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Home My WebLink AboutSHJ25-011 UHC AMENDMENT 1 - PARTIALLY EXECUTEDAmendment to the Medical Group Participation Agreement This amendment (this "Amendment') is to the Medical Group Participation Agreement, effective as of 06/01/2026 (the "Agreement'), between UnitedHealthcare Insurance Company, UnitedHealthcare of Washington, Inc., and UnitedHealthcare of Oregon, Inc. ("United") contracting on behalf of each entity individually (collectively, "United") and Kittitas County ("Medical Group"). This Amendment is effective on 06/01/2026 (the "Amendment Effective Date"). The parties agree to modify the Agreement as follows: 1. The capitalized terms used in this Amendment, but not otherwise defined, will have the meanings ascribed to them in the Agreement. 2. Appendix 4 to the Agreement is deleted in its entirety and replaced with the Appendix 4 attached hereto. 3. Medical Group represents that it has provided United with a Medical Group Professional Roster that includes all of the following data elements for each Professional: Any previous Professional Roster attached to the Agreement is deleted in its entirety. - Name of Professional (first name, middle initial, last name) - Degree (MD, DO, NP, PA, other) - Gender(M/F) - Provider Specialty(ies) (primary, secondary, additional specialties) - Operates as and willing to be listed/assigned as a Primary Care Professional "PCP" (Y/N) - State License Number - Medicaid ID Number - NPI Number - Foreign Language(s) - Admitting Hospital(s) If any data element is not applicable to a specific Medical Group Professional, Medical Group will indicate "not applicable" in the appropriate field. Acceptable formats include in writing, electronically in Excel, ANSI, or text (comma delineated) formats. 4. The attached "Behavioral Health Services and Payment Addendum" is hereby added to the Agreement as Attachment 1. All other provisions of the Agreement shall remain in full force and effect. In the event of a conflict between the terms of the Agreement and this Amendment, the Amendment will control. Gen.slmd.SMGA.BH. Wd0615 - I - UniledHealtheare Confidential and Proprietary UnitedHealthcare Insurance Company, as signed by its authorized representative Signature: Print Name: Title: Date: Kittitas County, as signed by its authorized representative Signature: ", ✓�.zy.r� Print Name: CLA y Nt y&g S Title: SHE'R1 Fr Date: 6 - W - x6 TIN: � f - (r b % 3 L/l UnitedHealthcare of Washington, Inc., as Kittitas County, as signed by its authorized signed by its authorized representative representative Signature: Signature: Print Name: Print Name: G ey4 jt !�c R S Title: Title: SHEf{1FF _ Date: Date: G -S D - AL TIN: I [evDi 3 Yg UnitedHealthcare of Oregon, Inc., as signed Kittitas County, as signed by its authorized by its authorized representative representative Signature: Signature: Print Name: Title: Date: Gen.Amd.SMGA. BH. WA.0625 7 Print Name: G,t.47 ,vr FRS Title: $Reg)r-F Date: 6 • 3O- X, �/ TIN: �� ( - L Db I l - 2 - UnitedHealtkcare Confidential and Proprietary Appendix 4 Medical Group Service Locations Medical Group attests that this Appendix identifies all services and locations covered under this Agreement. IMPORTANT NOTE: Medical Group acknowledges its obligation pursuant to the agreement to promptly report any change in Medical Group's name or Taxpayer Identification Number. Failure to do so may result in denial of claims or incorrect payment. Identify only if a common name and address appears on all Medical Group service location bills that utilize the Medical Grou 's Taxpayer Identification Numbers under the A reement. Practice Name: Kittitas Countv Street Address: 307 W UMPTANUM RD City: ELLENSBURG State:WA Zip: 98926 Taxpayer Identification Number(s) (TIN) 916001349 National Provider ID (NPI): 1063226272 11tEDICAI GROUP LOCATION - List BOTH the'Scivice Location and the Billing Address'for the Service Location' Service Location Billing Address for the Service Location (if different from above) Medical Group Name Medical Group Name Kittitas County Kittitas County Street Address Street Address 205 W 5TH AVE STE 1 205 W 5TH AVE STE 1 City City ELLENSBURG ELLENSBURG State and Zip Code State and Zip Code WA 98926 WA 98926 Phone Number Phone Number 506 962-7527 506 962-7527 TIN I different rom above National Provider ID PI ADDITIONAL MEDICAL GROUP LOCATIONS - List BOTH the Service Location and the Billing Address for the Service Location Service Location Billing Address for the Service Location (if different from above) Medical Group Name Medical Group Name Street Address Street Address City City State and Zip Code State and Zip Code GenAnid.SMGA. BN. WA. 06.25 - 3 - UnitedNealthcare Confidential and Proprietary Phone Number Phone Number TIN (If dtfferentfrom above National Provider ID P Medical Group Name Medical Group Name Street Address Street Address City City State and Zip Code State and Zip Code Phone Number Phone Number TIN (If differentfinom above National Provider ID NP Medical Group Name Medical Group Name Street Address Street Address city City State and Zip Code State and Zip Code Phone Number Phone Number TIN (If different.ftom above National Provider ID NP D Gen.Amd.SMGA.BH. WA.06.25 - 4 - UnitedHealthcare Confidential and Proprietary BILLpVG AI)I)RESS FOR MHISUD S�RVIGES ONLY Identify only if a common name and address appears on all Medical Group service location bills LL that utilize the Medical Group's Taxpayer Identification Numbers) under the Agreement. Practice Name: Kittitas County Street Address: 307 W UMPTANUM RD City: ELLENSBURG State: WA Zip: 98926 Taxpayer Identification Number(s) (TIN) 916001349 National Provider ID (NPI): 1063226272 MEDICAL GROUP LOCATION FOR MWSUD SERVICES ONLY -"List BOTH ithe ,Service Location an`d the Bill in Address far"thc'Service Location Service Location Billing Address for the Service Location (if different from above) Medical Group Name Medical Group Name Kittitas County Kittitas County Street Address Street Address 307 W UMPTANUM RD 307 W UMPTANUM RD city City ELLENSBURG ELLENSBURG State and Zip Code State and Zip Code WA 98926 WA 98926 Phone Number Phone Number 506)962-7527 506 962-7527 TIN (If differentfirom above National Provider ID(NM ADDITIONAL MEDICAL GROUP LOCATIONS FOR MII/SUD SERVICES ONLY - List BOTH the Service Location and the Billing Address for the Service Location Service Location Billing Address for the Service Location (if different from above) Medical Group Name Medical Group Name Street Address Street Address city city State and Zip Code State and Zip Code Phone Number Phone Number TIN Qf di erent ram above National Provider ID NP Medical Group Name Medical Group Name Street Address Street Address Gen.Amd.SNLGA BIL WA.06.25 - 5 - Unitedtlealthcare Confidential and Proprietary city City State and Zip Code State and Zip Code Phone Number Phone Number TIN I different rom above) National Provider ID(NM Medical Group Name Medical Group Name Street Address Street Address City City State and Zip Code State and Zip Code Phone Number Phone Number TIN (If differentfinom above National Provider ID NPI Gen.Amd.SMGAJ3R WA.06.25 - 6 - United Healthcare Confidential and Proprietary BEHAVIORAL HEALTH SERVICES AND PAYMENT ADDENDUM WASHINGTON MEDICAID AND CHIP BENEFIT PLANS This Behavioral Health Services and Payment Addendum (this "Addendum") sets forth the terms and conditions under which Medical Group will participate in one or more behavioral health networks to provide Covered MITSUD Services (as defined below) to Customers enrolled in Washington Medicaid and CHIP Benefit Plans. This Addendum applies to the Washington Medicaid network. In the event of a conflict between the terms and conditions in this Addendum and the terms of the Agreement, including all other addenda, appendices and attachments, the terms in this Addendum will control Medical Group's provision of Covered MH/SUD Services, except that the terms of any regulatory requirements appendix will control over any conflicting terms of this Addendum, as applicable. This Addendum does not apply to Covered Services other than Covered MH/SUD Services. ARTICLE 1 Definitions Unless otherwise defined in this Article 1, capitalized terms used in this Addendum have the meanings assigned to them in the Agreement. For purposes of this Addendum, the following definitions will apply: CMHC: A Community Mental Health Center. CMHC Provider: An employee of a CMHC who provides MH/SUD Services, but is not a CMHC Supervising Provider. CMHC Supervising Provider: A psychiatrist, psychologist, social worker, family or other therapist duly - licensed and qualified in the state in which MH/SUD