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ASURIS NORTWEST HEALTH MEDICARE ADVANTAGE PPO REIMBURSEMENT ADDENDUM This is an Addendum ("Addendum"), effective on December 31, 9999, to the Participating Agreement ("Agreement"), by and between Asuris Northwest Health ("Company") and KITTITAS COUNTY HEALTH DEPT ("Provider"). All references herein to "Provider" shall mean "Provider," or "Medical Group," as those terms are used and defined in the Agreement(s). WHEREAS, Company has a contract to serve as a Medicare Advantage (MA) plan for the U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), to administer Medicare benefits within certain counties in the Company service areas; WHEREAS, Provider has an existing Agreement to provide medical services to Members, as more particularly set forth in the Agreement; WHEREAS, Provider is entering into this Addendum to provide medical services to MA PPO Members; NOW THEREFORE, in consideration of the foregoing premises and other good and valuable consideration, receipt and sufficiency of which are acknowledged, the parties hereby agree as follows: A. REIMBURSEMENT PROVISIONS The following reimbursement provisions and fee schedule amounts shall apply to Provider for Covered Services rendered to MA PPO Members: The fee schedule for professional providers is structured on the most recent edition of the CPT coding manual. For most procedures, Company will determine Maximum Allowable Fees using the Resource Based Relative Value Scale (RBRVS) published by the Centers for Medicare & Medicaid Services (CMS). In the absence of CMS RBRVS unit values for specific procedures, Company will establish such unit values for purposes of its Maximum Allowable Fee determination. For certain procedures, the Maximum Allowable Fee will be individually determined at Company's discretion. Procedures assigned "by report" status are paid as determined by Company's Medical Director. 2. The allowance for each CPT procedure code is the lesser of the charge or the fee assigned to that procedure code under the fee schedule. Payment for Covered Services is based upon this allowance. 3. For Covered Services provided by MDs, DOs, DPMs, and ODs, the fee schedule shall be based upon one hundred and two percent (102%) of the current Medicare fee schedule for the locale where the service is rendered. 4. For Covered Services provided by Advanced Practice Professional Nurses and Physician Assistants, the fee schedule shall be based upon eighty-five percent (85%) of the MD/DO/DPM/OD rate listed above. Payments for Physician Assistants and Certified Registered Nurse First Assistants assisting at surgery shall be reimbursed based on Medicare guidelines. 5. For Covered Services provided by other provider types (i.e., not MDs, DOs, DPMs, ODs, NPs and PAs), including but not limited to: PT, OT, ST, CRNAs, DCs, the fee schedule shall be based upon the current Medicare allowable for the provider type based on the locale where the service is rendered. Company follows Chapter 12 of the Medicare Claims Processing Manual for the provider type, example: Licensed Clinical Social Worker (LCSW) is paid seventy-five percent (75%) of the Medicare physician fee schedule. 6. For Covered Services for Laboratory and Pathology services for which Medicare has established a fee through its Clinical Laboratory Fee Schedule, reimbursement shall be based upon ninety percent (90%) of the current Medicare fee schedule for the locale where the service is rendered. 7. Durable Medical Equipment, Prosthetics, Orthotics, Supplies (DMEPOS) and Drugs will be reimbursed according to Company reimbursement policy. MA PPO Professional Reimbursement Addendum Asuris1 A18816854AA Page 1 of 2