Common use of Effective December 1, 2011 Clause in Contracts

Effective December 1, 2011. The State is divided into five regions consisting of six FQHCs and the University of Iowa Hospitals and Clinics (UIHC) and Broadlawns Medical Center as shown in Table 5. Regions 1 and 2 are assigned to UIHC. Broadlawns will become a medical home serving the 7 counties surrounding Polk County and become a regional hospital providing secondary care for IowaCare members assigned to medical homes in Regions 3, 4, and 5. Members in Regions 3, 4, & 5 who are not assigned to a medical home will continue to receive services at UIHC. Table 5 REGIONS 3, 4, & 5 Hospital Medical Home Counties Served Broadlawns Broadlawns Medical Center • Polk • Xxxxx • Dallas • Jasper • Madison • Xxxxxx • Story • Xxxxxx Broadlawns Community Health Center of Fort Dodge • Cerro Gordo • Xxxxx • Xxxxxxxx • Xxxxxxxx • Worth • Xxxxxxx * Broadlawns Council Bluffs Community Health Center* • Xxxxxxxx * • Xxxxx* • Xxxxxxxxxx* • Pottawattamie* • Xxxxxx* • Audubon* • Fremont* • Page* Broadlawns Siouxland Community Health Center • Cherokee • Xxxxxxxx • Xxx • Monona • X’Xxxxx • Plymouth • Sioux • Woodbury • Buena Vista* • Xxxxxxx* • Clay* • Xxxxxxxxx* • Xxxx • Osceola • Sac* REGIONS 1 & 2 UIHC Crescent Community Health Center • Chickasaw • Fayette • Xxxxxx • Winneshiek • Dubuque * UIHC Peoples Community Health Clinic • Black Hawk • Xxxxxx • Xxxxxxxx • Xxxxxx Broadlawns Primary Health Care, Inc. • Grundy UIHC University of Iowa Hospitals & Clinics • Xxxxxx • Cedar • Iowa • Xxxxxxx • Xxxxx • Keokuk • Linn • Xxxxxx • Muscatine • Washington • Clinton* • Xxxxx* • Des Moines* • Xxxxx* • Xxxxxxx* • Xxxxxxxxx* • Xxx* • Poweshiek* • Xxxxx* • Xxx Xxxxx* • Wapello* *Effective December 1, 2011

Effective December 1, 2011. The State is divided into five regions consisting of six FQHCs and the University of Iowa Hospitals and Clinics (UIHC) and Broadlawns Medical Center as shown in Table 5. Regions 1 and 2 are assigned to UIHC. Broadlawns will become a medical home serving the 7 counties surrounding Polk County and become a regional hospital providing secondary care for IowaCare members assigned to medical homes in Regions 3, 4, and 5. Members in Regions 3, 4, & 5 who are not assigned to a medical home will continue to receive services at UIHC. Table 5 REGIONS 3, 4, & 5 Hospital Medical Home Counties Served Broadlawns Broadlawns Medical Center • Polk • Xxxxx • Dallas • Jasper • Madison • Xxxxxx • Story • Xxxxxx Broadlawns Community Health Center of Fort Dodge • Cerro Gordo • Xxxxx • Xxxxxxxx • Xxxxxxxx • Worth • Xxxxxxx * Broadlawns Council Bluffs Community Health Center* • Xxxxxxxx * • Xxxxx* • Xxxxxxxxxx* • Pottawattamie* • Xxxxxx* • Audubon* • Fremont* • Page* Broadlawns Siouxland Community Health Center • Cherokee • Xxxxxxxx • Xxx • Monona • X’Xxxxx • Plymouth • Sioux • Woodbury • Buena Vista* • Xxxxxxx* • Clay* • Xxxxxxxxx* • Xxxx • Osceola • Sac* REGIONS 1 & 2 UIHC Crescent Community Health Center • Chickasaw • Fayette • Xxxxxx • Winneshiek • Dubuque * UIHC Peoples Community Health Clinic • Black Hawk • Xxxxxx • Xxxxxxxx • Xxxxxx Broadlawns Primary Health Care, Inc. • Grundy UIHC University of Iowa • Xxxxxx Hospitals & Clinics • Xxxxxx • Cedar • Iowa • Xxxxxxx • Xxxxx • Keokuk • Linn • Xxxxxx • Muscatine • Washington • Clinton* • Xxxxx* • Des Moines* • Xxxxx* • Xxxxxxx* • Xxxxxxxxx* • Xxx* • Poweshiek* • Xxxxx* • Xxx Xxxxx* • Wapello* *Effective December 1, 2011