Services are provided to Customers who practices as an employee of CMHC and has been approved as a CMHC Supervising Provider in writing by United. Covered MH/SUD Services: MH/SUD Services that are (i) Covered Services under a Benefit Plan (ii) provided at a Service Location listed in Appendix 4 of the Agreement as providing MH/SUD Services, and (M) which are set forth in one or more Behavioral Health Service Payment Appendices attached to this Addendum. Emergency Care for Mental Health Condition: Covered MH/SUD Services provided for an individual, that, if not provided, would likely result in the need for crisis intervention or hospital evaluation due to concerns of potential danger to self, others, or grave disability according to chapter 71.05 RCW. Facility -based Provider: A health care professional, who is employed by or under contract or supervision to render MH/SUD Services to Customers. Facility -based Providers include, but are not limited to, emergency room physicians, pathologists, radiologists, anesthesiologists, certified registered nurse anesthetists ("CRNAs"), and intensivists. Facility Participating Provider: A health care professional, facility, or other organization that has a written Facility Participating Provider Agreement in effect with United, directly or through another entity, to provide MH/SUD Services to Customers. Group: Group -based Provider, and Group Participating Provider. Gen.Amd.SMGA.BS WA.06.25 - 7 - United1lealthcare Confidential and Proprietary Group -based Provider: A health care professional, psychiatrist, psychologist, therapist or other behavioral health professional who is employed by or under contract or supervision by Group to render MH/SUD Services to Customers. Group Participating Provider: An entity, organization, group, partnership or affiliation however categorized, consisting of health care professionals, facilities, psychiatrists, psychologists, therapists or other behavioral health professionals that is duly -licensed or certified to provided MH/SUD Services within the state such MH/SUD Services are provided, and who has a written Group Participating Provider Agreement in effect with United, directly or through another entity, to provide MH/SUD Services to Customers. Mental Health and Substance Use Disorder Services ("MH/SUD Services"): Health care services, treatment or supplies that are used to treat a mental health or substance abuse illness, condition or disease, MH/SUD Payment Policies: For purposes of this Addendum, MH/SUD Payment Policies are Payment Policies or other guidelines adopted by United for calculating payment of claims for Covered MH/SUD Services provided by Medical Group (including claims from Medical Group under this Addendum). The MH/SUD Payment Policies operate in conjunction with the specific reimbursement rates and terms set forth in the applicable Behavioral Health Services Payment Appendix to this Agreement. Like other Payment Policies, the MH/SUD Payment Policies may change from time to time as discussed in -the Payment of Claims provision of the Agreement. MH/SUD Protocols: For purposes of this Addendum only, MH/SUD Protocols are Protocols limited to those programs and administrative procedures adopted by United or a Payer to be followed Medical Group in providing Covered MH/SUD Services and doing business with United and Payers under this Addendum. These MH/SUD Protocols may include, among other things, credentialing and recredentialing processes, utilization management and care management processes, quality improvement, peer review, Customer grievance or concurrent review. The MH/SUD Protocols may change from time to time as described in the Agreement and this Addendum. MH/SUD Provider Manual: Those provisions of an administrative guide that apply to Covered MH/SUD Services will be made available to Medical Group online, WWW.UHCProvider.com, or upon request. Any changes to the manual will be made consistent with the terms of the Agreement. ARTICLE 2 MH/SUD Services 2.1 Provision of MH/SUD Services. Medical Group hereby acknowledges and agrees to cooperate and comply with all of the terms and conditions of this Addendum and the Agreement as a participating provider for the provision of Covered MH/SUD Services to Customers as designated by United or Payer. At the request of a Payer, Medical Group may not be authorized to provide Covered MH/SUD Services for some or all of Payer's Customers. Medical Group will otherwise accept Customers as new patients on the same basis as Group is accepting non -Customers as new patients without regard to race, religion, gender, color, national origin, age or physical or mental health status, or on any other basis deemed unlawful under federal, state or local law. At all times, Medical Group will require any employed or subcontracted MH/SUD providers to comply with the terms and conditions of this Addendum, all MH/SUD Protocols and MH/SUD Payment Policies, as may be sett forth in the MH/SUD Provider Manual and the requirements of all applicable laws and regulations. Gen.Aind.SMGA.BH. WA.06.15 - 8 - UnitedHealtheare Confidential and Proprietary 2.2 Cooperation with MH/SUD Provider Manual, MH/SUD Protocols, MH/SUD Payment Policies. Medical Group will be bound by, accept, strictly comply with, and cooperate with applicable MH/SUD Protocols and applicable MH/SUD Payment Policies, as may be set forth in the MH/SUD Provider Manual. The MH/SUD Protocols and MH/SUD Payment Policies will be made available to Medical Group online or upon request. Some or all MH/SUD Protocols and MH/SUHD Payment Policies also may be disseminated in the MH/SUD Provider Manual or in other communications. Currently, the MH/SUD Protocols and MH/SUD Payment Policies may be found at www.UHCProvider.com. United will notify Medical Group of Medical Group's failure to comply with the applicable MH/SUD Protocols or applicable MH/SUD Payment Policies may result in loss of or reduction of payment or reimbursement to Medical Group or the imposition of other corrective action by United To the extent that the provisions of the MH/SUD Provider Manual differ from this Addendum or the Agreement, the terms and conditions of the Agreement and this Addendum govern. For purposes of Covered MH/SUD Services, the MH/SUD Protocols and the MH/SUD Payment Policies control and supersede all other Protocols, Payment Policies or administrative manuals or guides, with the exception of Additional Manuals, if applicable as described in the Agreement. 2.3 Continuity of Care; Referral to Other Health Professionals. Medical Group will furnish Covered MH/SUD Services, providing continuity of care and ready referral of Customers to other participating providers as may be appropriate and consistent with the standards of care in the community. As appropriate, Medical Group will coordinate and exchange Customer data with Customer's primary care provider ("PCP"), to properly accomplish person -centered, integrated care. If a Customer requires additional services or evaluation, including Emergency Care for Mental Health Condition, Medical Group agrees to refer Customer to Customer's PCP or another participating provider in accordance with the terms and conditions of Customer's Benefit Plan. Medical Group will refer Customers requiring Emergency Care for Mental Health Condition to the "94-l" emergency response system. 2.4 Payment of Services. All payments obligated by Payer will be paid to Medical Group in accordance with the terms of the applicable Behavioral Health Services Payment Appendix to this Addendum and in accordance with applicable MH/SUD Payment Policies. Medical Group agrees to continue to provide MH/SUD Services to Customers who have exhausted his/her covered benefits under the Benefit Plan and agrees not to collect or charge more than the contracted rate for those MH/SUD Services. Medical Group may bill the Customer directly for those MH/SUD Services for which there is no longer any coverage under the Benefit Plan, provided the Medical Group obtained the Customer's prior written consent. Each party agrees to defend, indemnify and hold the other party harmless for any claims, damages, actions, or judgments arising from any employee or contractor related to the provision ofMFI/SUD Services to Customers. ARTICLE 3 MH/SUD Submission of Claims. Medical Group will submit claims for Covered MH/SUD Services to United in a manner and format prescribed by United. [Medical Group agrees that claims received by United after the relevant time period(s) set forth in the Agreement may be rejected for payment, at United's and/or Payer's sole discretion. Gen.Amd.SMGA.BF/. WA. 06.25 - 9 - UnUedflealthcare Confidential and Proprietary ARTICLE 4 Alcohol and Drug Abuse Patient Records Medical Group aclmowledges that in receiving, storing, processing or otherwise dealing with information from United or Payer about Customers, it is fully bound by the provisions of the federal regulations governing Confidentiality of Alcohol and Drug Abuse Patient Records, 42 CFR Part 2, as amended (the "Confidentiality Regulations"); an Medical Group agrees that it will resist in judicial proceedings any effort to obtain access to information pertaining to patients otherwise than as expressly provided for in the Confidentiality Regulations. ARTICLE 5 Miscellaneous 5.1 Survival. Upon termination of the Agreement or this Addendum, the provisions herein, which contemplate performance or observance subsequent to termination, will survive and remain of full force and effect between the parties. 