Common use of Post-Turnover Services Clause in Contracts

Post-Turnover Services. Thirty (30) days following turnover of operations, the HMO must provide HHSC with a Turnover Results report documenting the completion and results of each step of the Turnover Plan. Turnover will not be considered complete until this document is approved by HHSC. If the HMO does not provide the required relevant data and reference tables, documentation, or other pertinent information necessary for HHSC or the subsequent Contractor to assume the operational activities successfully, the HMO agrees to reimburse the State for all reasonable costs, including, but not limited to, transportation, lodging, and subsistence for all state and federal representatives, or their agents, to carry out their inspection, audit, review, analysis, reproduction and transfer functions at the location(s) of such records. The HMO also agrees to pay any and all additional costs incurred by the State that are the result of the HMO’s failure to provide the requested records, data or documentation within the time frames agreed to in the Turnover Plan. The HMO must maintain all files and records related to Members and Providers for five years after the date of final payment under the Contract or until the resolution of all litigation, claims, financial management review or audit pertaining to the Contract, whichever is longer. The HMO agrees to repay any valid, undisputed audit exceptions taken by HHSC in any audit of the Contract. Subject: Attachment B-2 - Covered Services DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version Attachment B-2, Covered Services Revision 1.1 June 30, 2006 Revised Attachment B-2, Covered Services, by adding Attachment B-2.1, STAR+PLUS Covered Services. Revision 1.2 September 1. 2006 Revised Attachment B-2 to include provisions applicable to MCOs participating in the STAR and CHIP Programs. STAR Covered Services, Services Included under the HMO Capitation Payment, is modified to clarify the STAR covered services related to “optometry” and “vision.” CHIP Covered Services is modified to correct services related to artificial aids including surgical implants. Revision 1.3 September 1, 2006 Contract amendment did not revise Attachment B-2, Covered Services. Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-2, Covered Services. Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-2, Covered Services.

Post-Turnover Services. Thirty (30) days following turnover Turnover of operations, the HMO MCO must provide HHSC with a Turnover Results report Report documenting the completion and results of each step of the Turnover Plan. Turnover will not be considered complete until this document is approved by HHSC. HHSC may withhold up to 20% of the last month’s Capitation Payment until the Turnover activities are complete and the Turnover Plan is approved by HHSC. If the HMO MCO does not provide the required relevant data and reference tables, documentation, or other pertinent information necessary for HHSC or the a subsequent Contractor contractor to assume the operational activities successfully, the HMO MCO agrees to reimburse the State HHSC for all reasonable costscosts and expenses, including, but not limited to, : transportation, lodging, and subsistence for all state and federal representatives, or their agents, to carry out their inspection, audit, review, analysis, reproduction and transfer functions at the location(s) of such records; and attorneys’ fees and costs. The HMO also agrees This section does not limit HHSC’s ability to pay any and all additional costs incurred by the State that are the result of the HMO’s failure to provide the requested records, data impose remedies or documentation within the time frames agreed to damages as set forth in the Turnover Plan. The HMO must maintain all files and records related to Members and Providers for five years after the date of final payment under the Contract or until the resolution of all litigation, claims, financial management review or audit pertaining to the Contract, whichever is longer. The HMO agrees to repay any valid, undisputed audit exceptions taken by HHSC in any audit of the Contract. Subject: Attachment B-2 - STAR Covered Services DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a September 1, 2011 Initial version of Attachment B-2, Covered Services Revision 1.1 June 30, 2006 Revised Attachment B-2, Covered Services, by adding Attachment B-2.1, STAR+PLUS Covered Services. Revision 1.2 September 1. 2006 Revised Attachment B-2 to include provisions applicable to MCOs participating in the STAR and CHIP Programs. “STAR Covered Services.” Revision 2.1 March 1, Services Included under the HMO Capitation Payment, 2012 Attachment B-2 is modified to reinstate the waiver of the three prescription limit for adults language and to clarify the waiver of the $200,000 individual annual limit on inpatient services. STAR covered services related to “optometry” and “vision.” CHIP Covered Services is modified to correct add “Cancer screening, diagnostic, and treatment services” and “Prenatal care services related rendered in a birthing center” as clarification items and to artificial aids including surgical implants. Revision 1.3 September 1, 2006 Contract amendment did not revise Attachment B-2, Covered Services. Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-2, Covered Services. Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-2, Covered Servicesclarify the requirements for services provided in free-standing psychiatric hospitals and chemical dependency treatment facilities in lieu of the acute care hospital setting.

Post-Turnover Services. Thirty (30) days following turnover of operations, the HMO must provide HHSC with a Turnover Results report documenting the completion and results of each step of the Turnover Plan. Turnover will not be considered complete until this document is approved by HHSC. If the HMO does not provide the required relevant data and reference tables, documentation, or other pertinent information necessary for HHSC or the subsequent Contractor to assume the operational activities successfully, the HMO agrees to reimburse the State for all reasonable costs, including, but not Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – HHSC Joint Medicaid/CHIP HMO RFP, Section 9 Version 1.7 limited to, transportation, lodging, and subsistence for all state and federal representatives, or their agents, to carry out their inspection, audit, review, analysis, reproduction and transfer functions at the location(s) of such records. The HMO also agrees to pay any and all additional costs incurred by the State that are the result of the HMO’s failure to provide the requested records, data or documentation within the time frames agreed to in the Turnover Plan. The HMO must maintain all files and records related to Members and Providers for five years after the date of final payment under the Contract or until the resolution of all litigation, claims, financial management review or audit pertaining to the Contract, whichever is longer. The HMO agrees to repay any valid, undisputed audit exceptions taken by HHSC in any audit of the Contract. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-2 - – Covered Services Version 1.7 DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version Attachment B-2, Covered Services Revision 1.1 June 30, 2006 Revised Attachment B-2, Covered Services, by adding Attachment B-2.1, STAR+PLUS Covered Services. Revision 1.2 September 1. 2006 Revised Attachment B-2 to include provisions applicable to MCOs participating in the STAR and CHIP Programs. STAR Covered Services, Services Included under the HMO Capitation Payment, is modified to clarify the STAR covered services related to “optometry” and “vision.” CHIP Covered Services is modified to correct services related to artificial aids including surgical implants. Revision 1.3 September 1, 2006 Contract amendment did not revise Attachment B-2, Covered Services. Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-2, Covered Services. Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-2, Covered Services.

