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Amendment to the Medical Group Participation Agreement <br />This amendment (this 'oAmendment") is to the Medical Group Participation Agreement, effective as <br />of 0610112026 (the 'oAgreement"), between UnitedHealthcare Insurance Company, <br />UnitedHealthcare of Washington, Inc., and UnitedHealthcare of Oregon, Inc. ("United") <br />contracting on behalf of each entity individually (collectively, oounited") and Kittitas County ("Medical <br />Group"). <br />This Amendment is effective on0610l12026 (the "Amendment Effective Date"). <br />The parties agree to modify the Agreement as follows: <br />1. The capitalized terms used in this Amendment, but not otherwise defined, will have the meanings <br />ascribed to them in the Agreement. <br />2. Appendix 4 to the Agreement is deleted in its entirety and replaced with the Appendix 4 attached <br />hereto. <br />3. Medical Group represents that it has provided United with a Medical Group Professional Roster <br />that includes all of the following data elements for each Professional: Any previous Professional <br />Roster aftached to the Agreement is deleted in its entirety' <br />- Name of Professional (first name, middle initial, last name) <br />- Degree (MD, DO, NP, PA, other) <br />- Gender (M/F) <br />- ProviderSpecialty(ies)(primary,secondary, additionalspecialties) <br />- Operates as and willing to be listed/assigned as a Primary Care Professional "PCP" (YA\l) <br />- State License Number <br />- Medicaid ID Number <br />- NPI Number <br />- Foreign Language(s) <br />- AdmittingHosPital(s) <br />If any data element is not applicable to a specific Medical Group Professional, Medical Group will <br />indicate "not applicable" in the appropriate field. Acceptable formats include in writing, <br />electronically in Excel, ANSI, or text (comma delineated) formats. <br />4. The attached "Behavioral Health Services and Payment Addendum" is hereby added to the <br />Agreement as Attachment l. <br />All other provisions of the Agreement shall remain in full force and effect. In the event of a conflict <br />between the terms of the Agreement and this Amendment, the Amendment will control. <br />UnitedHealthcare <br />C o nf de ntial and P ro pri e tary <br />Gen. Amd.SMGA. B H. WA.06. 2 5