5.2 Entire Agreement. On the Effective Date, this Agreement and this Addendum will supersede and replace any existing provider agreements between the parties related to the provision of Covered MH/SUD Services for Benefit Plans to which this Addendum applies as described in the preamble, including any agreements between Medical Group and United or a United Affiliate including United Behavioral Health. This Agreement, together with any and all attachments, addenda, appendices, as may be amended or modified from time to time, whether contemporaneous or subsequently made, are hereby incorporated herein by reference, and constitutes the entire agreement between the parties in regard to its subject matter. Gen.AmdSMGA.BfI. 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A9NOSGIEI, WNIt SLORMGANVNIXVMEM1'EATI 219991ps i6 5,9 i6 5.6 9G119 Prµholndkal leslEng mW. ien sere+e hynhysioanm Mmr q bfiM b-1411 grcpwlnubml ndudk.S megaalmn a,wa dale, uann nr.tand+W4M to P2VIIP 6L55 6151 SF.SS 61 i5 g6lm PsµM1oluglral letting naWxbrvservlcn byphYsicmanurolherqua4hM M1eaXM1eareprelnabnal. in[lutlinq ln[egralbn ofpxenWxY, n of runtlaWAM test o-2VlOP 4B.63 6963 b9,63 6R 6] m Inline n+lwlimn remrm hyphYskian wader quaXEM M1eahhc4repmlessunal,ndutlingb Sr+lbn9fpal'rm data, n of sontlaNAM test 21999lIP 6135 6L55 61,55 4455 m n nFvnhys4aan orodnrquafiEM M1edNumprelnauml,.rclutlin;in U n V+ ld +, 31999lOP G6.63 6a.63 6B,63 69.5g 9G13O IG Poycheingial tern gnenNalion service hY gM1Ysician or oemrquahgml hen4etarcpmkssbnal.nduding l��eda[bnal natrcntdata, n d sla 42WIP mob I'JA6 9d.9b ge,9G 961m IG Ps}tFdo3 nl lezang ewWa ann seMcn by physician orotlmr -II nduainq ln[e;nlionafpx.n[dbtb. {rarer revMnol runa,rtlhM lest Plw_ g9A4 q 1 N.96 g4-96 m RKhoiogiral costing evaluation snmc by P1.01 an erelMrq II healm+are pmlessmntl,ndud�nq lntegrarionof palenr dan, pile a nol snntlaNAM leu 21 111 R4A6 44.V6 g1.06 84 N6 m a on e m bI phvNrmn mrodarqu 11 neahL+are pml.smnd, n dlbgIn g n p rank d+le, daad'grd lnr v,r 219WIGP g4A6 81.96 9994 81.06 %Ill Psychd glcal tntmg evalua9on seMeany plrµi ran er glher nuafifietl M1rahM1eare prebssnnel, irdutling inlemakbnof pakenkdata, ndsNrNaNnM Im[ 9 11P 42-53 g2,II 92.5E 42,5E %Ill Ps%hdeFlul teNbg rnluaurnsmiceby physician ornuxr quenFelhwhhcampmkssbnal, ntluding nyydind paicmeam, nnl sIa WaraiaM Les I 10P 49g9 49,96 d9A4 49,95 JI RKhologlral[estmgewluadon seMseshy plrysl[dn or ether quaNEea M1eaXM1aarepmfessbPy,ndudinp btegratnnof parknteata, nolaordwtlhM lnl 1[A99AP 425] 425E 42.5E 425E ll Fde9ul[crlMp walwiim rerry[nby pM1µkhn or olM1n qualiRW heahn.artpmfessund,nduJlntln MratbnoF parlenrdata. •yMaNknllnr 11.101O1 49.95 49,us 490 49,95 si nvnMpMsltian orolM1erqualifiM M1eahLcarepmkssunslndutlln9b x nef P+tbntdara. �nl P3PAP 60,11 66.6P ® 1 60.6T .III TG f}lJnbMhul tntiinrdxNUW,n vMi.e lT phsrwianwotlermuliGrat LallF.eeepmfwinmL tlrclWReincm Nnf Pa4m[Jaa imupraalimu{ uad,N'uai ts'sI 6MA]P 69,6] �6] EOAT W67 %13l TG P.}JebPidt nmaLsdiun n.ni,abphrsiomxeuy rpeNf Iwllharc pmlbssfonvL iwlW'arg iru.2u mr ofpatient dda_ mnfamdanleW Wt 21-WP fn,1] W61 fd.6] Gp-Fl 96L11 16 4N.v Il Imal ya'mg-6uliunxni-by Phssieiar rr eRprrpuleiW hwllh wrc pl-in Li JWereimex uo ui p.Xeu&L, nnlsasuNNizd lent 11-9996oP W,11 W.6] yu.6] W,67 32 •wnp=�I.rWui.-,I la4irg_I.ion sm-im br ph)swinrmalle. gmliI Lobh ure prul'oaimr.L u Wj.p iwep',t ofpavau nwnp+3vMlgeiul PNIA, Yi.44 59.99 Nel prhra nut P•eN L lcttng mlmdunx'nr:vLl'ph55rimrrncllcv 9u+liNW hesb-,pmf•ni=met. incluemgimcgalur'afpaumz Ilxv/oe -n,ei ]sgs NOI P*M NUl prose g6FA .S..pr3Jnlrwiul uvi•ymlusGonrnieahc phsswismmiecqualine€heylh,pmfw.LinJutieg;unofp.6m �LL 21 999111 99.99 59.Iq No[Prkkd Not Prk•d 96131 \=vnfasvhNrreiullNirig ssahutionzn..v he pl,51.iena"9 '9wMicd I,-pmf .1. owhdineiwevaliun efpr4w dau. ]1-Iw9 13b5 73.8S Nnt lr Not RIM 96)3] -svryn.M1ulugiulldirfe.ahulinnsm'iwh3'Phlrwianx'wh[rgMi6W h,bllh sane PmfmiuuLirwlWurg inl+ymym of Ps4ml dal+, 132uP 9L13 913z Mok RkM Net RkM 32 eenpslq,ningwellNasE napulion xnua br phyzuixma6a g4alifiudhdlAvaaep 6viu aL'rtlWind ixegalim ol'pagw �LL 0.29IOP %Xi 9L23 NeI P.kM Nd Ries x IG unupn inloEinlI uum nuhsatbnxnkv IV pk3.wimardlmc 9m1d-hedw dau. 11.23 Nor RkM No[Reee %]32 1G \''vr.epsl<leWgisallNinec+ahulinn xnin be phlsi:un 01-q'vliliW hdlAcve pmfcuiwvI. u Wing imuvalion p JaLL 21-'YMr 91 i1 91.13 Nut Rketl NO RkN W133 ndoglralttstirg uvaluuAgn snrrieas by phyaklan wogrer quaggM heoM nrh ryofussbrwl, Inc WrfmgirRo�ollgn m w6n�l aala. imnranuhm d rWnmrdrcn I>_3a1P 4Z.Ti Q.71 Nul E4teM Nd RN:M %13] NewopsKAdogkd ttstng eval..... .A -by pAysis]anmutFer ge— heallha•e prd m...1. in[II nnul meam mtw m nnnumNrdtle P2N19lP 5fi19 5fi 14 N-it" Not I`— 33 Nrrmpsythdogkal ttstkrg enluadon ursi[n NYPM1ynktlnerekher qualiNM healtNure prdnpwral.In[IUMng b[egntion of simtdar, b nnfrttneaNhe asg11P g2.11 IL91 No1PriM Nrt Pru:ed %l3] a rs+rc[ by phgsh4anor other gnabf6M heal6 Pndesimal, Intl flniry•+nee nl n9991OP 56.31 S6,4 Nnl PrkN Not Pikers 96133 74 mpsµhtlogkal mttsr4euasl a4ondiesxnlry phyrh .ther prdil Aeafthcme pr fk ..al,imlu 4 3 on el Pi911P 64.] 69.] NOIPrcM Not RkM 943)) TG Newapsy[AeloSkahnti.r9eu+sA'al'uantluernces hY PlgsNun nrefne•yWiFrtl hnhh+are Prohalionul, Indn,Yngintegrationoi rnldata in nofsanaaNiee 0.) p 6'J.l rA,i Nal pl- Me[Rk••I 86F]1 TG rlewopsyrNobgkal restinS n,Nrawnsermm by phrysvn mother qudlhN hnllh<art protnsional, IrHlrrdnd'eNeSmnenel n[aatt tole a ran nlsuntl,WVe 999/IP 9i.1 69_] Not piked Mal Rneil 33 TG NcurapsKAobgkal ttstin; evaluation se+uun by phytir6n mother qualifcetl FeatlA++rt prglnsional. NHludn3 integntlervnl ent a+tt. mtt. 9 nWaena,mAe 994lOP 9].T �] Nut piked rW[PrcM 96L6 nr wflnf+dmiNstnhon seas and Ny rd'rv=ynorolh q 4M nearyLu eprgfnrbnal.tw or nctnn anYmnhod,fint 39 minutes PIalIP l]L6 13.94 ]3.G6 13.96 96134 l"b.IbpI:A wncuroprythdograltestadminnnaunn+ndrmring by pbYvdanerelbn gn9l'r6M hrahhare probubnal, Menr wrtnN, anYmetnoa: Rnt 30 mfnwez 0.1NOP H.43 2493 EgIt ]6 PSKnobgkalw eurnpsyrNdegkal teat aAninistmtion antl xorme Ay lRivsirianorotheagwl'rRM heaNrrare pcekssurul, M1w9 nr et ymeWetl; Mu ]tl mmubs _gggllp ]]A6 11,94 -6 11 96l]s uanlarneumpvKM1do®cot tatadmihrshelien andworing by PAYSF[laner othe[gwlifsd M1nXM1r pmbss eer eten ymetbd; fnstIDminutes ri 9%!OP 2443 14: 13 2443 Ed 43 6 w mmµ6der3u911n1 adminismeon antl uwng 6y physiclanoroM q health reW lrsscn.It verso, Y N;fest ]Gmingxs mdp As, 39,54 -l', 30.56 s4 RKholpd'ral or rreumprysM1ONginllntadmbhn,tbnand awing by phys.sianer elfin qu+lifrd AnMM1eare probssenal, Menr rr rots. any metAM; Rst 30minuttz PIDfOP ID.56 39-56 39.56 3V.54 96l% TG RµAdoglral9r rxwrepsY[Nab�callnl admNrrstrationannsswurg try p6yd[ianorotnerqualrriee M1nhN ore lunkssurul, two oe reI rnelNM;rn1]pmlmin 11-999f 10 1p.56 3956 31.56 m.56 %1l6 TG Rychd�uicalor mumpsµbbgifal tell atlmnlsnanen9•d uoaArg by PM1y4runer aihef qu+liFed M1eaXM1r m lessnvl, Mnnr esters y I tIDminuNs 21999fOP 30.56 30.56 3V,56 10.5E 39 R1v19aWN.alvmmgn)dr,r{nEwnI NJ AbniNrtraliun ud xnring hY'pM3ician woMm giulifN N:eld w[e PnrfwipmL Nvwmxe [x4 m=' eeewd ras'Ir asbii4rmil 3V 0.I9Ap lVA] SVV] 19,u1 19A1' i9 YncMb_mral urmaupurhn[ookilte�Wndn:,4+fim,W semmgF2 plps4ianwuNa gmfrfrcd hold. wrcpref+ai Ltunrnmm te4.mnwhnd cM aJdili9na! 1n o-2VlOP u19 1Lle IJ.I9 22t9 %137 I'ayJkrbgd nr nennml:]r,dnyeiultN mlmriisbatiue ae•1 syinP hvpineiei,n m ofin WI`Fkahh.Ssc Pmfad I`N-o wanxe am' ued W urh sJdliawl m 99aJ11T ]9.9] 10.07 1-1 -1 96l3] Ik.z•N4vod urnmerpnuAnlucwd tea arlrmn66edrm.W sµrrvx ErpMsuunwe9rn yediF Jleallh:uepmfewnruL Nernamrt am rend W uhaJdilirmal29 rfhrvhnlopcl 21999lOP 22. L9 22.]9 23.19 F2.14 3] rr nmmP9s9'nlrmial[na sdede:svaliwrad rmrmg hJ-pM3icianmoMv yw6fpdFcallh unpnl'xaiunvL m'ensuanc rul5 alrywy W.aeErnlrGli,wl ]n o-2V/IP 2x 26 2a.]6 2q.26 ]9.24 WEED HEALTHCARE WASHINGTON MEDICAID AND W A5HINGTON BENEFIT PLANS FOR THE UNINSURED BEHAVIORAL HEALTH PROFESSIONAL REIMBURSEMENT SCHEDULE %]3] fG Psclubpwl+umuopslsgsluvi:+t tuu+tlmurb4+[iun+rdrrn;ngbY pl9a.ian wotlrc 4wA6y brs1t3-.