Common use of Legal Entity for HIDE SNP Status Clause in Contracts

Legal Entity for HIDE SNP Status. For HIDE SNP status, MAO offered D-SNP PBP(s) covered under this Agreement (H0321-002) shall meet one of the following criteria: The legal entity holding a contract with CMS for the D-SNP(s) also contracted with the State under this Agreement is under the ownership and control of the same parent organization, as its integrated companion ACC, ALTCS DD, or ACC- RBHA health plan, and is authorized to operate only in the same counties delineated in Section 4 of this Agreement. XXX’s integrated companion ACC, ALTCS DD, or ACC-RBHA health plan is responsible for covering the Medicaid benefits described in Attachment 2: AHCCCS Covered Physical Health Services, and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; • ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD contract CTR-047021, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO LICITATION.pdf o Section D, Paragraph 11: Behavioral Health Services Delivery. X The legal entity holding a contract with CMS for the D-SNP(s) covered under this Agreement also receives direct capitation from AHCCCS to provide integrated coverage of the Medicaid benefits as described in Attachment 2: AHCCCS Covered Physical Health Services and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; • ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD contract CTR-047021, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO LICITATION.pdf o Section D, Paragraph 11: Behavioral Health Services Delivery.

Legal Entity for HIDE SNP Status. For HIDE SNP status, MAO offered D-SNP PBP(s) covered under this Agreement (H0321H5590-002008) shall meet one of the following criteria: X The legal entity holding a contract with CMS for the D-SNP(s) also contracted with the State under this Agreement is under the ownership and control of the same parent organization, Centene Corporation, as its integrated companion AHCCCS Complete Care (ACC), ALTCS DD, or ACC- RBHA health plan, and is authorized to operate only in the same counties delineated in Section 4 of this Agreement. XXXThe MAO’s integrated companion AHCCCS Complete Care (ACC), ALTCS DD, or ACC-RBHA health plan is responsible for covering the Medicaid benefits described in Attachment 2: AHCCCS Covered Physical Health Services, and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, Agreement and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; •  ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD  Regional Behavioral Health Authority (RBHA) contract CTR-047021YH17-0001, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO LICITATION.pdf xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery. X The legal entity holding a contract with CMS for the D-SNP(s) covered under this Agreement also receives direct capitation from AHCCCS to provide integrated coverage of the Medicaid benefits as described in Attachment 2: AHCCCS Covered Physical Health Services and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; •  ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD  Regional Behavioral Health Authority (RBHA) contract CTR-047021YH17-0001, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO LICITATION.pdf xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery.

Legal Entity for HIDE SNP Status. For HIDE SNP status, MAO offered D-SNP PBP(s) covered under this Agreement (H0321H4931-002001, -006, -007, and -008) shall meet one of the following criteria: X The legal entity holding a contract with CMS for the D-SNP(s) also contracted with the State under this Agreement is under the ownership and control of the same parent organization, Banner Health, Inc., as its integrated companion AHCCCS Complete Care (ACC), ALTCS DD, or ACC- RBHA health plan, and is authorized to operate only in the same counties delineated in Section 4 of this Agreement. XXXThe MAO’s integrated companion AHCCCS Complete Care (ACC), ALTCS DD, or ACC-RBHA health plan is responsible for covering the Medicaid benefits described in Attachment 2: AHCCCS Covered Physical Health Services, and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; •  ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD contract CTR-047021contract, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021; • ACC-xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/  Regional Behavioral Health Agreement Authority (ACC-RBHA) contract YH20YH17-00020001, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO LICITATION.pdf xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery. X The legal entity holding a contract with CMS for the D-SNP(s) covered under this Agreement also receives direct capitation from AHCCCS to provide integrated coverage of the Medicaid benefits as described in Attachment 2: AHCCCS Covered Physical Health Services Services, and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; •  ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD contract CTR-047021contract, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021; • ACC-xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/  Regional Behavioral Health Agreement Authority (ACC-RBHA) contract YH20YH17-00020001, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO LICITATION.pdf xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery.

