/2021 © 2019 Nov V3 — Grant County dba Grant County Integrated Services Amerigroup Washington, Inc. Hospice reimbursement is inclusive of skilled nursing, home health aide, medical social worker services, dietary, pastoral, bereavement counseling, DME, medical supplies and administration of medication. Specialty Provider Individual and/or group (Non -MD or DO) shall be reimbursed in accordance with Regulatory Requirements for the applicable methodology based on the referenced fee schedule. If such reimbursement is based on an Amerigroup proprietary fee schedule, the applicable state methodology on which such fee schedule is based, shall be used to determine the appropriate level of reimbursement. Specialty Provider Individual and/or group (including Non -MD or DO) shall be reimbursed for anesthesiology services in accordance with the accumulation of base, modifier and time units multiplied by the Washington State Medicaid Anesthesia Conversion Factor. The services should be billed in minute increments. One time unit will be allowed for each fifteen (15) minute interval, or fraction thereof, starting from the time Provider begins to prepare the Member for induction and ending when the Member may safely be placed under post-operative supervision and Provider is no longer in personal attendance. "Ambulatory Patient Group" ("APG") means the Amerigroup Rate that is a fixed reimbursement to a facility for Outpatient Services and which incorporates data regarding the reason for the visit and patient data. "Ambulatory Payment Classification" ("APC") or its successor shall have the meaning set forth in the Medicare law and CMS regulations and guidance. "Amerigroup DMEPOS and PEN Fee Schedule" means the applicable Amerigroup DMEPOS and PEN Fee Schedule for the market(s) and program(s) covered by the Agreement. The parties acknowledge and agree that the Amerigroup DMEPOS and PEN Fee Schedule is subject to modification by Amerigroup at any time during the term of the Agreement. Amerigroup DMEPOS and PEN Fee Schedule and/or rate changes will be applied on a prospective basis. "Amerigroup Reference Laboratory Fee Schedule" means the Amerigroup Rate that is the Amerigroup Reference Laboratory Fee Schedule that is based on the Medicare Fee Schedule and may contain additional CPT/HCPCS codes. Amerigroup Reference Laboratory Fee Schedule and/or rate changes will be applied on a prospective basis. "Amerigroup Medicaid Rate(s)/Fee Schedule(s)/Methodologies" means the Amerigroup Medicaid Rate(s)/Fee Schedule(s)/ in effect on the date of service for the provider types)/service(s) identified herein for the applicable Medicaid Program(s). "CMS Outpatient Prospective Payment System" COPPS") shall have the meaning set forth in Medicare law and CMS regulations and guidance. "Medical Care Management Rate" means the amount paid by Amerigroup to Provider on a per member per month basis for facilitation of collaborative programs meant to manage medical/social/mental health conditions more effectively. "Medicare Fee Schedule" means the applicable Medicare Fee Schedule for the provider type(s) identified herein, including payment conversion factor, where applicable, and in effect on the date of the service is initiated to Members. Medicare Fee Schedule and/or rate changes will be applied on a prospective basis. "Medicare LUPA National Base Rate" means the Medicare LUPA ("Low Utilization Payment Adjustment") National Base rate in effect as of the date of service for the market(s) and program(s) covered by the Agreement at the time the Covered Services are initiated to the Member. Medicare LUPA National Base Rate changes will be applied on a prospective basis. "Medicare Part B Drug Average Sales Price ("ASP") Fee Schedule" means the Medicare Part B Drug Average Sales Price ("ASP") Fee Schedule (or successor) in effect as of the date of service for the market(s) and programs covered by the Agreement at the time the Covered Services is initiated to the Member. Medicare Part B Drug Average Sales Price ("ASP") Fee Schedule and/or rate changes will be applied on a prospective basis. "Washington State Medicaid Rate(s)/Fee Schedule(s)/Methodologies" means the Washington State Medicaid Rates)/Fee Schedule(s)/ in effect on the date of service for the provider types)/service(s) identified herein for the applicable Medicaid Program(s). Washington Enterprise Provider Agreement PCS Attachment 39 1508596321 Medicaid — Behavioral Health Facility 04/14/2021 © 2019 Nov V3 — Grant County dba Grant County Integrated Services Amerigroup Washington, Inc. PLAN COMPENSATION SCHEDULE ("PCS") ATTACHMENT MEDICAID For purposes of determining the Amerigroup Rate, the total reimbursement amount that Provider and Amerigroup have agreed upon for the applicable provider type(s) for Covered Services provided under this Agreement in effect on the date of service shall be as set forth below. The parties acknowledge and agree that the Medicaid Fee Schedule is subject to modification by Amerigroup at any time during the term of this Agreement and will be applied on a prospective basis. Pro ram: Amery rou Medicaid Network :Behavioral Health1 ractitioner Service Descri tion Bilin Code = Rate/Ma odo1 Rate Descri i n to Eligible Outpatient Services Grant County Medicaid Eligibles Amerigroup's percentage of Eligibles multiplied by the amount in Section 1. a. Per Month Capitated Outpatient Services include the following: - Outpatient Mental Health Services for children/youth/adults - All SUD services including Alcohol and Drug Evaluations/ Assessments, Intensive Outpatient and Outpatient Services Excluded from capitation are the following codes: H201 1, S9484, S9485, H0031, T1001, 90792, H0018, H0019 1. Compensation for Services: a. Amerigroup's pro rata portion of total Eligibles for Grant County multiplied by $601,835.00 (Provider's monthly prior year base). 2. "Eligibles" are defined as any individuals who are eligible beneficiaries under Amerigroup's Washington State Medicaid IMC Managed Care Program and reside within the North Central county of Grant. 3.The capitation amounts set forth above are inclusive of all services rendered by the Provider. Such payment shall be made monthly for the current month. 4. Performance Measures: a. Provider and Amerigroup agree to review and negotiate, in good faith, appropriate quality and performance metrics upon written request by Provider to initiate such discussion. Subsequent agreed upon metrics will be incorporated by way of amendment. 5. Provider agrees to reference SERI coding guidelines, available through Amerigroup's Web portal, to ensure the proper billing and reimbursement. Pro ram: Ameri irou Medicaid Network Behavioral Health Practitioner , Service Descri tion Billiln Code Rate/Methodolo Rat escri ption. WISe Services Grant County Medicaid Eligibles $3,360.00 Per Member Per Month 1. Monthly Compensation for WISe Services Include: a. WISe: Amerigroup's actual number of total IMC Eligible members in Grant County enrolled in the WISe program and served by the Provider during the month invoiced multiplied by the case rate of $3,360.00 per member and based on a 45 capitated monthly member caseload. 2. "Eligibles" are defined as any individuals who are eligible beneficiaries under Amerigroup's Washington State Medicaid IMC Managed Care Program and reside within the North Central county of Grant. 3. Wraparound with Intensive Services (WISe) are a range of services for children and young adults that are individualized, intensive, coordinated, comprehensive, culturally competent, and provided in the home and community. Washington Enterprise Provider Agreement PCS Attachment 40 1508596321 Medicaid — Behavioral Health Practitioner 04/14/2021 © 2019 Nov V3— Grant County dba Grant County Integrated Services Amerigroup Washington, Inc. 4. The case rate amount set forth above is inclusive of all services rendered by the Provider. Such payment shall be made monthly for the current month. 5. Provider agrees to reference SERI coding guidelines, available through Amerigroup's Web portal, to ensure the . . I ruer L)11!lrly anU reirTwurserrrent. T1001 $20.52 Per Encounter Pro ram: Ameri rola Medicaid Network Behavioral Health Practitia►ner , 90792 Service Descr tion . Per Encounter Bill! n Code Rate/IVlethodolo :Rate Descri tion Crisis intervention mental S9484 $63.98 Behavioral health, short Per Hour health services, per hour Per Diem term residential, without stabilization Behavioral health, long term H0019 Crisis Intervention mental S9485 residential, without room $625.00 Per Diem health services, per diem up Crisis Intervention Service H2O11 to 14 days Per Unit Mental Health Assessment, H0031 $156.65 Per Encounter by non phvsician Nursing assessment/ T1001 $20.52 Per Encounter evaluation Psychiatric diagnostic 90792 $149.52 Per Encounter evaluation with medical services