diff --git a/streamlit_multipage/Interface_1.py b/streamlit_multipage/Interface_1.py index afde0f6..e6182a1 100644 --- a/streamlit_multipage/Interface_1.py +++ b/streamlit_multipage/Interface_1.py @@ -99,52 +99,23 @@ with buttons[1]: else: with st.spinner('Running...'): time.sleep(2) - if (save_uploaded_files(file_list, os.path.join(os.getcwd(), f'temp/{client}'))): - st.session_state.numFiles = len(file_list) - st.session_state.uploading = False - st.session_state.show_batchID = True - st.rerun() - else: - st.error("Failed to upload the files.") + st.session_state.numFiles = len(file_list) + st.session_state.uploading = False + st.session_state.show_batchID = True + st.rerun() + if st.session_state.show_batchID: st.write(f"{st.session_state.numFiles} files uploaded successfully!") # st.session_state.file_list = [] add_vertical_space(1) -checks = st.columns([0.1, 0.12, 0.12, 0.12, 0.12, 0.12, 0.12, 0.12]) -with checks[0]: - st.write("**Group No.**") - -with checks[1]: - a = st.checkbox('Unique Key') -with checks[2]: - b = st.checkbox('Pricing Before Carveouts') -with checks[3]: - c = st.checkbox('Contract Related') -with checks[4]: - d = st.checkbox('Provider') -with checks[5]: - e = st.checkbox('Timeline') -with checks[6]: - f = st.checkbox('Carveout Indicator') -with checks[7]: - g = st.checkbox('Carveout Methodology') - -add_vertical_space(1) - -df = pd.DataFrame(columns=['Contract Name', 'Unique Key','Pricing Before Carveouts' - , 'Contract Related', 'Provider', 'Timeline', 'Carveout Indicator', 'Carveout Methodology']) +df = pd.DataFrame(columns=['Contract Name', 'Run Flag']) df['Contract Name'] = [file.name for file in st.session_state.file_list] # df['Contract Name'] = st.session_state.file_list -df['Unique Key'] = a -df['Pricing Before Carveouts'] = b -df['Contract Related'] = c -df['Provider'] = d -df['Timeline'] = e -df['Carveout Indicator'] = f -df['Carveout Methodology'] = g +df['Run Flag'] = True + dir_path = os.path.dirname(os.path.realpath(__file__)) print(f'DEBUGGING: PWD= {dir_path}') df.to_csv('temp1.csv', index=False) @@ -168,45 +139,14 @@ additional_info = pd.DataFrame(columns=['CLIENT_NAME', 'REQUEST_USERNAME', 'REQU additional_info.loc[0] = [client, st.session_state.user_info['mail'], datetime.now().strftime("%Y-%m-%d %H:%M:%S")] st.write(additional_info) -st.session_state.contract_count = 0 -contract_list = [] -for index, row in edited_df.iterrows(): - allow_run_for_contract = False - group_list = [] - if row['Unique Key']: - group_list.append('A') - allow_run_for_contract = True - if row['Pricing Before Carveouts']: - group_list.append('B') - allow_run_for_contract = True - if row['Contract Related']: - group_list.append('C') - allow_run_for_contract = True - if row['Provider']: - group_list.append('D') - allow_run_for_contract = True - if row['Timeline']: - group_list.append('E') - allow_run_for_contract = True - if row['Carveout Indicator']: - group_list.append('F') - allow_run_for_contract = True - if row['Carveout Methodology']: - group_list.append('G') - allow_run_for_contract = True - if allow_run_for_contract: st.session_state.contract_count += 1 - buttons = st.columns([0.8, 0.2]) with buttons[0]: st.download_button("Download Table", csv, "file.csv", "text/csv", key='download-csv') with buttons[1]: if st.button("Run Doczy.AI Pipeline"): - if not st.session_state.contract_count == len(edited_df): - st.error("Select at least one Group No. for every Contract") - else: - with st.spinner('Running...'): - time.sleep(2) - st.write("Success!") - st.write("Current processing time for A & C: 1 min") - st.write("Current processing time for B: 10 mins") + with st.spinner('Running...'): + time.sleep(2) + st.write("Success!") + st.write("Current processing time for Contract Terms: 1 min") + st.write("Current processing time for Reimbursement: 10 mins") diff --git a/streamlit_multipage/pages/1_Interface_2.py b/streamlit_multipage/pages/1_Interface_2.py index 0f24f9b..a8cb1c3 100644 --- a/streamlit_multipage/pages/1_Interface_2.py +++ b/streamlit_multipage/pages/1_Interface_2.py @@ -5,6 +5,7 @@ from streamlit_pdf_viewer import pdf_viewer import pandas as pd from typing import List import os +import re st.set_page_config(layout = "wide") # Sidebar contents @@ -65,7 +66,9 @@ if client: try: folder_path = os.path.join(os.getcwd(), f'temp/{client}') files = os.listdir(folder_path) - file_list = [f for f in files if os.path.isfile(os.path.join(folder_path, f))] + for f in files: + print(f.lower().endswith('.pdf')) + file_list = [f for f in files if f.lower().endswith('.pdf')] except Exception as e: print(f"An error occurred: {e}") file_list = [] @@ -106,12 +109,15 @@ if client: df2 = pd.read_csv('temp2.csv') if st.button("Show Results"): try: - df2 = pd.read_csv('Demo_Test_data.csv') + csv_name = re.sub(r'\.pdf', '.csv', os.path.join(folder_path, file_name), flags=re.IGNORECASE) + df2 = pd.read_csv(csv_name) except: - df2 = pd.DataFrame(columns=['Contract Name','Field Name', 'SF_DB_COL_NAME', 'Snippet','Page Number' - , 'Field Extracted Value', 'Actual Value','Imputed Value']) + df2 = pd.DataFrame(columns=['Filename','Agreement_Name (Contract Title)','PAYER NAME','Health Plan State','Affiliate (Y/N)','Credentialing Application Indicator','Term Clause','Evergreen, Fixed or Hard Term','Termination Date','Termination Upon Notice - Days','Termination With Cause - Days','Amend Contract Upon notice Flag (Y/N)','Timeframe  to Object - Days','Assignments Clause  (Y/N)','Contract Effective Date','IRS #','IRS_Name' + ,'NPI (10-digits)','NPI_NAME','PROV_GROUP_TIN_SIGNATORY','PROV_TIN_OTHER','PROV_NPI_OTHER','Notice to Provider Name','Notice to Provider Address','Sequestration Language','Sequestration Reductions, included [Medicare only] (Y/N)','PROV_TIN_OTHER.1','PROV_NPI_OTHER.1','Parent Agreement Code','Pages','page_num', + 'Attachment/Exhibit','Line of Business','Provider Type','Provider Type - Level 2','Service Type','Plan Type','Lesser of Logic Language, included (Y/N)','Lesser of Rate','Reimb. Methodology','Reimb. Methodology_short','If rate is % of Payer or MCR [STANDARD]','If rate is % of Payer or MCR [STANDARD]_Short','If rate is Flat Fee [STANDARD]','Default Term','Default Rate','Inclusion of essential RBRVS "Fee Source" Language (Y/N)','CDM Neutralization Language, included (Y/N)','Chargemaster Protection Language','Exclusions','Not to Exceed','Escalator or COLA (Y/N)','Escalator I, Eff. Date','IP/OP','IP - DSH/IME/UC, included (Y/N)','IP - Stoploss Catastrophic Threshold']) + df2['Imputed Value'] = '' - # df2.to_csv('temp2.csv', index=False) + df2.to_csv('temp2.csv', index=False) edited_df = st.data_editor(df2) @@ -127,7 +133,4 @@ if client: st.download_button("Download Table", csv, "file.csv", "text/csv", key='download-csv') with buttons[1]: # st.download_button("Download Table", csv, "file.csv", "text/csv", key='download-csv') - st.write("") - with buttons[2]: - if st.button("Kickoff Database Integration"): - st.write("Stored in DB") \ No newline at end of file + st.write("") \ No newline at end of file diff --git a/streamlit_multipage/temp/Prime Care/13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1.Pdf b/streamlit_multipage/temp/Prime Care/13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1.Pdf new file mode 100644 index 0000000..290b3ad Binary files /dev/null and b/streamlit_multipage/temp/Prime Care/13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1.Pdf differ diff --git a/streamlit_multipage/temp/Prime Care/13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1.csv b/streamlit_multipage/temp/Prime Care/13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1.csv new file mode 100644 index 0000000..17dcfb8 --- /dev/null +++ b/streamlit_multipage/temp/Prime Care/13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1.csv @@ -0,0 +1,48 @@ +Filename,Agreement_Name (Contract Title),PAYER NAME,Health Plan State,Affiliate (Y/N),Credentialing Application Indicator,Term Clause,"Evergreen, Fixed or Hard Term",Termination Date,Termination Upon Notice - Days,Termination With Cause - Days,Amend Contract Upon notice Flag (Y/N),Timeframe  to Object - Days,Assignments Clause  (Y/N),Contract Effective Date,IRS #,IRS_Name,NPI (10-digits),NPI_NAME,PROV_GROUP_TIN_SIGNATORY,PROV_TIN_OTHER,PROV_NPI_OTHER,Notice to Provider Name,Notice to Provider Address,Sequestration Language,"Sequestration Reductions, included [Medicare only] (Y/N)",PROV_TIN_OTHER.1,PROV_NPI_OTHER.1,Parent Agreement Code,Pages,page_num,Attachment/Exhibit,Line of Business,Provider Type,Provider Type - Level 2,Service Type,Plan Type,"Lesser of Logic Language, included (Y/N)",Lesser of Rate,Reimb. Methodology,Reimb. Methodology_short,If rate is % of Payer or MCR [STANDARD],If rate is % of Payer or MCR [STANDARD]_Short,If rate is Flat Fee [STANDARD],Default Term,Default Rate,"Inclusion of essential RBRVS ""Fee Source"" Language (Y/N)","CDM Neutralization Language, included (Y/N)",Chargemaster Protection Language,Exclusions,Not to Exceed,Escalator or COLA (Y/N),"Escalator I, Eff. Date",IP/OP,"IP - DSH/IME/UC, included (Y/N)",IP - Stoploss Catastrophic Threshold +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Inpatient Covered Services - Medical/Surgical,,N,,"103.5 percent of the applicable CMS Medicare Inpatient Prospective Payment (IPPS) rates of Medicare Severity Diagnosis Related Groups (MS-DRGs) published on the CMS website on the date of the Member's discharge, including associated add-on and outlier payments as determined by CMS. All costs that are excluded by CMS from the IPPS rate will not be paid by Health Plan.",103.