Legal Entity for HIDE SNP Status. For HIDE SNP status, MAO offered D-SNP PBP(s) covered under this Agreement (H0321H8845-002001) shall meet one of the following criteria: The legal entity holding a contract with CMS for the D-SNP(s) also contracted with the State under this Agreement is under the ownership and control of the same parent organization, as its integrated companion ACC, ALTCS DD, or ACC- RBHA health plan, and is authorized to operate only in the same counties delineated in Section 4 of this Agreement. XXX’s integrated companion ACC, ALTCS DD, or ACC-RBHA health plan is responsible for covering the Medicaid benefits described in Attachment 2: AHCCCS Covered Physical Health Services, and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; • ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD contract CTR-047021contract, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract manage public/; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE SO LICITATION.pdf o Section D, Paragraph 11: Behavioral Health Services Delivery. X The legal entity holding a contract with CMS for the D-SNP(s) covered under this Agreement also receives direct capitation from AHCCCS to provide integrated coverage of the Medicaid benefits as described in Attachment 2: AHCCCS Covered Physical Health Services and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; • ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD contract CTR-047021contract, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract manage public/; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE SO LICITATION.pdf o Section D, Paragraph 11: Behavioral Health Services Delivery.

Legal Entity for HIDE SNP Status. For HIDE SNP status, MAO offered D-SNP PBP(s) covered under this Agreement (H0321H8845-002001) shall meet one of the following criteria: The legal entity holding a contract with CMS for the D-SNP(s) also contracted with the State under this Agreement is under the ownership and control of the same parent organization, as its integrated companion AHCCCS Complete Care (ACC), ALTCS DD, or ACC- RBHA health plan, and is authorized to operate only in the same counties delineated in Section 4 of this Agreement. XXXThe MAO’s integrated companion AHCCCS Complete Care (ACC), ALTCS DD, or ACC-RBHA health plan is responsible for covering the Medicaid benefits described in Attachment 2: AHCCCS Covered Physical Health Services, and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; •  ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD  Regional Behavioral Health Authority (RBHA) contract CTR-047021YH17-0001, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO LICITATION.pdf xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery. X The legal entity holding a contract with CMS for the D-SNP(s) covered under this Agreement also receives direct capitation from AHCCCS to provide integrated coverage of the Medicaid benefits as described in Attachment 2: AHCCCS Covered Physical Health Services Services, and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; •  ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD  Regional Behavioral Health Authority (RBHA) contract CTR-047021YH17-0001, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO LICITATION.pdf xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery.

Legal Entity for HIDE SNP Status. For HIDE SNP status, MAO offered D-SNP PBP(s) covered under this Agreement (H0321H5580-002001 and H5580-005) shall meet one of the following criteria: The legal entity holding a contract with CMS for the D-SNP(s) also contracted with the State under this Agreement is under the ownership and control of the same parent organization, as its integrated companion ACC, ALTCS DD, or ACC- RBHA health plan, and is authorized to operate only in the same counties delineated in Section 4 of this Agreement. XXX’s integrated companion ACC, ALTCS DD, or ACC-RBHA health plan is responsible for covering the Medicaid benefits described in Attachment 2: AHCCCS Covered Physical Health Services, and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; • ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD contract CTR-047021CTR-043263, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract manage public/43263; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE SO LICITATION.pdf o Section D, Paragraph 11: Behavioral Health Services Delivery. X The legal entity holding a contract with CMS for the D-SNP(s) covered under this Agreement also receives direct capitation from AHCCCS to provide integrated coverage of the Medicaid benefits as described in Attachment 2: AHCCCS Covered Physical Health Services and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; • ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD contract CTR-047021CTR-043263, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract manage public/43263; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE SO LICITATION.pdf o Section D, Paragraph 11: Behavioral Health Services Delivery.

