SHJ25-014 MOLINA HEALTHCARE RENEWAL - PARTIALLY EXECUTED

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3.4 Medical Necessity Determination. Health Plan's determination with regard to Medically Necessary services and scope of Covered Services, including determinations of level of care and length of stay benefits available under the Member's health program shall govern. The primary concern with respect to all medical determination shall be the interest of the Member. 3.5 Member Services. Health Plan will provide services to Members including, but not limited to, assisting Members in selecting a primary care physician, processing Member complaints and grievances, informing Members of the Health Plan's policies and procedures, providing Members with membership cards, providing Members with information about Health Plan, and providing Members with access to Health Plan's Provider Directory, updated from time to time, identifying the professional status, specialty, office address, and telephone number of Health Plan contracted providers. 3.6 Provider Services. Health Plan will maintain a Provider Manual describing Health Plan's policies and procedures, Covered Services, limitations and exclusions, and coordination of benefits information. Health Plan will maintain a Provider Services Department available to educate Provider regarding Health Plan's policies and procedures. 3.7 Medical Director. Health Plan will employ a physician as medical director who shall be responsible for the management of the scientific, technical, and medical aspects of Health Plan. ARTICLE FOUR - TERM AND TERMINATION 4.1 Term. This Agreement shall commence on the Effective Date indicated on page one of this Agreement and will continue in effect for one (1) year and will renew for successive one (1) year terms unless terminated by either Party in accordance with this Agreement or in accordance with applicable state licensing statutes and regulations set forth in Attachment 1 and Attachment 2. 4.2 Termination without Cause. This Agreement may be terminated without cause by either party on at least one hundred twenty (120) days written notice to the other party. 4.3 Termination with Cause. In the event of a breach of any material provision of this Agreement, the party claiming the breach will give the other party written notice of termination setting forth the facts underlying its claim(s) that the other party has breached the Agreement. The party receiving the notice of termination shall have thirty (30) days from the date of receipt of such notice to remedy or cure the claimed breach to the satisfaction of the other party. During this thirty (30) day period, the parties agree to meet as reasonably necessary and to confer in good faith in an attempt to resolve the claimed breach. If the party receiving the notice of termination has not remedied or cured the breach within such thirty (30) day period, the party who provided the notice of termination shall have the right to immediately terminate this Agreement. 4.4 Immediate Termination. Notwithstanding any other provision of this Agreement, Health Plan may immediately terminate this Agreement and transfer Member(s) to another provider by giving notice to Provider in the event of any of the following: a. Provider's license or certificate to render health care services is limited, suspended or revoked, or disciplinary proceedings are commenced against Provider by the state licensing authority. b. Provider fails to maintain insurance required by this Agreement. c. Provider loses credentialed status. d. Provider becomes insolvent or files a petition to declare bankruptcy or for reorganization under the bankruptcy laws of the United States, or a trustee in bankruptcy or receiver for Provider is appointed by appropriate authority. e. if Provider is capitated and Health Plan determines Provider to be financially incapable of bearing capitation or other applicable risk -sharing compensation methodology. f. Health Plan determines that Provider's facility and/or equipment is insufficient to render Covered Services to Members. MHWPROV22.3 MHWPSA/Revised Jan 2024 Page 13 of25