Common use of ACRONYMS Clause in Contracts

ACRONYMS. ABD Aged, Blind, and Disabled XXXXX Xxxxxxx, Drug Addiction, and Mental Health AMA American Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society of Addiction Medicine CAHP Consumer Assessment of Healthcare Providers CANS Ohio Children’s Initiative Child and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services CEO Chief Executive Officer CFO Chief Financial Officer CFR Code of Federal Regulations CFT Child and Family Team CHIP Children's Health Insurance Program CICIP Care Innovation and Community Improvement Program CIO Chief Information Officer CMHSP Community Mental Health Services Provider CME Care Management Entity CMO Chief Medical Officer CMS Centers for Medicare and Medicaid Services COA Certificate of Authority CPC Comprehensive Primary Care CPSE Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Electronic Clinical Quality Measure EDI Electronic Data Interchange EHR Electronic Health Record EPSDT Early and Periodic Screening, Diagnosis, and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification FDR First Tier, Downstream, and Related Entities FFS Fee-for-Service FQHC Federally Qualified Health Center HCBS Home and Community-Based Service HIC Health Insuring Corporation HIE Health Information Exchange HIPAA Health Insurance Portability and Accountability Act IMD Institution for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA Mental Health Parity and Addiction Equity Act MPS Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners NCQA National Committee for Quality Assurance NPI National Provider Identifier OAC Ohio Administrative Code ODI Ohio Department of Insurance ODM Ohio Department of Medicaid OMHAS Ohio Department of Mental Health and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code PCP Primary Care Provider PDSA Plan-Do-Study-Act PHI Protected Health Information PIP Performance Improvement Project PMPM Per Member Per Month QAPI Quality Assessment and Performance Improvement QI Quality Improvement RHC Rural Health Clinic SDOH Social Determinants of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Substance Use Disorder TPL Third Party Liability UM Utilization Management US United States USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.

ACRONYMS. ABD Aged, Blind, The list of acronyms applicable to the TSS-E base contract(s) PWS and Disabled XXXXX Xxxxxxx, Drug Addiction, individual task orders are as follows: ACOR Alternate Contracting Officer's Representative A2/C2 Airspace Command and Mental Health AMA American Medical Association APM Alternative Payment Control AAR After Action Review AARS After Action Review System ABCS Army Battle Command System ACAT I Acquisition Category AFARS Army Federal Acquisition Regulation Supplement ACOM Army Command ACP Army Campaign Plan ACSIM Assistant Chief of Staff for Installation Management ACUB Army Compatible Use Buffer ADOCS Automated Deep Operations Coordination System ADP Automated Data Processing (ADSI) Air Defense Systems Integrator AEC Army Environmental Command AETF Army Evaluation Task Force AFATDS Advanced Field Artillery Tactical Data System AIS Automated Information Systems AITR Army Information Technology Registry AKO Army Knowledge Online AMDPCS Air and Missile Defense Planning and Control System AMR Army Modernization Review AMRDEC Aviation & Missile Research Development & Engineering Center AMRP Army Master Range Plan AOM Average Occupancy Models AQL Acceptable Quality Level AR Army Regulation ARFORGEN Army Force Generation ARNG Army National Guard ARRM Army Range Requirements Model APRN Advanced Practice Registered Nurse ASAM American Society ASAS All Source Analysis System ASAT Automated Systems Approach to Training ASCC Army Service Component Command ASO Army Safety Office ASP Army Safety Program ATO Authority to Operate ATSC Army Training Support Center ATTRS Army Training Requirements and Resources System BAX Battle Area Complex BCCS Battle Command Common Services BCTC-ES Battle Command Training Capability-Equipment Support BMP Best Management Practices BES Basis of Addiction Medicine CAHP Consumer Assessment Estimate Summary BFT Blue Force Tracker BLUFOR Blue Force BOIP Basis of Healthcare Providers CANS Ohio Children’s Initiative Child Issue Plan BSC Battle Simulation Center BVT Battlefield Visualization Team C&A Certification and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services CEO Chief Executive Officer CFO Chief Financial Officer Accreditation CFR Code of Federal Regulations CFT Child C/I Coach/Interactors C2PC Command and Family Team CHIP Children's Health Insurance Program CICIP Care Innovation Control Personal Computer C4ISR Command, Control, Communications, Computers, Intelligence, Surveillance and Community Improvement Program CIO Reconnaissance CACTF Combined Arms Collective Training Facility CATT Combined Arms Tactical Trainers CBCSE Common Battle Command Simulation Equipment CCB Configuration Control Board CCI Construction Compliance Inspections CCTT Close Combat Tactical Trainer CD Combat Developer CDD Capabilities Development Document CDRL Contract Data Requirement List CG Commanding General CHP Common Hardware Platform CIM Contractor Installation Manager CJCSI Chairman of the Joint Chiefs of Staff Instruction CJCSM Chairman of the Joint Chiefs of Staff Manual CLIN Contract Line Item Number CLS Contract Logistics Support CMR Contract Manpower Reporting XxX Corps of Engineers XXX Contemporary Operational Environment COI Course of Instruction COMSEC Communications Security CONUS Continental United States (excludes Alaska and Hawaii) COR Contracting Officer Representative COTS Commercial-Off-the-Shelf CPD Capability Production Document CPOF Command Post of the Future CPX Command Post Exercise CTC Combat Training Center CTIA Common Training Instrumentation Architecture DA Department of the Army DAA Designated Approving Authority DAC Department of the Army Civilian DAGIR Digital Air Ground Integration Range DCGS-A Distributed Common Ground System-Army DCSOPS Deputy Chief of Staff for Operations DCSOPS&T Deputy Chief of Staff for Operations and Training DD Department of Defense (forms only) DD250 Department of Defense Form 250 (Receiving Report) DD254 Department of Defense Contract Security Requirement List DFARS Defense Federal Acquisition Regulation Supplement DIACAP Defense Information Officer CMHSP Community Mental Health Services Provider CME Care Assurance Certification and Accreditation Process DITSCAP DoD Information Technology DMDC Defense Manpower Data Center DOD Department of Defense DoD RMF Risk Management Entity CMO Chief Medical Officer CMS Centers for Medicare and Medicaid Services COA Certificate Framework DOIM Directorate of Authority CPC Comprehensive Primary Care CPSE Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Electronic Clinical Quality Measure EDI Electronic Data Interchange EHR Electronic Health Record EPSDT Early and Periodic ScreeningInformation Management DOTMLPF Doctrine, DiagnosisOrganization, Training, Materiel, Logistics, Personnel, and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification FDR First TierFacilities DPTM Director of Plans, DownstreamTraining, and Related Entities FFS FeeMobilization DPTM Director of Plans, Training, and Mobilization DPTMS Director of Plans, Training, Mobilization and Security DPW Director of Public Works DRU Direct Reporting Unit EADSIM Extended Air Defense Simulation EOD Explosive Ordnance Disposal EOY End Of Year ERF Entity Resolution Federation ESRI Environment Services Research Institute EST 2000 Engagement Skills Trainer 2000 ETC Exportable Training Center ETC-forIS Exportable Training Capability Instrumentation System ETR Explosive Training Range ETSIU Enhanced Tactical Simulation Interface FAR Federal Acquisition Regulation FASIT Future Army System of Integrated Targets FBCB2 Force XXI Battle Command Brigade and Below FCS Future Combat Systems FDD Functional Description Document FFP Firm Fixed Price FGDC Federal Geographic Data Committee FIRESIM Fire Simulation FISMA Federal Information Security Management Administration FORSCOM Forces Command FOUO For Official Use Only FYDP Future Years Defense Plan GAT Government Acceptance Tests GCCSA Global Combat Support System-Service FQHC Federally Qualified Health Army GFD Graphic Fire Desk GFE Government-Furnished Equipment GFF Government-Furnished Facilities GFI Government-Furnished Information GFP Government-Furnished Property GFS Government-Furnished Software GFU Government-Furnished Utilities GIS Geographic Information System GOTS Government Off the Shelf GSA Government Services Administration GSC Geospatial Support Center HCBS Home and Community-Based Service HIC Health Insuring Corporation HIE Health Information Exchange HIPAA Health Insurance Portability and Accountability Act IMD Institution for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA Mental Health Parity and Addiction Equity Act MPS Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners NCQA National Committee for Quality Assurance NPI National Provider Identifier OAC Ohio Administrative Code ODI Ohio Department of Insurance ODM Ohio Department of Medicaid OMHAS Ohio Department of Mental Health and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code PCP Primary Care Provider PDSA Plan-Do-Study-Act PHI Protected Health Information PIP Performance Improvement Project PMPM Per Member Per Month QAPI Quality Assessment and Performance Improvement QI Quality Improvement RHC Rural Health Clinic SDOH Social Determinants of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Substance Use Disorder TPL Third Party Liability UM Utilization Management US United States USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio1996 HITS Homestation Instrumentation Training Systems HQDA Headquarters, Department of Insurance the Army IA Information Assurance Cybersecurity IATO Interim Authority to Operate ICD Initial Capabilities Document ICTs Information and Communication Technology ID Identification IDIQ Indefinite Delivery-Indefinite Quantity IGI&S Installation Geospatial Information and Services IMCOM Installation Management Command IMI Installation Management Institute INRMP Integrated Natural Resource Management Plan IOC Initial Operating Capability IPB Installation Planning Board IPBO Installation Property Book Officer IPR In-Process Review IPT Integrated Process Team IS Information Systems ISA Interservice Agreement ISEC Information Security Engineering Command ISM Independent Stimulation Module IT Information Technology ITAM Integrated Training Area Management IWAM Installation Workplan Analysis Module JCATS Joint Conflict and Tactical Simulation JCIDS Joint Capabilities Integration and Development System JFCOM Joint Forces Command JIIM Joint-Interagency-Intergovernmental-Multinational JLCCTC Joint Land Component Constructive Training Capability JMRC Joint Multinational Readiness Center JMTC Joint Multinational Training Command JNEM Joint Non-kinetic Effects Model JNTC Joint National Training Capability JRTC Joint Readiness Training Center JTEN Joint Training and Experimentation Network LAN Local Area Network LMS Learning Management System LOGFED Logistics Federation LOS Line-of-Sight LRAM Land Rehabilitation and Maintenance LT2-FTS Family of Live Training Systems LTP Leader Training Program LVC Live, Virtual, & Constructive LVC&G Live, Virtual, Constructive & Gaming LVC-IA Live, Virtual, Constructive - Integrated Architecture LVC-ITE Live, Virtual, Constructive - Integrated Training Environment M&S Modeling and Simulation MATDEV Material Developer XXXX Xxxxxxxx Armywide Tracking System MC Mission Command MCA Military Construction, Army MCS Maneuver Control System MCTP Mission Command Training Program MCTSD Mission Command Training Support Division MDEP Management Decision Package MDMP Military Decision Making Process MEDEVAC Medical Evacuation METL Mission Essential Task List MER Mission Essential Requirements MILCON Military Construction MIM Military Installation Map MIMT Military Installation Map Toolkit MIS Management Information System MRF-W Multi-Resolution Federation- WARSIM MRX Mission Rehearsal Exercise MSR Monthly Status Report MTC Mission Training Complex MTT Mobile Training Team NAC National Agency Check NACI National Agency Check With Inquiries NACLC National Agency Check with Local Agency and Credit Check NGA National Geospatial-Intelligence Agency NGB National Guard Bureau NIPRNET Non-Classified Internet Protocol Router Network NOTAM Notice to Airmen NPDES National Pollutant Discharge Elimination System NSA National Security Agency NSC National Simulation Center NTC National Training Center NWARS National Wargaming System OCI Organizational Conflict of Interest OCONUS Outside Continental United States (hereinafter referred to as ODI)includes Alaska and Hawaii) ODC Other Direct Costs OE Operational Environment OF Objective Force OMA Operation and Maintenance, pursuant to Chapter 1751 Army OSCOR On-Site Contracting Officers Representative OneSAF One Semi-Automated Forces OPA Other Procurement, Army OPFOR Opposing Force OPFOR TS Opposing Force Training Systems ORAH On Range Ammunition Handling ORE Operational Readiness Exercise OS Operating System PEO STRI Program Executive Office for Simulation, Training and Instrumentation PFTEA Post Fielding Training Effectiveness Analysis PH Probability of the Ohio Revised Code (ORC) Hit PK Probability of Kill PM Program Manager PMR Program Management Review POC Point of Contact POI Program of Instruction POM Program Objective Memorandum POP Period of Performance PRIDE Planning Resources for Infrastructure Development and is organized and must operate as prescribed by Chapter 5167 of the ORCEvaluation PRS Performance Requirements Summary PWS Performance Work Statement QA Quality Assurance QAP Quality Assurance Program QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Plan QCP Quality Control Protocol RC Reserve Component RCB Requirements Control Board RCCB Range Configuration Control Board RCMP Range Complex Master Plan RCMP-T Range Complex Master Plan - Tool RDA Research, Chapter 5160-26 of the Ohio Administrative Code (OAC)Development, and other applicable portions of the OAC as amended from time to time. Upon requestAcquisition RDAP Range Development and Planning RDP Range Development Plan RFMSS Range Facility Management Support Systems RMTK Range Managers Toolkit ROPD Range Officer Professional Development RSC Regional Support Center RSWG Range Safety Working Group RTAM Range and Training Area Management RTLA Range and Training Land Assessment RTLP Range and Training Land Program RTM Run Time Manager RTOC Reconfigurable Tactical Operations Center SA Systems Administrator SCORM Sharable Content Object Reference Model SDSFIE Spatial Data Standard for Facilities Infrastructure and Environment SDZ Surface Danger Zone SIMPLE SIM C4I Interchange Module for Plans, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectivelyLogistics, and economically during the term of this Agreement. This Exercises SIPRNET Secret Internet Protocol Router Network SMC Senior Mission Commander SOP Standard Operating Procedures SOSO Stability Operations and Support Operations SRA Sustainable Range Awareness SRP Sustainable Range Program SSAA System Security Authorization Agreement is a contract between ODM STD System Training Devices XXXXX Systems Training Integration and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 Devices Directorate STRAP System Training Plan STSP Soldier Training Support Program SWPPP Stormwater Pollution Prevention Plan SWT STRAP Writing Tool TACOM Tank Automotive and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26Armaments Command TACSIM Tactical Simulation TADSS Training Aids, assuming the risk of lossDevices, Simulations, and at all times complying with federal Simulators TBUD Training Budget TCI Training Capabilities Integration TCM TRADOC Capabilities Manager TCM-R TRADOC Capabilities Manager Reconnaisance TDY Temporary Duty TE Technical Exhibit TEC Topographic Engineering Center TECOM Training and state laws Education Command TEPS Training Events Planning System TES Tactical Engagement Systems TII Target Interface Inspections TIR Technical Information Report TIWG Testing Integration Work Group TR TRADOC Regulation TRADOC Training and regulations, federal Doctrine Command TRI Training Requirements Integration TS Training Support TS-MATS Training System - Materiel Armywide Tracking System TSP Training Support Package TSS Training Support System TSSR Training Support System Review USARC United States Army Reserve Command UTMS Unit Training Management System UWG Users Working Group UXO Unexploded Ordnance V&V Verification and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.Validation VIP Very Important Person VRSG Virtual Reality Scene Generator VV&A Verification/Validation/Accreditation WAM Workplan Analysis Model WAN Wide Area Network WARSIM Warfighters Simulation WAWF Wide Area Workflow WDZ Weapons Danger Zones WFF Warfighting Functions XXX XXXXXX Intelligence Model