Post-Turnover Services. Thirty (30) days following turnover Turnover of operations, the HMO MCO must provide HHSC with a Turnover Results report Report documenting the completion and results of each step of the Turnover Plan. Turnover will not be considered complete until this document is approved by HHSC. HHSC may withhold up to 20% of the last month’s Capitation Payment until the Turnover activities are complete and the Turnover Plan is approved by HHSC. If the HMO MCO does not provide the required relevant data and reference tables, documentation, or other pertinent information necessary for HHSC or the a subsequent Contractor contractor to assume the operational activities successfully, the HMO MCO agrees to reimburse the State HHSC for all reasonable costscosts and expenses, including, but not limited to, : transportation, lodging, and subsistence for all state and federal representatives, or their agents, to carry out their inspection, audit, review, analysis, reproduction and transfer functions at the location(s) of such records; and attorneys’ fees and costs. The HMO also agrees This section does not limit HHSC’s ability to pay any and all additional costs incurred by the State that are the result of the HMO’s failure to provide the requested records, data impose remedies or documentation within the time frames agreed to damages as set forth in the Turnover Plan. The HMO must maintain all files and records related to Members and Providers for five years after the date of final payment under the Contract or until the resolution of all litigation, claims, financial management review or audit pertaining to the Contract, whichever is longer. The HMO agrees to repay any valid, undisputed audit exceptions taken by HHSC in any audit of the Contract. Subject: Attachment B-2 - STAR Covered Services DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a September 1, 2011 Initial version of Attachment B-2, “STAR Covered Services.” 1 Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions 2 Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision. 3 Brief description of the changes to the document made in the revision. STAR Covered Services Revision 1.1 June 30The following is a non-exhaustive, 2006 Revised Attachment B-2high-level listing of Acute Care Covered Services included under the Medicaid STAR Program. STAR MCOs are responsible for providing a benefit package to Members that includes all Medically Necessary services covered under the traditional, Covered Services, by adding Attachment B-2.1, STAR+PLUS Covered fee-for-service Medicaid programs except for Non-capitated Services. Revision 1.2 September 1Non-capitated Services are listed in Attachment B-1, RFP Section 8.2.2.8. 2006 Revised Attachment B-2 to include provisions applicable to MCOs participating Non-capitated services are not included in the STAR MCOs’ Capitation Rates; however, STAR MCOs must coordinate care these Non-capitated Services so that Members have access to a full range of Medically Necessary Medicaid services, both capitated and CHIP Programsnon-capitated. STAR Covered ServicesMCOs may also elect to include Value-added Services in their benefit packages, if approved by HHSC (see UMCM Chapter 4.5 “Physical and Behavioral Health Value-Added Services Included under Template”). STAR Program benefits are subject to the HMO Capitation Paymentsame benefit limits and exclusions that apply to the traditional, is modified fee-for-service Medicaid programs, with the following three (3) exceptions. Adult STAR Members are provided with three (3) enhanced benefits compared to clarify the STAR covered services related to “optometry” and “vision.” CHIP Covered Services is modified to correct services related to artificial aids including surgical implants. Revision 1.3 September 1traditional, 2006 Contract amendment did not revise Attachment B-2, Covered Services. Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-2, Covered Services. Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-2, Covered Services.fee-for-service Medicaid coverage:

Post-Turnover Services. Thirty (30) days following turnover of operations, the HMO must provide HHSC with a Turnover Results report documenting the completion and results of each step of the Turnover Plan. Turnover will not be considered complete until this document is approved by HHSC. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – HHSC Joint Medicaid/CHIP HMO RFP, Section 9 Version 1.0 If the HMO does not provide the required relevant data and reference tables, documentation, or other pertinent information necessary for HHSC or the subsequent Contractor to assume the operational activities successfully, the HMO agrees to reimburse the State for all reasonable costs, including, but not limited to, transportation, lodging, and subsistence for all state and federal representatives, or their agents, to carry out their inspection, audit, review, analysis, reproduction and transfer functions at the location(s) of such records. The HMO also agrees to pay any and all additional costs incurred by the State that are the result of the HMO’s failure to provide the requested records, data or documentation within the time frames agreed to in the Turnover Plan. The HMO must maintain all files and records related to Members and Providers for five years after the date of final payment under the Contract or until the resolution of all litigation, claims, financial management review or audit pertaining to the Contract, whichever is longer. The HMO agrees to repay any valid, undisputed audit exceptions taken by HHSC in any audit of the Contract. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-2 - Covered Services DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version Attachment B-2, Covered Services Revision 1.1 June 30, 2006 Revised Attachment B-2, Covered Services, by adding Attachment B-2.1, STAR+PLUS Covered Services. Revision 1.2 September 1. 2006 Revised Attachment B-2 to include provisions applicable to MCOs participating in the – STAR and CHIP Programs. Covered Services Version 1.0 STAR Covered ServicesServices The following is a non-exhaustive, high-level listing of Acute Care Covered Services Included included under the HMO Capitation Payment, is modified to clarify the STAR covered services related to “optometry” and “visionMedicaid managed care program.” CHIP Covered Services is modified to correct services related to artificial aids including surgical implants. Revision 1.3 September 1, 2006 Contract amendment did not revise Attachment B-2, Covered Services. Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-2, Covered Services. Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-2, Covered Services.

