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Docusign Envelope lD 7 4E827C5-FAB8-8084-827C-41 4AD59920A0 PROVIDER SER\ACES AGREEMENT This Provider Services Agreement ("Agreement") is entered by and between Molina Healthcare of Washington, Inc,, a Washington corporation ("Health Plan'), and County of Kittitas DBA Kittitas County ('?rovider"). The purpose of this Agreement is to make available Covered Services to Members according to the terms and conditions set forth below. RECITALS A. Health Plan ananges for the provision of certain health care servioes to Members pursuant to contracts with various government sponsored health programs. Health Plan intends to participate in additional government sponsored health programs and offer other health Products as the opportunities become available. B. Health Plan arranges for the prcvision of certain health care services to Members by entering into provider service agreements with individual physicians, groups of physicians, individual practice associations, hospitals, clinics, ancillary health providers, and other health providers, C. Provider is licensed to render certain health care services and desires to provide such services to Health Plan's Members in connection with Health Plan's contractual obligations to provide and/or arrange for Covered Services for Flealth Plan's Members. Now, therefore, in consideration of the promises, covenants and warranties stated herein, Health Plan and Provider agree as follows: ARTICLD ONE - DEFINITIONS 1.1 Capitalized words or phrases in this Agreement shall have the meaning set forth below, a. Advance Directive is a Member's written instructions, recognized under state law, relating to the provision of health care when the Member is not competent to make a health care decision as determined under state law. Examples of Advance Directives are living wills and durable powers of attorney for health care. b. Affiliate means an entity owned or controlled by Flealth Plan or Molina Healthcare, Inc, c. Agreement means this Provider Services Agreement, all attachments and incorporated documents or materials. d. Capitated Provider is a Plovider who receives a monthly premium from Health Plan for each Member assigned to Providet'. Capitated Provider may be responsible for payment of some or all covered health services (professional, institutional, pharmacy) incurred by Member, e. Centers for Medicarc and Medlcaid Services ((CMS") is the Centers for Medicare and Medicaid Services, an administrative agency of the United States Government, responsible for administering the Medicare program and certain parts of the Medicaid, CHIP, Medicare-Medicaid Program, and the Health Insurance Marketplace. f. Claim means an invoice for services rendered to a Member by Provider, subrnitted in a format apprcved by I{ealth Plan and with all setvice and encounter information required by Health Plan, g, Clean Clnim means a Claim for Covered Services that has no defect, impropriety, lack of any required substantiating documentation, or particular circumstance requiring special treaflnent that prevents timely payment from being made on the Claini. h. Covered Services mean those health care services that are Medically Necessary, are within the normal scope ofpractice and licensure ofProvider and are benefits ofthe l-Iealth Plan Product or a Health Plan affiliate's Product which covers the Member. i. Downstream Entity means any pafly that enters into a written arrangement, acceptable to CMS, with persons or entities involved with Medicare or, Medicaid Products, below the level of the MT.IWPROV2z.3 MHWPS A/Revis ed laa 2024 Page2 ot25