% of MCR,103.5% of MCR,1.035,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,All costs that are excluded by CMS from the IPPS rate will not be paid by Health Plan.,,N,,IP,N, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Inpatient Covered Services - Inpatient Rehabilitation,,N,,103.5 percent of Health Plan's Medicare rate schedule based on the applicable CMS Medicare Case-Mix Group (CMG) rates for inpatient rehabilitation published on the CMS website on the date of the Member's discharge.,103.% of MCR,103.5% of MCR,1.035,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,IP,N, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Inpatient Covered Services - Inpatient psychiatric /Alcohol/Substance Abuse Covered Services rendered to Member in an inpatient psychiatric facility or unit within the Provider's hospital facility,,N,,"$1,750 per diem",Flat Fee,,,"$1,750 Per Diem","All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,Y,1-Apr-22,IP,N, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Specialty Hospital - IP Specialty Hospital for Long Term Acute Care: - IP Specialty Hospital for Long Term Acute Care Covered Services rendered to Member within Henry J. Carter Specialty Hospital,,N,,"$2,250 per diem (Non-COVID 19 Diagnosis) $2,750 per diem (COVID19 Diagnosis: ICD. 10 Code - U07.1) $350 per treatment (Dialysis Add-On: Rev Codes 0800-0809)",Flat Fee,,,"$2,250 Per Diem (Non-COVID 19 Diagnosis) / $2,750 Per Diem (COVID19 Diagnosis) / $350 Per Treatment (Dialysis Add-On)","All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,Y,1-Apr-22,IP,N, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,"Outpatient Covered Services - Emergency Room (technical only, not inclusive of physician services)",,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - Urgent Care (Per Visit) (Rev Code 0516),,N,,150 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR OPPS/APC rates,150% of MCR OPPS/APC rates,1.5,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,"Outpatient Covered Services - Ambulatory Surgery (Including but not limited to Lithotripsy, PTCA, Cardiac Cath, Laparoscopy)",,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - Observation,,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - PT/OT/ST (Per Visit),,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - Dialysis,,N,,110 percent of the End Stage Renal Dialysis (ESRD) Prospective Payment System (PPS) rates published on the CMS website on the date the Covered Service is rendered.,% of ESRD PPS rates,110% of ESRD PPS rates,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - Chemotherapy Administration (Excludes Drugs),,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,Excludes Drugs,,N,,OP,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - Behavioral Health: -Intensive Outpatient Mental Health / Substance Abuse -Partial Hospitalization -Continuing Day Treatment -ECT -Ambulatory Detox -Telehealth Services,,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - Lab/Radiology/Pathology,,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - Radiation Therapy Hyperbaric Therapy,,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - MRI / CAT Scan / PET Scan / Sonograms,,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR OPPS/APC rates,110% of MCR OPPS/APC rates,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - Trauma Activation Fees (Rev Codes 0681-0684),,N,,60% of Charges,% of BC,60% of BC,0.6,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - All Other Outpatient Services (including clinic and DTC services),,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered or other successor CMS methodology as applicable.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,FQHC,FQHC Services (Payment Codes G0466-G0470),,N,,110 percent of the applicable CMS Medicare FQHC Prospective Payment System rates published on the CMS website on the date the Covered Service is rendered or other successor CMS methodology as applicable.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,All other outpatient services not priced by Medicare,,N,,"115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",% of MCD,115% of MCD,1.15,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Primary Care Services: (CPT-4 Codes 99201-99499),,N,,110 percent of the CMS Medicare physician fee schedule for the applicable locality published on the CMS website on the date the Covered Services are rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,OBGYN Maternity Care and Deliveries: (CPT-4 Codes 59000-59622),,N,,110 percent of the CMS Medicare physician fee schedule for the applicable locality published on the CMS website on the date the Covered Services are rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Specialty Services,,N,,103.5 percent of the CMS Medicare physician fee schedule for the applicable locality published on the CMS website on the date the Covered Services are rendered.,103.% of MCR,103.5% of MCR,1.035,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Anesthesia Conversion Factor (15 Minute Time Units) (CPT-4 Codes 00100 to 01999),,N,,$45 per unit,Flat Fee,,,$45 per unit,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,Y,1-Apr-22,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Telehealth Services,,N,,103.5 percent of the CMS Medicare physician fee schedule for the applicable locality published on the CMS website on the date the Covered Services are rendered.,103.% of MCR,103.5% of MCR,1.035,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Allied Health Professionals,,N,,85 percent of the CMS Medicare Primary Care Services fee schedule referenced above for the applicable locality published on the CMS website on the date the Covered Services are rendered.,% of MCR,85% of MCR,0.85,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,All other Specialties,,N,,103.5 percent of the CMS Medicare physician fee schedule for the applicable locality published on the CMS website on the date the Covered Services are rendered.,103.% of MCR,103.5% of MCR,1.035,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,All other professional services not priced by Medicare,,N,,"115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",% of MCD,115% of MCD,1.15,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,Skilled Nursing Facility,Health Plan's Medicare SNF Per Diem Rate Table - Level 1,,N,,Level 1 | $575 | 191,Flat Fee,,,$575 ,,,N,N,,,,Y,1-Apr-22,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,Skilled Nursing Facility,Health Plan's Medicare SNF Per Diem Rate Table - Level 2,,N,,Level 2 | $675 | 192,Flat Fee,,,$675 ,,,N,N,,,,Y,1-Apr-22,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,Skilled Nursing Facility,Health Plan's Medicare SNF Per Diem Rate Table - Level 3,,N,,Level 3 | $725 | 193,Flat Fee,,,$725 ,,,N,N,,,,Y,1-Apr-22,IP,N, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,Skilled Nursing Facility,Health Plan's Medicare Specialty SNF Per Diem Rate Table - Traumatic Brain Injury (Seaview Only),,N,,Traumatic Brain Injury (Seaview Only) | $875 | 199,Flat Fee,,,$875 ,,,N,N,,,,Y,1-Apr-22,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,Skilled Nursing Facility,Health Plan's Medicare Specialty SNF Per Diem Rate Table - Ventilator (Harry J. Carter Only),,N,,"Ventilator (Harry J. Carter Only) | $1,325 | 199",Flat Fee,,,"$1,325 ",,,N,N,,,,Y,1-Apr-22,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,Skilled Nursing Facility,Covered Services,,N,,"Effective April 1, 2022, services priced at a flat rate shall be increased by 3% annually up to year 3 through March 31, 2024.",% of AC,3% of AC,0.03,,,,N,N,,,,Y,1-Apr-22,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,,Home Health Care - Skilled Nursing,,N,,Skilled Nursing | 551 | $180 per visit,Flat Fee,,,$180 per visit,,,N,N,,,,Y,1-Apr-22,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,,Home Health Care - LPN,,N,,LPN | 550 | $180 per visit,Flat Fee,,,$180 per visit,,,N,N,,,,Y,1-Apr-22,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,,Home Health Care - Medical Social Services,,N,,Medical Social Services | 561 | $230 per visit,Flat Fee,,,$230 per visit,,,N,N,,,,Y,1-Apr-22,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,,Home Health Care - Physical Therapy,,N,,Physical Therapy | 421 | $195 per visit,Flat Fee,,,$195 per visit,,,N,N,,,,Y,1-Apr-22,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,,Home Health Care - Speech Therapy,,N,,Speech Therapy | 441 | $215 per visit,Flat Fee,,,$215 per visit,,,N,N,,,,Y,1-Apr-22,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,,Home Health Care - Occupational Therapy,,N,,Occupational Therapy | 431 | $200 per visit,Flat Fee,,,$200 per visit,,,N,N,,,,Y,1-Apr-22,,, +13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,,Home Health Care - Home Health Aide,,N,,Home Health Aide | 571 | $85 per visit,Flat Fee,,,$85 per visit,,,N,N,,,,Y,1-Apr-22,,, +,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, +,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, +,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, +,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, +,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, +,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, +,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, diff --git a/streamlit_multipage/temp/Prime Care/43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3.Pdf b/streamlit_multipage/temp/Prime Care/43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3.Pdf new file mode 100644 index 0000000..25bba2d Binary files /dev/null and b/streamlit_multipage/temp/Prime Care/43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3.Pdf differ diff --git a/streamlit_multipage/temp/Prime Care/43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3.csv b/streamlit_multipage/temp/Prime Care/43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3.csv new file mode 100644 index 0000000..12c7440 --- /dev/null +++ b/streamlit_multipage/temp/Prime Care/43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3.csv @@ -0,0 +1,76 @@ +Filename,Agreement_Name (Contract Title),PAYER NAME,Health Plan State,Affiliate (Y/N),Credentialing Application Indicator,Term Clause,"Evergreen, Fixed or Hard Term",Termination Date,Termination Upon Notice - Days,Termination With Cause - Days,Amend Contract Upon notice Flag (Y/N),Timeframe  to Object - Days,Assignments Clause  (Y/N),Contract Effective Date,IRS #,IRS_Name,NPI (10-digits),NPI_NAME,PROV_GROUP_TIN_SIGNATORY,PROV_TIN_OTHER,PROV_NPI_OTHER,Notice to Provider Name,Notice to Provider Address,Sequestration Language,"Sequestration Reductions, included [Medicare only] (Y/N)",PROV_TIN_OTHER.1,PROV_NPI_OTHER.1,Parent Agreement Code,Pages,page_num,Attachment/Exhibit,Line of Business,Provider Type,Provider Type - Level 2,Service Type,Plan Type,"Lesser of Logic Language, included (Y/N)",Lesser of Rate,Reimb. Methodology,Reimb. Methodology_short,If rate is % of Payer or MCR [STANDARD],If rate is % of Payer or MCR [STANDARD]_Short,If rate is Flat Fee [STANDARD],Default Term,Default Rate,"Inclusion of essential RBRVS ""Fee Source"" Language (Y/N)","CDM Neutralization Language, included (Y/N)",Chargemaster Protection Language,Exclusions,Not to Exceed,Escalator or COLA (Y/N),"Escalator I, Eff. Date",IP/OP,"IP - DSH/IME/UC, included (Y/N)",IP - Stoploss Catastrophic Threshold +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,3,EXHIBIT 1 GROUP COMPENSATIO SCHEDULE - MEDICAID,MEDICAID,Professional,Primary Care Provider,Covered Services provided by a primary care provider to a Covered Person,,Y,100% of AC,"For Covered Services provided by a primary care provider to a Covered Person, Payor shall pay Group for the codes listed in Attachment A the lesser of: (i) Group's Allowable Charges; or (ii) the Contracted Rate listed in Attachment A - ACA Codes and Rates. For Covered Services provided by a primary care provider to a Covered Person, Payor shall pay Group for codes not listed in Attachment A the lesser of: (i) Group's Allowable Charges; or (ii) one hundred thirty-nine percent (139%) of the State's Medicaid fee schedule in effect on the date of service.",% of MCD,139% of MCD,1.39,,"For Covered Services for which there is no established fee amount, Payor shall pay thirty-five percent (35%) of the Allowable Charges until such time as Payor establishes a fee amount.",35% of Allowable Charges,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,3,EXHIBIT 1 GROUP COMPENSATIO SCHEDULE - MEDICAID,MEDICAID,Professional,Specialist,Covered Services provided by a specialist provider,,Y,100% of AC,"For Covered Services provided by a specialist provider, Payor shall pay Group the lesser of (i) Group's Allowable Charges; or (ii) one hundred forty-two percent (142%) of the State's Medicaid fee schedule in effect on the date of service.",% of MCD,142% of MCD,1.42,,"For Covered Services for which there is no established fee amount, Payor shall pay thirty-five percent (35%) of the Allowable Charges until such time as Payor establishes a fee amount.",35% of Allowable Charges,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,3,EXHIBIT 1 GROUP COMPENSATIO SCHEDULE - MEDICAID,MEDICAID,Professional,,"Covered Services as listed in Table I, laboratory services",,Y,100% of AC,"For Covered Services as listed in Table I, laboratory services will be reimbursed at the lesser of: (i) Group's Allowable Charges; or (ii) one hundred two percent (102%) of the State's Medicaid fee schedule in effect on the date of service.",% of MCD,102% of MCD,1.02,,"For Covered Services for which there is no established fee amount, Payor shall pay thirty-five percent (35%) of the Allowable Charges until such time as Payor establishes a fee amount.",35% of Allowable Charges,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,3,EXHIBIT 1 GROUP COMPENSATIO SCHEDULE - MEDICAID,MEDICAID,Professional,Specialist,pathology services,,Y,100% of AC,"For pathology services, all pathology services will be paid at the lesser of (i) Group's Allowable charges; or (ii) one hundred forty-two percent (142%) of the State's Medicaid fee schedule in effect on the date of service and specific to the Covered Services rendered.",% of MCD,142% of MCD,1.42,,"For Covered Services for which there is no established fee amount, Payor shall pay thirty-five percent (35%) of the Allowable Charges until such time as Payor establishes a fee amount.",35% of Allowable Charges,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,3,EXHIBIT 1 GROUP COMPENSATIO SCHEDULE - MEDICAID,MEDICAID,Professional,,Covered Services for which there is no established fee amount,,N,,"For Covered Services for which there is no established fee amount, Payor shall pay thirty-five percent (35%) of the Allowable Charges until such time as Payor establishes a fee amount.",% of AC,35% of AC,0.35,,"For Covered Services for which there is no established fee amount, Payor shall pay thirty-five percent (35%) of the Allowable Charges until such time as Payor establishes a fee amount.",35% of Allowable Charges,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,3,EXHIBIT 1 GROUP COMPENSATIO SCHEDULE - MEDICAID,MEDICAID,Professional,,Clinical laboratory codes 80000 - 80499,,Y,100% of AC,The lesser of: (i) Group's Allowable Charges; or (ii) 102% of State's Medicaid fee schedule,% of MCD,102% of MCD,1.02,,"For Covered Services for which there is no established fee amount, Payor shall pay thirty-five percent (35%) of the Allowable Charges until such time as Payor establishes a fee amount.",35% of Allowable Charges,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,3,EXHIBIT 1 GROUP COMPENSATIO SCHEDULE - MEDICAID,MEDICAID,Professional,Specialist,Professional laboratory codes 80500 - 80999,,Y,100% of AC,The lesser