-Prvf ;nwL muru uvm nv nmdaJ eah+Jd;[iimal ]b �tubgalw o-1wRP 2P15 2d.26 1az6 2816 9613] wm•p!`i°duyi:+{Iea.u6.dnir4,nensN e'+uinp FY PAf ianw olAs ywiifnElr+IJr urep amnrut moor uu nedurJ erAauditiuul �n tFksep,rWpiulrnwvn•psyv},.,Ingiwlrrn.xbrvnuvalionaM 11-999/FP 2A,26 2..26 2E36 3l wnty hypMsi:ianmirtl.ry qualifad kalth weprrrliwieuL[xvrw mne mctlrud uxhaddilirwl)n u.999/6P 2.16 W.!B-i6 39,26 F4�vkrbmwllvwavopnJulo6iaal eevmWilrirvniup abl uvin3 by mdnddmn+n or rmmtas my-l". f Ial nnngn R2911P lv.t 1a,] I61 1p] %136 RycbrLrpulrnr.wrryn�du•leg;:a11a..bninisvaFion arJ rurine hr ta'Arui�m.lxnmmrrt vu .mvbrtF 3b m:,wm a1Wop m,] ]0,I 16.1 !0.7 %]39 ikv.h•1nme+irumxmpslvFu ew.Jnrt.umrirdsv+[wu+y rainy Al re:glrJam swo ur mdrc tns4 art rrralul.f I?n nnwn u-9•}]/IP 29.1 2p,] m7 ]9] 951.38 _ Is reemq.{vp.,le5i:,Ike+,Lnim•rr4irn,rrdspnnP Eyt>Ani:iv�sx'a r,rfmmtury arimnhnr[tm[sR nwrum ]5-9991OP 211.] 3R] !o] E0.] m }ky:AaiomwlwwuupsfWloawal uu Nnrurcvxian ay wire 6y teaAedvim swu ur mumtasy arynvhr,J;fl?P 1r®nnn R2MP 19.14 16,"1 T514 11 86136 FG Ps]cAelbgiwlrrnmrepsvcM1elepwlsnlaaminirtmllun andxorargby krnnbian, e+m er mere[nv. anYmr[betl; Pm530 m{notes 61Nup -24 ¢1n 1919 L6,l6 38 RxhpkglniornmmpsycM1obghaisntatlminixudmrndxwbtghykNntNan, [wearmomsa4,+nym[ nt 59minehs 21999/R 25.E4 25.14 MM 1914 96139 yehologluler nmrepsvrM1etegw{rnl+dmtnHtra Amend xmmg bf FeUrn'v{an,tr.aurmweFn4, anymemorb 5mt 39minnks 11-9y910, 25.24 25.2. 19.l4 Z9.24 .139 ycM1OWgiratw neumpsycnobgiral Wsl adrrenislmtleneM sewln6 by heelmiian. Mawmnrd lists, atry ruolhutl; eacM1 bddid... 13D rNnutn9 o-2tvlP 2116 21.26 21 26 2116 9 i's}N11on:aF ornwruWM1'Aulap'a:.511en+Jnwe.,u+ti..rad.6n 6Yt dmtSxu mmuretma4.prjnglpy; evhsddiuowl 3t1 mk+ R1610P u.16 u.16 21.26 u2. 9b139 Psy9u]npiuim nam,rn{druWp'.,I ma adridrdnbxivm ad rmring by tnFadm55wemmrrt limn m'miFmd:exhadtli[i.•1ul?n 3-999fiP u.36 2116 2116 !]26 96139 irnlu3un.:J wnewpsraneWu'mal lest+riekeuv+Si,m+N..ryintl AY talvddm.tma ur mrrctoty wm nsfh,J; _..hadditioml-II -99910P ll.26 2116 u.l6 L.26 39 1•rvsiuiegi.uiw rvwup3ekrWM•xltd rd+mtdcvaliw and taxing EytMeivarcwumn+m leas nn nv+ilmrl;ennadJiwm+l In o-ZGIR E599 25.94 lssn 25.94 rk hofogiul xrnmmprycM1ofoghal tntatlmmnmdm unduwdghy kri'nefan, Fw crab addi['lona33p 0.ffiIUP 25.94 25.94 96133 TG vsyrhulug;calnnmmpryrhobgraltm ewµglry knhnkmn. wo prmorc [nn.+nY mubetl; mrh atldaimai 30 u99911P 35.9R 23.94 35,94 23.94 FR Pswh.lsgj-1 or neuropsycfalpgultntatlmin nrNxon,od rrwnr WFerFnnan, Iwo er meet [nik any metbotl:exh ydi['rwra330 2F-99g10P 25,gq 961•I6 •pnobgiol anobgrltmtadminlse.auen.whh sinldeaummaty.santlartl4ed in.lrnm•ntw 0.29/IP I.31 ill 131 Psttboloscdl or neurppsychologralt�t adluinlsu,uon nnA sinpeawomwed,s4ntlartl'vylmePmrntvh eknronk phtrwm. with 0.3trIOP Nos Ricy 96146 ikyr3roingul or neumpsyahningkzlta[adm,nn[raven.•+,rb sMdc auwmased. uantlmS4edimunmmtrra nit phtrwm, with u-999]tP 1.31 111 131 Pstthplogiul or nearppsycholegicaltnt adminisrmumw slnlde swomakd,sandxtl4ylnsM1dmrnlmr4nron4platrwm.whh 21999YUp Hw pricy g5196 en[Ir.FmgFTaxsrtl cllniallnteniew. helrnmral obmrvatiun rusaltlecebn makingl RIDIIP 6].ql 6).4] 6].41 96156 HnlJrbduvr,w.nmlor m,nmxmn[ic.lydthfr��eul:luu:+l'uumim',h•1mi,n,I rdxsvaBwry Jini:al Jcri[irmrre4r,gl 101OP ]6]5 ln.]5 ]6.]5 l6 ]5 96196 Ilcaltlr bdusioraxvnrmr wn,+aassrem[ie FxalesirmmlJitimlwarirr'. bchrieral aMcvaBrm+diniwlJnidrmrwliml 99911P b]tll 61 q1 61,g1 6lAl 8539n Ilolrhbelrarimasw.mnlS rn r•vswngdfic lr�IN heuW clmiul inmiw', hdwirrnl nhratalinnv liru:al Jeeisim-I, iF-5551pp T6.T5 16.)5 ]6,]5 58 Ile+wrbduvinr intm'rm[ipn, mlir'iJw6 facMo-Yace: w4al c0 miouw 0.2wtp 46,18 45, 1p 5111 19.16 - HralU hNauio entlon, InJh4dual,fxcto-race; rnitt+t Namnwes 0.2W.P 52 Mlsil wtln+L faeeto-raeG lmr'utwminnn uy891tP 45,18 49,i6 4 45.18 Health behavior Inurventlon, lntllrWu+l, farom-face; mow 39mnusa 2i99f Jp 5Z 96g69 - ea=hayHbnall5 mhmnitlas upxxnh lnaadlbn REMp J5,I5 L4.F5 I9,15 59 HmIN hMador inurvmt on. intlritlu+l, rxsm-ratti mtM1 adtlitbnal lg mbrwalm p xcly in addHpn mcyefpr primary 0.1b1RP 11,66 1]6H 11.66 1268 99 Ikallh hMardor lmrrvention, in6dtluaL faco-m-face; each+Jtli6enal15 m;nmm Mist pankryln+Jdr[1eP terndr far prhnary a999f IP IS, I1 Is- MiI 15, 15 96I59 normkrveniion, ind u+L ra o-te-r ,c+ch vkHknal l5 mbutnibxsepu+tely In atlArbn mrr+tle p ry 11"Op I1,66 1].6tl 11. IT66 96IEU admbraf panmrlmusy M1ealFM1+eS assessmew instsument(ee, hrallh Mrard appraiuVl wrN ruring+y dwrmmlaliun,pm o-lwlp 114 174 ;]4 1.14 ® :W rverufP+l;madmmd hdWri.Amvsmrmrl immunw l+c Anlw nn.ud+pppimll �'i[h xrxirmmtl Jo:unsawwns lb+'.urJ,rJ;erJ -oloP 5]4 3.]R 1]4 3.]q 9616R rent-fmusetl inshusmnll .beailA haaN aP a2sa11 wnh smrin .vntl MummnmAon, 21-99wHp %lfA :W1rm[ufMFirnHftrcrnal hul[hdskrurlsman[shueuxmaul+p, hcAhh e„d 4rpmisah xirA.mbey and J,..ummunwl pn mm.J'mnl ml.urPla 21Ag910p %IGI .5dmx[erurcuisvr-S vrJ kaNuid:a.•o mml;nb.mnn 4gdryrmir,nm�wYlFrhrndl •Fr),e patlmLx w+ug xrl rlo:wn auon per pmrdsil'uM Amrunav -Al 3,]A 114 3.T9 II., g6r61 Mmin of crg2kdl+lba+aed hd4dn rrth assessrmn[ins umnul lap, dbpression mvetdoryJ forbeneftl Plthd Wtlbnl,w 114 3.N I.14 i]q 81 iJnon nfun wdw+.altulthrid asxsi rmnunui dgrmmien imew.ayat rbmSta€rAe p,vmtw., _ml Jucwrwtialt ivclWVJ'vcS imLveud r� i1999l1P 114 3.)9 2,14 1]e %161 4 oFwregiserfwusy Fe+an reY assessmew loss•umrnt{e&deprnuon lnvenmeyF farbment of sTepabenr,wseonng+nd mencat p sendarduy nsnument • ]1999fOP 3, ]4 ii4 S74 174 b.F+de. Mlcrvmlbn, erwPl2m more P+slentsl, hce-to-fue; mitut 30minuFm Rb]/IP 21,94 2114 21.. %I4q UT nealN beh+viw brtenma[iun, wpl2 w more paRen4l,mro-to-taee; 8rilW 3flmimm� R!U/UP 31.94 L94 21.94 21.94 Heglµ behallor'mrcmnrbn. mpl2w more paticntsl hro-lo-ram;;ntliJ 3Flminmr3 21A99/IP 21.9q 2194 21.. s.. UT rmlth behas5ur mtemnlbn,pwpllw more patien4l. mao-to-tacr. inbia139 minulez 999YOP 21.99 n.. 31.44 HealA behavior ln[emmkn.pmpl2w mare pxlen[al, hrmtmdaa; bnW 30minuln 0.10/Iv ]69b 2696 96161 mpllw more panml+l, her to-hn: MnW 3Aminu[n P29/UP 36.96 2636 Neal[h beTaribr In erven[Ubn, pouf l2w mwc paN•n[al, hrmro-mm;lnitul30ml9xln 1999/IP 2194 23.44 96a61 uP l2w mere gllcnlH. hrnmhu; MitW bemnaln 21A99/GP 13A4 2344 HealA behal.brm[enewimr, peep law more paYenlsl, hrrro-mre; lnilml39 minvin P!U/IP 2F+96 l6.96 nuP 1]er matt pa6nnlrl,harlo-hn; Nitul3pminutm H•+tµhmrawnr-ertery 0.20IUP 26.96 I- 961G IF nrimr, pum2 n4l, neo-lmhcr. m6hl39minwn 599YIP 23.H 23.44 23.44 Inhh hNrasinr'mxrvmsim, pow IZw more padenul, At<tvhcr, ini[d130minu[v 21A991tlp 23,9q 96165 U] Hwllh hehar,iw biervensim, pom llormwe Wnen4l. nrcro-lxr. racA adtlldonal L6 mmutn llnt reparamty maddebn mrude -11P 1p.91 10.97 -7 9516s .1HraAh bebavlorinirrvnnslm. pulp l2w mwe patlenuk tare-Imfxr, earM1 atldltlunal i5mkn[eslbtrmamxtylnayhknmmtle 0. ;W 10.91 19,97 96165 UT HmltM1 heM1awnr uricnendm, group llxrmwe patlen4l, hrrlo-Ine:eacA atltlltlowl lSmhwtn llnirmarao-ry ba a 21999/tP Fp.91 ]69I 10.97 HwIN heM1ariw mcervundm. poop l2nrmwe Wbart4l,hxlxlxe; 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ini[ulIDminlrt�+ b2o/iP 61.16 62]6 9666] Healtn beNsior iwe+•mn[ion, family lwim µe patlenl Perunll,hmmfaze; lnnul36 mineln 619lr1P 62I6 61.16 62,16 HralN hebesior intemntion.hen,h lwlm sAe Pwkn[pmmnrL Fare-m-ixe; innnl3pmmnhs 993/IP bE.l6 6E.16 Y6I61 hmay lwlµ sire pgtknlpmxnnl.fxemfue; ,n,[rawminutn 26999lOp -1 62.16 HralW behavior mutt,mtrkn,hmly lwlth she WlkdFpmsenH, faeo-m-face; moot }p minut3s R1g9P 62.16 61.I6 Haallh bch+ww, bsrcrvmfmn.Rmly W. she RaVenlPmuntl.r«o-m hce; innial3n minute 0.291Gp 62.I6 6].16 9616] HF Health beluwor inleruen[bn, (amity lwim mepatkn[prcsenH, fno-ho.Pxe: ini[ial 30 mirvutn I-999/1P 62,SG 6l.16 6216 Ilralth brhasior mrcrvrn[bn.hmly lwirh We Ratkrvsprcund, fxmb firr; innW 3R minutes IL-1. 