ACRONYMS. ABD AgedACA The Patient Protection and Affordable Care Act and the Health Care Education Reconciliation Act of 2010, Blind, and Disabled XXXXX Xxxxxxx, Drug Addiction, and Mental Health AMA American Medical Association APM as amended ADA Americans with Disabilities Act AFDC Aid to Families with Dependent Children AIDS Acquired Immune Deficiency Syndrome APA Alternative Payment Model APRN Arrangement APD Advanced Practice Registered Nurse Planning Document ARD Accelerated Rehabilitation Decision ASAM American Society of Addiction Medicine CAHP Consumer Assessment ASCII American Standard Code for Information Interchange ASD Autism Spectrum Disorder BEC Basic Education Circular BHEF Behavioral Health Encounter File BH-MCO Behavioral Health Managed Care Organization BHRS Behavioral Health Rehabilitation Services for Children and Adolescents BMWBO Bureau of Healthcare Providers CANS Ohio Children’s Initiative Minority and Women Business Opportunities BNDD Bureau of Narcotic Drugs and Devices BSU Base Service Unit CAO County Assistance Office CASSP Child and Adolescent Needs Service System Program CAU County Administrative Unit CBCM Community Based Care Management CBO Community Based Organization CCRS Consolidated Community Reporting System CCYA County Children and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services CEO Chief Executive Officer Youth Agency CFO Chief Financial Officer CFR Code of Federal Regulations CFT Child C/FST Consumer/Family Satisfaction Team XXXXX Children with Attention Deficit Disorders CHC Community HealthChoices CHC-MCO Community HealthChoices Managed Care Organization CIS Client Information System CISC Children and Family Team CHIP Children's Health Insurance Program CICIP Adolescents in Substitute Care Innovation and Community CLIA Clinical Laboratory Improvement Program CIO Chief Information Officer CMHSP Community Mental Health Services Provider CME Care Management Entity CMO Chief Medical Officer Amendment CMS Centers for Medicare and Medicaid Services COA Certificate COB Coordination of Authority CPC Comprehensive Primary Care CPSE Benefits CQI Continuous Quality Improvement CRCS Capitation Rate Calculation Sheet CRD/LIC Credentials/License CRF Consumer Registry File CRNP Certified Registered Nurse Practitioner CRR Community Residential Rehabilitation CSI Consumer Satisfaction Instruments CSP Community Support Program CST Consumer Satisfaction Team C&Y Children and Youth D&A Drug and Alcohol DAP Disability Advocacy Program DDAP Department of Drug and Alcohol Programs DEA Drug Enforcement Agency DHHS U.S. Department of Health and Human Services DHS Department of Human Services DME Durable Medical Equipment DMIRS Data Management and Information Retrieval System DOH Department of Health DSH Disproportionate Share DSM Diagnostic and Statistical Manual of Mental Disorders DUR Drug Utilization Review EAP Enrollment Assistance Program ECC Electronic Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Capture ECM Electronic Clinical Quality Measure EDI Claims Management EIN Employee Identification Number EMC Electronic Data Interchange EHR Electronic Health Record Media Claims EPSDT Early and Periodic Screening, Diagnosis, Diagnosis and Treatment EQRO External Quality Review Organization EVV Electronic Visit ED Emergency Department ERISA Employee Retirement Income Security Act, 1974 EVS Eligibility Verification FDR First Tier, Downstream, System FA Fiscal Agent FBMHS Family Based Mental Health Services FDA Food and Related Entities Drug Administration FFS Fee-forFor-Service FPL Federal Poverty Level FQHC Federally Qualified Health Center HCBS Home FRR Financial Reporting Requirements FST Family Satisfaction Team FTE Full Time Equivalent FTP File Transfer Process FWA Xxxxx, Xxxxx and CommunityAbuse GA General Assistance GAAP Generally Accepted Accounting Principles GME Graduate Medical Education HC HealthChoices HC BH HealthChoices Behavioral Health HC-Based Service HIC L/C HealthChoices Lehigh/Capital HC N/C HealthChoices North/Central HC-NE HealthChoices Northeast HCPCS CMS Common Procedure Coding System HCQU Health Care Quality Unit HC-SE HealthChoices - Southeast HC-SW HealthChoices - Southwest HEDIS Healthcare Effectiveness Data and Information Set HIO Health Insuring Corporation HIE Health Information Exchange Organizations HIPAA Health Insurance Portability and Accountability Act HIV/AIDS Human Immuno Deficiency Virus/Acquired Immune Deficiency Syndrome HMO Health Maintenance Organization IBHS Intensive Behavioral Health Services IBNR Incurred But Not Reported Claims ICD International Classification of Diseases ICF Intermediate Care Facility ICF/ID Intermediate Care Facilities for Persons with Intellectual Disabilities ICP Integrated Care Plan ICWC Integrated Community Wellness Centers ID Insurance Department IFB Invitation for Bid IHCP Indian Health Care Provider IMD Institution for Institutions For Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker Diseases ISP Individualized Service Plan JDC Juvenile Detention Center JPO Juvenile Probation Office L/C Lehigh/Capital LEP Limited English Proficient LGBTQI Lesbian, Gay, Bisexual, Transgender, Questioning and Intersex LTC Long Term Care LTSS Long Term Services and Support MA Medical Assistance MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MAID Medical Assistance Identification Number MATP Medical Assistance Transportation Program MBE Minority Business Enterprise MBE/WBE Minority Business Enterprise/Women Business Enterprise MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA Mental Health Parity and Addiction Equity Act MPS MIS Management Information System MOE Method of Evaluation MPL Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners Participating Levels NCE Non-Continuous Eligibility NCQA National Committee for Quality Assurance NPI NDC National Provider Identifier OAC Ohio Administrative Drug Code ODI Ohio Department NMP Non-money payment OBRA Omnibus Budget Reconciliation Act OCYF Office of Children, Youth & Families ODP Office of Developmental Programs OIP Other Insurance ODM Ohio Department Paid OMAP Office of Medicaid OMHAS Ohio Department Medical Assistance Programs OMHSAS Office of Mental Health and Addiction Substance Abuse Services OMES Ohio Medicaid Enterprise ORC Other Related Conditions OTC Over the Counter PCIS Patient Census Information System ORC Ohio Revised Code PCO Private Coverage Organization PCP Primary Care Provider PDSA PlanPractitioner PDA Pennsylvania Department of Aging PH-Do-Study-Act PHI Protected MCO Physical Health Information PIP Performance Improvement Project Managed Care Organization PHSS Physical Health Service System PIHP Prepaid Inpatient Health Plan PIN Parents Involved Network PMPM Per Member Per Month QAPI POM Performance Outcome Measures POMS Performance Outcome Management System POSNet Pennsylvania Open Systems Network PPO Preferred Provider Organization PROMISe Provider Reimbursement and Operations Management Information System in electronic format PRTF Psychiatric Residential Treatment Facility QARI Quality Assessment and Performance Improvement QI Assurance Reform Initiative QM Quality Improvement Management QMB Qualified Medicare Beneficiaries QSF Quarterly Status File RBUC Received But Unpaid Claims RFP Request for Proposal RHC Rural Health Clinic RTF Residential Treatment Facility SAP Statutory Accounting Principles SBP State Blind Pension SCA Single County Authority SDOH Social Determinants of Health SFTP Secure File Transfer Protocol SFY SE Southeast SMH State Fiscal Year SIU Mental Hospital SMM State Medicaid Manual SNF Skilled Nursing Facility SNU Special Investigative Needs Unit SPBM Single Pharmacy Benefit Manager SPR System Performance Review SSA Social Security Administration SSI Supplemental Security Income SSN Social Security Number SUD Substance Use Disorder SUR Surveillance and Utilization Review SURS Surveillance and Utilization Review System SW Southwest TANF Temporary Assistance to Needy Families TPL Third Party Liability TTY Text Telephone Typewriter UM Utilization Management US United States UM/QM Utilization Management/Quality Management UPIN Unique Physician Identification Number USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.WBE Women’s Business Enterprise

ACRONYMS. ABD Aged, Blind, A&A Assessment and Disabled XXXXX Xxxxxxx, Drug Addiction, and Mental Health AMA American Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society of Addiction Medicine CAHP Consumer Assessment of Healthcare Providers CANS Ohio Children’s Initiative Child and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services CEO Chief Executive Officer CFO Chief Financial Officer Authorization ACOR Alternate Contracting Officer's Representative AFARS Army Federal Acquisition Regulation Supplement AGC US Army Geospatial Center AQL Acceptable Quality Level AR Army Regulation AT Antiterrorism BCT Brigade Combat Team CDR Contract Deficiency Report CDRL Contract Data Requirements List CFR Code of Federal Regulations CFT Child CMR Contract Manpower Reporting CONUS Continental United States (excludes Alaska and Family Team CHIP Children's Health Insurance Program CICIP Care Innovation and Community Improvement Program CIO Chief Hawaii) COR Contracting Officer Representative COTS Commercial-Off-the-Shelf DA Department of the Army DD250 Department of Defense Form 250 (Receiving Report) DD254 Department of Defense Contract Security Requirement List DFARS Defense Federal Acquisition Regulation Supplement DMDC Defense Manpower Data Center DOD Department of Defense FAR Federal Acquisition Regulation FOIA Freedom of Information Officer CMHSP Community Mental Health Services Provider CME Care Management Entity CMO Chief Medical Officer CMS Centers for Medicare and Medicaid Services COA Certificate of Authority CPC Comprehensive Primary Care CPSE Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Electronic Clinical Quality Measure EDI Electronic Data Interchange EHR Electronic Health Record EPSDT Early and Periodic Screening, Diagnosis, and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification FDR First Tier, Downstream, and Related Entities FFS Fee-for-Service FQHC Federally Qualified Health Center HCBS Home and Community-Based Service HIC Health Insuring Corporation HIE Health Information Exchange HIPAA Act FOUO For Official Use Only FPCON Force Protection Condition GEOINT Geospatial Intelligence HIPPA Health Insurance Portability and Accountability Act IMD Institution for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA Mental of 1996 IT Information Technology JER Joint Ethics Regulation JTR Joint Travel Regulation KO Contracting Officer LOS Line of Sight MDO Multi-Domain Operations OCI Organizational Conflict of Interest OCONUS Outside Continental United States (includes Alaska and Hawaii) ODC Other Direct Costs OSHA Occupational Safety and Health Parity Administration POA&M Plan of Action and Addiction Equity Act MPS Minimum Milestones POC Point of Contact POP Period of Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners NCQA National Committee for PRS Performance Requirements Summary PWS Performance Work Statement QA Quality Assurance NPI QAP Quality Assurance Program QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Program RF Radio Frequency RGT Remote Ground Terminal RMF Risk Management Framework SATCOM Satellite Communication SIGINT Signals Intelligence SCI Sensitive Compartmented Information SOFA Status of Forces Agreement TARP Threat Awareness and Reporting Program TE Technical Exhibit TENCAP Tactical Exploitation of National Provider Identifier OAC Ohio Administrative Code ODI Ohio Department of Insurance ODM Ohio Department of Medicaid OMHAS Ohio Department of Mental Health and Addiction Capabilities TITAN Technical Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code PCP Primary Care Provider PDSA Plan-Do-Study-Act PHI Protected Health Information PIP Performance Improvement Project PMPM Per Member Per Month QAPI Quality Assessment and Performance Improvement QI Quality Improvement RHC Rural Health Clinic SDOH Social Determinants of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Substance Use Disorder TPL Third Party Liability UM Utilization Management US United States USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.Tactical Intelligence Targeting Access Node TS Top Secret