Legal Entity for HIDE SNP Status. For HIDE SNP status, MAO offered D-SNP PBP(s) covered under this Agreement (H0321H5590-002008 and H5590-009) shall meet one of the following criteria: X The legal entity holding a contract with CMS for the D-SNP(s) also contracted with the State under this Agreement is under the ownership and control of the same parent organization, as its integrated companion ACC, ALTCS DD, or ACC- RBHA health plan, and is authorized to operate only in the same counties delineated in Section 4 of this Agreement. XXX’s integrated companion ACC, ALTCS DD, or ACC-RBHA health plan is responsible for covering the Medicaid benefits described in Attachment 2: AHCCCS Covered Physical Health Services, and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; • ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD contract CTR-047021contract, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract manage public/; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE SO LICITATION.pdf o Section D, Paragraph 11: Behavioral Health Services Delivery. X The legal entity holding a contract with CMS for the D-SNP(s) covered under this Agreement also receives direct capitation from AHCCCS to provide integrated coverage of the Medicaid benefits as described in Attachment 2: AHCCCS Covered Physical Health Services and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; • ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD contract CTR-047021contract, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract manage public/; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE SO LICITATION.pdf o Section D, Paragraph 11: Behavioral Health Services Delivery.

Legal Entity for HIDE SNP Status. For HIDE SNP status, MAO offered D-SNP PBP(s) covered under this Agreement (H0321-002) shall meet one of the following criteria: The legal entity holding a contract with CMS for the D-SNP(s) also contracted with the State under this Agreement is under the ownership and control of the same parent organization, as its integrated companion AHCCCS Complete Care (ACC), ALTCS DD, or ACC- RBHA health plan, and is authorized to operate only in the same counties delineated in Section 4 of this Agreement. XXXThe MAO’s integrated companion AHCCCS Complete Care (ACC), ALTCS DD, or ACC-RBHA health plan is responsible for covering the Medicaid benefits described in Attachment 2: AHCCCS Covered Physical Health Services, and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery;  ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD contract CTR-047021, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021;  Regional Behavioral Health Authority (RBHA) contract YH17-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery. X The legal entity holding a contract with CMS for the D-SNP(s) covered under this Agreement also receives direct capitation from AHCCCS to provide integrated coverage of the Medicaid benefits as described in Attachment 2: AHCCCS Covered Physical Health Services, and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; •  ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD contract CTR-047021, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021; • ACC- Regional Behavioral Health Agreement Authority (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO LICITATION.pdf o Section D, Paragraph 11: Behavioral Health Services Delivery. X The legal entity holding a contract with CMS for the D-SNP(s) covered under this Agreement also receives direct capitation from AHCCCS to provide integrated coverage of the Medicaid benefits as described in Attachment 2: AHCCCS Covered Physical Health Services and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19YH17-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; • ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD contract CTR-047021, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO LICITATION.pdf o Section D, Paragraph 11: Behavioral Health Services Delivery.

Legal Entity for HIDE SNP Status. For HIDE SNP status, MAO offered D-SNP PBP(s) covered under this Agreement (H0321H5587-002) shall meet one of the following criteria: The legal entity holding a contract with CMS for the D-SNP(s) also contracted with the State under this Agreement is under the ownership and control of the same parent organization, as its integrated companion ACC, ALTCS DD, or ACC- RBHA health plan, and is authorized to operate only in the same counties delineated in Section 4 of this Agreement. XXX’s integrated companion ACC, ALTCS DD, or ACC-RBHA health plan is responsible for covering the Medicaid benefits described in Attachment 2: AHCCCS Covered Physical Health Services, and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND Participant Health Choice Arizona, Inc. d/b/a Health Choice Pathway AHCCCS AGREEMENT # YH23-0010-03 • ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD contract CTR-047021contract, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO LICITATION.pdf o Section D, Paragraph 11: Behavioral Health Services Delivery. X The legal entity holding a contract with CMS for the D-SNP(s) covered under this Agreement also receives direct capitation from AHCCCS to provide integrated coverage of the Medicaid benefits as described in Attachment 2: AHCCCS Covered Physical Health Services and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; • ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD contract CTR-047021contract, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO LICITATION.pdf o Section D, Paragraph 11: Behavioral Health Services Delivery.. MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND Participant Health Choice Arizona, Inc. d/b/a Health Choice Pathway AHCCCS AGREEMENT # YH23-0010-03