6l-I6 62.16 9610 UT FsyshomempyxitA Wbmt antl/nrhmdy member le+eF add{Inrml lS minuted "IMP 39,16 34.1 3e16 Rychothempy Am Wdent antl/orhm9r member Im:haddllb-1 is minutal o-10fnP Sal 34,1 8- 1ll7 py with Wtientand/nrtamtly member le+ch+ddltioml l5 minutes} i1-999fIP 39.1 34.1 311 UNITED HEALTHCARE WASHINGTON MEDICAID AND W A9HINGTON BENEFIT PLANS FOR THE UNINSURED BEHAVIORAL HEALTH PROFESSIONAL REIMBURSEMENT SCHEDULE 96149 U] PSKhethnaPywllM1 pasnlardrer hmdy member leatM1 atldixonal SSmimrlal 9991pP XL 31.1 3e,1 . blcrvrntbn,hmtly lwirh the PatbntAmttnQ. fata-to-hte; 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E$ 1259 S169 sa uN Grnrq+daphr=6ehawrtkalment hyprolmtl, admimdncd by l«M1nkhn under Ne dhet .nla pl.yuean erel q 6ea heAN car=prulnswna4�ase-tnfine gyglpp 12.66 UIs ll,6s 12.65 n- UP wry adaptive hehamrtrealmentbyP mlydylrrrtl by Nchnkbnunder Ne dlmclbnula phyu morn W Rea IMc P nsonatfa rto-fine 420/1P ll.6d ll.6a um 11.69 sq 1.uip+daptM1e�wFnr lemn.vy Ayprruvol. admwaaN bytuAn.im rudcthed'rrmionu€apM1seieianr. ultv4mliriedlwlrh ..ue Ina€md.m$ Wu+u-rw= o-]ofaV tsb1 t1.w IlW lt➢d 59 6•oup adapytyr heM1avor xea[ment hT Wdoaol, admin:aoetl by let M1nkbn ender lh=dhnWnula Physician orodNrqualrfietl Nn{N are WUYevlonal. f«o-oo-hs= 99911P 1i59 I]61 LL61 ll.6d y]W UP Gtwp Ppthxhducl.aI f-bi-tumo<oL aasrdadoeel by lniPdim cede the ductimn ai phlaicdahre utlVr qualil9d kilJn arc paio+iwaL lama{ ]191a]p lI6a il.w 11.6a 1IW 91I54 FIG nl AyP adminhleraH by In M1nkun antler We dimtmnnla physi an Oro y 5=d INt P aJmaf batlo-h•c 0.20rIP all an 19]i 10.n 9n54 UG nrlrca[mrnl by p•ol«ol, admindtNed by lnhnibn undo Ne alreetbn olaphyidan ororl.erquafihed Iwe W =isle ern laeu 0.20rW Itin ]IV1 L0.]L IY,n UNITED HEALTHCARE WASHINGTON MEDICAID AND WASHINGTON BENEFIT PLANS FOR THE UNINSURED BEHAVIORAL HEALTH PROFESSIONAL REIMBURSEMENT SCHEDULE MswrcOPlPa1a APAN 9i159 u0 Grwp adaptive beMrlx Neatm,bt M prutmel, atlminisbretl by IsrM1nkcn untln 1M1e tlnew6nel9 PAnidan papNer qualified hedUure Pminslmal,fxs[o-lxen it IO, II l6.11 l4]L 1, 4q Cnoup rd+pthclydu.i�mlm+[mw hP molwuL admumanedhP' lniwum m.[v Ine JiPaipn e(a pA+*uunw uuiu spu9Re1 kaM rate pmfndwul. fw,seriaa 9991OP loll l0.11 10.11 10,]I 9]15d uR G.nryr aLptnebelu.:wrmamu=tl br p.r,tuei, nJm:retlgdsy lnimiam mJa tree dinr:tMe ofa pin,'r:unw adra rlmlifid bNh ..un luufeJmal. f=vbdse D iMI 9.86 R84 9.86 9e6 0lM URIeufauinuE,f ewm. Ar p.e r.,rl adm�.gml nr 1,.aw:iwr wrd., Nb tlirubn „r, pbl,:enmmhm muYGel R�Im ,nm(:ne P1tVilP 9.86 986 9.66 gR6 9]]59 uR atlapahe heF+wrPrwmrnr by pmtxd.atlminialeM by tnbnrun untln lNvdamtbnula plgskmoreU Paallfied IUe P ewend, hcrwkre 1}999/1P 966 9.YG 9R6 9.e6 9]]5d +uertmalmrnt by potxd. atlminiwwM by lnimkhn untlru Ue dnmtannla pM,idan oroU q IfiM hwllh cmc w¢lnvknw. faro-rohce 999fgP 966 9,85 986 9.86 A Grout' adaPmc hYa.tn uawreu hy' Prnme,rt, vNrdrddud bP 1duo:i:n mdm Ue Ju.�{ienaf=pM,i:iannrnlha quYliW haltlr w=e Pmf bnm[. fa:eu.G.e 1}10/IP 9A.6 9.06 Ab6 gore 9]]51 ub Gi-i atlaprhe beha.nrtrcnmenl by prat-, admidstered by lechnkan untln Ue Ureelbq of,, pkyrkim or¢1ber quaIIRM IrealU ere pnfn4urW,f+crlehce R2llIGP 9.06 H.116 9Ag 9W 9113a Is Group atlaplare beh+w rot 6yp.umd, admindered by[eelmnLanundm the &rtt1Nn ¢faphyaklanormber qualiFN NaEU o.e Pefmvonal`faccm-lace 999fIP AI16 9.06 9,W 9.96 Gmyr wlaVni.0 hehaiur Neamme br Pren�al, eUrdrdygd l,y 1Wmi=im mrda the dimiiunr,fa ldr{y:inur,rrMvwlifiul kafU melwinml, [a.•qo-Ire ss91gP 9,os 9ttr 4.11s gob 9]1E9 ai n Wpret,w mafilkauws atlmmnrcretlby pheskioner nchmpwoNrdhealmc w asvo utle umdcmeeps dNttlipn gl[tth cr PEW{P 1R3e 14.3a lane 143e 9]195 rcwmcnl wirF Prxxd-ilk.- .-s Nyphryban nr ether qualdxd M1ealme w .++1wral, whleA Uae a,mulseneegs dFxfmry ¢f itth q]O1gP Io3R 14,38 ]a 36 _ 143e 55 :W=P1i•rhlunpr vuvmm wiJr prwrwui naJiFr:+6ea shdni.lmml6. Plp�iuianu.utler ywh6d luahn we ImMnshmrl whi:nnuy FrJe shrvdWrrxm•Jir„limr nfruh 21999/EI W.38 1488 ]4.36 ]9.3R 9]]55 Malnlrcbehadmvument w,U Promcul mudif anon, aaminurcrea bypAyskmnm elhw gwErxtl hni[d rwe pr¢fnslmal,whbh maY inclWe Nmuluneora hheclbn ultmh 211W.1 19.36 I438 ]a]8 1q,36 PY156 Famdyadaptl.v beh+. e, admmwser by pM1yNeun e. elhcrgwl'RN heaYhure preksaaullwVh or vm M1e the parlmtprnmt3, fac.m hcen8uartlane t 0.20NP 1e.69 ul. 18,69 1e,69 vE54 Pamly adalnna buhniur lmahmv{uuiJan:t=rhrdrAammlMphni.iannr whrr 4oaM5M hnlNnm prof iumllwr[A orwidwrp me INr:.p pr�>. ss...r>" �,e.dcrn q]OyOP 1g69 1e.69 ]g 69 1R.69 91556 miNatlapti.e heharnr[ream,-m aunlnpce,admmisreretl by physkkn orglhergwliRed NealUomprole nellwi[h er wdheul 21'399111 18.69 1e.69 le.B9 Ig,y3 9]356 FamilYadapdve hekarror nea[runt.guidance, aaminisleretl by pM1yskimmmhergwM1Fra hraYh.are pr¢kukaullwkhnr weNuur 219w1uv 1B.69 Ig.6g 91357 1. ......... t e. adminiNerM hypAyllctse merhmquatiSetlM1 fe�+lenal D20PP 1A55 I0.55 10,55 9]]5] VN Mukkk Nmllyyqupadap[ue ls.hauiur rrwlmmt duitlanse, atlminNlmetl byphy=kyn amUerqudl6ed M1rclNure pmresslnul D2l 10.55 10.55 up+daprxc hchsyior rrealmmt gikanee. admdrNlmN MphYabtln m mNmqual HhealUam pmfrsi 1 ally&auP+d+prire 2L99911P ig56 I0.55 91131 uN hluhpk la behauier rrealmml �Manee,+elmlrwtned Mph Irla....NetquallSetl Neallh[+ee pmfesaiurul 219Y1(RP 30.55 IQ 55 apaa+prf+e behaynrueammt3ukance, atlmMNtnetl Mphmimn moNe.qua115etlh pmfnslxul 0.20AP A)15 9,11 9,>! 91157 up Muhpk ivnlRNuup aGp[be behamrVeahnmt3uManee+eMmNlned Mph i li, qua111Ltl NU Ill, ere pmfe,slewl ..Jo, I 1 9,71 I'll upMuulpk-lamlNywpadaplNe brhrviprrrcammt itlanrq utlmWUned byphnbun mome.quailfxtlb uskwl na"ilp - 9]t 9]257 uP MUEdpk faml[y yeup adaptve tmhauurrmalmmti;uitlanee,+dm'edcened 4y K is ¢r oNerquMlf<tl Lea{Uc+vp.efesrlewl a99uRP I9,n 9, 11 NR mlb as Padap[We beM1wior ueatmenteud+rem, admirudmetl bYPM1YsieM1n ordFeegwikird M1ralNurn profeasiowl Iwip 8.9E 9)151 uR M,rlt[ipk hmily armip A.ptve.1,. o......roarer;uidgwr. adm'pdalwed by liK icon ¢r dhergwlVlxd M1ealUo.e prnfsssiowl 0.]ryRP 8.4E g,9E 5.92 Nq Mulhpk-ram{ly ynvP adap[we be havkr ueatment euiduuce, admhedmetl Mph ysi or ocher qualilkd hrallM1ure pr¢fessiortal 21Afl110 8.9E 11 9]SS] uo Mu[tgk hmi[y Rreup adaptbc heM1 ., Neatment;u[dgmr,admhddned wphyslr4n wothergwlilsd healUo.e pmFeslowl 9RWM d92 8.9E 9.9E Mu41p]FNm{[v group atlapt'we heM1avi¢r uea[menl;ui,i.tnm,admwd w byphysldan meUnqueill}d bl:. arc pofesslmal 0.3Mp A21 e,ll 9]0] uR MoItlpLhml[y gaup adaptive behave. bea[ment3uklgn[r. admbirttted b)phyzlrJm xnUcr qu+3lfvd M1ealUo.e qulesslowl 0.hWRP g.2] e,il 9.2] Mu4btrhmi4 quup adaptive behavior ueatment eual+.uv, admmidmed M phyie meUe.9ualihcdM1 11hrure W¢fesslorwl 21A93(IP &21e,zl §]l5] uR mrlmatmrnr 6nitlanre. atlmldamee byp hpkbn amrherquarebetlM1 anal E1999JOP 8.33 N.25 e,El B.EI 115 9] Mu1lNkham lY peuP adaptive heMvmr ueatment ed MPFHkbn worherquallfietl bill ere pgfeulwdl wml!p Iss Is, ],54 91157 u5 Mnluptre .ib padaplweh ,lierlrratmem euNanre. atlminutnM byphpl[bnwmherqua3ihetlM1 end IMJf 1.511 ].56 7.56 9Y)5] usMultiple fimi[y goup atlaplhe hNuvinr trwtmenl FUNanm, adminutnetl by Phnhkn mglherqualifietl heal.. ere pafmbnal IiA/IP Y-56 ].56 ]-Sb 91ISi VS Ieriza3mrnl Itlanre. atlminhterN NV PhyabLn mmrhuquaiihe dM1wa(e _q1 21-99910P 1. 56 gll9a UN Grolup atlaptne behx'nraue to meNuwllh prelucd medifirasion,a hyphnkkn orolM1erquaNfietlebeaYM1 ere prefeniewl, D]u11P IS.45 1E55 12.65 re,tmegt wi,h pmlad m¢difiusan,admireistemd by lahYskkn ..mbar quaNevd huph rem prmkssonal. In. 1E.65 1E55 9Ill. uN Group atlapli.eN 1"' rmatmrnt with pmlm d mmdiAeaakn, administered hvphpkhn¢tetherq Need neaRh om profess-1, 2 999/IP 1i 45 iMs ur lrratmen]withpmtxd m¢tliputkn, administmed 6y pM1ysienmelha gwbfiM hnRh care pmfussnrtal, 211WIR u.65 lE.GS 9- up Group atlep 6vnivur treatment wiU wmmd modiRealkn, admmi,serrd by pM1yakhngrnUcr gwyfivd l20.h ore pmfessuw3, 0.I0/IP I164 ll.69 ll.H 7- UPwiN prwxd motllR:nien,aamkrisieretl by pbrykirnerenc�r gayfirtl Arakhure pmbssonai, 6j. ll.F 9]L58 up Gianp atlaPliueBehrvbr treatment wilM1 wdmdmodwulbn. admNl, by phYkunaralher NfiiiheakM1 ore pmfew . i1-999/IP ll llq ll.61 ll.Gl up up aaeplMhehrvbrlmaiment wish prwxol mod,Rt+lbn, admkrisle.ed hY Pkfskune.elhaggapfiN M1ea4h �rc pmfe .1, ll99g/l3P ll.61 §7L58 4A pgleegl mptlifirarkn, atlmMlsrerM Nv pl.y=bbn M1eakh ewe peefewbwl, r}20/R S0.]3 I0.]I q]13b 44 Group atlapdvehehav w w[N prutesul me&ficatmn, atlmnlssee by p4p4knm¢NerquaRfietl neakM1u pmfenawl, fare t¢hce wkh mukrle ea ]OfOp IUl] ] art 58 qq v..r lrcarmcnt with prxx¢I moGRulbn, admnistered hYtahYskknurmhn gpgyfied haAhure pmfessowl, mlwkh mull'k atknu. ll999/IP 10.Y3 10,]L 10.71 lfL]L 9115e uq ameue x:t4p.wxolmoGRradon, atlmmukred by pM1iii: ovme.q Nfied lwkhrare Prpkssbnal, 21-MP 10.71 Iq,Yi 10,11 §]I56 V0. p .eel mgdRcalkn, administered hydMb4nmrome.quaNRetl lrokFe ee pmfasbxal, ha�m,hcetwkh mutt , 6 WIP 1— § 1 916 4.fi6 9715e VR G.¢upadap[ke...hauler uealmnml wkb protueoimodRewkm+dminiwered by pl kb......r.r Wled hvakhom...sson.1. fuvgela.e w.M1 marl k 0.lw.1 9-e6 9.8E 9.86 9e6 9]15B VR Grwpadapthebeharkrueaunent wdhpmleculmudrnwugadminh byPhpkknsm¢NerquaNfirJ lmyhh.aee pemkssional, facelolxe wiN mule. k a ll999fIP Ius 9.gb 996 9P6 Se mrp adaptive bphavbr[realment whh premealmrWificwioW atlmldstwed by phy.