Effective December 1, 2011. The State is divided into five regions consisting of six FQHCs and the University of Iowa Hospitals and Clinics (UIHC) and Broadlawns Medical Center as shown in Table 5. Regions 1 and 2 are assigned to UIHC. Broadlawns will become a medical home serving the 7 counties surrounding Polk County and become a regional hospital providing secondary care for IowaCare members assigned to medical homes in Regions 3, 4, and 5. Members in Regions 3, 4, & 5 who are not assigned to a medical home will continue to receive services at UIHC. Table 5 REGIONS 3, 4, & 5 Hospital Medical Home Counties Served & 5 Broadlawns Broadlawns Medical Center • Polk • Xxxxx • Dallas • Jasper • Madison • Xxxxxx • Story • Xxxxxx REGIONS 3, 4, Broadlawns Community Health Center of Fort Dodge • Cerro Gordo • Xxxxx • Xxxxxxxx • Xxxxxxxx • Worth • Xxxxxxx * Broadlawns Council Bluffs Community Health Center* • Xxxxxxxx * • Xxxxx* • Xxxxxxxxxx* • Pottawattamie* • Xxxxxx* • Audubon* Table 5 Formatted: Indent: Hanging: 0.5", Tab stops: 0.22", Left + Not at 0.24" • Fremont* • Page* Broadlawns Siouxland Community Health Center • Cherokee • Xxxxxxxx • Xxx • Monona • X’Xxxxx • Plymouth • Sioux • Woodbury • Buena Vista* • Xxxxxxx* • Clay* • Xxxxxxxxx* • Xxxx • Osceola • Sac* REGIONS 1 & 2 UIHC Crescent Community Health Center • Chickasaw • Fayette • Xxxxxx • Winneshiek • Dubuque * UIHC Peoples Community Health Clinic • Black Hawk • Xxxxxx • Xxxxxxxx • Xxxxxx Broadlawns Primary Health Care, Inc. • Grundy UIHC University of Iowa Hospitals & Clinics • Xxxxxx • Cedar • Iowa • Xxxxxxx • Xxxxx • Keokuk • Linn • Xxxxxx • Muscatine • Washington • Clinton* • Xxxxx* • Des Moines* • Xxxxx* • Xxxxxxx* • Xxxxxxxxx* • Xxx* • Poweshiek* • Xxxxx* • Xxx Xxxxx* • Wapello* Formatted: Indent: Left: -0", Hanging: 0.19", Bulleted + Level: 1 + Aligned at: 0.38" + Indent at: 0.63", Tab stops: 0.18", Left *Effective December 1, 2011

Effective December 1, 2011. The State is divided into five regions consisting of six FQHCs and the University of Iowa Hospitals and Clinics (UIHC) and Broadlawns Medical Center as shown in Table 5. Regions 1 and 2 are assigned to UIHC. Broadlawns will become a medical home serving the 7 counties surrounding Polk County and become a regional hospital providing secondary care for IowaCare members assigned to medical homes in Regions 3, 4, and 5. Members in Regions 3, 4, & 5 who are not assigned to a medical home will continue to receive services at UIHC. Table 5 REGIONS 3, 4, & 5 Hospital Medical Home Counties Served Formatted: Indent: Hanging: 0.5" Broadlawns Broadlawns Medical Center • Polk • Xxxxx • Dallas • Jasper • Madison • Xxxxxx • Story • Xxxxxx Deleted: ¶ Broadlawns Community Health Center of Fort Dodge • Cerro Gordo • Xxxxx • Xxxxxxxx • Xxxxxxxx • Worth • Xxxxxxx * Formatted: Indent: Hanging: 0.5", Tab stops: 0.22", Left + Not at 0.24" Broadlawns Council Bluffs Community Health Center* • Xxxxxxxx * • Xxxxx* • Xxxxxxxxxx* • Pottawattamie* • Xxxxxx* • Audubon* • Fremont* • Page* Formatted: Indent: Left: -0", Hanging: 0.19", Bulleted + Level: 1 + Aligned at: 0.38" + Indent at: 0.63", Tab stops: 0.18", Left Broadlawns Siouxland Community Health Center • Cherokee • Xxxxxxxx • Xxx • Monona • X’Xxxxx • Plymouth • Sioux • Woodbury • Buena Vista* • Xxxxxxx* • Clay* • Xxxxxxxxx* • Xxxx Lyon • Osceola • Sac* Deleted: ¶ REGIONS 1 & 2 UIHC Crescent Community Health Center • Chickasaw • Fayette • Xxxxxx • Winneshiek • Dubuque * UIHC Peoples Community Health Clinic • Black Hawk • Xxxxxx • Xxxxxxxx • Xxxxxx Broadlawns Primary Health Care, Inc. • Grundy UIHC University of Iowa • Xxxxxx Hospitals & Clinics • Xxxxxx • Cedar • Iowa • Xxxxxxx • Xxxxx • Keokuk • Linn • Xxxxxx • Muscatine • Washington • ClintonXxxxxxx* • Xxxxx* • Des Moines* • Xxxxx* • Xxxxxxx* • Xxxxxxxxx* • Xxx* • Poweshiek* • Xxxxx* • Xxx Xxxxx* • Wapello* *Effective December 1, 2011