Post-Turnover Services. Thirty (30) days following turnover of operations, the HMO must provide HHSC with a Turnover Results report documenting the completion and results of each step of the Turnover Plan. Turnover will not be considered complete until this document is approved by HHSC. If the HMO does not provide the required relevant data and reference tables, documentation, or other pertinent information necessary for HHSC or the subsequent Contractor to assume the operational activities successfully, the HMO agrees to reimburse the State for all reasonable costs, including, but not limited to, transportation, lodging, and subsistence for all state and federal representatives, or their agents, to carry out their inspection, audit, review, analysis, reproduction and transfer functions at the location(s) of such records. The HMO also agrees to pay any and all additional costs incurred by the State that are the result of the HMO’s failure to provide the requested records, data or documentation within the time frames agreed to in the Turnover Plan. The HMO must maintain all files and records related to Members and Providers for five years after the date of final payment under the Contract or until the resolution of all litigation, claims, financial management review or audit pertaining to the Contract, whichever is longer. The HMO agrees to repay any valid, undisputed audit exceptions taken by HHSC in any audit of the Contract. Subject: Attachment B-2 - – Covered Services Version 1.8 DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version Attachment B-2, Covered Services Revision 1.1 June 30, 2006 Revised Attachment B-2, Covered Services, by adding Attachment B-2.1, STAR+PLUS Covered Services. Revision 1.2 September 1. 2006 Revised Attachment B-2 to include provisions applicable to MCOs participating in the STAR and CHIP Programs. STAR Covered Services, Services Included under the HMO Capitation Payment, is modified to clarify the STAR covered services related to “optometry” and “vision.” CHIP Covered Services is modified to correct services related to artificial aids including surgical implants. Revision 1.3 September 1, 2006 Contract amendment did not revise Attachment B-2B­2, Covered Services. Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-2B­2, Covered Services. Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-2B­2, Covered Services.

Post-Turnover Services. Thirty (30) days following turnover Turnover of operations, the HMO MCO must provide HHSC with a Turnover Results report Report documenting the completion and results of each step of the Turnover Plan. Turnover will not be considered complete until this document is approved by HHSC. HHSC may withhold up to 20% of the last month’s Capitation Payment until the Turnover activities are complete and the Turnover Plan is approved by HHSC. If the HMO MCO does not provide the required relevant data and reference tables, documentation, or other pertinent information necessary for HHSC or the a subsequent Contractor contractor to assume the operational activities successfully, the HMO MCO agrees to reimburse the State HHSC for all reasonable costscosts and expenses, including, but not limited to, : transportation, lodging, and subsistence for all state and federal representatives, or their agents, to carry out their inspection, audit, review, analysis, reproduction and transfer functions at the location(s) of such records; and attorneys’ fees and costs. The HMO also agrees This section does not limit HHSC’s ability to pay any and all additional costs incurred by the State that are the result of the HMO’s failure to provide the requested records, data impose remedies or documentation within the time frames agreed to damages as set forth in the Turnover Plan. The HMO must maintain all files and records related to Members and Providers for five years after the date of final payment under the Contract or until the resolution of all litigation, claims, financial management review or audit pertaining to the Contract, whichever is longer. The HMO agrees to repay any valid, undisputed audit exceptions taken by HHSC in any audit of the Contract. Subject: Attachment B-2 - STAR Covered Services DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a September 1, 2011 Initial version of Attachment B-2, “STAR Covered Services.” 1 Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions 2 Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision. 3 Brief description of the changes to the document made in the revision. STAR Covered Services Revision 1.1 June 30The following is a non-exhaustive, 2006 Revised high-level listing of Acute Care Covered Services included under the Medicaid STAR Program. STAR MCOs are responsible for providing a benefit package to Members that includes all Medically Necessary services covered under the traditional, fee-for-service Medicaid programs except for Non-capitated Services. Non-capitated Services are listed in Attachment B-1, RFP Section 8.2.2.8. Non-capitated services are not included in the STAR MCOs’ Capitation Rates; however, STAR MCOs must coordinate care these Non-capitated Services so that Members have access to a full range of Medically Necessary Medicaid services, both capitated and non-capitated. STAR MCOs may also elect to include Value-added Services in their benefit packages, if approved by HHSC (see Attachment B-2). STAR Program benefits are subject to the same benefit limits and exclusions that apply to the traditional, fee-for-service Medicaid programs, with the following exception. Adult STAR Members are not subject to the 30-day spell-of-illness limitation that applies to traditional, fee-for-service Medicaid coverage. Adult STAR Members are generally limited to three (3) prescriptions per month. However, STAR MCOs in the Medicaid Rural Service Area must provide unlimited prescriptions to Members who are enrolled in a 1915(c) waiver program for Community-Based Long-Term Services and Supports. For a complete listing of the limitations and exclusions that apply to each Medicaid benefit category, STAR MCOs should refer to the current Texas Medicaid Provider Procedures Manual and the bi-monthly Texas Medicaid Bulletin. (These documents can be accessed online at: xxxx://xxx.xxxx.xxx.) The services listed in this Attachment are subject to modification based on changes in Federal and State laws, regulations, and policies. STAR Covered Services include, but are not limited to, Medically Necessary: • Ambulance services • Audiology services, including hearing aids, for adults and children • Behavioral Health Services*, including: Inpatient mental health services for Children (birth through age 20) Outpatient mental health services Psychiatry services Counseling services for adults (21 years of age and over) Outpatient substance use