ACRONYMS. ABD Aged, Blind, AAALAC Association for Assessment and Disabled XXXXX Xxxxxxx, Drug Addiction, and Mental Health AMA Accreditation of Laboratory Animal Care ACE American Medical Counsel on Education ACLS Advanced Cardiac Life Support ADP Automatic Data Processing AHA American Heart Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society of Addiction Medicine CAHP Consumer Assessment of Healthcare Providers CANS Ohio Children’s Initiative Child and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services CEO Chief Executive Officer CFO Chief Financial Officer AIMS-R Automated Instructional Management System-Revised AR Army Regulation ASAT Automated System Approached to Training AT Anti-Terrorism ATTRS Army Total Training Resource System BLS Basic Life Support BTLS Basic Trauma Life Support C4 Command Control Communication Computers CAC Common Access Card CDR Contractor Discrepancy Report CFR Code of Federal Regulations CFT Child CM Contract Manager CMR Contractor Manpower Reporting CONUS Continental United States (excludes Alaska and Family Team CHIP Children's Health Insurance Program CICIP Care Innovation and Community Improvement Program CIO Chief Information Hawaii) COR Contracting Officer CMHSP Community Mental Health Services Provider CME Care Management Entity CMO Chief Representative COTS Commercial-Off-the-Shelf DA Department of the Army DD250 Department of Defense Form 250 (Receiving Report) DD254 Department of Defense Form 254 DFARS Defense Federal Acquisition Regulation Supplement DMDC Defense Manpower Data Center DOD Department of Defense EMT-B Emergency Medical Officer CMS Centers for Medicare and Medicaid Services COA Certificate of Authority CPC Comprehensive Primary Care CPSE Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Electronic Clinical Quality Measure EDI Electronic Data Interchange EHR Electronic Health Record EPSDT Early and Periodic Screening, Diagnosis, and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification FDR First Tier, Downstream, and Related Entities FFS FeeTechnician – Basic EMT-for-Service FQHC Federally Qualified Health Center HCBS Home and Community-Based Service HIC Health Insuring Corporation HIE Health Information Exchange P Emergency Medical Technician – Paramedic FAR Federal Acquisition Regulation HIPAA Health Insurance Portability and Accountability Act IMD Institution for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA Mental Health Parity and Addiction Equity Act MPS Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners NCQA National Committee for Quality Assurance NPI National Provider Identifier OAC Ohio Administrative Code ODI Ohio Department of Insurance ODM Ohio Department of Medicaid OMHAS Ohio Department of Mental Health and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code PCP Primary Care Provider PDSA Plan-Do-Study-Act PHI Protected Health Information PIP Performance Improvement Project PMPM Per Member Per Month QAPI Quality Assessment and Performance Improvement QI Quality Improvement RHC Rural Health Clinic SDOH Social Determinants of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Substance Use Disorder TPL Third Party Liability UM Utilization Management US United States USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. 1996 IAW In accordance with 42 CFR 438.3(f)(1), this IT Information Technology IACUC Institutional Animal Care and Use Committee KO Contracting Officer MTN Military Training Network NREMT National Registry of Emergency Medical Technicians OCI Organizational Conflict of Interest OCONUS Outside Continental United States (includes without limitation: Title VI Alaska and Hawaii) ODC Other Direct Costs OPSEC Operational Security OT Overtime PA Property Administrator PCS Permanent Change of the Civil Rights Act Station PEPP Pediatric Education for Pre-Hospital Professionals PER Performance Evaluation Report PEM Performance Evaluation Meetings PHTLS Pre-Hospital Trauma Life Support PIPO Phase-In/Phase- Out POC Point of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.Contact PSC Product Service Code PRS Performance Requirements Summary PWS Performance Work Statement QA Quality Assurance QAP Quality Assurance Program QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Plan SOF Special Operations Forces SWCS Special Warfare Center & School TE Technical Exhibit TS Top Secret UIC Unit Identification Code USASOC United States Army Special Operations Command USSOCOM United Stated Special Operations Command

ACRONYMS. ABD AgedAFHS Adolescent friendly health services AGYW Adolescent girls and young women ART Antiretroviral therapy BE Behavioral economics BMGF Bill and Xxxxxxx Xxxxx Foundation C&T Care and treatment CBHSP Community-based health service providers CBHTC+ Community-based HIV testing and counseling plus CHIF Community Health Insurance Fund CHMT Council health management team CPR Contraceptive prevalence rate CQM Continuous quality management CSO Civil society organization CTC Care and treatment clinics CWM College of Xxxxxxx and Xxxx DC District council DQA Data quality assessments DQA Data quality assessments DREAMS Determined, BlindResilient, AIDS-Free, Mentored, and Disabled XXXXX XxxxxxxSafe EJAF Xxxxx Xxxx AIDS Foundation EWs Empowerment workers FAQ Frequently asked questions FGD Focus group discussions FP Family Planning FSW Female sex worker GBV Gender-based violence GOT Government of Tanzania HBC Home based care HCD Human centered design HIVST HIV self-testing HRT HIV rapid test HTC HIV testing and counseling HTS HIV testing services IBBS Integrated biological and behavior survey IGA Income generating activities IPC Interpersonal communication IPN Incentivized peer network IPs Implementing partners IQA Internal quality assurance IQC Internal quality control IRB Institutional Review Board KP Key populations KVP Key and vulnerable population LGAs Local government authorities LNGO Local non-governmental organization LVT Literacy volunteer training MC Municipal council MCT Management committee training MOHCDGEC Ministry of Health, Drug AddictionCommunity Development, Gender, Elderly and Mental Health AMA American Children MSM Men who have sex with men MSD Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society Stores Department NACOPHA National Council of Addiction Medicine CAHP Consumer Assessment People Living with HIV NGO Non-governmental organization NIMR National Institute for Medical Research OVC Orphan and vulnerable children XXXXXX X.X. President’s Emergency Plan for AIDS Relief PHDP Positive health, dignity and prevention PFSW Partners of Healthcare Providers CANS Ohio Childrenfemale sex workers PLHIV People living with HIV PMTCT Prevention of mother-to-child HIV transmission XX-XXXX President’s Initiative Child Office Regional Administration and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services CEO Chief Executive Officer CFO Chief Financial Officer CFR Code of Federal Regulations CFT Child and Family Team CHIP Children's Health Insurance Program CICIP Care Innovation and Community Improvement Program CIO Chief Information Officer CMHSP Community Mental Health Services Provider CME Care Management Entity CMO Chief Medical Officer CMS Centers for Medicare and Medicaid Services COA Certificate of Authority CPC Comprehensive Primary Care CPSE Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Electronic Clinical Quality Measure EDI Electronic Data Interchange EHR Electronic Health Record EPSDT Early and Local Government PPP Public private partnership PPT Periodic Screening, Diagnosis, and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification FDR First Tier, Downstream, and Related Entities FFS Feepresumptive treatment PrEP Pre-for-Service FQHC Federally Qualified Health Center HCBS Home and Community-Based Service HIC Health Insuring Corporation HIE Health Information Exchange HIPAA Health Insurance Portability and Accountability Act IMD Institution for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA Mental Health Parity and Addiction Equity Act MPS Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners NCQA National Committee for Quality Assurance NPI National Provider Identifier OAC Ohio Administrative Code ODI Ohio Department of Insurance ODM Ohio Department of Medicaid OMHAS Ohio Department of Mental Health and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code PCP Primary Care Provider PDSA Plan-Do-Study-Act PHI Protected Health Information PIP Performance Improvement Project PMPM Per Member Per Month QAPI Quality Assessment and Performance Improvement exposure prophylaxis PSG Psychosocial support group QA/QI Quality Improvement RHC Rural assurance/quality improvement RCHS Reproductive Child Health Clinic SDOH Section RHMT Regional health management team SBCC Social Determinants behavior change communication SNU Subnational units SOP Standard operating procedure STI Sexually transmitted infection TACAIDS Tanzania Commission for AIDS TWG Technical working group URT United Republic of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Substance Use Disorder TPL Third Party Liability UM Utilization Management US Tanzania USAID United States USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, Agency for International Development vAGYW Vulnerable adolescent girls and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) young women VETA Vocational Education and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.Training Authority VMMC Voluntary medical male circumcision

ACRONYMS. ABD AgedACA or Ark. Code Xxx. Arkansas Code Annotated ADT Admission, Blind, Discharge and Disabled XXXXX Xxxxxxx, Drug Addiction, and Mental Transfer Notices AID Arkansas Insurance Department BAA Business Associate Agreement BH Behavioral Health AMA American Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society of Addiction Medicine CAHP CAC PASSE Consumer Assessment of Healthcare Providers CANS Ohio Children’s Initiative Child and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services Advisory Council CAP Corrective Action Plan CEO Chief Executive Officer of the PASSE CES Community and Employment Support Waiver CFO Chief Financial Officer of the PASSE CFR Code of Federal Regulations CFT CHMS Child and Family Team CHIP Children's Health Insurance Program CICIP Care Innovation and Community Improvement Program CIO Chief Information Officer CMHSP Community Mental Health Management Services Provider CME Care Management Entity CMO Chief Medical Officer CMS Centers Center for Medicare and Medicaid Services COA Certificate COO Chief Operating Office of Authority CPC Comprehensive Primary Care CPSE Claims Payment Systemic Error CSP Coordinated the PASSE DD Developmental Disabilities DDTCS Developmental Day Treatment Clinic Services Program CY Calendar Year eCQM Electronic Clinical Quality Measure EDI Electronic DHS Arkansas Department of Human Services DMS Division of Medical Services (Arkansas Medicaid) DUA Data Interchange Use Agreement ED Emergency Department (also ER) EHR Electronic Health Record EPSDT Early and Periodic Screening, Diagnosis, and Treatment EQRO External Quality Review Organization EVV Records EMR Electronic Visit Verification FDR First Tier, Downstream, and Related Entities FFS Fee-for-Service Medical Records ER Emergency Room (also ED) FQHC Federally Qualified Health Center HCBS Home and Community-Community Based Service HIC Services HHS United States Department of Health Insuring Corporation HIE Health Information Exchange and Human Services HIPAA Health Insurance Portability and Accountability Act IMD Institution of 1996, Public Law 104-191 – see Privacy definition HITECH Health Information Technology for Mental Disease IMS Incident Management System LISW Licensed Economic and Clinical Health, enacted as part of the American Reinvestment & Recovery Act (ARRA) of 2009 – see Privacy definition IA Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MCO Managed Assessment ICF/DD/ID Intermediate Care Organization Facilities for persons with Developmental Disabilities or Intellectual Disabilities ICF/IID Intermediate Care Facilities for Individuals with Intellectual Disabilities IT/IS Information Technology/Information Systems MFCU Medicaid Fraud Control Unit MHPAEA Mental Health Parity and Addiction Equity Act MPS Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners NCQA National the Arkansas Attorney General’s Office MOI Memorandum of Intent MQM Medical/Quality Management Committee for Quality Assurance NPI National Provider Identifier OAC Ohio Administrative Code ODI Ohio Department OIG Office of Insurance ODM Ohio Department the Inspector General of HHS OMIG Office of the Medicaid OMHAS Ohio Department of Mental Health and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code Inspector General, an independent Arkansas agency PASSE Provider-Led Arkansas Shared Savings Entity PCP Primary Care Provider PDSA Plan-Do-Study-Act Physician PHI Protected Health Information PIP – see Privacy definition PI Performance Improvement Project – see QAPI definition PII Personal Identifying Information – see Privacy definition PIPA Arkansas Personal Information Protection Act, Act 1526 of 2005 (Ark. Code Xxx. §0-000-000 et seq.) – see Privacy definition PMPM Per Member Per Per-Member-Per-Month (Care Coordination Payment) PRTU Psychiatric Residential Treatment Units (Center Placements?) QA Quality Assurance – see QAPI definition QAPI PASSE Quality Assessment Assurance and Performance Improvement QI Quality Improvement RBPO Risk Based Provider Organization RHC Rural Health Clinic SDOH Social Determinants of Health SFTP Secure File Transfer Protocol SFY RN Registered Nurse SAC Security Advisory Committee SPA State Fiscal Year SIU Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Substance Use Disorder TPL Third Party Liability UM Utilization Management US United States USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Plan Amendment SSA Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide Act TIN/EIN Tax ID Number or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.Employer ID Number

ACRONYMS. ABD Aged, Blind, and Disabled XXXXX XxxxxxxADAMH Alcohol, Drug Addiction, and Mental Health or County Board of Alcohol, Drug Addiction, and Mental Health AMA American Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society of Addiction Medicine BDD Board of Developmental Disabilities CAHP Consumer Assessment of Healthcare Providers CANS Ohio Children’s Initiative Child and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services CEO CFCP Chief Executive Officer Child and Family-Centered Care Plan CFO Chief Financial Officer CFR CFT Code of Federal Regulations CFT Child and Family Team CHIP Children's Health Insurance Program CHW Community Health Worker CICIP Care Innovation and Community Improvement Program CIO Chief Information Officer CMHSP CMHC Community Mental Health Services Provider Center CME Care Management Entity CMO Chief Medical Officer CMS Centers for Medicare and Medicaid Services COA Certificate of Authority XXX Center of Excellence CPC Comprehensive Primary Care CPSE Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year DME Durable Medical Equipment DODD DYS EAPG Department of Developmental Disabilities Ohio Department of Youth Services Enhanced Ambulatory Patient Grouping eCQM Electronic Clinical Quality Measure EDI Electronic Data Interchange EHR Electronic Health Record EPSDT Early and Periodic Screening, Diagnosis, and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification ESC Educational Service Center FCFC Family and Children First Council FDR First Tier, Downstream, and Related Entities FFS Fee-for-Fee for Service FQHC Federally Qualified Health Center FWA HCBS Fraud, Waste, and Abuse Home and Community-Based Service HIC Health Insuring Corporation HIE Health Information Exchange HIPAA Health Insurance Portability and Accountability Act HITECH Health Information Technology for Economic and Clinical Health Act IHBT Intensive Home-Based Treatment IMD IMS Institution for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA Mental Health Parity and Addiction Equity Act MISP Maternal and Infant Support Program MPS Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners NCQA National Committee for Quality Assurance NPI National Provider Identifier OAC Ohio Administrative Code ODI ODE Ohio Department of Insurance ODM Education ODH Ohio Department of Medicaid Health ODJFS Ohio Department of Job and Family Services ODRC Ohio Department of Rehabilitation and Correction OFCF Ohio Family and Children First OMHAS Ohio Department of Mental Health and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code ORP Ordering, Referring, and Prescribing PCP Primary Care Provider PDSA Plan-Do-Study-Act PCSA Public Children Services Agency PHI Protected Health Information PIP Performance Improvement Project PMPM PNM Per Member Per Month Provider Network Management QAPI Quality Assessment and Performance Improvement QI Quality Improvement RHC Rural Health Clinic SDOH Social Determinants of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU Special Investigative Unit SPA State Plan Amendment SPBM Single Pharmacy Benefit Manager SSA Social Security Act SUD Substance Use Disorder TPL TSS Third Party Liability Transitional Services and Supports UM Utilization Management US United States USC United States Code USCDI United States Core Data for Interoperability This Provider Agreement (hereinafter "Agreement") is entered into this first day of JulyJanuary, 20212022, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO OhioRISE Plan is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-59 and, when applicable, 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO OhioRISE Plan must submit to ODM any data submitted to ODI to establish that the MCO OhioRISE Plan has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO OhioRISE Plan's debts, including those that remain in the event of MCO OhioRISE Plan's insolvency or the insolvency of any subcontractors. The MCO OhioRISE Plan is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services as a prepaid inpatient health plan as described in 42 CFR 438.2 through the managed care program for the Medicaidprovision of services described in OAC 000-eligible 00-00 for the Medicaid population described in OAC rule 5160-2659-02 along with any other Medicaid-Medicaid eligible populations population authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO the OhioRISE Plan's services for the benefit of certain Medicaid recipients. In doing so, the MCO OhioRISE Plan has provided and must continue to provide proof of the MCOOhioRISE Plan's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO OhioRISE Plan pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO OhioRISE Plan must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter Chapters 5164 and 5167 and OAC Chapter 5160-2626 and 5160-59, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.