¢bnar¢1M1erquaFRed lteahh ere prii, , 1, wirM1 multi k a -ill Is. 9d6 9.36 9e6 e mr Nealmrnl wdh prpme¢Im¢difrcatun, adminnlered hY dr/skiannrelheegwyRN brakhram pmfesslonai..2MP wimp 406 9.V6 AC4 9A6 97t6p tlaptiveibehauue[reabnmtwM prglgcpl mpdiRcalhn. atlmin,uercJ bYpMskknor¢U q Rerl Feakhnrr prgkssionaf. Face uaha wiU multi k 620NP 9.96 3A6 A06 A0.6 91159 us Gxupadaptiue Nehawrtmammt witM1 pmmcd mudlreal'mn. admirpwnM by phrakunarulhee quaFfied M1eakM1om pmless6nay hcmtvha wale mm vexmmt 2Ia39911p A06 9.06 A06 9.06 I- u5 Gr¢upatlapsRrcbeM1aw vMNmolaN mudf&xon, adminisrrrM hyphya'rchnor¢lhn gmYRed Neakhoeepmkuvna{ tare-tPRau wnM1 mull' k a 21-999/gP 404 A96 9,It6 g,rry 99p)5 MNkal Teslvnony 61A4P ]q !0 3N 10 ]5 kalTalemnY blOJOP ]0 FO FO 10 Y5 kalTe y ]3A9911P IN ]0 ]0 IO w0]5 balTml r 21999/gP ]0 ]u l0 lu 9920E New palkntautp+tknr nit-taraltime LS]9 noels g1RPp 41.53 Not Prketl Not Pr,N 91.63 9920E Hew PalkMoutpa[Im[vibt, lem[time 1 m bg.37 Not PrkM Nat P.ked N4.11 Mp0] c•v Palknl outwliml All lotalsime]5-l9 mnuly. u2r>hP 11 a2 Net P.ked Not WkN 314E 02 ewP+IknlwwEknl resit..prat slme 15-H mlmutes o-fifnv SOAJ Hut Prked IMt W'red Sq.g9 2 p t W dui=If, tglal lime 1529mhu1u 0.4MMMA1(Ip 411. Not Wked Not Wked 4].16 931h3 q 1 W nt rest, mralbme lh-29 mhrgln -9MAT" ]3.4] Hut Prkrd Net Prked ]3A) Y920E palwnteutwtmnt wnl lotalbme]S29mUmeq 2]-9991fP E3.38 MetWnd Nol Weed Zl3e UNITED HEALTHCARE WASHINGTON MEDICAID AND WASHINGTON BENEFIT PLANS FOR THE UNINSUREn BEHAVIORAL HEALTH PROFESSIONAL REIMBURSEMENT SCHEDULE qqw dr mimnO 9929E ew pdkntuurpa[mtuisiL tMal lime 1529 minute 2199410P 3555 Nor Aked Ibt Ametl 33.55 99}02 TG New pakmmtWtkn[rhit,ioralnme l5-29 mmutn 620AP 83,4I Nor Pied Nor P-d P34S 9920E !G NcwpalkntputW[kn[ visit. ttal time 15-29 .mule aID(9p ed92 Ner piked Npl Pried el r, xi Naw pH'enleu[par'mnl orate, Iola, t-l5-}9minure llA99Ap -2 No Priwd Mer Mked axu2 92 p m W Ins t,tutalfime l529mmdn L999l9P 83A2 Nol Prkctl rmt Mnavl 83,41 M!M Newtleent¢utpalwr+l uen, coral tim.lo-aA mne[n 0.1a(10 >t9 Nel tlrk.y Net Mked rye 3 =w pyiw nwrytind saM1 lwlriar Hell mimrtn 4u/. 19111 N¢I Mced Nelprked 191.n 99ZW tw pmirn nmrytkN vkit knM rmc ASH mMu[w a29fIP 54.19 Met Nued Not PrkN 9q i9 M201 \'m'P9ia eup+tine ui.il m�llorw?la•JJ nikrwo PZ9)9p -1 Mel Mked N¢r Prketl 1G_Sl S \'rnpmi. omW[em .ad luWltirre =lsu mmutm 0W9 AT21P g1.45 Not Im II Nor Piked g1.95 5 p nr W enruaLSMaltme30-14 mnnre aM9M.1 -11 Not Ilk. Nor AeN S1L9g 3 wn+tmnr W .rum[, lomlumem49 mmvrn 219 11P 36R2 Nt Prkpd NM ACN IS.gE 99N]l llew ParmM cetpakenl.tuL mmlFme l9-14 mkwtn 11-9m?op 5i.36 NM PekN N¢t P- S1.36 99201 SG l2cw parkpt ou[Wrimt Nul Piked M19s pe p ea wlimlv2pt. [oral time ip46 minpra o-19(OP 124.ri Net Aked Nel PrkN 130.T3 95 wpatmnl oulWbenr wul, melume 30�l9 mrnMn 21 99911P IM.73 Nor PakM emt Reed 124.]3 991W i4 New palm�l eelWNee[wil, 1¢mlbme 3NJ4 minutes }1-9991PP 124,i1 Net Rked Nat Mked 124.]3 MZW New patentoutWuent y L[¢ml-4S59minute 0]pIIP I]?94 Not Pitied Not Paretl 11?O6 99ItN N=wP+bet enpNkt.:pl. matbmcg5-59 mieuxn alef9v 351.35 nM Pied Not prkN m1.35 W W ni p enr,-..L mmldmedi59 minutn 12MP eels Not NkM N.[Preed ..M M W Mou�aHenr vi+L mW Nme4559 minNtn 0W.P .4. Not MkM Nut Rrted 114.9E 5910i New Wtkni ou[Wilenr ddt mW tlme 4159 m+ntn 9M6T/lp 31Pa9 Mel MFem NM Piked 15218 99204 New Wtknt otpatient sidr. rural bme 4559 m1nu[n 9M4T711P ]69,96 Nor Pied IMt MkM 1dAM M p tit ou[pa[ienS WiL mralNme65-59 minu[n ZIAMlIp SA91 Net lrced Not Meed 59g1 w valmnt p tint nul mrareme4559 mmMn Z1A99/GP 19.75 Not P- Nor Pncetl M.➢5 M p tit p tint wv4 mralNme45 s9 mmWn 620AP 1]GM Not PrkM Xur 1- 1]6M M1M TG New patent outpatient vWr,md time R559 mintn 0.M1OP 1]fi99 Nul Piked Nor Piked ]]fiM M104 TG New patient outpatient Nsir, mraldme4559 mfno[n ll-9991rP ]]fi99 Not Rked Not Piked 1]699 992GR p tit pueetndl rel.a dmedS59 m'melei e999/0P l]6.99 Nutp.ked Nee Piked 1Yb99 OS p et p tint nut, m+al tlme Ftr]4 mmuln -Ap L59.3 lmrPaked Met Rued L59.3 9a2p5 New oaf:et ¢Mpmrnt.:ul, l¢a+l tlme GR]a mnrMe. 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Plekry o-19AP 13v.15 Noi hnN Nor Prked I3].Ss 99Ig6 mlNJ nunntlfaoltlyrue, pegday, mmp M1ntmy, comp exam; and metlkal d-i, mating el dlgh eempleaty 0181GP ]3T.15 31nt %kd Nor - 99Y5 InitiN nunbgke6tyrxe.pn tlay, mmp Nlslnry; temp uam; andmNkaldecisan makindof 1.0-p-i, 43o11P I- No[Prkee Net heed 1N951 N nun eaamkvmr,pnday. romp M1isrory: camp uam: and metlkaldnbbn mukingnl higkcpmpinity 62p/OP ipi51 xo[Preed Nn%teed 10 i5l anu g y . , mp hil r, emnp rum:ond,r-Idreidon makingol M1iaJt[omple.slh 9991tP I03.51 HurlRea Nol Pried FO],sl h.i Anuninafadlrryun,pmd.,mmp W-,;empmm;+nd medkeldvrtaen mokineol hk8ttcnnp14 i1- V., IP3.SI Nor PmN Nnl Prk[tl ]v3.31 99JJ6 TG hidil nunkgfaekycare, per da-ph;slnrr.•.prom;and-1 tleniaon makingol lii9M1emnpledh -Op 158.49 Not Prcetl -P- 156.e9 593W iG Mhia nunbgSadfrRrarc. per tlaYmmp M1iNory;[omp uam;+M mdk+IdurNen makingel k�r rmnple.iTy DID30n ISg.49 Not N'cN Nelprtd 158.49 T. ml9.a nursngimrdymr, par dry,rump WWI, comp aram: and mdialtlttbinn mullrtgnTWgn rempleeity -f,p Isg.N Nnl PrkN 3ks%bd 55868 TG .-A nvnagladfrryram,p y, p s , D medkal wf 1F649 Nvt heetl Nns R'x¢d 158.49 9gFOT Subar -I mrraag breity 1.,tmr1,y,2aL pmbkm keen hgmry;p-1- keen wm;,H ,I,hed d[dsion making 0.18AP 30.J9 Nat 11- He[heN 30]9 99lJT Subsequentnursing WIN, ran, per 1., 2 oh Pmhkm loetnbdmry: Prnhkm bras nam; staaigaHwd tlerislonm 3 -1- 39.19 Nor Prk[d Nol piked 38.39 ] eq r-It F,rlkY-w,d.,2eE. Pmbkm locuah'ii ii-kms wen; -tip L1. Net heN N-- A. 'fly} e4 rnu gklik, I.,]ef�mehEm brrn M1'ntarv: prohkm bens caam; svalgbUwtl tleFJoa m,kbfl g.}OIW ]2.9d Nvc hnN Nor PtkM R99 3 eq enl nmvn9[xr4ty mrperdaY.ioF.nmbkm lrcmM1bmry: Prohkm W[as-..m;,tolghtnwddedummaLad -wip 21.9a Plee wkN Not %erd 2191 99J0] egvenl nunmB lxAeyarc, rcrdaY,iol;mm�kmfnrm M1gmrv: prahkm k[na.,,m;,enlyl,tf„aeraron a ]1993/OP u9a No[Preed Nel liked zzso a 596srquenr rvwymp luigryrare, pdrday,2of: prohkm lrctn M1'ntary;pmWem ferns esam; stnigpt3wdaeduunm g D20AP 90,13 Noe Prkea Not Pend sp,33 I t[. 5uhsequmrnurskgixiliry tare,peraay.leT: prukErN lokm hklwy; problem lams aam; svalehHwd tl=dsmn mpNPg H2OA]P -3 Nut ReN Nal- M.13 99J8T TG Suhsequen mdawtg lxAlcy rare, par day,}ef.p-kmI--M1eI.,p.Wem bens esam; siraghrfml dmismn maxng ti.r VLP S0.1J NorncN Ne[hkN SO.1J ie tiub.gpmtrm.irm L.tlitytarn, Inr JaJ, 2of moblmnfeimbatuvy. pn,l+lanf Harm maidufwd J«'tdmnsaN 21 gs9/oP w23 Net Pmea Net%kN Su23 Sifmmruammum Gvgiy vmy pw Jay, iul gpJJ F.-I-hwc[ .Ad -I -taus -law rbs.ivn-mu oIanp w,3a Not heea Not Psketl 563a 99l98 yub•pPunrmmoe fadilS rare. pnday.2A. espdd .1- 1-1 hr,pJJ prnhh frwusm m, lun r6isiunmekeul mlMop 5g,34 Nol Pried Het PrkN III ,34 99JJ8 Sifoleyueuxtn'utS faaJiry mre pN 111,2v11arl"IJ pmNenfm..hc,,agaJ pmbNm fu[m�v.mlaw Jca•ipn nnbma 0.2glIP I15i Nm Prkd Nor Prnd 42,5E m Subrmltunl rnm6gfailiH--arc lnr Ja.,luT.cpN nmNmn fv:w lm ryuld pnrhkm fwm wren low Jc.bkomshina 0.1NOP n2.52 Nm hkd Nnl huN 41.51 tiubrmlrimitnm'umf ilityaus prods., lul espd luoymn Nuw hr. qAd pnbbm funs curt luu Jai+innmd:'mf 999/tP a2.s2 Not amen .1PrkM g252 99lOg end hrei a poraay.2oF. erptld prohrmtluus ln;eydd pmWem lams �ram;bwtlm i3-r991op a2.52 NorPhctl Nat Piked rtx 53 1� L,hsr9uenr nm,kre �xilitycao, perday,2uf.e•ptld mohletn ideas h.;�9+dd pnWem Forvs namibwtlnkkn matng 20ltP Nef P.'cN 0].T2 993W Te Supsc9utnl nmskr hcili nn, pmday. 2 ob.uptld Prohlern IL-, 6.;n de.-larmseum, low den -wmI 83.1E Nw Piked Hut P•krd gfR subiryuenl nmskt hrdiryom,peraay,2vp. erptld prohrgn leees h.;r dpmblem lams nam: batln;skn mating 21-999l IP Het hkrtl 63.2E 99]98 gG Svbsrqum nwskrp hcigrynm, prrdaW.2oT: exptla pohkdr lxns b; eq,dd problem lmrsnam, k.vtlnulen m+ g 21999/0P 83.1E Noe %ked Nor heN gl 99N9 ep rnm,mg}a•Hitygm. per 111,.b.d[ni.h'nnry; tkralld Dart; medmte metlinl tlerisionm g 0.1enP g1.51 Nothkra Nn%red gt 56 eq In gmillty rite, per dpy,iel dcmikd WHory; denilea dam;mdeoremNkaltledsionm g -f., g155 xet wkN Not P.. gLss Svh,rr rnr emsrn0 hlihtyram,peraay,2uNd-ii Wsrmy, derpikd yam: moaen to metlin l de[blonmukbrg p}pAP 6L35 Nor Prnea Nel pm. 61.55 g9ld9 Suhsryuen ntaakg}a[ilkynre, perday,2eF. detalkd Msrory, rkralld e,am: mpdrra[emetlkal Mciskn making 0.10(HO b1.55 Not Preea NOI%kd 6I55 99399 Svbsequem nursinSfr[iRy rate, per tlay,laIA-1Ldd ksrary; rkraika nam; mmtval=mrd'uldmtionmaXing 21-999/IP 6L55 lier Piked Nol Rked 6L55 99399 S.byryu=elnmsln8 hdlilycam.Itrrd.,. .E.eenikd Wsroty, Jeralkd nam;.-Li,-d-1de[Y;enm g 219nicp Ii- Nor Piked -I.- 61-63 eq aria m9}aeigryore, per dil, i r:d.-kilt -1W nam; mdmk metlialrh[isbnm s -1, 11y19 Nor PskN fks%eN ll]-19 ry tnu inglarihryanm,peraay,2op. tlenika kslery; dcraikd uam: motlenmmetleal tleremn mkng 02pfHP 11i]9 amri'rtN Not PriN 13 r.19 Se Svbsryamttnm,ine}ailirycam,peraay,2vg. tlenikd ksmry, rklaikd uam; moderanmedkal eecb:nn making a199f1p llT.l9 Norl4tetl NPl Print 1F1.19 wJbS TG Sulnequent nunkg fa[J;I, r+rr, prr day, 2 vP. tlntaikd ka .rktalktl qam: modrnrr medbxldecbbn making I1999fOP IV- Nw Pmetl Not PrkN 1F].l9 .150 Svbsrqumt nursingfrd8ryaan, perd.,2o1-p hbmrv.mmp emm;.