disorder treatment services including: o Assessment o Detoxification services o Counseling treatment o Medication assisted therapy Residential substance use disorder treatment services including: o Detoxification services o Substance use disorder treatment (including room and board) *These services are not subject to the quantitative treatment limitations that apply under traditional, fee-for-service Medicaid coverage. The services may be subject to the MCO’s non-quantitative treatment limitations, provided such limitations comply with the requirements of the Mental Health Parity and Addiction Equity Act of 2008. • Birthing services provided by adding a physician or Advanced Practice Nurse in a licensed birthing center • Birthing services provided by a licensed birthing center • Chiropractic services • Dialysis • Durable medical equipment and supplies • Early Childhood Intervention (ECI) services • Emergency Services • Family planning services • Home health care services • Hospital services, including inpatient and outpatient • Laboratory • Mastectomy, breast reconstruction, and related follow-up procedures, including: inpatient services; outpatient services provided at an outpatient hospital and ambulatory health care center as clinically appropriate; and physician and professional services provided in an office, inpatient, or outpatient setting for: all stages of reconstruction on the breast(s) on which medically necessary mastectomy procedure(s) have been performed; surgery and reconstruction on the other breast to produce symmetrical appearance; treatment of physical complications from the mastectomy and treatment of lymphedemas; and prophylactic mastectomy to prevent the development of breast cancer. external breast prosthesis for the breast(s) on which medically necessary mastectomy procedure(s) have been performed. • Medical checkups and Comprehensive Care Program (CCP) Services for children (birth through age 20) through the Texas Health Steps Program • Oral evaluation and fluoride varnish in the Medical Home in conjunction with Texas Health Steps medical checkup for children 6 months through 35 months of age. • Outpatient drugs and biologicals; including pharmacy-dispensed and provider-administered outpatient drugs and biologicals • Drugs and biologicals provided in an inpatient setting • Podiatry • Prenatal care • Primary care services • Preventive services including an annual adult well check for patients 21 years of age and over • Radiology, imaging, and X-rays • Specialty physician services • Therapies – physical, occupational and speech • Transplantation of organs and tissues • Vision (Includes optometry and glasses. Contact lenses are only covered if they are medically necessary for vision correction, which can not be accomplished by glasses.) Subject: Attachment B-2 - CHIP Covered Services DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a September 1, 2011 Initial version of Attachment B-2.1, STAR+PLUS “CHIP Covered Services.” 1 Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions 2 Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision. 3 Brief description of the changes to the document made in the revision. CHIP Covered Services Covered CHIP services must meet the CHIP definition of Medically Necessary Covered Services. Revision 1.2 September 1. 2006 Revised Attachment B-2 There is no lifetime maximum on benefits; however, 12-month period or lifetime limitations do apply to include provisions applicable to MCOs participating certain services, as specified in the STAR following chart. Co-pays apply until a family reaches its specific cost-sharing maximum. Covered CHIP Perinatal services must meet the definition of Medically Necessary Covered Services. There is no lifetime maximum on benefits; however, 12-month period or lifetime limitations do apply to certain services, as specified in the following chart. Co-pays do not apply to CHIP Perinatal Members. CHIP Perinate Newborns are eligible for 12-months continuous coverage, beginning with the month of enrollment as a CHIP Perinate. Covered Benefit CHIP Members and CHIP ProgramsPerinate Newborn Members CHIP Perinate Members (Unborn Child) Inpatient General Acute and Inpatient Rehabilitation Hospital Services Services include, but are not limited to, the following: § Hospital-provided Physician or Provider services § Semi-private room and board (or private if medically necessary as certified by attending) § General nursing care § Special duty nursing when medically necessary § ICU and services § Patient meals and special diets § Operating, recovery and other treatment rooms § Anesthesia and administration (facility technical component) § Surgical dressings, trays, casts, splints § Drugs, medications and biologicals § Blood or blood products that are not provided free-of-charge to the patient and their administration § X-rays, imaging and other radiological tests (facility technical component) § Laboratory and pathology services (facility technical component) § Machine diagnostic tests (EEGs, EKGs, etc.) § Oxygen services and inhalation therapy § Radiation and chemotherapy § Access to DSHS-designated Level III perinatal centers or Hospitals meeting equivalent levels of care § In-network or out-of-network facility and Physician services for a mother and her newborn(s) for a minimum of 48 hours following an uncomplicated vaginal delivery and 96 hours following an uncomplicated delivery by caesarian section. STAR Covered Services§ Hospital, Services Included under the HMO Capitation Paymentphysician and related medical services, is modified to clarify the STAR covered such as anesthesia, associated with dental care § Inpatient services related to “optometry” associated with (a) miscarriage or (b) a non-viable pregnancy (molar pregnancy, ectopic pregnancy, or a fetus that expired in utero). Inpatient services associated with miscarriage or non-viable pregnancy include, but are not limited to: § dilation and “vision.” CHIP Covered Services is modified to correct services related to curettage (D&C) procedures; § appropriate provider-administered medications; § ultrasounds, and § histological examination of tissue samples. § Surgical implants § Other artificial aids including surgical implantsimplants § Inpatient services for a mastectomy and breast reconstruction include: § all stages of reconstruction on the affected breast; § external breast prosthesis for the breast(s) on which medically necessary mastectomy procedure(s) have been performed § surgery and reconstruction on the other breast to produce symmetrical appearance; and § treatment of physical complications from the mastectomy and treatment of lymphedemas. Revision 1.3 September 1§ Implantable devices are covered under Inpatient and Outpatient services and do not count towards the DME 12-month