ACRONYMS. ABD Aged, Blind, and Disabled XXXXX Xxxxxxx, Drug Addiction, and Mental Health AMA American Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society of Addiction Medicine CAHP Consumer Assessment of Healthcare Providers CANS Ohio Children’s Initiative Child and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services CEO Chief Executive Officer CFO Chief Financial Officer CFR Code of Federal Regulations CFT Child and Family Team CHIP Children's Health Insurance Program CICIP Care Innovation and Community Improvement Program CIO Chief Information Officer CMHSP Community Mental Health Services Provider CME Care Management Entity CMO Chief Medical Officer CMS Centers for Medicare and Medicaid Services COA Certificate of Authority CPC Comprehensive Primary Care CPSE Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Electronic Clinical Quality Measure EDI Electronic Data Interchange EHR Electronic Health Record EPSDT Early and Periodic Screening, Diagnosis, and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification FDR First Tier, Downstream, and Related Entities FFS Fee-for-Service FQHC Federally Qualified Health Center HCBS Home and Community-Based Service HIC Health Insuring Corporation HIE Health Information Exchange HIPAA Health Insurance Portability and Accountability Act IMD Institution for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA Mental Health Parity and Addiction Equity Act MPS Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners NCQA National Committee for Quality Assurance NPI National Provider Identifier OAC Ohio Administrative Code ODI Ohio Department of Insurance ODM Ohio Department of Medicaid OMHAS Ohio Department of Mental Health and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code PCP Primary Care Provider PDSA Plan-Do-Study-Act PHI Protected Health Information PIP Performance Improvement Project PMPM Per Member Per Month QAPI Quality Assessment and Performance Improvement QI Quality Improvement RHC Rural Health Clinic SDOH Social Determinants of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Substance Use Disorder TPL Third Party Liability UM Utilization Management US United States USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.

ACRONYMS. ABD AgedThe acronyms included in this Contract stand for the following terms: ACH Automated Clearinghouse ACIP Advisory Committee on Immunization Practices ADAP AIDS Drug Assistance Program ADFAN Puerto Rico Administración de Familias y Niños, Blindor Families and Children Administration AHRQ Agency for Health Care Research and Quality AICPA American Institute of Certified Public Accountants API Application Programming Interface ASES Administración de Seguros de Salud, and Disabled XXXXX Xxxxxxx, Drug Addiction, and or Puerto Rico Health Insurance Administration ASSMCA Puerto Rico Mental Health AMA American Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society of and Anti-Addiction Medicine CAHP Services Administration or Administración de Servicios de Salud Mental y Contra la Adicción ASUME Minor Children Support Administration BC-DR Business Continuity and Disaster Recovery CAHPS Consumer Assessment of Healthcare Health Care Providers CANS Ohio Children’s Initiative Child and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services Systems CEO Chief Executive Officer CFO Chief Financial Officer CFR Code of Federal Regulations CFT Child and Family Team CHIP Children's Health Insurance Program CICIP Care Innovation and Community CLIA Clinical Laboratory Improvement Program CIO Chief Information Officer CMHSP Community Mental Health Services Provider CME Care Management Entity CMO Chief Medical Officer Amendment CMS Centers for Medicare and & Medicaid Services COA Certificate CPTET Centro de Prevención y Tratamiento de Enfermedades Transmisibles, or Communicable Diseases Prevention and Treatment Center DME Durable Medical Equipment DOJ DSM The Puerto Rico Department of Authority CPC Comprehensive Primary Justice Diagnostic and Statistical Manual for Mental Disorders ECHO Experience of Care CPSE and Health Outcomes Survey ECM Electronic Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Electronic Clinical Quality Measure Management EDI Electronic Data Interchange EHR EFT Electronic Health Record Funds Transfer EIN Employer Identification Number EMTALA Emergency Medical Treatment and Labor Act EPLS Excluded Parties List System EPSDT Early and Periodic Screening, DiagnosisDiagnostic, and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification FDR First Tier, Downstream, ER Emergency Room FAR Federal Acquisition Regulation FMC Formulary of Medications Covered FDA Food and Related Entities Drug Administration FFS Fee-for-Service FQHC Federally Qualified Health Center HCBS Home FTP File Transfer Protocol GHP Government Health Plan HEDIS HCIP The Health Care Effectiveness Data and CommunityInformation Set Health Care Improvement Program HHS US Department of Health & Human Services HHS-Based Service HIC OIG US Department of Health Insuring Corporation & Human Services Office of the Inspector General HIE Health Information Exchange HIO Health Information Organization HIPAA Health Insurance Portability and Accountability Act IMD Institution of 1996 HITECH The Health Information Technology for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Economic and Clinical Counselor LSW Licensed Social Worker MAGI Health Act of 2009, 42 USC 17391 et. seq IBNR Incurred-But-Not-Reported ICD-10 International Statistical Classification of Diseases and Related Health Problems (10th edition) LEIE LME List of Excluded Individuals and Entities List of Medications by Exception MAC Maximum Allowable Cost M-CHAT Modified Adjusted Gross Income MAT Medication Assisted Treatment Checklist for Autism in Toddlers MCO Managed Care Organization MFCU MD Medical Doctor MDRP Medicaid Fraud Control Unit MHPAEA Drug Rebate Program MHSIP Mental Health Parity and Addiction Equity Act MPS Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners Statistics Improvement Program MMIS Medicaid Management Information System NCQA National Committee for Quality Assurance NEMT Non-Emergency Medical Transportation NPI National Provider Identifier OAC Ohio Administrative Code ODI Ohio Department NPL National Provider List NPPES National Plan and Provider Enumeration System NQMC National Quality Measures Clearinghouse ONCHIT Office of Insurance ODM Ohio Department of Medicaid OMHAS Ohio Department of Mental the National Coordinator for Health Information Technology P&T Pharmacy and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code Therapeutics PBM Pharmacy Benefit Manager PCP Primary Care Provider PDSA Plan-Do-Study-Act Physician PHI Protected Health Information PIP Performance Improvement Project PMPM Per Member Per Month Projects PMG Primary Medical Group PPACA Patient Protection and Affordable Care Act PPN Preferred Provider Network PRHIEC Puerto Rico Health Information Exchange Corporation QAPI Quality Assessment and Performance Improvement QI Quality Improvement Program RFP Request for Proposals Rh Rhesus RHC Rural Health Clinic SDOH Clinic/Center SAMHSA Substance Abuse and Mental Health Services Administration SAS SMI Statements on Auditing Standards Serious Mental Illness SED Serious Emotional Disturbance SSN Social Determinants of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Security Number SUDs Substance Use Disorder Disorders TDD Telecommunication Device for the Deaf TPL Third Party Liability UM Utilization Management US or USA United States of America USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.Code

ACRONYMS. ABD Aged, Blind, and Disabled XXXXX Xxxxxxx, Drug Addiction, and Mental Health AMA American Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society of Addiction Medicine CAHP Consumer Assessment of Healthcare Providers CANS Ohio Children’s Initiative Child and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services CEO Chief Executive Officer CFO Chief Financial Officer CFR Code of Federal Regulations CFT Child and Family Team CHIP Children's Health Insurance Program CICIP Care Innovation and Community Improvement Program CIO Chief Information Officer CMHSP Community Mental Health Services Provider CME Care Management Entity CMO Chief Medical Officer CMS Centers for Medicare and Medicaid Services COA Certificate of Authority CPC Comprehensive Primary Care CPSE Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Electronic Clinical Quality Measure EDI Electronic Data Interchange EHR Electronic Health Record EPSDT Early and Periodic Screening, Diagnosis, and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification FDR First Tier, Downstream, and Related Entities FFS Fee-for-Service FQHC Federally Qualified Health Center HCBS Home and Community-Based Service HIC Health Insuring Corporation HIE Health Information Exchange HIPAA Health Insurance Portability and Accountability Act IMD Institution for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA Mental Health Parity and Addiction Equity Act MPS Minimum Performance Standards MRSS Mobile Response and Stabilization Services MSP Medicaid School Program NAIC National Association of Insurance Commissioners NCQA National Committee for Quality Assurance NPI National Provider Identifier OAC Ohio Administrative Code ODI Ohio Department of Insurance ODM Ohio Department of Medicaid OMHAS Ohio Department of Mental Health and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code PCP Primary Care Provider PDSA Plan-Do-Study-Act PHI Protected Health Information PIP Performance Improvement Project PMPM Per Member Per Month QAPI Quality Assessment and Performance Improvement QI Quality Improvement RHC Rural Health Clinic SDOH Social Determinants of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Substance Use Disorder TPL Third Party Liability UM Utilization Management US United States USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 20212024, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.

ACRONYMS. ABD Aged, Blind, and Disabled XXXXX Xxxxxxx, Drug Addiction, and Mental Health AMA American Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society ACOR Alternate Contracting Officer's Representative AFARS Army Federal Acquisition Regulation Supplement AR Army Regulation CCE Contracting Center of Addiction Medicine CAHP Consumer Assessment of Healthcare Providers CANS Ohio Children’s Initiative Child and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services CEO Chief Executive Officer CFO Chief Financial Officer Excellence CFR Code of Federal Regulations CFT Child CONUS Continental United States (excludes Alaska and Family Team CHIP ChildrenHawaii) COR Contracting Officer Representative COTR Contracting Officer's Health Insurance Technical Representative DA Department of the Army DD250 Department of Defense Form 250 (Receiving Report) DD254 Department of Defense Form 254 DFARS Defense Federal Acquisition Regulation Supplement DMDC Defense Manpower Data Center DOD Department of Defense XXXX Department of Defense Instruction DODD Department of Defense Directive DPM Deputy Program CICIP Care Innovation and Community Improvement Program CIO Chief Information Officer CMHSP Community Mental Health Services Provider CME Care Management Entity CMO Chief Medical Officer CMS Centers for Medicare and Medicaid Services COA Certificate of Authority CPC Comprehensive Primary Care CPSE Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Electronic Clinical Quality Measure EDI Electronic Data Interchange EHR Electronic Health Record EPSDT Early and Periodic Screening, Diagnosis, and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification FDR First Tier, Downstream, and Related Entities FFS Fee-for-Service FQHC Federally Qualified Health Center HCBS Home and Community-Based Service HIC Health Insuring Corporation HIE Health Information Exchange Manager FAR Federal Acquisition Regulation FOUO For Official Use Only HD Hostage Detention HIPAA Health Insurance Portability and Accountability Act IMD Institution for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA Mental Health Parity of 1996 HSPD-12 Homeland Security Presidential Directive 12 ICP Instructor Certification Program JPRA Joint Personnel Recovery Agency JRTIC Joint Resistance Training Instruction Course (JRTIC) ISTP In-Service Training Program JTS Joint Training Standards KO Contracting Officer OCI Organizational Conflict of Interest OCONUS Outside Continental United States (includes Alaska and Addiction Equity Act MPS Minimum Hawaii) PARC Principal Assistant Responsible to Contracting PGD Peace-Time Governmental Detention PIPO Phase-In/Phase- Out PM Program Manager POC Point of Contact PRS Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners NCQA National Committee for Requirements Summary PTE Post-Training Event PWS Performance Work Statement QA Quality Assurance NPI National Provider Identifier OAC Ohio Administrative Code ODI Ohio Department of Insurance ODM Ohio Department of Medicaid OMHAS Ohio Department of Mental Health QAP Quality Assurance Program QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Plan RAD Resistance Academics Detachment RTL Resistance Training Laboratory SFAS Special Forces Selection and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code PCP Primary Care Provider PDSA Plan-Do-Study-Act PHI Protected Health Information PIP Performance Improvement Project PMPM Per Member Per Month QAPI Quality Assessment SME Subject Matter Expert SOF Special Operations Forces SERE Survival, Evasion, Resistance, Escape SUT Small Unit Tactics SWCS Special Warfare Center and Performance Improvement QI Quality Improvement RHC Rural Health Clinic SDOH Social Determinants of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU School SWTG (A) Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Substance Use Disorder TPL Third Party Liability UM Utilization Management US Warfare Training Group (Airborne) TE Technical Exhibit TTP Tactics, Techniques and Procedures USASOC United States USC Army Special Operations Command USAJFKSWCS United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, Army Xxxx X. Xxxxxxx Special Warfare Center and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.School USSOCOM United States Special Operations Command WT Wartime Captivity

ACRONYMS. ABD Aged, Blind, The acronyms included in this Contract stand for the following terms: ACH Automated Clearinghouse AICPA American Institute of Certified Public Accountants ARRA American Recovery and Disabled XXXXX Xxxxxxx, Drug Addiction, and Reinvestment Act of 2009 ASA Average Speed to Answer ASES Administración de Seguros de Salud or Puerto Rico Health Insurance Administration ASSMCA The Mental Health AMA American Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society of and Against Addiction Medicine CAHP Consumer Assessment of Healthcare Providers CANS Ohio Children’s Initiative Child Services Administration or Administración de Servicios de Salud Mental y Contra la Adicción ASUME Minor Children Support Administration BC-DR Business Continuity and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services Disaster Recovery CEO Chief Executive Officer CFO Chief Financial Officer CFR Code of Federal Regulations CFT Child and Family Team CHIP Children's ’s Health Insurance Program CICIP Care Innovation and Community Improvement Program CIO Chief Information Officer CMHSP Community Mental Health Services Provider CME Care Management Entity CMO Chief Medical Officer CMS Centers for Medicare and & Medicaid Services COA Certificate of Authority CPC Comprehensive Primary Care CPSE ECM Electronic Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Electronic Clinical Quality Measure Management EDI Electronic Data Interchange EHR EFT Electronic Health Record EPSDT Early Funds Transfer EPLS Excluded Parties List System FAR Federal Acquisition Regulation FMC Formulary of Medications Covered FDA Federal Food and Periodic Screening, Diagnosis, and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification FDR First Tier, Downstream, and Related Entities FFS Fee-for-Service Drug Administration FQHC Federally Qualified Health Center HCBS Home and CommunityFTP File Transfer Protocol GHP Government Health Plan HHS US Department of Health & Human Services HHS-Based Service HIC OIG US Department of Health Insuring Corporation HIE Health Information Exchange & Human Services Office of the Inspector General HIPAA Health Insurance Portability and Accountability Act IMD Institution of 1996 HITECH The Health Information Technology for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Economic and Clinical Counselor LSW Licensed Social Worker MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment Health Act of 2009, 42 USC 17391 et. Seq HIPAA Health Insurance Portability and Accountability Act of 1996 LEIE List of Excluded Individuals and Entities LME List of Medications by Exception MAC Maximum Allowable Cost MCO Managed Care Organization MFCU MDRP Medicaid Fraud Control Unit MHPAEA Mental Health Parity and Addiction Equity Act MPS Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC Drug Rebate Program MMIS Medicaid Management Information System NDC National Association of Insurance Commissioners NCQA Drug Code NDRA National Committee for Quality Assurance Drug Rebate Agreement NPI National Provider Identifier OAC Ohio Administrative Code ODI Ohio Department of Insurance ODM Ohio Department of Medicaid OMHAS Ohio Department of Mental Health PAD Physician Administered Drug P&T Pharmacy and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code PCP Primary Care Provider PDSA Plan-Do-Study-Act Therapeutics PBM Pharmacy Benefit Manager PHI Protected Health Information PIP Performance Improvement Project PMPM Per Member Per Month QAPI Quality Assessment PMG Primary Medical Group PPACA Patient Protection and Performance Improvement QI Quality Improvement RHC Rural Health Clinic SDOH Social Determinants of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Affordable Care Act RA Rebate Aggregator RFP Request for Proposals SAS Statements on Auditing Standards SUDs Substance Use Disorder Disorders TPL Third Party Liability UM Utilization Management US or USA United States of America USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.UM Utilization Management