-I tleusion mekingef Wgbawnpk•i!y -Ap 1ifi15 Nm %ic.M HotPmN I]bLY 99lIp spbs=9prnl naming}npnycam.p¢rday,2ob.romp hbmry;mmpn,m; mrdnalderision maeurgof M1lgnempk.ily s38lpP 115.15 Nn Prketl Nvl Piked 11k15 9]JSo r9 tnu ga•'dily cam, qer J.,. .l: comp hb.1mnp Inn; meaual derision maabgol M1igM1aompkary o-30AP 8],54 Nw l- Nnr P[kd e1.66 Ip eq tnu inbhirbtyram,1-12 of mmp xbbrp:mmn[wm; metli[al der:slm ttulmgel Nlflh cmnpleary 0.29/0P .1. Nol heN Not Pdcetl dY.ga IO SuMequmt nursing6raryum,peraaY.2d- cwnp hisbHs mmp nam: mediraltlnision makng olkldltm 1141, -1.P a1,16 Nol Pr<N la9t hkN gT.Na 99JI0 Subsryuent nursinS fa[Nry=ate, per day,2.NI.p hhI.i,, mmp wen; merhnldm:dertmaFmg O bigh rn,i llaJ .p a," Nei Pskd Not PruN 8].65 .1. TG SubsrgumtnurzingfrrTrycan. per., l o -p kik, mmp cum; meaultleelsbnm+smg efhigh sompkpiry DMip H.I. ..lied Nm Pmed Fa8T8 9IJI0 gG spbscgnrm nu•sinbficiGryan. prrd., 2obcomp hbmry,romp men: mednitle[ision ma5mg efblglrmmpEairY DSoIUP l9fi]8 Net hkd Nvs,-. 148T8 SO r9 nu gaeJtyenm, per day,iel'cpmp hbrory:romp wen; meJlralderisan maLindel dish mmpkssry iF-99%tP ;Ifiig No[Pok[d Not Rkd F4kT8 1p eq tnu rymegihum, per day. 2 ep eemp h-r mmp exam; medlmldr[Eien mLinael h;gN mmpk,iry IIel9yOP 14d]g NM liked Not Ptke4 .-Ii UNITED HEALTHCARE WASHINGTON MEDICAID AND WASHINGTON BENEFIT PEANS FOR THE UNINSURED BEHAVIORAL HEALTH PROFESSIONAL REIMBURSEMENT SCHEDULE as 99]Ss Nunbs FauliYduYarge ear 4Nnagemmt; JO VFm IXe 0.1gnP 63.5] No4 PrkN Mot wkN r191 993I5 Hunm; Paaiary AulurBe pat Nbnagumen4: 30 hkn de 0.]&/OP a;53 Net RRN Nat%kN el �] 35 g aedhty Js6iM1yt8e DaY Nkmacmrnl: JO Min Ore pxONP 96,99 No4 weN No[PrkN 46.94 Is gaai6tysauM1srge my Management moan dr o-EWoP a69a Not weN Net R'red J6.d4 99318 IJuuess%ellllyilluluage eau hknagemenl;AlWm IN ll-A, 46.44 Nn PrkN No[PaN 16M 99315 Ilunbd FacgiryllimNrge pat Mru+gemenl;mM.nd� ES-999fOP rr _v Not PhN NeI P.iN dead 96 gFeelgly 9lreM1erge pav NkmJFmen4: •30 M:r OF&fIP 9g59 Not PrkN Not PrkN 9g,s9 Sb g asility plsiM1erge deY Managemem;.30 Mn OI&/OP 9g.59 Not wnN Nnl PrkN 99.59 16 g antitylliscNrge Day Managmenta30 Mn pI0141 ]J.JI Nnl Hied 43116 Nursing%ciliry Dluherge pay hAnagemen4;s3tl Mn -0D 1 ]dpl No[PreM Not wiN ]dvl 99318 N-M,I iliry -.,p Dav Managemenc,�30 Mk 1-99yIP ]d Jl No 1- IJot paned ]d4l 16 n 4+p6Jy plsi M1nge Dav Managemrm;e30Mk -99 F ]LJ5 Net PrkN Notp- N4l x9 mrdkryfreu M1omeubit new pa4knt,pmhlem fomM1hlory;pro[Pem foeweym; NealghdvrwaN tlnipon makk8 0.90(IP 1d9 Nal Pried Not PrkN i0.9 -4 1G Dnmiiluryfmsl hwneuGl, new pNknl,pm6kmfocm hhluT Prebkm faw exam;Mxle rferw+rd duNPnmaking p]AlpP )p.9 Nor prYM MotweN ]p.9 9932a 1G Dnm'rliarvlmst M1omeubit new patkm,prohlem focus M1bmry; probimfrcw •aam;NmigM1tlorwartl decision g 21 mip ID,9 Not%kcd Net%aN R9 9rlixd D-iii+,0-hmne v!L ncwpNkm.pmhlcm four M1'nmry: problemfawewam; w+4gNrterwvrd dechlmmAm. 2]-I9- A9 No4 %eM Not PriN TI.9 25 ikry/resl Foneunit ne.pal'enl,uptld preM1lem lean kNnrv;r•pdd➢robkm lrcusowm; kwdeuunnmakmg tF20/IP IO33g Nns P+eN Not PrkN W3.1g 4]315 FG t-.Jarv,-hwnerNtnewnaknl.erpdd pmMem mmshistory; eapN probkrrr ls<w eym: le+rdc lon mating g]plDP ]03.J8 Nat prkN No4 PreN 1-03.38 99326 TG pome,lurylrnt hmmena{tnew Patient, dpdd problemlesur N+Iwrl; erpdd Problem mc-, mwdemlm makn4 21�993/IP ]03.38 Ibt n- NUI PaN toll& 99325 TG pwrvilkry/mst homevbt newpNkm, Mptld pmhlem loom ldamry. mPM pro6km levuseaam; low tlemsionm g -99a2oP 109lg Mol PriN No4 wiM lt1138 26 mlkry{rest Ponedclt Hen Pe4'rn4, detvaN Nblwy:dnailN uam:dtthion maFingolmNerarc campk.uy pxMIP 199.]3 Not PreN efot %'uN 199.13 26 moi+rvfmst Pone-1 new pa4knt detaJN NisrorydeYdM vvm; dc'slon making olmNemm mmpkairy 0.lofov 199.13 Not PmN Net R'eN 119.13 99326 TG pnnkJluy/rest Faneuhtnewpbent,d--NiNeM.de4alNeram; desalm making olmMemrc mmpk.Vry ]3.999/Ip 149.13 Not PhN Nol Pried Id9.11 4932G TG -Icilkry/rest M1mne wt new patkm. hen JN hhmrytlewlNe•+m; de=g;on making dmoderaoe --I, 31-959fGP 34 U Not PrkN Net P- 199I3 m3YP pmm'r�lyrylmw honrnrlt newnalkm.comp Mstory: comp exam; dec4Non mabn; elmademte mmpb•iry 0.3onP 198]d Neel- NotP- 19629 2] mo uryfmst Fonendt newpatkn., mmprksmry; rmnp eeam; d«'men m+YinB Dime&rammmplMiry PJILJOP 19424 Not PreN Nel%kN -24 Tl3J] TG Rmd:ilial"rd hone sidt ppdind,unrmr hi4on: 99911P )9G)4 Not P,.w Not ReN I462q x] IJunoA---red hum+idi rmn paieq comp Nidun; uurgcr+rrt,6.d.ym nnkmp of rnxkmz wngicuN 99g/ov 19ru14 -11- Iba RiPd 396 Jq x8 Ty mn,nrv/rew Fmnewn,nrw natmm.comp hiuoT cwnP er:am:du'uion mating MNighmmpkaty p2pllP tvl9 Ne4%kM Noi PrrN 24x,9 28T.morarrlmst M1mne dslt new patknl, romp Msmry; ramp cum; dee'rue9 m+Ykg nlh®hmmpk.iry Yl9lov 24L9 No4 PreN Net PrrN ]dL9 993Y8 TG IbmiJi,rv(•3l hwneurt new Palknt, mmp history; coop eeam; decision making elhgFmmpk•ity 21-93514P tax9 Not RON Not PreN 24E,9 99328 TG pomilkry/mst M1anevist newpatknt, mmp M1ismry; comp exam;tlx'aian maYmg olhyh samplerity YF-9YNOP 24L9 Not PrtN Nnl PliM 3419 .1. TG pomilkrylmst M1anevrdt ntpa0ent]ok paohkm4nrnhkmry;Prahlmn bms Ham: sthvd mNkal tleeislwr eru g 0.21op 54.89 No4 Pried Nm PrkN Sf.89 Y ppmi�lkrvlrnl hnmcndt e•I palknt.2ol: problem Eocmh'amry;pmhlan locus e.vm; s[Iwd medkaldms.. ma g 0.NyNP Sd.a9 11e4 PrsM No4%kN H,g9 >4 oirryfmst Fore visit m1pahen1,2.11ruhkm Fam Lhmry; h.- Ham: stlwtl medkaldnlslon maY4ng 999f1P 5989 -1- Net RkN M316 FG midilryfrest None Nlr,Itp-,xol;pmbkm Fam M1bmry;Pmhlem Nos wied .1%kM SI,g9 99335 TG pomiT ry/mst M1an utn4 Wrtent]or:npdd M1Nmry;e•pol.•+nri bwdttgimn making 6)MP gG46 X¢t%ked Nul vied a1f 9g3]9 TG Oomkilkrylmsl h-Oft utpali-t]ol; updtl Nsmry;exptltl exam; 1- dnklon maYmg p1p/p0 gg4a Not1- N¢t lriN g6,46 35 perrV4Jbry/real honcvrsl4,eilp-k,2-1;npdd Mrwrycrpddmm.: kw dnNl¢n rnaYmg 2 WIP aed6 Ne{PriN Hot PrkN mI{ 99336 YG omnkdkryfmst honendt es4patient 2d: u pdtl ks ry, p ,bw dubcrvma5ing 1ww9 8696 -1- NelI,k g6.46 9933G TG pmiuibrrfmil Nwneuidl, nl patimt,xol:dekdN ksmry;tlnaikd e•ain;mM deds;enmp4ng 0.J0/IP 1JLw Not PreN NotF- 13266 99336 TG pmnkJury/rest MmevWr. nlprtlent,)¢l:deYJN Mrlervi delaikd cram; motltlecuion inaNng p]WOP ll266 rqt P4iad Not PnN 112% W- Te Domkdiarv/mst hmmCviml. eslpatlenl.] nEi. Bed N3mry;tlnmkd eeam; madde.R4en mating 1111w,, U- Nal PriN Noc w'iN 13L66 % DemkdYrvlrntFamevhlY ar pnelenr,2nF� decoded MNoltdnalkd Ham; moddeuckn mAI 9...P 112A No4 P•kM mmp- J3Lb6 3l eYevlmst hnmevkit m4patien[,1-1 mmp M1Merre mmp nam;mN m hldh dnh;mr mating -A, 19533 Nm RSM Not- 19l.. 9933i iG miduw/mat hemekidl, col patienl,xeF.mmp hb]ory; comp-.,;mN m I,kh duirkn making 1Njw x95.33 No4%eN Nol P4iN .5,]3 9933] TG DemadU,)-, hum knr Wtient }oNmmp hbb scoop eom;mN m hlglr-1-mating nnmliP 195.3) Nor %ied No4 PreN 19SJ3 95337 TG D.kilkry/cost hwnevidt.1 W-I. of mmphbmry; comp •.vm; mutl b hldh declsnn -mg 2,999IOP L9S33 Not Prked Nor Pried I9533 493d3 wnc YSR N-Pt3YeaCwnpwrrnrs:%Pb rows ll,'Prob Faus E.w;9ulR.d Mmd [leri•im 0.1anP v,,3 Not PrkN No4%kN 32.31 3 me WrtNew%3k+-P[onpenmb. Pmhrewrll.: Prob Faus ExNn; 5lrthytl Metl peJslmr 0.181GP 3)JI Not P- 11o4%kN 1Y.. 9gNI me YnNNewR3 uY ponenn, Penb Fours W, Pmb Feeos Penm: Strllwd Mad Decision OLply xe l6 [lolPmN Net Rkrd ]8,]d 993d+ YmN New %34y [em Pmb Focus He; Prob Faus Eeam; svtNva Ncd Ouiskn enh:Pmb 0.JOfav 28,16 993d1 Nome YSR New %31kv Cwn Fowz Hr; PmbFaus &vm; 51mlwtl Ned Oeaiskn JS-999/1P 18�16 IJot PdcN taut Pried Torus Team; ShaFwd Nx:d Duislon 21 ryop vrkN I8,16 993dI 1G Homu YNl NewR3Nn Cmnpmrcnm Pmb Focus Hx,Pmb -E•mn; srrlhvtl Ned oecisim D3%IP Kr,l6 Not%kN H tvriN webFaus Exam: Synfwtl Med pecNmn p211/ar aRkN Hot PNCN J015 99341 TG Home WttNew%3AeyCompennY: Psah Faros lk; P.ab Fiscus Fsam; 9trtcwtl MeJ Deehmn LJA99/Ip 40.16 vriN db-15 avrll.; PrcbFowl &am:9tah,d MeJ petamn F-Vop d0,15 »ked Not PskN 9931J Heme Vrsh liew%]0.eyCnmpvnen N:6rptN Prob FemslM1 FwpaM Prob Foere E+am; MH Dun low [ompka 0.ldllP bg.gl wiN 58A1 WrtNew%3v+y �mPencnM1'F+wM Proh Faus M:Fa p- PmhFnen F++m;MN pernFwiamp .'p- 5g.8] Not Prked Notkl. ie81 90b1 YrtR New %]&eytan nb:F.wN Prob Focus Ha;Ea paM web feew E.+m; Mrd Dunirsw Comple• 0.261iP priedN.141.39 493dx woe WRclew%3peP[om;wnrnb',ErgM Proh Faus]Is:&WN Preh FmmE.am;MN �ec�lmv Cnm -zlop 4R.39 Not PrkN Nne wkN %3geyIonponenn.