SHJ25-009 KCJ AND CHPW - PARTIALLY EXECUTED

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EXHIBIT B-3-A CHPW HEALTH BENEFIT EXCHANGE REIMBURSEMENT RATES 1. Rates. Subject to the tenns and conditions of the Agreement, reimbursement rates for Covered Services billed under Facility's tax ID number for the CHPW Health Benefit Exchange Benefit Plans listed below shall be the lesser of billed charges or the following and will be less any applicable Cost Sharing Amounts. A. CHPW-Affiliated "Cascade Care" Public Option Plans: Network Name: CHPW Cascade Care Affiliate Network Inpatient Services: Outpatient Services: Professional Services: 2. Payment. {Rate - Exchangel % of Medicare Fee Schedule for all Covered Services described therein; and {Rate - Exchangel% of the Washington State Health Care Authority's ("HCA's") Apple Health (Medicaid) Fee Schedule for all Covered Services for which no Medicare fee exists. {Rate - Exchangel % of Medicare Fee Schedule for all Covered Services described therein; and {Rate - Exchangel% of the Washington State Health Care Authority's ("HCA's") Apple Health (Medicaid) Fee Schedule for all Covered Services for which no Medicare fee exists. {Rate - Exchangel % of Medicare Fee Schedule for all Covered Services described therein; and {Rate - Exehangel% of the Washington State Health Care Authority's ("HCA's") Apple Health (Medicaid) Fee Schedule for all Covered Services for which no Medicare fee exists. A. CHPW will adjust payments to Facility consistent with adjustments that CMS and/or HCA appliesto their respective fee schedule(s). 1 CHPW will pay, or require the applicable third party plan sponsor to pay, Facility for Covered Services rendered to Members in accordance withthe terms of this Agreement, the Provider Manual, the applicable Benefit Plan, and billing instructions and policy guidelines published and periodically updated by applicable state and federal agencies. 2021 Facility Exh B3A — CHPWHBERates Page 46 of 51 Contract #f Contract 91-1PRC Agreement ID}