ACRONYMS. ABD AgedThe acronyms included in this Contract stand for the following terms: ACH Automated Clearinghouse ACIP Advisory Committee on Immunization Practices ADAP AIDS Drug Assistance Program ADFAN Puerto Rico Administración de Familias y Niños, Blindor Families and Children Administration AHRQ Agency for Health Care Research and Quality AICPA American Institute of Certified Public Accountants ASES Administración de Seguros de Salud, and Disabled XXXXX Xxxxxxx, Drug Addiction, and or Puerto Rico Health Insurance Administration ASSMCA The Puerto Rico Mental Health AMA American Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society of and Anti-Addiction Medicine CAHP Services Administration or Administración de Servicios de Salud Mental y Contra la Adicción ASUME Minor Children Support Administration BC-DR Business Continuity and Disaster Recovery CAHPS Consumer Assessment of Healthcare Health Care Providers CANS Ohio Children’s Initiative Child and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services Systems CEO Chief Executive Officer CFO Chief Financial Officer CFR Code of Federal Regulations CFT Child and Family Team CHIP Children's Health Insurance Program CICIP Care Innovation and Community CLIA Clinical Laboratory Improvement Program CIO Chief Information Officer CMHSP Community Mental Health Services Provider CME Care Management Entity CMO Chief Medical Officer Amendment CMS Centers for Medicare and & Medicaid Services COA Certificate CPTET Centro de Prevención y Tratamiento de Enfermedades Transmisibles, or Transmisible Diseases Prevention and Treatment Center DME Durable Medical Equipment DOJ DSM The Puerto Rico Department of Authority CPC Comprehensive Primary Justice Diagnostic and Statistical Manual for Mental Disorders ECHO Experience of Care CPSE and Health Outcomes Survey ECM Electronic Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Electronic Clinical Quality Measure Management EDI Electronic Data Interchange EHR EFT Electronic Health Record Funds Transfer EIN Employer Identification Number EMTALA Emergency Medical Treatment and Labor Act EPLS Excluded Parties List System EPSDT Early and Periodic Screening, DiagnosisDiagnostic, and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification FDR First Tier, Downstream, ER Emergency Room FAR FMC Federal Acquisition Regulation Formulary of Medications Covered FDA Food and Related Entities Drug Administration FFS Fee-for-Service FQHC Federally Qualified Health Center HCBS Home FTP File Transfer Protocol GHP Government Health Plan HEDIS HCIP The Health Care Effectiveness Data and CommunityInformation Set Health Care Improvement Program HHS US Department of Health & Human Services HHS-Based Service HIC OIG US Department of Health Insuring Corporation & Human Services Office of the Inspector General HIE Health Information Exchange HIO Health Information Organization HIPAA Health Insurance Portability and Accountability Act IMD Institution of 1996 HITECH The Health Information Technology for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Economic and Clinical Counselor LSW Licensed Social Worker MAGI Health Act of 2009, 42 USC 17391 et. seq IBNR Incurred-But-Not-Reported ICD-10 International Statistical Classification of Diseases and Related Health Problems (10th edition) LEIE LME List of Excluded Individuals and Entities List of Medications by Exception MAC Maximum Allowable Cost M-CHAT Modified Adjusted Gross Income MAT Medication Assisted Treatment Checklist for Autism in Toddlers MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA MD Medical Doctor MHSIP Mental Health Parity and Addiction Equity Act MPS Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners Statistics Improvement Program MMIS Medicaid Management Information System NCQA National Committee for Quality Assurance NEMT Non-Emergency Medical Transportation NPI National Provider Identifier OAC Ohio Administrative Code ODI Ohio Department NPL National Provider List NPPES National Plan and Provider Enumeration System NQMC National Quality Measures Clearinghouse ONCHIT Office of Insurance ODM Ohio Department of Medicaid OMHAS Ohio Department of Mental the National Coordinator for Health Information Technology P&T Pharmacy and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code Therapeutics PBM Pharmacy Benefit Manager PCP Primary Care Provider PDSA Plan-Do-Study-Act Physician PHI Protected Personal Health Information PIP Performance Improvement Project PMPM Per Member Per Month Projects PMG Primary Medical Group PPA Pharmacy Program Administrator PPACA Patient Protection and Affordable Care Act PPN Preferred Provider Network PRHIEC Puerto Rico Health Information Exchange Corporation QAPI Quality Assessment and Performance Improvement QI Quality Improvement Program RFP Request for Proposals Rh Rhesus RHC Rural Health Center/Clinic SDOH SAMHSA Substance Abuse and Mental Health Services Administration SAS SMI Statements on Auditing Standards Serious Mental Illness SED Serious Emotional Disturbance SSN Social Determinants of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Security Number SUDs Substance Use Disorder Disorders TDD Telecommunication Device for the Deaf TPL Third Party Liability UM Utilization Management US or USA United States of America USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.Code

ACRONYMS. ABD AgedIf used in this Agreement (including in the Program Implementation Description and any other annex or attachment to this Agreement), Blindthe following acronyms have the meanings ascribed to them below: ACT Artemisinin-based combination therapy AIDS Acquired immune deficiency syndrome ANC Antenatal Clinic ART Antiretroviral therapy ARV Antiretroviral BCC Behavioral change communication BSS Behavior Surveillance Survey CBO Community-based organization CHBC Community Home Based Care CCM Country Coordinating Mechanism XXXX Country response information system CT Counseling and testing DDT Dichlorodiphenyltrichloroethane DFID United Kingdom Department for International Development DHS Demographic and Health Surveys DOTS Directly Observed Treatment, Short Course DRS Drug resistance surveillance DST Drug susceptibility testing FBO Faith-based organization EML Essential medicines list ERP Expert Review Panel GLC Green Light Committee GMP Good Manufacturing Practices GTZ German Technical Cooperation HAART Highly active antiretroviral therapy HCW Health care worker HDI Human development index HIS Health Information System HIV Human immunodeficiency virus HMIS Health Management Information System ICH International Conference on Harmonization of Technical Requirements for the Registration of Pharmaceuticals for Human Use IDU Injecting drug user IEC Information education and Disabled XXXXX Xxxxxxxcommunication IPT Intermittent preventive treatment IRS Indoor residual spraying ITN Insecticide-treated net KAP Knowledge, Attitudes and Practices survey LFA Local Fund Agent LLITN Long-lasting insecticide treated net MDG United Nations Millennium Development Goals MDR Multi-drug resistant M&E Monitoring and Evaluation MERG Monitoring and Evaluation Reference Group MICS Multi indicator cluster surveys MoH Ministry of Health MSM Men who have sex with men NAC National AIDS Committee NAP National AIDS Program NDRA National Drug Addiction, Regulatory Authority NGO Non-governmental organization NMCP National malaria control program NTP National tuberculosis control program OI Opportunistic infection OVC Orphans and Mental children made vulnerable by AIDS PAHO Pan American Health AMA American Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society Organization PHC Primary Health Care PEP Post-Exposure Prophylaxis PIC/S Pharmaceutical Inspection Cooperation Scheme PMTCT Prevention of Addiction Medicine CAHP Consumer Assessment Mother to Child Transmission PLWHA Persons living with HIV/AIDS PPTCT Prevention of Healthcare Providers CANS Ohio Parent to Child Transmission PR Principal Recipient PSM Procurement and Supply Management RBM Roll Back Malaria RCM Regional Coordinating Mechanism RDT Rapid diagnostic test SR Sub-recipient STD Sexually transmitted disease STG Standard treatment guidelines STI Sexually transmitted infection TB Tuberculosis UNAIDS Joint United Nations Programme on HIV/AIDS UNCITRAL United Nations Commission on International Trade Law UNDP United Nations Development Programme UNESCO United Nations Educational Scientific and Cultural Organization UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session UNICEF United Nations Children’s Initiative Child and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Department Fund UNIDROIT International Institute for the Unification of Job and Family Services CEO Chief Executive Officer CFO Chief Financial Officer CFR Code of Federal Regulations CFT Child and Family Team CHIP Children's Health Insurance Program CICIP Care Innovation and Community Improvement Program CIO Chief Information Officer CMHSP Community Mental Health Services Provider CME Care Management Entity CMO Chief Medical Officer CMS Centers for Medicare and Medicaid Services COA Certificate of Authority CPC Comprehensive Primary Care CPSE Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Electronic Clinical Quality Measure EDI Electronic Data Interchange EHR Electronic Health Record EPSDT Early and Periodic Screening, Diagnosis, and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification FDR First Tier, Downstream, and Related Entities FFS Fee-for-Service FQHC Federally Qualified Health Center HCBS Home and Community-Based Service HIC Health Insuring Corporation HIE Health Information Exchange HIPAA Health Insurance Portability and Accountability Act IMD Institution for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA Mental Health Parity and Addiction Equity Act MPS Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners NCQA National Committee for Quality Assurance NPI National Provider Identifier OAC Ohio Administrative Code ODI Ohio Department of Insurance ODM Ohio Department of Medicaid OMHAS Ohio Department of Mental Health and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code PCP Primary Care Provider PDSA Plan-Do-Study-Act PHI Protected Health Information PIP Performance Improvement Project PMPM Per Member Per Month QAPI Quality Assessment and Performance Improvement QI Quality Improvement RHC Rural Health Clinic SDOH Social Determinants of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Substance Use Disorder TPL Third Party Liability UM Utilization Management US Private Law USAID United States USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, Agency for International Development VCT Voluntary counseling and , Managed Care testing WHO World Health Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.WHOPES WHO Pesticide Evaluation Scheme

ACRONYMS. ABD Aged, Blind, and Disabled XXXXX Xxxxxxx, Drug Addiction, and Mental Health AMA American Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society ACOR Alternate Contracting Officer's Representative AFARS Army Federal Acquisition Regulation AR Army Regulation AT Anti-Terrorism BFSB Battlefield Surveillance Brigade CCE Contracting Center of Addiction Medicine CAHP Consumer Assessment of Healthcare Providers CANS Ohio Children’s Initiative Child and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services CEO Chief Executive Officer CFO Chief Financial Officer Excellence CFR Code of Federal Regulations CFT Child CONUS Continental United States (excludes Alaska and Family Hawaii) COR Contracting Officer Representative COTS Commercial Off The Shelf DA Department of the Army DD250 Department of Defense Form 250 (Receiving Report) DD254 Department of Defense Contract Security Requirement List DFARS Defense Federal Acquisition Regulation Supplement DMDC Defense Manpower Data Center DOD Department of Defense DOTMLPF Doctrine, Organization, Training, Materiel, Leadership, Personnel and Facilities FAR Federal Acquisition Regulation ABCT Armored Brigade Combat Team CHIP Children's Health Insurance Program CICIP Care Innovation and Community Improvement Program CIO Chief Information Officer CMHSP Community Mental Health Services Provider CME Care Management Entity CMO Chief Medical Officer CMS Centers for Medicare and Medicaid Services COA Certificate of Authority CPC Comprehensive Primary Care CPSE Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Electronic Clinical Quality Measure EDI Electronic Data Interchange EHR Electronic Health Record EPSDT Early and Periodic Screening, Diagnosis, and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification FDR First Tier, Downstream, and Related Entities FFS Fee-for-Service FQHC Federally Qualified Health Center HCBS Home and Community-Based Service HIC Health Insuring Corporation HIE Health Information Exchange HIPAA Health Insurance Portability and Accountability Act IMD Institution for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA Mental Health Parity of 1996 MAIDIQ Multiple Award Indefinite Delivery/Indefinite Quantity MCoE Maneuver Center of Excellence OTOM Onsite Task Order Manager OCI Organizational Conflict of Interest OCONUS Outside Continental United States (includes Alaska and Addiction Equity Act MPS Minimum Hawaii) ODC Other Direct Costs OPSEC Operational Security PIPO Phase In /Phase Out POC Point of Contact PRS Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners NCQA National Committee for Requirements Summary PWS Performance Work Statement QA Quality Assurance NPI National Provider Identifier OAC Ohio Administrative Code ODI Ohio Department of Insurance ODM Ohio Department of Medicaid OMHAS Ohio Department of Mental Health and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code PCP Primary Care Provider PDSA Plan-Do-Study-Act PHI Protected Health Information PIP Performance Improvement Project PMPM Per Member Per Month QAPI QAP Quality Assessment and Performance Improvement QI Assurance Program QASP Quality Improvement RHC Rural Health Clinic SDOH Social Determinants of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Substance Use Disorder TPL Third Party Liability UM Utilization Management US United States USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of JulyAssurance Surveillance Plan QC Quality Control QCP Quality Control Plan TE Technical Exhibit TO Task Order TOCO Task Order Contracting Officer TOCOR Task Order Contracting Officer Representative WfF Warfighter’s Forum GOVERNMENT FURNISHED PROPERTY, 2021EQUIPMENT, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.AND SERVICES