-E•pN Preh Focus w;kspaM Pmb Focus &am:MN Dnrvlaw FamPkv ll99yIP Not RkN 9d.39 9939i Home Ysi[clew%3geFCwnponnrs;Srp+N Prnb Fecw Vb;&paM vmbFocm Esam;MN Deco lew EemMu 11999)pP J4.39 Net prgN Mot RrN dd.39 i umPYSR NcwR3pePCompmunh;F•MM Proh Faus Hx:ErpaN ptnh Fncas f.am; Meb oecrelmv Cnmper 0.2onP 5].i1 Not PriN Not wiN sy.yF x mevnrt New w 3 Pay[onpencno:E-M Prnb Faus lh:£tpand Pmb Tows Sum; MN Oecn low Comp p]DJOP 51,17 Xp1 PnrN Not PrrN 51.11 1 me WrtNew%3 Kry Gmpeeenb:4 Preh Peenslk;Fxpand%oh Focus dam:MN pnn cow Cmnpin 2]-9 ,p 5L]1 NeI RkM Not Ilk- SL11 993as 16 me Yrs:t New R 3 ray eempwren6:F•ryrd Prob -- larjipaxtl-1, Fnem in 999/oP 77 No4 weN I el v7, 5].]] UNITED HEALTHCARE WASHINGTON MEDICAID AND W ASHINGTON BENEFIT PLANS FOR THE UNINSURED BEHAVIORAL HEALTH PROFES51ONAL REIMBURSEMENT SCHEDULE 3 limn=t'irit\'ea-plt&eJCrmgrnrmu:l]ssadnllMlkuiled Fr+r¢\fat lJ:.i,.m,\I:,J Crmgtleyin omflP n.s Net v,ren rvotneea n.s 3 Nrrma\6X\�a»Rsx+Foer9mnnb, Hpadrd llsi ka+a+a c..m. Ord Dddan sled �,mq�t. o-2woP ns uerwaa Nal Prrea ns t tG 3al\eu R3seyemyww.as-lxNilnl xt lSewJed F.+rr�Lsd Dsisiw \]rot ernylnit. )]-NN ., ]],5 Nes pre+d Nat Pried n.s 9939] 1G 14nrm 1'hilYm'D3Kag fmyrmmu. Dusild xy: PaauM FwaLNd nvdanYWl CmaglmN)' 1]9941DP n,s Nat Rirca Nd liked »s a9]M IWnwlu1 P,3I:ny Cmgw:lw': Cwyr dcmbcfle Covgtrhmn'cE \I3 Dntdu¢3bJCwylc'itg 1aHP ]0499 Net hketl Net AiM 3D69g 14me L'i.ii\'euR]Key Cwrp�ena.:C•miprde+sn'clk:Cwgrirh.eiyc F.utrt11.LL I5e.iurm 3loJ ('my.letitt- o-salNP IV6.99 Nut PreN no[Pmea SOQ99 ¢ Ilonmtwit\'ex H?Aart'mquruae_Commdatwwi.elL�.k'oryahmix lismmRluE Hii.'um\lod eoegkdtr D2DlIP Knls Not heed NOI PekM gD.]9 993K Ilrrm=t-isil t.+r Pr 3l:ry Cwnprmrnl•'C.mpr iry rv=ISV Crimpn]wen9 Fynm;\IN Iktia�m.\IMI t'oiNrk.uly W. W.]3 Wthird Not Prketl Kp.is ?]3N6 Ilumc l'hh �neM3Kcy L'mgmreu:L'on4rciwinb'c ILe F:wyrthwuhr Gmc\INI SY.+titiw lbtl Cwyktity 21999/lp K0.]s Not hketl Net hV:ed KH.]s va3ad HHec Yhit\rn'R3K¢r CwquayKa:Cungr haubs HCCwyrchaehr Hysb\IeJ I)nvian \L.J C.mpktityn avaloP W.'s Nnl R+vetl Nul Area 6n.]3 Ileme Yml Nnr R 3 K4y C.mN^nkm.;fam]eduur].+RI: Crmgreh n. Fab•clhl T]oddensbd Cr 1,l n o-iDpP 132w Not Pmea loot weed I32.G4 99Nd4 elwrt\e»A)Key Cm�nnurts: Croup 3niene Hr C.mgneRmne Fs+ml6lx�uep,llud C.mg•I=':il!' o)opoP 1)Z,61 Nel pr[=d Not PricN I]2W 993W TG lirm=v.it,\=u IN l-i-%M3l'Im 1-, i199911P I1L61 Not PrkN Hothked S3LM 99344 TG ifrmc Y'hil Nem Ril:n'Cotuimx¢s:CwapteltemnclEclungtehnn'eE ane\fW Ne vim\fuJ Cangksv]' Y]A09/OP z1261 Nnrh'cM N.. 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P nsrve H•, pmlmnsire Ram; MotllHyM1 [nmPrealty 0.I9pP I29.53 Not Print Nm I- IE4-S! 91350 16 Neme Ylr9 ht P12+kry[nmpnrnm[s, fnmprcM1enshre H,p, fnmpeFensxe Gam; hledlNyN 6omAle.ity -X, 129.£3 Net PreN Nm RbN 129.93 99350 ]6 Home Vu'I Em PS I, PI, mponen¢:CampreM1emive Hn:CampmFwnsire Ram; ModINyM1 Cwnpk•Ny 99911P 129.h3 IR[PreN Nos RkN F39.53 99350 1G Name Writ Est Prl-NryCampprrnu: GrmPrnhcrvnivr Nx; 6pmpwM1rnsirc Ram; ModIHiEN Compkairy 1s"op 3x9.S1 Nol lwiJ Hot PreN SE9.53 lan9 y rwre,W/RdongN Phryirian Alsmtlanre, hsM1 301rkn 61M1P tl3.99 Nos Prked Nei P- e�9q Fa NrPiMn slanffiYS+++rire,W/RderMJ Plgeinan Anend.nre, E+rh mein o-lJpp 4l J9 N., pried Nos PricN J3s9 99366 M-d Team Conkrenu,Fa+eTo-Fa+ewilM1 P.-,N 1.,-AY MMinor More, Pa rucrpaeon hY Nnnphysi4n o-2xfrP 26.E2 2S.El iE9t 36.81 993E6 MNkal Team Cmkmnrc.Fair-lo-htawllM1 PalirnlaMlpr lam4y.mM14nm Mort, Pndclparion by NonpM1ykun 6dOlOP 3d.P1 36J1 26L1 26.61 M kvl]e+mCnrrinprre, Fac TmFaeewlrM1 PaNnnnrdferRmdy, 3n Atinm Mar Pxrhs+parion by NonpFykkn 2199971P 2fi.pI ]6.Bi 36E1 26.81 [6 MJial leamCmlemnrc,R.c]nFx•wim wllrnr andler Yamrly,mMinw Mme, Pwtiopadnn ay NonpFy n E1-999fNP 16A5 ]681 26.9E 2E31 9836i MNmtl leam[nnlerenee, panentaNyx Fms,lyNn present,30M;n er Mere; parN.ipatbn by vFysicrzn lluip EI]N Nes hkJ Hot PrkN 61 N4 9936i MNkai TeamCminente.Padent -fn Family Not-M.m M-1 Mote: Pardt;paton by Ph,.- 18/NP E9.21 Not PrkN Net Pr I. &32) Ll McdeJ leamCmrinen•e, Patlent and/w iamity Nnt Preserrt,m Miner Morr; Pxurp.ebn by PNYsit ian 629/IP 169T Nat FreN Ner RCN 4607 61 of team Gnlne tlent antlfm Famiy Not Proen[,m Minor Mme; Partie4arbn by phllrn+n 0.29IOP 636 Not Prketl Nnl hkJ m.6 .I. 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UNITED HFAUTHCARE WASHINGTON MEDICAID AND W ASHINGTON BENEFIT PLANS FOR THE UNINSURED BEHAVIORAL HEALTH PROFESSIONAL REIMBURSEMENT SCHEDULE �VTlROPCS 2 9_ AcdodkCompxhensire Pre•rnuse MMhlne E6M WAk/EMm, Est Pt, Ib Vr D19A]P 9E.p5 Inl%ied Noe Pricd gg.n5 ] talk p rxem[rewenw MMldnc EBM WM•ffPam. 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E. b; 12-0Yr D20AIP 1]0 Nel Pried Nel Pried 1]P 99395 ftnudiul:rmmmks�'•e ln�emn<\tedime FR\I SVHs--tiseq F�llY; ly-inli 0.ig/IP 1. 13 lbtheerl NOI Priaed ]E 13 95 P,uiodic l'rmNrabuuiae WnemMe \te1..eE�l"',IKE- En El: 1k11 Yr MIy1xP Im.n Nor Pried .1 preed F99.R 95 u,d,=r'rurrprµPmy=1'mvdbs llWiNeER11 MHe Cn E p,I"Yr 0.2nJM 51.9) Not Wked Nos Preen 5p.97 95 P-0,,l:Pmprchxd•e line2bx \1wli:klc E.11 1 LtamFIR; M. }'r W.Mp dlA3 Net hked N¢[Wkcd W.u1 99}]9 i. 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Not Prced Net Weal N%2 99{{1 TekpheneE.1- and Mmnagmens 5- P.- 4 a Phssldan: 5� M Mlmauc of Me 1Psuwldn 61VAP f5 B9 A4,e pried Net pskel ISBy 993J1 Tekpbulr. FwWnarl and Management gerpse PeeMtled bya PhLrklm: SlOMlrwter of RAe 1Nuwlen o-ID(OP -21 MI IF- Noe Areed 99g91 Trkphone Evaluatnn and ManapRanervs Sets•. Wended bya Th,-; 114 Mlnurcc W Medlnl Msnndon 99311P 13 gg IlWPaN Not Prketl IsdE dl leiphpnr Ewluatkn and Management Senice PmeidN bya Ol,y.ic.n: sl9Mlmrim mMrdkal Gs=rnJe•r !]A99/t]P 1fi]g Nel Ried N¢I preN 16]8 ! Felelges EsxbvtionmW\£uu,uma[Savex Wrnid=J hia Hnakive l]-N]?fiwlm of\1uNcal l]isusmn P38Ap HI.39 IJmhked N¢I Preetl 39,34 J! F=klir�m E.•alwiun and\Tmuumxn[Ssnix I-idd by.Pbp:las lt-VI\fima¢s us\fdi:y lhusw+rvn 0.lgl0P 95.fd Iyul P.setl Nos heed 55,66 999u! Telephurc Euluauun anJ\Inux¢rne5mis W.,s;dd hYa Plne:ian J]-ID \hmrrq r,f lkNul lTsusw¢ 0.]tlAp 869 IlosPreN Nos WkN H,VI 99J1! 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P6rre pens.. -anon LLmNp ]5.] ID.] FO] 1G.] 33 tM1ll Iker.,drm:tdn9r9vau„n unl.t uwm�lkre 2xA9 1 1d) -1 1.] I9.1 3] dal Mnds.tr9n adrrrmnir+tu , 5 act Cbse..eTon i599910P lO.i 50.] 1u] 10.] PYb3A ealmn Tra gA.pporL Per lS Mfrwte 0.1G/IP 9.pI 9,9E 9.ex 4pI }Pp9d uatlon Trai g pp ,pv lS Mmn[n tr25(OP -2 9.px 98x 9.GI HDD39 Metlk.- Trainmg AM SUPPOM1 Per IS Mbw[ez 219 1p 981 9.8E i 9.82 UNITED HEALTHCARE WASHINGTON MEDICAID AND WASHINGTON BENEFIT PLANS FOR THE UNINSURED BEHAVIORAL HEALTH PROFESSIONAL REIMBURSEMENT SCHEDULE HPGxI M-.- T-Ml and soppnL Pn is Mlwta x1999/oP 9.a2 9.8E 9.a2 Medralun Trainnv ana seppert,➢er l5 Mlmnn OtOAP 9.0E HOpx TG Mryiatipn nairiing a�tl soppnL Pee is Mlwre 020lW 9.5E Aa2 9.8E ra, pet l5 Mlwtn 93d/IP 9.ai HPax IG Mcdh+taco naieinq ana soppml, Pw is Mlwte 21.I./. 9.5E 9.9E 9.8L xaalS an, Ontmen4lau TWn l4 Hews 02H(IP 103.OJ HW35 HK Mervral HealN PartdalHwpitalhmion, Trnrmeny. ass flan 24 Noun 6XV0➢ 101trJ EO].03 }BlW -is HK men4 M+sTNn2A Hew 999IIP at. 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HAlis unity suppwtservias, per JSminuser EI999fIP Jb,63 ]a.6J ]8.53 'u.is 16 Comprehensi a ommuniry suppwtservius. per tsminutn II-94lfOP Fa.63 11.1 620AP 1)]a JS63 L1.1 IDI] 0.ythnsA.ul mN9hillution seMrn, per l5 miwin 0.tApP t" ]].] ..7 21A9911p I1_1 lY.} Lt.) wKhorwxlyduLdlutlen serMeLPer LS mitmtn S�1mnp 11,T L, 1 L17 1).x N2011 1G -0111 Ill it lY.] ?x0(OP L7.1 I],] 17.7 120IT 2].] a2.7 L.2b999yQP a LT.] L]T 1xx 112iR4 rRxapeuk LeM1xforalumkn,px LSmnutn 6IDAP11 1111 11 S2ll.52 Hxln9 V-1 11.5E U.52 U.51 2NerapeutY Ikh9.sorarurukn.pn L-a- -pp 115I 115E N2N5 Fkmaprut*hrhaNmalscmicn. ml5minulcs 9p9/pP 1F 51 walxru�n, nl5minwes o-2011P ]6.35 ]G.15 36.Ss L.LS Niil19 16 ihwaprutk hnM1Mwaiurvtcs. pn l9mmutn O2p/uP 1e.35 HIOy3 E1999lIP 36.35 36.35 -s ttEW9 T6 TRe apeuti hehanwa[urvkn. pn l9 minutes 999f- 36, 35 NxvxO -Ap Sat% 5a19s 501% the.+p.uu 6.n+vic�+t s.mtres. per dkm llt0l� 5019a Set 96 X2,96 50296 UNITED HEALTHCARE W ASHINGTON MEDICAID AND W ASHINGTON BENEFIT PLANS FOR THE UNINSURED BEHAVIORAL HEALTH PROFESSIONAL REIMBURSEMENT SCHEDULE oral sererq per diem J]A9)!IP Sp296 9g3.96 56296 ux4xA Tnnapen «Jmnadnrvlxmiea.pertlem JmroP .e S9 ]br 94 saz96 o-t9rlP lo-s ]m IGk�6 xx4u enmmnnrey Wsee wrap.arvnm aerries. per lsminnrr, o-loro-P lot lei 214AM 301 µI itrl PI-i G.-iN WSMwrap.amuM servies. per 15-.P. aJ99ft]P ]OI let 1.1 per tlicm 4ltulty 53,91 H292t [emman rybasetl wmp areuM xrtitts, pee diem 4Z4IO1 53.4E 53,9E 51 5392 pn tlicm 53,9E 539E HNI2£ Cnmmamtr-Wsetl er,porvuM rerdrq pe. diem £199914P 53.92 53,9E 53.9E p<r Mem o-xp/tP 5392 51.9E HNIt2 lti fnmmun eYW3etl xe,prmwd reruns, per diem P 53.92 53.9Ediem 911P SIR ILI- ]G ilr-based ma amdrd servicespn diem 910P 539E 51.9EmulPN2p33 5appudN emtxmvnentper l5 mamas OP ]G6 10G9fIPHib2] Parted emplrnnent lcmpbvmrnt. 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