period limit § Pre-surgical or post-surgical orthodontic services for medically necessary treatment of craniofacial anomalies requiring surgical intervention and delivered as part of a proposed and clearly outlined treatment plan to treat: § cleft lip and/or palate; or § severe traumatic skeletal and/or congenital craniofacial deviations; or severe facial asymmetry secondary to skeletal defects, 2006 Contract amendment did congenital syndromal conditions and/or tumor growth or its treatment. For CHIP Perinates in families with incomes at or below 185% of the Federal Poverty Level, the facility charges are not revise Attachment B-2a covered benefit; however, Covered Servicesprofessional services charges associated with labor with delivery are a covered benefit. Revision 1.4 September 1For CHIP Perinates in families with incomes above 185% to 200% of the Federal Poverty Level, 2006 Contract amendment did benefits are limited to professional service charges and facility charges associated with labor with delivery until birth, and services related to miscarriage or a non-viable pregnancy. Services include: § Operating, recovery and other treatment rooms § Anesthesia and administration (facility technical component Medically necessary surgical services are limited to services that directly relate to the delivery of the unborn child, and services related to miscarriage or non-viable pregnancy (molar pregnancy, ectopic pregnancy, or a fetus that expired in utero). Inpatient services associated with (a) miscarriage or (b) a non-viable pregnancy (molar pregnancy, ectopic pregnancy, or a fetus that expired in utero) are a covered benefit. Inpatient services associated with miscarriage or non-viable pregnancy include, but are not revise Attachment B-2limited to: § dilation and curettage (D&C) procedures; § appropriate provider-administered medications; § ultrasounds, Covered Servicesand § histological examination of tissue samples. Revision 1.5 January 1Skilled Nursing Facilities (Includes Rehabilitation Hospitals) Services include, 2007 Contract amendment did but are not revise Attachment B-2limited to, Covered Servicesthe following: § Semi-private room and board § Regular nursing services § Rehabilitation services § Medical supplies and use of appliances and equipment furnished by the facility Not a covered benefit.

Post-Turnover Services. Thirty (30) days following turnover Turnover of operations, the HMO MCO must provide HHSC with a Turnover Results report Report documenting the completion and results of each step of the Turnover Plan. Turnover will not be considered complete until this document is approved by HHSC. HHSC may withhold up to 20% of the last month’s Capitation Payment until the Turnover activities are complete and the Turnover Plan is approved by HHSC. If the HMO MCO does not provide the required relevant data and reference tables, documentation, or other pertinent information necessary for HHSC or the a subsequent Contractor contractor to assume the operational activities successfully, the HMO MCO agrees to reimburse the State HHSC for all reasonable costscosts and expenses, including, but not limited to, : transportation, lodging, and subsistence for all state and federal representatives, or their agents, to carry out their inspection, audit, review, analysis, reproduction and transfer functions at the location(s) of such records; and attorneys’ fees and costs. The HMO also agrees This section does not limit HHSC’s ability to pay any and all additional costs incurred by the State that are the result of the HMO’s failure to provide the requested records, data impose remedies or documentation within the time frames agreed to damages as set forth in the Turnover Plan. The HMO must maintain all files and records related to Members and Providers for five years after the date of final payment under the Contract or until the resolution of all litigation, claims, financial management review or audit pertaining to the Contract, whichever is longer. The HMO agrees to repay any valid, undisputed audit exceptions taken by HHSC in any audit of the Contract. Subject: Attachment B-2 - STAR Covered Services DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a September 1, 2011 Initial version of Attachment B-2, “STAR Covered Services.” 1 Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions 2 Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision. 3 Brief description of the changes to the document made in the revision. STAR Covered Services Revision 1.1 June 30The following is a non-exhaustive, 2006 Revised high-level listing of Acute Care Covered Services included under the Medicaid STAR Program. STAR MCOs are responsible for providing a benefit package to Members that includes all Medically Necessary services covered under the traditional, fee-for-service Medicaid programs except for Non-capitated Services. Non-capitated Services are listed in Attachment B-1, RFP Section 8.2.2.8. Non-capitated services are not included in the STAR MCOs’ Capitation Rates; however, STAR MCOs must coordinate care these Non-capitated Services so that Members have access to a full range of Medically Necessary Medicaid services, both capitated and non-capitated. STAR MCOs may also elect to include Value-added Services in their benefit packages, if approved by HHSC (see Attachment B-2). STAR Program benefits are subject to the same benefit limits and exclusions that apply to the traditional, fee-for-service Medicaid programs, with the following exception. Adult STAR Members are not subject to the 30-day spell-of-illness limitation that applies to traditional, fee-for-service Medicaid coverage. Adult STAR Members are generally limited to three (3) prescriptions per month. However, STAR MCOs in the Medicaid Rural Service Area must provide unlimited prescriptions to Members who are enrolled in a 1915(c) waiver program for Community-Based Long-Term Services and Supports. For a complete listing of the limitations and exclusions that apply to each Medicaid benefit category, STAR MCOs should refer to the current Texas Medicaid Provider Procedures Manual and the bi-monthly Texas Medicaid Bulletin. (These documents can be accessed online at: xxxx://xxx.xxxx.xxx.) The services listed in this Attachment are subject to modification based on changes in Federal and State laws, regulations, and policies. STAR Covered Services include, but are not limited to, Medically Necessary: • Ambulance services • Audiology services, including hearing aids, for adults and children • Behavioral Health Services*, including: Inpatient mental health services for Children (birth through age 20) Outpatient mental health services Psychiatry services Counseling services for adults (21 years of age and over) Outpatient substance use disorder treatment services including: o Assessment