of: (i) Group's Allowable Charges; or (ii) 142% of State's Medicaid fee schedule,% of MCD,142% of MCD,1.42,,"For Covered Services for which there is no established fee amount, Payor shall pay thirty-five percent (35%) of the Allowable Charges until such time as Payor establishes a fee amount.",35% of Allowable Charges,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,3,EXHIBIT 1 GROUP COMPENSATIO SCHEDULE - MEDICAID,MEDICAID,Professional,,Clinical laboratory codes 81000 - 81099,,Y,100% of AC,The lesser of: (i) Group's Allowable Charges; or (ii) 102% of State's Medicaid fee schedule,% of MCD,102% of MCD,1.02,,"For Covered Services for which there is no established fee amount, Payor shall pay thirty-five percent (35%) of the Allowable Charges until such time as Payor establishes a fee amount.",35% of Allowable Charges,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,3,EXHIBIT 1 GROUP COMPENSATIO SCHEDULE - MEDICAID,MEDICAID,Professional,Specialist,Professional laboratory codes 81200 - 81999,,Y,100% of AC,The lesser of: (i) Group's Allowable Charges; or (ii) 142% of State's Medicaid fee schedule,% of MCD,142% of MCD,1.42,,"For Covered Services for which there is no established fee amount, Payor shall pay thirty-five percent (35%) of the Allowable Charges until such time as Payor establishes a fee amount.",35% of Allowable Charges,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,3,EXHIBIT 1 GROUP COMPENSATIO SCHEDULE - MEDICAID,MEDICAID,Professional,,Clinical laboratory codes 82000 - 87999,,Y,100% of AC,The lesser of: (i) Group's Allowable Charges; or (ii) 102% of State's Medicaid fee schedule,% of MCD,102% of MCD,1.02,,"For Covered Services for which there is no established fee amount, Payor shall pay thirty-five percent (35%) of the Allowable Charges until such time as Payor establishes a fee amount.",35% of Allowable Charges,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,3,EXHIBIT 1 GROUP COMPENSATIO SCHEDULE - MEDICAID,MEDICAID,Professional,Specialist,Professional laboratory codes 88000 - 88199,,Y,100% of AC,The lesser of: (i) Group's Allowable Charges; or (ii) 142% of State's Medicaid fee schedule,% of MCD,142% of MCD,1.42,,"For Covered Services for which there is no established fee amount, Payor shall pay thirty-five percent (35%) of the Allowable Charges until such time as Payor establishes a fee amount.",35% of Allowable Charges,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,3,EXHIBIT 1 GROUP COMPENSATIO SCHEDULE - MEDICAID,MEDICAID,Professional,,Clinical laboratory codes 88200 - 88299,,Y,100% of AC,The lesser of: (i) Group's Allowable Charges; or (ii) 102% of State's Medicaid fee schedule,% of MCD,102% of MCD,1.02,,"For Covered Services for which there is no established fee amount, Payor shall pay thirty-five percent (35%) of the Allowable Charges until such time as Payor establishes a fee amount.",35% of Allowable Charges,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,3,EXHIBIT 1 GROUP COMPENSATIO SCHEDULE - MEDICAID,MEDICAID,Professional,Specialist,Professional laboratory codes 88300 - 88399,,Y,100% of AC,The lesser of: (i) Group's Allowable Charges; or (ii) 142% of State's Medicaid fee schedule,% of MCD,142% of MCD,1.42,,"For Covered Services for which there is no established fee amount, Payor shall pay thirty-five percent (35%) of the Allowable Charges until such time as Payor establishes a fee amount.",35% of Allowable Charges,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,3,EXHIBIT 1 GROUP COMPENSATIO SCHEDULE - MEDICAID,MEDICAID,Professional,,Clinical laboratory codes 88400 - 89999,,Y,100% of AC,The lesser of: (i) Group's Allowable Charges; or (ii) 102% of State's Medicaid fee schedule,% of MCD,102% of MCD,1.02,,"For Covered Services for which there is no established fee amount, Payor shall pay thirty-five percent (35%) of the Allowable Charges until such time as Payor establishes a fee amount.",35% of Allowable Charges,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90460,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90461,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,12.23,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90471,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90472,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,12.23,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90473,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90474,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,12.23,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90633 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90644 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90647 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90648 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90649 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90650 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90655 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90656 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,$25 ,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90658 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,$25 ,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90660 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,$25 ,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90669 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,$25 ,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90670 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,$25 ,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90672 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90680 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90681 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90685 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90686 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90696 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90698 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,3/1/2016,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90700 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90702 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90707 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90710 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90713 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90714 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90715 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90716 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90718 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90723 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90732 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90734 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90744 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,90748 SL,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,24.58,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99201,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,42.96,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99201 EP,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,42.96,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99201 GT,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,42.96,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99201 GE,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,42.96,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99202,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,73.5,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99202 EP,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,73.5,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99202 GE,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,73.5,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99202 GT,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,73.5,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99203 GT,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,106.61,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99203,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,106.61,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99203 GE,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,106.61,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99203 EP,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,106.61,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99204 