ACRONYMS. ABD AgedACA The Patient Protection and Affordable Care Act and the Health Care Education Reconciliation Act of 2010, Blind, and Disabled XXXXX Xxxxxxx, Drug Addiction, and Mental Health AMA American Medical Association APM as amended ADA Americans with Disabilities Act AFDC Aid to Families with Dependent Children AIDS Acquired Immune Deficiency Syndrome APA Alternative Payment Model APRN Arrangement APD Advanced Practice Registered Nurse Planning Document ARD Accelerated Rehabilitation Decision ASAM American Society of Addiction Medicine CAHP Consumer Assessment ASCII American Standard Code for Information Interchange ASD Autism Spectrum Disorder BEC Basic Education Circular BHEF Behavioral Health Encounter File BH-MCO Behavioral Health Managed Care Organization BMWBO Bureau of Healthcare Providers CANS Ohio Children’s Initiative Minority and Women Business Opportunities BNDD Bureau of Narcotic Drugs and Devices BSU Base Service Unit CAO County Assistance Office CASSP Child and Adolescent Needs Service System Program CAU County Administrative Unit CBCM Community Based Care Management CBO Community Based Organization CCRS Consolidated Community Reporting System CCYA County Children and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services CEO Chief Executive Officer Youth Agency CFO Chief Financial Officer CFR Code of Federal Regulations CFT Child C/FST Consumer/Family Satisfaction Team XXXXX Children with Attention Deficit Disorders CHC Community HealthChoices CHC-MCO Community HealthChoices Managed Care Organization CIS Client Information System CISC Children and Family Team CHIP Children's Health Insurance Program CICIP Adolescents in Substitute Care Innovation and Community CLIA Clinical Laboratory Improvement Program CIO Chief Information Officer CMHSP Community Mental Health Services Provider CME Care Management Entity CMO Chief Medical Officer Amendment CMS Centers for Medicare and Medicaid Services COA Certificate COB Coordination of Authority CPC Comprehensive Primary Care CPSE Benefits CQI Continuous Quality Improvement CRCS Capitation Rate Calculation Sheet CRD/LIC Credentials/License CRF Consumer Registry File CRNP Certified Registered Nurse Practitioner CRR Community Residential Rehabilitation CSI Consumer Satisfaction Instruments CSP Community Support Program CST Consumer Satisfaction Team C&Y Children and Youth D&A Drug and Alcohol DAP Disability Advocacy Program DDAP Department of Drug and Alcohol Programs DEA Drug Enforcement Agency DHHS U.S. Department of Health and Human Services DHS Department of Human Services DME Durable Medical Equipment DMIRS Data Management and Information Retrieval System DOH Department of Health DSH Disproportionate Share DSM Diagnostic and Statistical Manual of Mental Disorders DUR Drug Utilization Review EAP Enrollment Assistance Program ECC Electronic Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Capture ECM Electronic Clinical Quality Measure EDI Claims Management EIN Employee Identification Number EMC Electronic Data Interchange EHR Electronic Health Record Media Claims EPSDT Early and Periodic Screening, Diagnosis, Diagnosis and Treatment EQRO External Quality Review Organization EVV Electronic Visit ED Emergency Department ERISA Employee Retirement Income Security Act, 1974 EVS Eligibility Verification FDR First Tier, Downstream, System FA Fiscal Agent FBMHS Family Based Mental Health Services FDA Food and Related Entities Drug Administration FFS Fee-forFor-Service FPL Federal Poverty Level FQHC Federally Qualified Health Center HCBS Home FRR Financial Reporting Requirements FST Family Satisfaction Team FTE Full Time Equivalent FTP File Transfer Process FWA Xxxxx, Xxxxx and CommunityAbuse GA General Assistance GAAP Generally Accepted Accounting Principles GME Graduate Medical Education HC HealthChoices HC BH HealthChoices Behavioral Health HC-Based Service HIC L/C HealthChoices Lehigh/Capital HC N/C HealthChoices North/Central HC-NE HealthChoices Northeast HCPCS CMS Common Procedure Coding System HCQU Health Care Quality Unit HC-SE HealthChoices - Southeast HC-SW HealthChoices - Southwest HEDIS Healthcare Effectiveness Data and Information Set HIO Health Insuring Corporation HIE Health Information Exchange Organizations HIPAA Health Insurance Portability and Accountability Act HIV/AIDS Human Immuno Deficiency Virus/Acquired Immune Deficiency Syndrome HMO Health Maintenance Organization IBHS Intensive Behavioral Health Services IBNR Incurred But Not Reported Claims ICD International Classification of Diseases ICF Intermediate Care Facility ICF/ID Intermediate Care Facilities for Persons with Intellectual Disabilities ICP Integrated Care Plan ICWC Integrated Community Wellness Centers ID Insurance Department IFB Invitation for Bid IHCP Indian Health Care Provider IMD Institution for Institutions For Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker Diseases ISP Individualized Service Plan JDC Juvenile Detention Center JPO Juvenile Probation Office L/C Lehigh/Capital LEP Limited English Proficient LGBTQI Lesbian, Gay, Bisexual, Transgender, Questioning and Intersex LTC Long Term Care LTSS Long Term Services and Support MA Medical Assistance MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MAID Medical Assistance Identification Number MATP Medical Assistance Transportation Program MAWA Mutually Agreed upon Written Arrangement MBE Minority Business Enterprise MBE/WBE Minority Business Enterprise/Women Business Enterprise MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA Mental Health Parity and Addiction Equity Act MPS MIS Management Information System MOE Method of Evaluation MPL Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners Participating Levels NCE Non-Continuous Eligibility NCQA National Committee for Quality Assurance NPI NDC National Provider Identifier OAC Ohio Administrative Drug Code ODI Ohio Department NMP Non-money payment OBRA Omnibus Budget Reconciliation Act OCYF Office of Children, Youth & Families ODP Office of Developmental Programs OIP Other Insurance ODM Ohio Department Paid OMAP Office of Medicaid OMHAS Ohio Department Medical Assistance Programs OMHSAS Office of Mental Health and Addiction Substance Abuse Services OMES Ohio Medicaid Enterprise ORC Other Related Conditions OTC Over the Counter PCIS Patient Census Information System ORC Ohio Revised Code PCO Private Coverage Organization PCP Primary Care Provider PDSA PlanPractitioner PDA Pennsylvania Department of Aging PH-Do-Study-Act PHI Protected MCO Physical Health Information PIP Performance Improvement Project Managed Care Organization PHSS Physical Health Service System PIHP Prepaid Inpatient Health Plan PIN Parents Involved Network PMPM Per Member Per Month QAPI POM Performance Outcome Measures POMS Performance Outcome Management System POSNet Pennsylvania Open Systems Network PPO Preferred Provider Organization PROMISe Provider Reimbursement and Operations Management Information System in electronic format PRTF Psychiatric Residential Treatment Facility QARI Quality Assessment and Performance Improvement QI Assurance Reform Initiative QM Quality Improvement Management QMB Qualified Medicare Beneficiaries QSF Quarterly Status File RBUC Received But Unpaid Claims RFP Request for Proposal RHC Rural Health Clinic RTF Residential Treatment Facility SAP Statutory Accounting Principles SBP State Blind Pension SCA Single County Authority SDOH Social Determinants of Health SFTP Secure File Transfer Protocol SFY SE Southeast SMH State Fiscal Year SIU Mental Hospital SMI Serious Mental Illness SMM State Medicaid Manual SNF Skilled Nursing Facility SNU Special Investigative Unit SPBM Single Pharmacy Benefit Manager Needs UnitSPR System Performance Review SSA Social Security Administration SSI Supplemental Security Income SSN Social Security Number SUD Substance Use Disorder SUR Surveillance and Utilization Review SURS Surveillance and Utilization Review System SW Southwest TANF Temporary Assistance to Needy Families TPL Third Party Liability TTY Text Telephone Typewriter UM Utilization Management US United States UM/QM Utilization Management/Quality Management UPIN Unique Physician Identification Number USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.WBE Women’s Business Enterprise

ACRONYMS. ABD AgedIf used in this Agreement (including in the Program Implementation Description and any other annex or attachment to this Agreement), Blindthe following acronyms have the meanings ascribed to them below: ACT Artemisinin-based Combination Therapy AIDS Acquired immune deficiency syndrome ANC Antenatal Clinic ART Antiretroviral therapy ARV Antiretroviral BCC Behavioral change communication BSS Behavior Surveillance Survey CBO Community-based organization CHBC Community Home Based Care CCM Country Coordinating Mechanism XXXX Country response information system CSW Commercial sex worker CT Counseling and testing DDT Dichlorodiphenyltrichloroethane DFID United Kingdom Department for International Development DHS Demographic and Health Surveys DOTS Directly Observed Treatment, Short Course DRS Drug resistance surveillance DST Drug susceptibility testing FBO Faith-based organization EML Essential Medicines List ERP Expert Review Panel GLC Green Light Committee GMP Good Manufacturing Practices GTZ German Technical Cooperation HAART Highly active antiretroviral therapy HCW Health care worker HDI Human development index HIS Health Information System HIV Human Immunodeficiency Virus HMIS Health Management Information System ICH International Conference on Harmonization of Technical Requirements for the Registration of Pharmaceuticals for Human Use IDU Injecting drug user IEC Information education and Disabled XXXXX Xxxxxxxcommunication IPT Intermittent preventive treatment IRS Indoor residual spraying ITN Insecticide-treated net KAP Knowledge, Attitudes and Practices survey LFA Local Fund Agent LLITN Long-lasting insecticide treated net MDG United Nations Millennium Development Goals MDR-TB Multi-drug resistant tuberculosis M&E Monitoring and Evaluation MERG Monitoring and Evaluation Reference Group MICS Multi indicator cluster surveys MoH Ministry of Health MSM Men who have sex with men NAC National AIDS Committee NAP National AIDS Programme NDRA National Drug Addiction, Regulatory Authority NGO Non-governmental organization NMCP National malaria control program NTP National tuberculosis control program OI Opportunistic infection OVC Orphans and Mental children made vulnerable by AIDS PAHO Pan American Health AMA American Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society Organization PHC Primary Health Care PEP Post-Exposure Prophylaxis PIC/S Pharmaceutical Inspection Cooperation Scheme PMTCT Prevention of Addiction Medicine CAHP Consumer Assessment Mother to Child Transmission PLWHA Persons living with HIV/AIDS PPTCT Prevention of Healthcare Providers CANS Ohio Parent to Child Transmission PR Principal Recipient PSM Procurement and Supply Management RBM Roll Back Malaria RCM Regional Coordinating Mechanism RDTs Rapid Diagnostic Tests SR Sub-recipient STD Sexually transmitted disease STG Standard Treatment Guidelines STI Sexually transmitted infection TB Tuberculosis UNAIDS Joint United Nations Programme on HIV/AIDS UNCITRAL United Nations Commission on International Trade Law UNDP United Nations Development Programme UNESCO United Nations Educational Scientific and Cultural Organization UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session UNICEF United Nations Children’s Initiative Child Fund UNIDROIT International Institute for the Unification of Private Law USAID United States Agency for International Development VCT Voluntary counseling and Adolescent Needs testing WHO World Health Organization WHOPES WHO Pesticide Evaluation Scheme Country: Democratic Socialist Republic of Sri Lanka Program Title: Response to maintain the current low prevalence of HIV and Strengths CCE Care Coordination Entity CDJFS County Department improve the quality of Job life of people infected with and affected by HIV Grant Number: SRL-913-G16-H Disease: HIV/AIDS Principal Recipient: The Family Services CEO Chief Executive Officer CFO Chief Financial Officer CFR Code of Federal Regulations CFT Child and Family Team CHIP Children's Health Insurance Program CICIP Care Innovation and Community Improvement Program CIO Chief Information Officer CMHSP Community Mental Health Services Provider CME Care Management Entity CMO Chief Medical Officer CMS Centers for Medicare and Medicaid Services COA Certificate of Authority CPC Comprehensive Primary Care CPSE Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Electronic Clinical Quality Measure EDI Electronic Data Interchange EHR Electronic Health Record EPSDT Early and Periodic Screening, Diagnosis, and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification FDR First Tier, Downstream, and Related Entities FFS Fee-for-Service FQHC Federally Qualified Health Center HCBS Home and Community-Based Service HIC Health Insuring Corporation HIE Health Information Exchange HIPAA Health Insurance Portability and Accountability Act IMD Institution for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA Mental Health Parity and Addiction Equity Act MPS Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Planning Association of Insurance Commissioners NCQA National Committee for Quality Assurance NPI National Provider Identifier OAC Ohio Administrative Code ODI Ohio Department of Insurance ODM Ohio Department of Medicaid OMHAS Ohio Department of Mental Health and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code PCP Primary Care Provider PDSA Plan-Do-Study-Act PHI Protected Health Information PIP Performance Improvement Project PMPM Per Member Per Month QAPI Quality Assessment and Performance Improvement QI Quality Improvement RHC Rural Health Clinic SDOH Social Determinants of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Substance Use Disorder TPL Third Party Liability UM Utilization Management US United States USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.Sri Lanka