Behavioral health, short H0018 $312.00 Per Diem term residential, without room and board, per diem Behavioral health, long term H0019 $290.00 Per Diem residential, without room and board, per diem Crisis Intervention Service H2O11 $35.10 Per Unit 1. Provider agrees to reference SERI coding guidelines, available through Amerigroup's Web portal, to ensure the proper billing and reimbursement. Medicaid Affiliate Services. Provider acknowledges that Amerigroup is affiliated with health plans that offer similar benefits under similar programs as the programs covered hereunder ("Medicaid Affiliates"). The parties acknowledge that Provider is not a Participating Provider in Medicaid Affiliate's Network for purposes of rendering services to Medicaid Members. However, in the event Provider treats a Medicaid Member of a Medicaid Affiliate, subject to Regulatory Requirements, Provider shall accept as payment in full the rates established by the Medicaid Affiliate's state program governing care to Medicaid Members. Such services must be Medicaid Covered Services under the Medicaid Affiliate's state program, and shall require prior authorization, except for Emergency Services and services for which a Medicaid Member is entitled to self -refer. Upon request, Amerigroup shall coordinate and provide information as necessary between Provider and Medicaid Affiliate for services rendered to Medicaid Member. Reimbursement Specific to Provider Type The following will be reimbursed for facility services only: Acute Care Hospital, ASC, Behavioral Health Facility, Free Standing Birthing Center, Rehabilitation Facility and SNF. Professional services are excluded. Ambulance Provider Air and/or Ground shall be reimbursed in accordance with Regulatory Requirements for the applicable methodology based on the referenced fee schedule. If such reimbursement is based on an Amerigroup Rate, the applicable state methodology on which such fee schedule is based, shall be used to determine the appropriate level of reimbursement. Hospice reimbursement is inclusive of skilled nursing, home health aide, medical social worker services, dietary, pastoral, bereavement counseling, DME, medical supplies and administration of medication. Specialty Provider Individual and/or group (Non -MD or DO) shall be reimbursed in accordance with Regulatory Requirements for the applicable methodology based on the referenced fee schedule. If such reimbursement is based on an Amerigroup proprietary fee schedule, the applicable state methodology on which such fee schedule is based, shall be used to determine the appropriate level of reimbursement. Washington Enterprise Provider Agreement PCS Attachment 41 1508596321 Medicaid — Behavioral Health Practitioner 04/14/2021 © 2019 Nov V3— Grant County dba Grant County Integrated Services Amerigroup Washington, Inc. Specialty Provider Individual and/or group (including Non -MD or DO) shall be reimbursed for anesthesiology services in accordance with the accumulation of base, modifier and time units multiplied by the Washington State Medicaid Anesthesia Conversion Factor. The services should be billed in minute increments. One time unit will be allowed for each fifteen (15) minute interval, or fraction thereof, starting from the time Provider begins to prepare the Member for induction and ending when the Member may safely be placed under post-operative supervision and Provider is no longer in personal attendance. "Ambulatory Patient Group" ("APG") means the Amerigroup Rate that is a fixed reimbursement to a facility for Outpatient Services and which incorporates data regarding the reason for the visit and patient data. "Ambulatory Payment Classification" ("APG") or its successor shall have the meaning set forth in the Medicare law and CMS regulations and guidance. "Amerigroup DMEPOS and PEN Fee Schedule" means the applicable Amerigroup DMEPOS and PEN Fee Schedule for the market(s) and program(s) covered by the Agreement. The parties acknowledge and agree that the Amerigroup DMEPOS and PEN Fee Schedule is subject to modification by Amerigroup at any time during the term of the Agreement. Amerigroup DMEPOS and PEN Fee Schedule and/or rate changes will be applied on a prospective basis. "Amerigroup Reference Laboratory Fee Schedule" means the Amerigroup Rate that is the Amerigroup Reference Laboratory Fee Schedule that is based on the Medicare Fee Schedule and may contain additional CPT/HCPCS