EP,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,163.12,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99204,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,163.12,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99204 GT,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,163.12,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99205 52,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,204.84,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99205 UB,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,204.84,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99205 U7,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,204.84,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99205 U9,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,204.84,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99205,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,204.84,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99205 GT,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,204.84,,,N,N,,,,N,,,, +"43-0654872-Saint Louis University dba SLUCare, a Missouri benevolent corporation-ICMProviderAgreement_92767_3",AMENDMENT NUMBER TWO GROUP AGREEMENT,"Home State Health Plan, Inc",Missouri,No,No,,Hard Term,,,,No,,No,42430,43-0654872,Saint Louis University dba SLUCare,,,43-0654872,,,,"School of Medicine, 2nd Floor 1402 South Grand Avenue St. Louis, MO 63104",,No,,,92767,10,5,ATTACHMENT A,,Professional,,99205 EP,,N,,PROCEDURE | MODIFIER | CONTRACTED RATE,Flat Fee,,,204.84,,,N,N,,,,N,,,, diff --git a/streamlit_multipage/temp/Prime Care/52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3.Pdf b/streamlit_multipage/temp/Prime Care/52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3.Pdf new file mode 100644 index 0000000..4075831 Binary files /dev/null and b/streamlit_multipage/temp/Prime Care/52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3.Pdf differ diff --git a/streamlit_multipage/temp/Prime Care/52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3.csv b/streamlit_multipage/temp/Prime Care/52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3.csv new file mode 100644 index 0000000..db3de59 --- /dev/null +++ b/streamlit_multipage/temp/Prime Care/52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3.csv @@ -0,0 +1,117 @@ +Filename,Agreement_Name (Contract Title),PAYER NAME,Health Plan State,Affiliate (Y/N),Credentialing Application Indicator,Term Clause,"Evergreen, Fixed or Hard Term",Termination Date,Termination Upon Notice - Days,Termination With Cause - Days,Amend Contract Upon notice Flag (Y/N),Timeframe  to Object - Days,Assignments Clause  (Y/N),Contract Effective Date,IRS #,IRS_Name,NPI (10-digits),NPI_NAME,PROV_GROUP_TIN_SIGNATORY,PROV_TIN_OTHER,PROV_NPI_OTHER,Notice to Provider Name,Notice to Provider Address,Sequestration Language,"Sequestration Reductions, included [Medicare only] (Y/N)",PROV_TIN_OTHER.1,PROV_NPI_OTHER.1,Parent Agreement Code,Pages,page_num,Attachment/Exhibit,Line of Business,Provider Type,Provider Type - Level 2,Service Type,Plan Type,"Lesser of Logic Language, included (Y/N)",Lesser of Rate,Reimb. Methodology,Reimb. Methodology_short,If rate is % of Payer or MCR [STANDARD],If rate is % of Payer or MCR [STANDARD]_Short,If rate is Flat Fee [STANDARD],Default Term,Default Rate,"Inclusion of essential RBRVS ""Fee Source"" Language (Y/N)","CDM Neutralization Language, included (Y/N)",Chargemaster Protection Language,Exclusions,Not to Exceed,Escalator or COLA (Y/N),"Escalator I, Eff. Date",IP/OP,"IP - DSH/IME/UC, included (Y/N)",IP - Stoploss Catastrophic Threshold +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Skilled Nursing - Registered Nurse,,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Skilled Nursing - Registered Nurse | Per Hour | $80",Flat Fee,,,$80 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Skilled Nursing - Licensed Practical Nurse,,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Skilled Nursing - Licensed Practical Nurse | Per Hour | $45",Flat Fee,,,$45 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Private Duty Nursing rendered by a RN (2 to 24 hours per day) - (S9123),,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Private Duty Nursing rendered by a RN (2 to 24 hours per day) - (S9123) | Per Hour | $52",Flat Fee,,,$52 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,1-Jan-23,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Private Duty Nursing rendered by a LPN (2 to 24 hours per day) - (S9124),,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Private Duty Nursing rendered by a LPN (2 to 24 hours per day) - (S9124) | Per Hour | $52",Flat Fee,,,$52 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,1-Jan-23,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Home Health Aide,,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Home Health Aide | Per Hour | $18",Flat Fee,,,$18 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Personal Care,,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Personal Care | Per Hour | $18",Flat Fee,,,$18 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Physical Therapy,,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Physical Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Occupational Therapy,,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Occupational Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Speech Therapy,,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Speech Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Respiratory Therapy,,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Respiratory Therapy | Per Diem | $75",Flat Fee,,,$75 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Medical Social Worker Visit,,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Medical Social Worker Visit | Per Diem | $100",Flat Fee,,,$100 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,T1030 - Skilled Nursing Registered Nurse,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. T1030 - Skilled Nursing Registered Nurse | Per Hour | $80",Flat Fee,,,$80 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,T1031 - Skilled Nursing Licensed Practical Nurse,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. T1031 - Skilled Nursing Licensed Practical Nurse | Per Hour | $45",Flat Fee,,,$45 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,S9123 - Private Duty Nursing rendered by an RN (2 to 24 hours per day),,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. S9123 - Private Duty Nursing rendered by an RN (2 to 24 hours per day) | Per Hour | 158% of the current Medicaid fee schedule",% of MCD,158% of MCD,1.58,,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,S9124 - Private Duty Nursing rendered by an LPN (2 to 24 hours per day),,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. S9124 - Private Duty Nursing rendered by an LPN (2 to 24 hours per day) | Per Hour | 158% of the current Medicaid fee schedule",% of MCD,158% of MCD,1.58,,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,T1021 - Home Health Aide,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. T1021 - Home Health Aide | Per Hour | $18",Flat Fee,,,$18 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,S9122 - Personal Care,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. S9122 - Personal Care | Per Hour | $18",Flat Fee,,,$18 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Physical Therapy,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Physical Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Occupational Therapy,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Occupational Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Speech Therapy,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Speech Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Respiratory Therapy,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Respiratory Therapy | Per Diem | $75",Flat Fee,,,$75 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,41,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE MANAGED MEDICAL ASSISTANCE ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Medical Social Worker Visit,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Medical Social Worker Visit | Per Diem | $100",Flat Fee,,,$100 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Skilled Nursing - Registered Nurse,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Skilled Nursing - Registered Nurse | Per Hour | $80",Flat Fee,,,$80 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,1-Jan-23,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Skilled