ACRONYMS. ABD AgedThe acronyms included in this Contract stand for the following terms: ACH Automated Clearinghouse ACIP Advisory Committee on Immunization Practices ADAP AIDS Drug Assistance Program ADFAN Puerto Rico Administración de Familias y Niños, Blindor Families and Children Administration AHRQ Agency for Health Care Research and Quality AICPA American Institute of Certified Public Accountants ASES Administración de Seguros de Salud, and Disabled XXXXX Xxxxxxx, Drug Addiction, and or Puerto Rico Health Insurance Administration ASSMCA Puerto Rico Mental Health AMA American Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society of and Anti-Addiction Medicine CAHP Services Administration or Administración de Servicios de Salud Mental y Contra la Adicción ASUME Minor Children Support Administration BC-DR Business Continuity and Disaster Recovery CAHPS Consumer Assessment of Healthcare Health Care Providers CANS Ohio Children’s Initiative Child and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services Systems CEO Chief Executive Officer CFO Chief Financial Officer CFR Code of Federal Regulations CFT Child and Family Team CHIP Children's Health Insurance Program CICIP Care Innovation and Community CLIA Clinical Laboratory Improvement Program CIO Chief Information Officer CMHSP Community Mental Health Services Provider CME Care Management Entity CMO Chief Medical Officer Amendment CMS Centers for Medicare and & Medicaid Services COA Certificate CPTET Centro de Prevención y Tratamiento de Enfermedades Transmisibles, or Communicable Diseases Prevention and Treatment Center DME Durable Medical Equipment DOJ The Puerto Rico Department of Authority CPC Comprehensive Primary Justice DSM Diagnostic and Statistical Manual for Mental Disorders ECHO Experience of Care CPSE and Health Outcomes Survey ECM Electronic Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Electronic Clinical Quality Measure Management EDI Electronic Data Interchange EHR EFT Electronic Health Record Funds Transfer EIN Employer Identification Number EMTALA Emergency Medical Treatment and Labor Act EPLS Excluded Parties List System EPSDT Early and Periodic Screening, DiagnosisDiagnostic, and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification FDR First Tier, Downstream, ER Emergency Room FAR Federal Acquisition Regulation FMC Formulary of Medications Covered FDA Food and Related Entities Drug Administration FFS Fee-for-Service FQHC Federally Qualified Health Center HCBS Home FTP File Transfer Protocol GHP Government Health Plan HEDIS The Health Care Effectiveness Data and CommunityInformation Set HCIP Health Care Improvement Program HHS US Department of Health & Human Services HHS-Based Service HIC OIG US Department of Health Insuring Corporation & Human Services Office of the Inspector General HIE Health Information Exchange HIO Health Information Organization HIPAA Health Insurance Portability and Accountability Act IMD Institution of 1996 HITECH The Health Information Technology for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Economic and Clinical Counselor LSW Licensed Social Worker MAGI Health Act of 2009, 42 USC 17391 et. seq IBNR Incurred-But-Not-Reported ICD-10 International Statistical Classification of Diseases and Related Health Problems (10th edition) LEIE List of Excluded Individuals and Entities LME List of Medications by Exception MAC Maximum Allowable Cost M-CHAT Modified Adjusted Gross Income MAT Medication Assisted Treatment Checklist for Autism in Toddlers MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA MD Medical Doctor MHSIP Mental Health Parity and Addiction Equity Act MPS Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners Statistics Improvement Program MMIS Medicaid Management Information System NCQA National Committee for Quality Assurance NEMT Non-Emergency Medical Transportation NPI National Provider Identifier OAC Ohio Administrative Code ODI Ohio Department NPL National Provider List NPPES National Plan and Provider Enumeration System NQMC National Quality Measures Clearinghouse ONCHIT Office of Insurance ODM Ohio Department of Medicaid OMHAS Ohio Department of Mental the National Coordinator for Health Information Technology P&T Pharmacy and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code Therapeutics PBM Pharmacy Benefit Manager PCP Primary Care Provider PDSA Plan-Do-Study-Act Physician PHI Protected Health Information PIP Performance Improvement Project PMPM Per Member Per Month Projects PMG Primary Medical Group PPA Pharmacy Program Administrator PPACA Patient Protection and Affordable Care Act PPN Preferred Provider Network PRHIEC Puerto Rico Health Information Exchange Corporation QAPI Quality Assessment and Performance Improvement QI Quality Improvement Program RFP Request for Proposals Rh Rhesus RHC Rural Health Clinic SDOH Clinic/Center SAMHSA Substance Abuse and Mental Health Services Administration SAS Statements on Auditing Standards SMI Serious Mental Illness SED Serious Emotional Disturbance SSN Social Determinants of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Security Number SUDs Substance Use Disorder Disorders TDD Telecommunication Device for the Deaf TPL Third Party Liability UM Utilization Management US or USA United States of America USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.Code

ACRONYMS. ABD Aged, Blind, ACRONYMS TERMS MEANINGS ASAP Alcohol and Disabled XXXXX Xxxxxxx, Drug Addiction, Abuse Prevention and Mental Health AMA Control ADR Alternate Dispute Resolution AFGE American Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society Federation of Addiction Medicine CAHP Consumer Assessment of Healthcare Providers CANS Ohio Children’s Initiative Child and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services CEO Chief Executive Officer CFO Chief Financial Officer Government Employees AIDS Acquired Immune Deficiency Syndrome AWS Alternate Work Schedule CFC Combined Federal Campaign CFR Code of Federal Regulations CFT Child and Family Team CHIP Children's Health Insurance Program CICIP Care Innovation and Community Improvement Program CIO Chief Information Officer CMHSP Community Mental Health Services Provider CME Care Management Entity CMO Chief Medical Officer CMS Centers for Medicare and Medicaid Services COA Certificate COP Continuation of Authority CPC Comprehensive Primary Care CPSE Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Electronic Clinical Quality Measure EDI Electronic Data Interchange EHR Electronic Health Record EPSDT Early and Periodic Screening, Diagnosis, and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification FDR First Tier, Downstream, and Related Entities FFS Fee-for-Service FQHC Federally Qualified Health Pay XXXX* Civilian Personnel Advisory Center HCBS Home and Community-Based Service HIC Health Insuring Corporation HIE Health Information Exchange HIPAA Health Insurance Portability and Accountability Act IMD Institution for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA Mental Health Parity and Addiction Equity Act MPS Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association CSRO Customer Support Representative Office DCP* Directorate of Insurance Commissioners NCQA National Committee for Quality Assurance NPI National Provider Identifier OAC Ohio Administrative Code ODI Ohio Civilian Personnel DOA Department of Insurance ODM Ohio Army DoD Department of Medicaid OMHAS Ohio Department Defense DSN Defense Switched Network EFT Electronic Funds Transfer eOPF Electronic Official Personnel Folder EEO Equal Employment Opportunity FECA Federal Employees Compensation Act FLRA Federal Labor Relations Authority FLSA Fair Labor Standards Act FMLA Family and Medical Leave FMCS Federal Mediation and Conciliation Service FPM Federal Personnel Manual FSIP Federal Service Impasse Panel FSLMR Federal Service Labor-Management Relations FTS Federal Telecommunications System FWS Federal Wage System GS General Schedule IBB Interest Based Bargaining IFB Invitation for Bid MEO Most Efficient Organization MOU Memorandum of Mental Understanding MSPB Merit Systems Protection Board OMB Office of Management and Budget OPF Official Personnel Folder OPM Office of Personnel Management OSHA Occupational Safety and Health and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code PCP Primary Care Provider PDSA Plan-Do-Study-Act PHI Protected Health Information Administration OWCP Office of Workers’ Compensation Program PIP Performance Improvement Project PMPM Per Member Per Month QAPI Quality Assessment and Plan PPE Personal Protective Equipment PWS Performance Improvement QI Quality Improvement RHC Rural Health Clinic SDOH Social Determinants of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Substance Use Disorder TPL Third Party Liability UM Utilization Management US United States Work Statement RFP Request for Proposal RIF Reduction in Force SCD Service Computation Date SF Standard Form SOP Standard Operating Procedures SQS Supplemental Qualification Statement TAPES Total Army Performance Evaluation System TDY Temporary Duty USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.VDT Visual Display Terminal

ACRONYMS. ABD Aged, Blind, ABNSOTD Airborne Special Operations Test Directorate Test AMC U.S. Army Materiel Command AO Area of Operation AR Army Regulation ATEC U.S. Army Test and Disabled XXXXX Xxxxxxx, Drug Addiction, and Mental Health AMA American Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society of Addiction Medicine CAHP Consumer Evaluation Command CAC Common Access Card CAP Contractor Acquired Property CCIR Commander’s Critical Information Requirements CDR Contract Deficiency Report CDRL Contract Data Requirements List CIMS Cost Information Management System CONUS Continental United States COR Contracting Officer's Representative CPAR Contractor Performance Assessment of Healthcare Providers CANS Ohio Children’s Initiative Child and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Rating CPFF Cost Plus Fixed-Fee CUI Controlled Unclassified Information DAG Data Authentication Group DID Data Item Description DFARS Defense Federal Acquisition Regulation Supplement DMP Data Management Plan DOD Department of Job Defense DOL Directorate of Logistic DTP Detailed Test Plan ECOD Estimated Cost of Damages ECMR Enterprise Contractor Manpower Reporting FAR Federal Acquisition Regulation FPCON Force Protection Condition FOIA Freedom of Information Act FOUO For Official Use Only FSC Federal Service Code FTC Forward Test Center GCSS-Army Global Combat Support System-Army GFF Government-Furnished Facilities GFP Government Furnished Property GP Government Property GPM Ground Precautionary Messages GPS Global Positioning System IAW In Accordance With ICIDS Integrated Commercial Intrusion Detection System IT Information Technology ITR Information Technology Resource IUID Item Unique Identification JER Joint Ethics Regulation JFTR Joint Federal Travel Regulation LAN Local Area Network LRC Logistics Readiness Center MICC Mission Installation Contracting Command MIL-STD Military Standard MWO Modification Work Order NACI National Agency Check with Inquiries NVD Night Vision Device OCI Organizational Conflict of Interest OCONUS Outside Continental United States ORSA Operations Research Systems Analysts OSHA Occupational Safety and Family Services CEO Chief Executive Officer CFO Chief Financial Officer CFR Code Health Administration OPSEC Operational Security OTA Operational Test Agency OTP Operational Test Plan OTC U.S. Army Operational Test Command PMP Property Management Plan PWS Performance Work Statement POI Program of Federal Regulations CFT Child Instruction POL Petroleum, Oils and Family Team CHIP Children's Health Insurance Program CICIP Care Innovation and Community Improvement Program CIO Chief Information Officer CMHSP Community Mental Health Services Provider CME Care Management Entity CMO Chief Medical Officer CMS Centers for Medicare and Medicaid Services COA Certificate of Authority CPC Comprehensive Primary Care CPSE Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Electronic Clinical Lubricants POV Privately Owned Vehicle PQDR Product Quality Measure EDI Electronic Data Interchange EHR Electronic Health Record EPSDT Early and Periodic Screening, Diagnosis, and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification FDR First Tier, Downstream, and Related Entities FFS Fee-for-Service FQHC Federally Qualified Health Center HCBS Home and Community-Based Service HIC Health Insuring Corporation HIE Health Information Exchange HIPAA Health Insurance Portability and Accountability Act IMD Institution for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA Mental Health Parity and Addiction Equity Act MPS Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners NCQA National Committee for Discrepancy Report QA Quality Assurance NPI National Provider Identifier OAC Ohio Administrative QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Plan RMF Risk Management Framework RSC RAM Scoring Conference SOUM Safety of Use Message SCI Sensitive Compartmented Information SOP Standing Operating Procedure STIG Security Technical Implementation Guide SDR Supply Discrepancy Report TAR Task Authorization Request TASC Training Audio-Visual Support Center TASS Trusted Associated Sponsorship System TB Technical Bulletin TC Training Circular TE Technical Exhibit TIP Task Implementation Plan TMDE Test Measurement and Diagnostic Equipment TO Test Officer TSO Test Support Officer UIC Unit Identification Code ODI Ohio Department of Insurance ODM Ohio Department of Medicaid OMHAS Ohio Department of Mental Health and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code PCP Primary Care Provider PDSA PlanUID Unique Identification 3.0. GOVERNMENT-Do-Study-Act PHI Protected Health Information PIP Performance Improvement Project PMPM Per Member Per Month QAPI Quality Assessment and Performance Improvement QI Quality Improvement RHC Rural Health Clinic SDOH Social Determinants of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Substance Use Disorder TPL Third Party Liability UM Utilization Management US United States USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care ActFURNISHED ITEMS.