o Detoxification services o Counseling treatment o Medication assisted therapy Residential substance use disorder treatment services including: o Detoxification services o Substance use disorder treatment (including room and board) *These services are not subject to the quantitative treatment limitations that apply under traditional, fee-for-service Medicaid coverage. The services may be subject to the MCO’s non-quantitative treatment limitations, provided such limitations comply with the requirements of the Mental Health Parity and Addiction Equity Act of 2008. • Birthing services provided by adding a physician or Advanced Practice Nurse in a licensed birthing center • Birthing services provided by a licensed birthing center • Chiropractic services • Dialysis • Durable medical equipment and supplies • Early Childhood Intervention (ECI) services • Emergency Services • Family planning services • Home health care services • Hospital services, including inpatient and outpatient • Laboratory • Mastectomy, breast reconstruction, and related follow-up procedures, including: inpatient services; outpatient services provided at an outpatient hospital and ambulatory health care center as clinically appropriate; and physician and professional services provided in an office, inpatient, or outpatient setting for: all stages of reconstruction on the breast(s) on which medically necessary mastectomy procedure(s) have been performed; surgery and reconstruction on the other breast to produce symmetrical appearance; treatment of physical complications from the mastectomy and treatment of lymphedemas; and prophylactic mastectomy to prevent the development of breast cancer. external breast prosthesis for the breast(s) on which medically necessary mastectomy procedure(s) have been performed. • Medical checkups and Comprehensive Care Program (CCP) Services for children (birth through age 20) through the Texas Health Steps Program • Oral evaluation and fluoride varnish in the Medical Home in conjunction with Texas Health Steps medical checkup for children 6 months through 35 months of age. • Outpatient drugs and biologicals; including pharmacy-dispensed and provider-administered outpatient drugs and biologicals • Drugs and biologicals provided in an inpatient setting • Podiatry • Prenatal care • Primary care services • Preventive services including an annual adult well check for patients 21 years of age and over • Radiology, imaging, and X-rays • Specialty physician services • Therapies – physical, occupational and speech • Transplantation of organs and tissues • Vision (Includes optometry and glasses. Contact lenses are only covered if they are medically necessary for vision correction, which can not be accomplished by glasses.) Subject: Attachment B-2.1 - CHIP Covered Services DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a September 1, 2011 Initial version of Attachment B-2.1, STAR+PLUS “CHIP Covered Services.” 1 Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions 2 Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision. 3 Brief description of the changes to the document made in the revision. CHIP Covered Services Covered CHIP services must meet the CHIP definition of Medically Necessary Covered Services. Revision 1.2 September 1. 2006 Revised Attachment B-2 There is no lifetime maximum on benefits; however, 12-month period or lifetime limitations do apply to include provisions applicable to MCOs participating certain services, as specified in the STAR following chart. Co-pays apply until a family reaches its specific cost-sharing maximum. Covered CHIP Perinatal services must meet the definition of Medically Necessary Covered Services. There is no lifetime maximum on benefits; however, 12-month period or lifetime limitations do apply to certain services, as specified in the following chart. Co-pays do not apply to CHIP Perinatal Members. CHIP Perinate Newborns are eligible for 12-months continuous coverage, beginning with the month of enrollment as a CHIP Perinate. Covered Benefit CHIP Members and CHIP ProgramsPerinate Newborn Members CHIP Perinate Members (Unborn Child) Inpatient General Acute and Inpatient Rehabilitation Hospital Services Services include, but are not limited to, the following: § Hospital-provided Physician or Provider services § Semi-private room and board (or private if medically necessary as certified by attending) § General nursing care § Special duty nursing when medically necessary § ICU and services § Patient meals and special diets § Operating, recovery and other treatment rooms § Anesthesia and administration (facility technical component) § Surgical dressings, trays, casts, splints § Drugs, medications and biologicals § Blood or blood products that are not provided free-of-charge to the patient and their administration § X-rays, imaging and other radiological tests (facility technical component) § Laboratory and pathology services (facility technical component) § Machine diagnostic tests (EEGs, EKGs, etc.) § Oxygen services and inhalation therapy § Radiation and chemotherapy § Access to DSHS-designated Level III perinatal centers or Hospitals meeting equivalent levels of care § In-network or out-of-network facility and Physician services for a mother and her newborn(s) for a minimum of 48 hours following an uncomplicated vaginal delivery and 96 hours following an uncomplicated delivery by caesarian section. STAR Covered Services§ Hospital, Services Included under the HMO Capitation Paymentphysician and related medical services, is modified to clarify the STAR covered such as anesthesia, associated with dental care § Inpatient services related to “optometry” associated with (a) miscarriage or (b) a non-viable pregnancy (molar pregnancy, ectopic pregnancy, or a fetus that expired in utero). Inpatient services associated with miscarriage or non-viable pregnancy include, but are not limited to: § dilation and “vision.” CHIP Covered Services is modified to correct services related to curettage (D&C) procedures; § appropriate provider-administered medications; § ultrasounds, and § histological examination of tissue samples. § Surgical implants § Other artificial aids including surgical implantsimplants § Inpatient services for a mastectomy and breast reconstruction include: § all stages of reconstruction on the affected breast; § external breast prosthesis for the breast(s) on which medically necessary mastectomy procedure(s) have been performed § surgery and reconstruction on the other breast to produce symmetrical appearance; and § treatment of physical complications from the mastectomy and treatment of lymphedemas. Revision 1.3 September 1§ Implantable devices are covered under Inpatient and Outpatient services and do not count towards the DME 12-month period limit § Pre-surgical or post-surgical