Nursing - Licensed Practical Nurse,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Skilled Nursing - Licensed Practical Nurse | Per Hour | $45",Flat Fee,,,$45 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Private Duty Nursing rendered by a RN (2 to 24 hours per day) - (S9123),,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Private Duty Nursing rendered by a RN (2 to 24 hours per day) - (S9123) | Per Hour | $52",Flat Fee,,,$52 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Private Duty Nursing rendered by a LPN (2 to 24 hours per day) - (S9124),,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Private Duty Nursing rendered by a LPN (2 to 24 hours per day) - (S9124) | Per Hour | $52",Flat Fee,,,$52 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Home Health Aide,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Home Health Aide | Per Hour | $18",Flat Fee,,,$18 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Personal Care,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Personal Care | Per Hour | $18",Flat Fee,,,$18 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,1-Jan-23,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Physical Therapy,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Physical Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,1-Jan-23,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Occupational Therapy,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Occupational Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,1-Jan-23,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Speech Therapy,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Speech Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,1-Jan-23,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Respiratory Therapy,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Respiratory Therapy | Per Diem | $75",Flat Fee,,,$75 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,1-Jan-23,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Medical Social Worker Visit,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Medical Social Worker Visit | Per Diem | $100",Flat Fee,,,$100 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,1-Jan-23,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,T1030 - Skilled Nursing Registered Nurse,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. T1030 - Skilled Nursing Registered Nurse | Per Hour | $80",Flat Fee,,,$80 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,T1031 - Skilled Nursing Licensed Practical Nurse,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. T1031 - Skilled Nursing Licensed Practical Nurse | Per Hour | $45",Flat Fee,,,$45 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,S9123 - Private Duty Nursing rendered by an RN (2 to 24 hours per day),,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. S9123 - Private Duty Nursing rendered by an RN (2 to 24 hours per day) | Per Hour | 158% of the current Medicaid fee schedule",% of MCD,158% of MCD,1.58,,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,S9124 - Private Duty Nursing rendered by an LPN (2 to 24 hours per day),,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. S9124 - Private Duty Nursing rendered by an LPN (2 to 24 hours per day) | Per Hour | 158% of the current Medicaid fee schedule",% of MCD,158% of MCD,1.58,,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,T1021 - Home Health Aide,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. T1021 - Home Health Aide | Per Hour | $18",Flat Fee,,,$18 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,S9122 - Personal Care,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. S9122 - Personal Care | Per Hour | $18",Flat Fee,,,$18 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,3/1/2022,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Physical Therapy,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Physical Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Occupational Therapy,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Occupational Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Speech Therapy,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Speech Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Respiratory Therapy,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Respiratory Therapy | Per Diem | $75",Flat Fee,,,$75 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,44,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILD WELFARE SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Medical Social Worker Visit,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Medical Social Worker Visit | Per Diem | $100",Flat Fee,,,$100 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Skilled Nursing - Registered Nurse,,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Skilled Nursing - Registered Nurse | Per Hour | $80",Flat Fee,,,$80 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Skilled Nursing - Licensed Practical Nurse,,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Skilled Nursing - Licensed Practical Nurse | Per Hour | $45",Flat Fee,,,$45 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Private Duty Nursing rendered by a RN (2 to 24 hours per day) - (S9123),,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Private Duty Nursing rendered by a RN (2 to 24 hours per day) - (S9123) | Per Hour | $52",Flat Fee,,,$52 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Private Duty Nursing rendered by a LPN (2 to 24 hours per day) - (S9124),,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Private Duty Nursing rendered by a LPN (2 to 24 hours per day) - (S9124) | Per Hour | $52",Flat Fee,,,$52 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Home Health Aide,,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Home Health Aide | Per Hour | $18",Flat Fee,,,$18 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Personal Care,,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Personal Care | Per Hour | $18",Flat Fee,,,$18 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Physical Therapy,,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Physical Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Occupational Therapy,,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Occupational Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Speech Therapy,,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Speech Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Respiratory Therapy,,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Respiratory Therapy | Per Diem | $75",Flat Fee,,,$75 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Medical Social Worker Visit,,Y,100% of AC,"Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Medical Social Worker Visit | Per Diem | $100",Flat Fee,,,$100 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,T1030 - Skilled Nursing Registered Nurse,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. T1030 - Skilled Nursing Registered Nurse | Per Hour | $80",Flat Fee,,,$80 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,T1031 - Skilled Nursing Licensed Practical Nurse,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. T1031 - Skilled Nursing Licensed Practical Nurse | Per Hour | $45",Flat Fee,,,$45 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,S9123 - Private Duty Nursing rendered by an RN (2 to 24 hours per day),,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. S9123 - Private Duty Nursing rendered by an RN (2 to 24 hours per day) | Per Hour | 158% of the current Medicaid fee schedule",% of MCD,158% of MCD,1.58,,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,S9124 - Private Duty Nursing rendered by an LPN (2 to 24 hours per day),,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. S9124 - Private Duty Nursing rendered by an LPN (2 to 24 hours per day) | Per Hour | 158% of the current Medicaid fee schedule",% of MCD,158% of MCD,1.58,,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,T1021 - Home Health Aide,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. T1021 - Home Health Aide | Per Hour | $18",Flat Fee,,,$18 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,S9122 - Personal Care,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. S9122 - Personal Care | Per Hour | $18",Flat Fee,,,$18 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Physical