ACRONYMS. ABD AgedAFHS Adolescent-friendly health services AGYW Adolescent Girls and Young Women AOR Agreement Officer Representative ART Antiretroviral Therapy C&T Care and Treatment CBHS Community based HIV service CBHTC Community Based HIV Testing and Counseling CBO Community based organization CCHP Council Comprehensive Health Plans CHAC Council HIV AIDS Coordinator CHMT Council Health Management Team CHSS Community Health Systems Strengthening CPR Contraceptive Prevalence Rate CSO Civil Society Organization CTC Care and Treatment Clinic DAC District Advisory Committees DACC District AIDS Control Coordinator DAMES DREAMS Auxiliary Monitoring and Evaluation System DED District Executive Director DHS Demographic and Health Survey DIC Drop-In Center DQA Data Quality Assessments DRCHCo District Reproductive and Child Health Coordinator DREAMS Determined, BlindResilient, Empowered, AIDS-Free, Mentored and Safe EJAF Xxxxx Xxxx AIDS Foundation EMMP Environmental Monitoring and Mitigation Plan EQA External Quality Assurance EW Empowerment Worker EWAT Economic Wellbeing Assessment Tool FP Family Planning FSW Female Sex Worker FY Fiscal Year GBV Gender-Based Violence GIS Geographical Information System XxXX Government Performance Index GoT Government of Tanzania HBC Home-Based Care HBTC Home-based testing and counseling HIV Human Immunodeficiency Virus HIVST HIV Self-Testing HPES Health Promotion and Education Section HTC HIV testing and counseling ICD Institutional Capacity Development IEC Information Education and Communication IP Implementing Partner IQC Internal Quality Control IRB Institutional Review Board ITOCA Integrated Technical and Organization Capacity Assessment IUD Intra-Uterine Device IVR Interactive Voice Recording KP Key Population KVP Key and Vulnerable Population KVPFHS Key and Vulnerable Population Friendly Health Services LARC Long Acting Reversible Contraceptive LGA Local Government Authority M&E Monitoring & evaluation MC Municipal Council MO Medical Officer MOHCDGEC Ministry of Health, Community Development, Gender, Elderly, and Disabled XXXXX XxxxxxxChildren MoIYCS Ministry of Information, Drug AddictionYouth, Culture, and Mental Sports MOU Memorandum of Understanding MSD Medical Stores Department MSM Men Who Have Sex with Men MUHAS Muhimbili University of Health AMA American and Allied Sciences NA Not Applicable NACOPHA National Council of People Living with HIV NACP National AIDS Control Programme NACS Nutritional Assessment, Counseling and Support NGO Non-Governmental Organization NIMR National Institute for Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Research OHSP Other Hot-Spot Populations OJT On-the Job Training ONA Organizational Network Analysis OPI Organizational Performance Index OVC Orphans and Vulnerable Children PE Peer Educator PEP Post Exposure Prophylaxis XXXXXX President’s Emergency Plan for AIDS Relief PFSW Partners of Female Sex Workers PHDP Positive Health, Dignity and Prevention PLHIV People Living with HIV/AIDS PMTCT Prevention of Mother-to-Child Transmission XX-XXXX President’s Office - Regional Administration and Local Government PPT Periodic Presumptive Treatment PrEP Pre-exposure prophylaxis QA/QI Quality Assurance/ Quality Improvement QIT Quality Improvement Teams Q2 Second Quarter Q3 Third Quarter Q4 Fourth Quarter RAC Research Advisory Committee RACC Regional AIDS Control Coordinator RAS Regional Administrative Secretary RC Regional Commissioner RCHS Reproductive and Child Health Services RHASP Regional HIV/AIDS Strategic Plans RHMT Regional Health Management Team RLT Regional Laboratory Technologist/Technician RMO Regional Medical Officer RNO Regional Nurse ASAM American Society Officer RS-LGA Regional Secretariat Local Government Authorities SASA! Start Awareness Support Action SAPTA Support for Addiction and Prevention in Africa SBCC Social and Behavior Change and Communication SEEO Socio-Economic Empowerment Officer XXXX Site Improvement Monitoring System SMS Short Message Service SNU Subnational Unit SOP Standard Operating Procedures SRH Sexual and Reproductive Health STI Sexually Transmitted Infections TA Technical Assistance TACAIDS Tanzania Commission for AIDS TAG Technical Advisory Group TASAF Tanzania Social Action Fund TB Tuberculosis TWG Technical Working Group URT United Republic of Addiction Medicine CAHP Consumer Assessment of Healthcare Providers CANS Ohio Children’s Initiative Child Tanzania USAID United States Agency for International Development USG United States Government vAGYW Vulnerable Adolescent Girls and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services CEO Chief Young Women VMMC Voluntary Medical Male Circumcision XXX Xxxx Executive Officer CFO Chief Financial Officer CFR Code of Federal Regulations CFT Child and Family Team CHIP Children's Health Insurance Program CICIP Care Innovation and Community Improvement Program CIO Chief Information Officer CMHSP Community Mental Health Services Provider CME Care Management Entity CMO Chief Medical Officer CMS Centers for Medicare and Medicaid Services COA Certificate of Authority CPC Comprehensive Primary Care CPSE Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year eCQM Electronic Clinical Quality Measure EDI Electronic Data Interchange EHR Electronic Health Record EPSDT Early and Periodic Screening, Diagnosis, and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification FDR First Tier, Downstream, and Related Entities FFS Fee-for-Service FQHC Federally Qualified Health Center HCBS Home and Community-Based Service HIC Health Insuring Corporation HIE Health Information Exchange HIPAA Health Insurance Portability and Accountability Act IMD Institution for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA Mental Health Parity and Addiction Equity Act MPS Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners NCQA National Committee for Quality Assurance NPI National Provider Identifier OAC Ohio Administrative Code ODI Ohio Department of Insurance ODM Ohio Department of Medicaid OMHAS Ohio Department of Mental Health and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code PCP Primary Care Provider PDSA Plan-Do-Study-Act PHI Protected Health Information PIP Performance Improvement Project PMPM Per Member Per Month QAPI Quality Assessment and Performance Improvement QI Quality Improvement RHC Rural Health Clinic SDOH Social Determinants of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Substance Use Disorder TPL Third Party Liability UM Utilization Management US United States USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.ZAC Zanzibar AIDS Commission

ACRONYMS. ABD Aged, Blind, Acronym‌ Explanation‌ A&A Assessment and Disabled XXXXX Xxxxxxx, Drug Addiction, and Mental Health AMA American Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society of Addiction Medicine CAHP Consumer Assessment of Healthcare Providers CANS Ohio Children’s Initiative Child and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Accreditation ADA Americans With Disability Act ADR Average Daily Rate AO Authorizing Official BAR Best Available Rate BPA Blanket Purchase Agreement CO Contracting Officer CONUS Continental United States COR Contracting Officers Representative COTS Commercially Available Off-The-Shelf CTO Commercial Travel Office DHS Department of Job and Family Services CEO Chief Executive Officer CFO Chief Financial Officer CFR Code of Federal Regulations CFT Child and Family Team CHIP Children's Health Insurance Program CICIP Care Innovation and Community Improvement Program CIO Chief Information Officer CMHSP Community Mental Health Services Provider CME Care Homeland Security DMP Data Management Entity CMO Chief Medical Officer CMS Centers for Medicare and Medicaid Services COA Certificate of Authority CPC Comprehensive Primary Care CPSE Claims Payment Systemic Error CSP Coordinated Plan DTS Defense Travel System ELS Emergency Lodging Services Program CY Calendar Year eCQM Electronic Clinical Quality Measure DUNS Data Universal Numbering System EDI Electronic Data Interchange EHR EFT Electronic Health Record EPSDT Early Funds Transfer ESF Emergency Support Function ETS‌ E-Gov Travel Service‌ FAR Federal Acquisition Regulation FAS Federal Acquisition Service FEMA Federal Emergency Management Agency FIPS Federal Information processing Standards FSS Federal Supply Service FTP File Transfer Protocol FTR Federal Travel Regulation FY Fiscal Year GDs Global Distribution System GSA U.S. General Services Administration IFF Industrial Funding Fee IPP Invoice Processing Platform ISA Interconnection Security Agreements ISSO Information Systems Security Office IT Information Technology M&IE Meals and Periodic Screening, Diagnosis, Incidental Expenses MOA/U Memorandum of Agreement/Understanding MAS Multiple Award Schedule NEMIS National Emergency Management Information Agency NIST National Institute of Standards and Treatment EQRO External Quality Review Organization EVV Electronic Visit Verification FDR First Tier, Downstream, and Related Entities FFS Fee-for-Service FQHC Federally Qualified Health Center HCBS Home and Community-Based Service HIC Health Insuring Corporation HIE Health Technology LRA Last Room Availability NLRA Non Last Room Availability NSSE National Special Security Event OCONUS Outside the Contiguous United States PII Personally Identifiable Information Exchange HIPAA Health Insurance Portability and Accountability Act IMD Institution PM Program / Project Manager PMO Program management Office RFP Request for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA Mental Health Parity and Addiction Equity Act MPS Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners NCQA National Committee Proposal RFQ Request for Quality Assurance NPI National Provider Identifier OAC Ohio Administrative Code ODI Ohio Department of Insurance ODM Ohio Department of Medicaid OMHAS Ohio Department of Mental Health and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code PCP Primary Care Provider PDSA Plan-Do-Study-Act PHI Protected Health Information PIP Performance Improvement Project PMPM Per Member Per Month QAPI Quality Assessment and Performance Improvement QI Quality Improvement RHC Rural Health Clinic SDOH Social Determinants of Health Quote SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU SIN Special Investigative Unit SPBM Single Pharmacy Benefit Manager SUD Substance Use Disorder TPL Third Party Liability UM Utilization Item Number SOW Statement of Work SP Security Plan SSP System Security Plan T&T Office of Travel and Transportation Services TDY Temporary Duty Travel TMC Travel Management US United States USC United States Code This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and , Managed Care Organization (MCO), an Ohio corporation, whose principal office is located in the city of , County of , state of Ohio. The MCO is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO must submit to ODM any data submitted to ODI to establish the MCO has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO debts, including those that remain in the event of MCO insolvency or the insolvency of any subcontractors. The MCO is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services described in 42 CFR 438.2 through the managed care program for the Medicaid-eligible population described in OAC rule 5160-26-02 along with any other Medicaid-eligible populations authorized by the Centers for Medicare and Medicaid Center TSA Transitional Sheltering Assistance TSAR Transitional Sheltering Assistance Reimbursement TSS Travel Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO services for the benefit of certain Medicaid recipients. In doing so, the MCO has provided and must continue to provide proof of the MCO's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter 5167 and OAC Chapter 5160-26, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.Solutions UDF User Defined Files

ACRONYMS. ABD Aged, Blind, and Disabled XXXXX XxxxxxxADAMH Alcohol, Drug Addiction, and Mental Health or County Board of Alcohol, Drug Addiction, and Mental Health AMA American Medical Association APM Alternative Payment Model APRN Advanced Practice Registered Nurse ASAM American Society of Addiction Medicine BDD County Board of Developmental Disabilities CAHP Consumer Assessment of Healthcare Providers CANS Ohio Children’s Initiative Child and Adolescent Needs and Strengths CCE Care Coordination Entity CDJFS County Department of Job and Family Services CEO Chief Executive Officer CFO Chief Financial Officer CFR Code of Federal Regulations CFT Child and Family Team CHIP Children's Health Insurance Program CHW Community Health Worker CICIP Care Innovation and Community Improvement Program CIO Chief Information Officer CMHSP CMHC Community Mental Health Services Provider Center CME Care Management Entity CMO Chief Medical Officer CMS Centers for Medicare and Medicaid Services COA Certificate of Authority XXX Center of Excellence CPC Comprehensive Primary Care CPSE Claims Payment Systemic Error CSP Coordinated Services Program CY Calendar Year DME Durable Medical Equipment DODD DYS EAPG Department of Developmental Disabilities Ohio Department of Youth Services Enhanced Ambulatory Patient Grouping eCQM Electronic Clinical Quality Measure EDI Electronic Data Interchange EHR Electronic Health Record EPSDT Early and Periodic Screening, Diagnosis, and Treatment EQRO External Quality Review Organization ESC Educational Service Center EVV Electronic Visit Verification FCFC Family and Children First Council FDR First Tier, Downstream, and Related Entities FFS Fee-for-Fee for Service FQHC Federally Qualified Health Center HCBS Home FWA Xxxxx, Xxxxx, and Community-Based Service HIC Health Insuring Corporation Xxxxx HIE Health Information Exchange HIPAA Health Insurance Portability and Accountability Act HITECH Health Information Technology for Economic and Clinical Health Act IHBT Intensive Home Based Treatment IMD Institution for Mental Disease IMS Incident Management System LISW Licensed Independent Social Worker LPCC Licensed Professional Clinical Counselor LSW Licensed Social Worker MAGI Modified Adjusted Gross Income MAT Medication Assisted Treatment MCO Managed Care Organization MFCU Medicaid Fraud Control Unit MHPAEA Mental Health Parity and Addiction Equity Act MISP Maternal and Infant Support Program MPS Minimum Performance Standards MRSS Mobile Response and Stabilization Services NAIC National Association of Insurance Commissioners NCQA National Committee for Quality Assurance NPI National Provider Identifier OAC Ohio Administrative Code ODI ODE Ohio Department of Insurance ODM Education ODH Ohio Department of Medicaid Health ODJFS Ohio Department of Job and Family Services ODRC Ohio Department of Rehabilitation and Correction OFCF Ohio Family and Children First OMHAS Ohio Department of Mental Health and Addiction Services OMES Ohio Medicaid Enterprise System ORC Ohio Revised Code ORP Ordering, Referring, and Prescribing PCP Primary Care Provider PDSA Plan-Do-Study-Act PCSA Public Children Services Agency PHI Protected Health Information PIP Performance Improvement Project PMPM Per Member Per Month QAPI Quality Assessment and Performance Improvement QI Quality Improvement RHC Rural Health Clinic SDOH Social Determinants of Health SFTP Secure File Transfer Protocol SFY State Fiscal Year SIU Special Investigative Unit SPA State Plan Amendment SPBM Single Pharmacy Benefit Manager SSA Social Security Act SUD Substance Use Disorder TPL Third Party Liability UM Utilization Management US United States USC United States Code USCDI United States Core Data for Interoperability This Provider Agreement (hereinafter "Agreement") is entered into this first day of July, 2021, at Columbus, Franklin County, Ohio, between the state of Ohio, the Ohio Department of Medicaid, (hereinafter referred to as ODM) whose principal office is located in the City of Columbus, County of Franklin, state of Ohio, and Aetna Better Health, Managed Care Organization (MCO)Inc., dba Aetna Better Health of Ohio, OhioRISE Plan, an Ohio corporation, whose principal office is located in the city of New Albany, County of Franklin, state of Ohio. The MCO OhioRISE Plan is licensed as a Health Insuring Corporation by the state of Ohio, Department of Insurance (hereinafter referred to as ODI), pursuant to Chapter 1751 of the Ohio Revised Code (ORC) and is organized and must operate as prescribed by Chapter 5167 of the ORC, Chapter 5160-59 and, when applicable, 5160-26 of the Ohio Administrative Code (OAC), and other applicable portions of the OAC as amended from time to time. Upon request, the MCO OhioRISE Plan must submit to ODM any data submitted to ODI to establish that the MCO OhioRISE Plan has adequate provisions against the risk of insolvency as required under 42 Code of Federal Regulations (CFR) 438.116 and to ensure that neither members nor ODM shall be liable for any MCO OhioRISE Plan's debts, including those that remain in the event of MCO OhioRISE Plan's insolvency or the insolvency of any subcontractors. The MCO OhioRISE Plan is an entity eligible to enter into this Agreement in accordance with 42 CFR 438.3 and is engaged in the business of providing the comprehensive services as a prepaid inpatient health plan as described in 42 CFR 438.2 through the managed care program for the Medicaidprovision of services described in OAC 000-eligible 00-00 for the Medicaid population described in OAC rule 5160-2659-02 along with any other Medicaid-Medicaid eligible populations population authorized by the Centers for Medicare and Medicaid Services (CMS) and described in the Ohio Medicaid state plan. ODM, as the single state agency designated to administer the Medicaid program under ORC section 5162.03 and Title XIX of the Social Security Act, desires to obtain MCO the OhioRISE Plan's services for the benefit of certain Medicaid recipients. In doing so, the MCO OhioRISE Plan has provided and must continue to provide proof of the MCOOhioRISE Plan's capability to provide quality services efficiently, effectively, and economically during the term of this Agreement. This Agreement is a contract between ODM and the undersigned MCO OhioRISE Plan pursuant to the federal contracting provisions of 42 CFR 434.6 and 438.6 in which the MCO OhioRISE Plan must provide or arrange for comprehensive Medicaid services through the managed care program as provided in ORC Chapter Chapters 5164 and 5167 and OAC Chapter 5160-2626 and 5160-59, assuming the risk of loss, and at all times complying with federal and state laws and regulations, federal and state Medicaid program requirements, and other requirements as specified by ODM. In accordance with 42 CFR 438.3(f)(1), this includes without limitation: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990 as amended; and Section 1557 of the Patient Protection and Affordable Care Act.