codes. Amerigroup Reference Laboratory Fee Schedule and/or rate changes will be applied on a prospective basis. The Amerigroup Reference Laboratory Fee Schedule contains all codes from the Medicare Clinical Laboratory Fee Schedule, pathology codes from the Medicare Physician Fee Schedule, and additional codes added by Plan. "Amerigroup Medicaid Rate(s)/Fee Schedule(s)/Methodologies" means the Amerigroup Medicaid Rate(s)/Fee Schedule(s)/ in effect on the date of service for the provider types)/service(s) identified herein for the applicable Medicaid Program(s). "CMS Outpatient Prospective Payment System" COPPS") shall have the meaning set forth in Medicare law and CMS regulations and guidance. "Medical Care Management Rate" means the amount paid by Amerigroup to Provider on a per member per month basis for facilitation of collaborative programs meant to manage medical/social/mental health conditions more effectively. "Medicare Fee Schedule" means the applicable Medicare Fee Schedule for the provider type(s) identified herein, including payment conversion factor, where applicable, and in effect on the date of the service is initiated to Members. Medicare Fee Schedule and/or rate changes will be applied on a prospective basis. "Medicare LUPA National Base Rate" means the Medicare LUPA ("Low Utilization Payment Adjustment") National Base rate in effect as of the date of service for the market(s) and program(s) covered by the Agreement at the time the Covered Services are initiated to the Member. Medicare LUPA National Base Rate changes will be applied on a prospective basis. "Medicare Part B Drug Average Sales Price ("ASP") Fee Schedule" means the Medicare Part B Drug Average Sales Price ("ASP") Fee Schedule (or successor) in effect as of the date of service for the market(s) and programs covered by the Agreement at the time the Covered Services is initiated to the Member. Medicare Part B Drug Average Sales Price ("ASP") Fee Schedule and/or rate changes will be applied on a prospective basis. "Washington State Medicaid Rate(s)/Fee Schedule(s)/Methodologies" means the Washington State Medicaid Rate(s)/Fee Schedule(s)/ in effect on the date of service for the provider types)/service(s) identified herein for the applicable Medicaid Program(s). Washington Enterprise Provider Agreement PCS Attachment 42 1508596321 Medicaid — Behavioral Health Practitioner 04/14/2021 © 2019 Nov V3— Grant County dba Grant County Integrated Services Amerigroup Washington, Inc. JaniceFlynn From: Kevin J. McCrae Sent: Wednesday, April 21, 2021 2:38 PIVI To: Linze Greenwalt Cc: Debra Larson; Janice Flynn Subject: RE: Agreement between GrIS and Molina Attachments: 2021029 -IMC -County of Grant - Full Final.pdf,- Agreement - 2021-04-14T094907.137.pdf I do not see any Issues with -these contracts. Kevin McCrae (please note my new e-mail address) Chief Deputy Prosecuting Attorney (Civil/Appellate Unit), .fir WSBA #43087 Grant County Prosecutor's Office P.O. Box 37 35 C. Street NW Ephrata, WA 98823 (509)-754-2011 ext. 3956 (Civil) 3996 (Criminal) Fax 754-3449 -kimccrae@grantcountywa.gov The contents of this e-mail message, including any attachments,, are intended solely for the use of the person or entity to whom the e-mail was addressed. It contains information that may be protected by attorney-client privilege, Work - product, or other privileges, and may be restricted from disclosure by applicable state and federal law. If you are not the intended recipient of this message, be advised that any dissemination, distribution, or use of the contents of this message is strictly prohibited. If you received this message in error,, please contact the sender by reply e-mail. Please also permanently delete all copies of the original e-mail and any attached documentation. Please be advised thot any reply to this email may be considere d a public record and be subject to discfosure upon request. Th a n k yo u. From: Linze Greenwalt <Igreenwalt@grantcountywa.gov> Sent: Tuesday, April 20, 20219:15 AM To: Kevin J. McCrae <kjmccrae@grantcountywa.gov> Cc: Debra Larson <dlarson@grantcountywa.gov> Subject: FW: Agreement between GrIS and Molina Good morning/ Attached are two agreements for Molina Healthcare and Amerigroup. Will you please review these and let me know if there are any issues? We are hoping to have these on next week's consent agenda. Thanks, Linze Greenwalt Executive Assistant to Dell Anderson, Executive Director