Therapy,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Physical Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Occupational Therapy,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Occupational Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Speech Therapy,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Speech Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Respiratory Therapy,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Respiratory Therapy | Per Diem | $75",Flat Fee,,,$75 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,47,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE SERIOUS MENTAL ILLNESS SPECIALTY PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Medical Social Worker Visit,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Medical Social Worker Visit | Per Diem | $100",Flat Fee,,,$100 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Skilled Nursing - Registered Nurse,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Skilled Nursing - Registered Nurse | Per Hour | $80",Flat Fee,,,$80 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Skilled Nursing - Licensed Practical Nurse,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Skilled Nursing - Licensed Practical Nurse | Per Hour | $45",Flat Fee,,,$45 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Private Duty Nursing rendered by a RN (2 to 24 hours per day) - (S9123),,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Private Duty Nursing rendered by a RN (2 to 24 hours per day) - (S9123) | Per Hour | $52",Flat Fee,,,$52 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Private Duty Nursing rendered by a LPN (2 to 24 hours per day) - (S9124),,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Private Duty Nursing rendered by a LPN (2 to 24 hours per day) - (S9124) | Per Hour | $52",Flat Fee,,,$52 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Home Health Aide,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Home Health Aide | Per Hour | $18",Flat Fee,,,$18 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Personal Care,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Personal Care | Per Hour | $18",Flat Fee,,,$18 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Physical Therapy,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Physical Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Occupational Therapy,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Occupational Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Speech Therapy,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Speech Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Respiratory Therapy,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Respiratory Therapy | Per Diem | $75",Flat Fee,,,$75 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Medical Social Worker Visit,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Medical Social Worker Visit | Per Diem | $100",Flat Fee,,,$100 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,Y,44927,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,T1030 - Skilled Nursing Registered Nurse,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. T1030 - Skilled Nursing Registered Nurse | Per Hour | $80",Flat Fee,,,$80 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,T1031 - Skilled Nursing Licensed Practical Nurse,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. T1031 - Skilled Nursing Licensed Practical Nurse | Per Hour | $45",Flat Fee,,,$45 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,S9123 - Private Duty Nursing rendered by an RN (2 to 24 hours per day),,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. S9123 - Private Duty Nursing rendered by an RN (2 to 24 hours per day) | Per Hour | 158% of the current Medicaid fee schedule",% of MCD,158% of MCD,1.58,,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,S9124 - Private Duty Nursing rendered by an LPN (2 to 24 hours per day),,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. S9124 - Private Duty Nursing rendered by an LPN (2 to 24 hours per day) | Per Hour | 158% of the current Medicaid fee schedule",% of MCD,158% of MCD,1.58,,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,T1021 - Home Health Aide,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. T1021 - Home Health Aide | Per Hour | $18",Flat Fee,,,$18 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,S9122 - Personal Care,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. S9122 - Personal Care | Per Hour | $18",Flat Fee,,,$18 Per Hour,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Physical Therapy,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Physical Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Occupational Therapy,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Occupational Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Speech Therapy,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Speech Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Respiratory Therapy,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Respiratory Therapy | Per Diem | $75",Flat Fee,,,$75 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,50,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE CHILDREN'S MEDICAL SERVICES HEALTH PLAN ANCILLARY SERVICES HOME HEALTH,MEDICAID,Ancillary,Home Health,Medical Social Worker Visit,,Y,100% of AC,"Should Health Plan determine Provider is not staffing cases, Health Plan reserves the right, at its sole discretion, to adjust the Contracted Rate set forth above in Table 1, to the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 2 with a thirty (30) day prior written notice. Medical Social Worker Visit | Per Diem | $100",Flat Fee,,,$100 Per Diem,Default Health Plan Fee Schedule. Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,53,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE LONG TERM CARE ANCILLARY SERVICES,MEDICAID,Ancillary,Home Health,Personal Care T1004,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Per 15 Minutes $4.00",Flat Fee,,,$4.00 Per 15 Minutes,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,53,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE LONG TERM CARE ANCILLARY SERVICES,MEDICAID,Ancillary,Home Health,Adult Companion S5135,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Per 15 Minutes $4.00",Flat Fee,,,$4.00 Per 15 Minutes,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,53,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE LONG TERM CARE ANCILLARY SERVICES,MEDICAID,Ancillary,Home Health,Attendant Care S5125,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Per 15 Minutes $8.75",Flat Fee,,,$8.75 Per 15 Minutes,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,53,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE LONG TERM CARE ANCILLARY SERVICES,MEDICAID,Ancillary,Home Health,Homemaker S5130,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Per 15 Minutes $4.00",Flat Fee,,,$4.00 Per 15 Minutes,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,53,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE LONG TERM CARE ANCILLARY SERVICES,MEDICAID,Ancillary,Home Health,Respite-In Home T1005,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Per 15 Minutes $4.00",Flat Fee,,,$4.00 Per 15 Minutes,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,53,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE LONG TERM CARE ANCILLARY SERVICES,MEDICAID,Ancillary,Home Health,Intermittent Skilled Nursing-LPN S9124,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Per Hour $45.00",Flat Fee,,,$45.00 Per Hour,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,53,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE LONG TERM CARE ANCILLARY SERVICES,MEDICAID,Ancillary,Home Health,Intermittent Skilled Nursing-RN S9123,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Per Hour $80.00",Flat Fee,,,$80.00 Per Hour,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,53,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE LONG TERM CARE ANCILLARY SERVICES,MEDICAID,Ancillary,Home Health,Medication Administration T1502,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Per Visit $50.00",Flat Fee,,,$50.00 Per Visit,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,53,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE LONG TERM CARE ANCILLARY SERVICES,MEDICAID,Ancillary,Home Health,Medication Management H2010,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Per 