orthodontic services for medically necessary treatment of craniofacial anomalies requiring surgical intervention and delivered as part of a proposed and clearly outlined treatment plan to treat: § cleft lip and/or palate; or § severe traumatic skeletal and/or congenital craniofacial deviations; or severe facial asymmetry secondary to skeletal defects, 2006 Contract amendment did congenital syndromal conditions and/or tumor growth or its treatment. For CHIP Perinates in families with incomes at or below 185% of the Federal Poverty Level, the facility charges are not revise Attachment B-2a covered benefit; however, Covered Servicesprofessional services charges associated with labor with delivery are a covered benefit. Revision 1.4 September 1For CHIP Perinates in families with incomes above 185% to 200% of the Federal Poverty Level, 2006 Contract amendment did benefits are limited to professional service charges and facility charges associated with labor with delivery until birth, and services related to miscarriage or a non-viable pregnancy. Services include: § Operating, recovery and other treatment rooms § Anesthesia and administration (facility technical component Medically necessary surgical services are limited to services that directly relate to the delivery of the unborn child, and services related to miscarriage or non-viable pregnancy (molar pregnancy, ectopic pregnancy, or a fetus that expired in utero). Inpatient services associated with (a) miscarriage or (b) a non-viable pregnancy (molar pregnancy, ectopic pregnancy, or a fetus that expired in utero) are a covered benefit. Inpatient services associated with miscarriage or non-viable pregnancy include, but are not revise Attachment B-2limited to: § dilation and curettage (D&C) procedures; § appropriate provider-administered medications; § ultrasounds, Covered Servicesand § histological examination of tissue samples. Revision 1.5 January 1Skilled Nursing Facilities (Includes Rehabilitation Hospitals) Services include, 2007 Contract amendment did but are not revise Attachment B-2limited to, Covered Servicesthe following: § Semi-private room and board § Regular nursing services § Rehabilitation services § Medical supplies and use of appliances and equipment furnished by the facility Not a covered benefit.

Post-Turnover Services. Thirty (30) days following turnover of operations, the HMO Business Associate must provide HHSC Covered Entity with a Turnover Results report documenting the completion and results of each step of the Turnover Plan. Turnover will not be considered complete until this document is approved by HHSCCovered Entity. If the HMO Covered Entity does not provide the required relevant data and reference tables, documentation, or other pertinent information necessary for HHSC Covered Entity or the subsequent Contractor its contractor to assume the operational activities successfully, the HMO Business Associate agrees to reimburse the State Covered Entity for all reasonable costs, including, but not limited to, transportation, lodging, and subsistence for all state and federal representatives, or their agents, to carry out their inspection, audit, review, analysis, reproduction and transfer functions at the location(s) of such records. The HMO Business Associate also agrees to must pay any and all additional costs incurred by the State Covered Entity that are the result of the HMOBusiness Associate’s failure to provide the requested records, data or documentation within the time frames agreed to in the Turnover Plan. The HMO must maintain all files and records related to Members and Providers for five years after Remainder of page intentionally left blank. Signature page follows. Each party is signing this agreement on the date stated opposite that party’s signature. OKLAHOMA HEALTH CARE AUTHORITY d.b.a OKSHINE By: Date Print Name: Title: COVERED ENTITY NAME: _____________________________ By: Date Print Name: Title: EXHIBIT D – ANNUAL PARTICIPATION FEES The annual participation fees for OKSHINE Participants is described below. These fees do not include implementation interface costs of final payment under the Contract or until the resolution of all litigationorganizational systems and vendors, claims, financial management review or audit pertaining to the Contract, whichever if applicable. OKSHINE pricing for hospital organizations is longerbased on Adjusted Patient Days (APD). The HMO agrees base price is set on a sliding scale to repay accommodate small and large organizations. On average hospitals pay $0.79 per APD per month, but exact costs will be determined in coordination with the onboarding and outreach team. OKSHINE pricing for provider clinics is based on the number of prescribing providers in each clinic. On average provider clinics pay $55 per prescribing provider per month, but exact costs will be determined in coordination with the onboarding and outreach team. External data feeds or interfaces for HL7 ADT feeds or EHR based API / FHIR connections will be charged at a rate of $10K each. Specific needs and additional pricing will be determined in coordination with the onboarding and outreach team. OKSHINE reserves the right to amend, terminate, or add additional Health Information Exchange (HIE) services at any valid, undisputed audit exceptions taken by HHSC in any audit of time which may affect participant pricing upon thirty (30) days prior written notice to Participants consistent with the ContractPolicies and Procedures. Subject: Attachment B-2 - Covered Services DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version Attachment B-2, Covered Services Revision 1.1 June 30, 2006 Revised Attachment B-2, Covered Services, by adding Attachment B-2.1, STAR+PLUS Covered Services. Revision 1.2 September 1. 2006 Revised Attachment B-2 to include provisions applicable to MCOs participating in the STAR and CHIP Programs. STAR Covered Services, Services Included under the HMO Capitation Payment, is modified to clarify the STAR covered services related to “optometry” and “vision.” CHIP Covered Services is modified to correct services related to artificial aids including surgical implants. Revision 1.3 September Invoicing for all participants will commence on July 1, 2006 Contract amendment did not revise Attachment B-22022. EXHIBIT E – OKSHINE AVAILABLE SERVICES OKSHINE reserves the right to amend, Covered Servicesterminate, or add additional Health Information Exchange (HIE) services at any time. Revision 1.4 September 1The availability of OKSHINE Services to individual Participants is dependent on the State of Oklahoma certification, 2006 Contract amendment did not revise Attachment B-2, Covered Services. Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-2, Covered Servicesthe technical capabilities of OKSHINE and Participant’s organization.