Legal Entity for HIDE SNP Status. For HIDE SNP status, MAO offered D-SNP PBP(s) covered under this Agreement (H0321H5590-002008) shall meet one of the following criteria: X The legal entity holding a contract with CMS for the D-SNP(s) also contracted with the State under this Agreement is under the ownership and control of the same parent organization, Centene Corporation, as its integrated companion AHCCCS Complete Care (ACC), ALTCS DD, or ACC- RBHA health plan, and is authorized to operate only in the same counties delineated in Section 4 of this Agreement. XXXThe MAO’s integrated companion AHCCCS Complete Care (ACC), ALTCS DD, or ACC-RBHA health plan is responsible for covering the Medicaid benefits described in Attachment 2: AHCCCS Covered Physical Health Services, and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, Agreement and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; • ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD • Regional Behavioral Health Authority (RBHA) contract CTR-047021YH17-0001, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO LICITATION.pdf xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery. X The legal entity holding a contract with CMS for the D-SNP(s) covered under this Agreement also receives direct capitation from AHCCCS to provide integrated coverage of the Medicaid benefits as described in Attachment 2: AHCCCS Covered Physical Health Services and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; • ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD • Regional Behavioral Health Authority (RBHA) contract CTR-047021YH17-0001, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO LICITATION.pdf xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery.

Legal Entity for HIDE SNP Status. For HIDE SNP status, MAO offered D-SNP PBP(s) covered under this Agreement (H0321H4931-002007) shall meet one of the following criteria: X The legal entity holding a contract with CMS for the D-SNP(s) also contracted with the State under this Agreement is under the ownership and control of the same parent organization, as its integrated companion ACC, ALTCS DD, or ACC- RBHA health plan, and is authorized to operate only in the same counties delineated in Section 4 of this Agreement. XXX’s integrated companion ACC, ALTCS DD, or ACC-RBHA health plan is responsible for covering the Medicaid benefits described in Attachment 2: AHCCCS Covered Physical Health Services, and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; • ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD contract CTR-047021contract, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract manage public/; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE SO LICITATION.pdf o Section D, Paragraph 11: Behavioral Health Services Delivery. X The legal entity holding a contract with CMS for the D-SNP(s) covered under this Agreement also receives direct capitation from AHCCCS to provide integrated coverage of the Medicaid benefits as described in Attachment 2: AHCCCS Covered Physical Health Services and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; • ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD contract CTR-047021contract, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract manage public/; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE SO LICITATION.pdf o Section D, Paragraph 11: Behavioral Health Services Delivery.

Legal Entity for HIDE SNP Status. For HIDE SNP status, MAO offered D-SNP PBP(s) covered under this Agreement (H0321H5587-002) shall meet one of the following criteria: The legal entity holding a contract with CMS for the D-SNP(s) also contracted with the State under this Agreement is under the ownership and control of the same parent organization, as its integrated companion AHCCCS Complete Care (ACC), ALTCS DD, or ACC- RBHA health plan, and is authorized to operate only in the same counties delineated in Section 4 of this Agreement. XXXThe MAO’s integrated companion AHCCCS Complete Care (ACC), ALTCS DD, or ACC-RBHA health plan is responsible for covering the Medicaid benefits described in Attachment 2: AHCCCS Covered Physical Health Services, and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; •  ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD  Regional Behavioral Health Authority (RBHA) contract CTR-047021YH17-0001, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO LICITATION.pdf xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery. X The legal entity holding a contract with CMS for the D-SNP(s) covered under this Agreement also receives direct capitation from AHCCCS to provide integrated coverage of the Medicaid benefits as described in Attachment 2: AHCCCS Covered Physical Health Services and for covering integrated Medicaid behavioral health benefits as described in Attachment 3: AHCCCS Covered Behavioral Health Services of this Agreement, and each of the following, as applicable: • AHCCCS Complete Care (ACC) contract YH19-0001, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery; •  ALTCS DD contract YH6-0014, as amended xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 10: Behavioral Health Services Delivery; o DD  Regional Behavioral Health Authority (RBHA) contract CTR-047021YH17-0001, as amended xxxxx://xxx.xx.xxx/page.aspx/en/ctr/contract_manage_public/47021; • ACC-Regional Behavioral Health Agreement (ACC-RBHA) contract YH20-0002, as amended xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/HealthPlans/YH20-0002.html xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/RFPInfo/YH20/CCE_SO LICITATION.pdf xxxxx://xxx.xxxxxxxx.xxx/Resources/OversightOfHealthPlans/SolicitationsAn dContracts/contracts.html o Section D, Paragraph 11: Behavioral Health Services Delivery.