Post-Turnover Services. Thirty (30) days following turnover of operations, the HMO must provide HHSC with a Turnover Results report documenting the completion and results of each step of the Turnover Plan. Turnover will not be considered complete until this document is approved by HHSC. If the HMO does not provide the required relevant data and reference tables, documentation, or other pertinent information necessary for HHSC or the subsequent Contractor to assume the operational activities successfully, the HMO agrees to reimburse the State for all reasonable costs, including, but not limited to, transportation, lodging, and subsistence for all state and federal representatives, or their agents, to carry out their inspection, audit, review, analysis, reproduction and transfer functions at the location(s) of such records. The HMO also agrees to pay any and all additional costs incurred by the State that are the result of the HMO’s failure to provide the requested records, data or documentation within the time frames agreed to in the Turnover Plan. The HMO must maintain all files and records related to Members and Providers for five years after the date of final payment under the Contract or until the resolution of all litigation, claims, financial management review or audit pertaining to the Contract, whichever is longer. The HMO agrees to repay any valid, undisputed audit exceptions taken by HHSC in any audit of the Contract. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-2 - Covered Services Version 1.6 DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version Attachment B-2, Covered Services Revision 1.1 June 30, 2006 Revised Attachment B-2, Covered Services, by adding Attachment B-2.1, STAR+PLUS Covered Services. Revision 1.2 September 1. 2006 Revised Attachment B-2 to include provisions applicable to MCOs participating in the STAR and CHIP Programs. STAR Covered Services, Services Included under the HMO Capitation Payment, is modified to clarify the STAR covered services related to “optometry” and “vision.” CHIP Covered Services is modified to correct services related to artificial aids including surgical implants. Revision 1.3 September 1, 2006 Contract amendment did not revise Attachment B-2, Covered Services. Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-2, Covered Services. Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-2, Covered Services.

Post-Turnover Services. Thirty (30) days following turnover of operations, the HMO Business Associate must provide HHSC Covered Entity with a Turnover Results report documenting the completion and results of each step of the Turnover Plan. Turnover will not be considered complete until this document is approved by HHSCCovered Entity. If the HMO Covered Entity does not provide the required relevant data and reference tables, documentation, or other pertinent information necessary for HHSC Covered Entity or the subsequent Contractor its contractor to assume the operational activities successfully, the HMO Business Associate agrees to reimburse the State Covered Entity for all reasonable costs, including, but not limited to, transportation, lodging, and subsistence for all state and federal representatives, or their agents, to carry out their inspection, audit, review, analysis, reproduction and transfer functions at the location(s) of such records. The HMO Business Associate also agrees to must pay any and all additional costs incurred by the State Covered Entity that are the result of the HMOBusiness Associate’s failure to provide the requested records, data or documentation within the time frames agreed to in the Turnover Plan. The HMO must maintain all files and records related to Members and Providers for five years after Remainder of page intentionally left blank. Signature page follows. Each party is signing this agreement on the date stated opposite that party’s signature. OKLAHOMA HEALTH CARE AUTHORITY d.b.a OKSHINE By: Date Print Name: Title: COVERED ENTITY NAME: By: Date Print Name: Title: EXHIBIT D – ANNUAL PARTICIPATION FEES The annual participation fees for OKSHINE Participants is described below. These fees do not include implementation interface costs of final payment under the Contract or until the resolution of all litigationorganizational systems and vendors, claims, financial management review or audit pertaining to the Contract, whichever if applicable. OKSHINE pricing for hospital organizations is longerbased on Adjusted Patient Days (APD). The HMO agrees base price is set on a sliding scale to repay accommodate small and large organizations. On average hospitals pay $0.79 per APD per month, but exact costs will be determined in coordination with the onboarding and outreach team. OKSHINE pricing for provider clinics is based on the number of prescribing providers in each clinic. On average provider clinics pay $55 per prescribing provider per month, but exact costs will be determined in coordination with the onboarding and outreach team. External data feeds or interfaces for HL7 ADT feeds or EHR based API / FHIR connections will be charged at a rate of $10K each. Specific needs and additional pricing will be determined in coordination with the onboarding and outreach team. OKSHINE reserves the right to amend, terminate, or add additional Health Information Exchange (HIE) services at any valid, undisputed audit exceptions taken by HHSC in any audit of time which may affect participant pricing upon thirty (30) days prior written notice to Participants consistent with the ContractPolicies and Procedures. Subject: Attachment B-2 - Covered Services DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version Attachment B-2, Covered Services Revision 1.1 June 30, 2006 Revised Attachment B-2, Covered Services, by adding Attachment B-2.1, STAR+PLUS Covered Services. Revision 1.2 September 1. 2006 Revised Attachment B-2 to include provisions applicable to MCOs participating in the STAR and CHIP Programs. STAR Covered Services, Services Included under the HMO Capitation Payment, is modified to clarify the STAR covered services related to “optometry” and “vision.” CHIP Covered Services is modified to correct services related to artificial aids including surgical implants. Revision 1.3 September Invoicing for all participants will commence on July 1, 2006 Contract amendment did not revise Attachment B-22022. EXHIBIT E – OKSHINE AVAILABLE SERVICES OKSHINE reserves the right to amend, Covered Servicesterminate, or add additional Health Information Exchange (HIE) services at any time. Revision 1.4 September 1The availability of OKSHINE Services to individual Participants is dependent on the State of Oklahoma certification, 2006 Contract amendment did not revise Attachment B-2, Covered Services. Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-2, Covered Servicesthe technical capabilities of OKSHINE and Participant’s organization.