15 Minutes $8.00",Flat Fee,,,$8.00 Per 15 Minutes,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,53,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE LONG TERM CARE ANCILLARY SERVICES,MEDICAID,Ancillary,Home Health,Caregiver Training S5108,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Per 15 Minutes $8.75",Flat Fee,,,$8.75 Per 15 Minutes,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,53,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE LONG TERM CARE ANCILLARY SERVICES,MEDICAID,Ancillary,PT/OT/ST,Occupational Therapy S9129,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Per Visit $75.00",Flat Fee,,,$75.00 Per Visit,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,53,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE LONG TERM CARE ANCILLARY SERVICES,MEDICAID,Ancillary,PT/OT/ST,Physical Therapy S9131,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Per Visit $75.00",Flat Fee,,,$75.00 Per Visit,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,53,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE LONG TERM CARE ANCILLARY SERVICES,MEDICAID,Ancillary,PT/OT/ST,Speech Therapy S9128,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Per Visit $75.00",Flat Fee,,,$75.00 Per Visit,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,53,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE LONG TERM CARE ANCILLARY SERVICES,MEDICAID,Ancillary,Home Health,Respiratory Therapy-Eval S5180,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Per Visit $75.00",Flat Fee,,,$75.00 Per Visit,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,53,Attachment A: Medicaid EXHIBIT 1 COMPENSATION SCHEDULE LONG TERM CARE ANCILLARY SERVICES,MEDICAID,Ancillary,Home Health,Respiratory Treatment S5180 U2,,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Per Visit $75.00",Flat Fee,,,$75.00 Per Visit,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,55,Attachment B: Medicare MEDICARE PRODUCT ATTACHMENT,MEDICARE,Ancillary,,Covered Services,,Y,100% of AC,"The Compensation Schedule for the Medicare Product at any given time is the lesser of (i) the Allowable Charges for the particular Covered Service, or (ii) the appropriate amount for such Covered Service under the Company's fee schedule in effect on the date of service for the Medicare Product.",% of Company's fee schedule,100% of Company's fee schedule,1,,,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,72,Attachment C: Commercial-Exchange EXHIBIT 1 COMPENSATION SCHEDULE ANCILLARY SERVICES HOME HEALTH,COMMERCIAL-EXCHANGE,Ancillary,Home Health,home health Covered Services,,Y,100% of AC,"The maximum compensation for home health Covered Services rendered to a Covered Person shall be the ""Allowed Amount."" Except as otherwise provided in this Compensation Schedule, the Allowed Amount for home health Covered Services is the lesser of: (i) Allowable Charges; or (ii) the ""Contracted Rate"" which is seventy percent (70%) of the Payor's fee schedule.",% of Payor's fee schedule,70% of Payor's fee schedule,0.7,,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,77,Attachment D: Healthy Kids EXHIBIT 1 COMPENSATION SCHEDULE ANCILLARY SERVICES HOME HEALTH,,Ancillary,Home Health,Skilled Nursing - Registered Nurse,Healthy Kids,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Skilled Nursing - Registered Nurse | Per Hour | $80",Flat Fee,,,$80 Per Hour,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,77,Attachment D: Healthy Kids EXHIBIT 1 COMPENSATION SCHEDULE ANCILLARY SERVICES HOME HEALTH,,Ancillary,Home Health,Skilled Nursing - Licensed Practical Nurse,Healthy Kids,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Skilled Nursing - Licensed Practical Nurse | Per Hour | $45",Flat Fee,,,$45 Per Hour,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,77,Attachment D: Healthy Kids EXHIBIT 1 COMPENSATION SCHEDULE ANCILLARY SERVICES HOME HEALTH,,Ancillary,Home Health,Private Duty Nursing - Registered Nurse,Healthy Kids,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Private Duty Nursing - Registered Nurse | Per Hour | $52",Flat Fee,,,$52 Per Hour,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,77,Attachment D: Healthy Kids EXHIBIT 1 COMPENSATION SCHEDULE ANCILLARY SERVICES HOME HEALTH,,Ancillary,Home Health,Private Duty Nursing - Licensed Practical Nurse,Healthy Kids,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Private Duty Nursing - Licensed Practical Nurse | Per Hour | $52",Flat Fee,,,$52 Per Hour,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,77,Attachment D: Healthy Kids EXHIBIT 1 COMPENSATION SCHEDULE ANCILLARY SERVICES HOME HEALTH,,Ancillary,Home Health,Home Health Aide,Healthy Kids,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Home Health Aide | Per Hour | $18",Flat Fee,,,$18 Per Hour,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,77,Attachment D: Healthy Kids EXHIBIT 1 COMPENSATION SCHEDULE ANCILLARY SERVICES HOME HEALTH,,Ancillary,Home Health,Personal Care,Healthy Kids,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Personal Care | Per Hour | $18",Flat Fee,,,$18 Per Hour,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,77,Attachment D: Healthy Kids EXHIBIT 1 COMPENSATION SCHEDULE ANCILLARY SERVICES HOME HEALTH,,Ancillary,Home Health,Physical Therapy,Healthy Kids,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Physical Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,77,Attachment D: Healthy Kids EXHIBIT 1 COMPENSATION SCHEDULE ANCILLARY SERVICES HOME HEALTH,,Ancillary,Home Health,Occupational Therapy,Healthy Kids,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Occupational Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,77,Attachment D: Healthy Kids EXHIBIT 1 COMPENSATION SCHEDULE ANCILLARY SERVICES HOME HEALTH,,Ancillary,Home Health,Speech Therapy,Healthy Kids,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Speech Therapy | Per Diem | $90",Flat Fee,,,$90 Per Diem,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,77,Attachment D: Healthy Kids EXHIBIT 1 COMPENSATION SCHEDULE ANCILLARY SERVICES HOME HEALTH,,Ancillary,Home Health,Respiratory Therapy,Healthy Kids,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Respiratory Therapy | Per Diem | $75",Flat Fee,,,$75 Per Diem,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, +52-1590951-Maxim Healthcare Services Inc-ICMProviderAgreement_265803_3,,,Florida,,,"7.1. Term. This Agreement is effective as of the Health Plan Effective Date, and will remain in effect for an initial term (“Initial Term”) of three (3) year(s), after which it will automatically renew for successive terms of one (1) year each (each a “Renewal Term”), unless this Agreement is sooner terminated as provided in this Agreement. Termination of any Contracted Provider’s participation in a particular Product will not have the effect of terminating either this Agreement or the Contracted Provider’s participation in any other Product in which the Contract Provider participates under this Agreement.",evergreen,,90,90,Y,30,,44621,52-1590951,Maxim Healthcare Services Inc,,,,,"1003918483, 1043327463, 1063529923, 1083720676, 1215044227,",,,,,,,265803,78,77,Attachment D: Healthy Kids EXHIBIT 1 COMPENSATION SCHEDULE ANCILLARY SERVICES HOME HEALTH,,Ancillary,Home Health,Medical Social Worker Visit,Healthy Kids,Y,100% of AC,"The maximum compensation for ancillary Covered Services rendered to a Covered Person shall be the ""Allowed Amount"" as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ancillary Covered Services is the lesser of: (i) Allowable Charges; or (ii) the applicable ""Contracted Rate"" set forth below in Table 1. Medical Social Worker Visit | Per Diem | $100",Flat Fee,,,$100 Per Diem,Any authorized and/or Covered Service not noted in this Compensation Schedule will default to Health Plan's fee schedule.,,N,N,,,,N,,,, diff --git a/streamlit_multipage/temp1.csv b/streamlit_multipage/temp1.csv index 947e312..d47cd0e 100644 --- a/streamlit_multipage/temp1.csv +++ b/streamlit_multipage/temp1.csv @@ -1 +1,2 @@ -Contract Name,Unique Key,Pricing Before Carveouts,Contract Related,Provider,Timeline,Carveout Indicator,Carveout Methodology +Contract Name,Run Flag +2013-01-01 Amendment MA FE PeaceHealth TIN 931251530 & 800537724.pdf,True diff --git a/streamlit_multipage/temp2.csv b/streamlit_multipage/temp2.csv index 186a228..d3e0483 100644 --- a/streamlit_multipage/temp2.csv +++ b/streamlit_multipage/temp2.csv @@ -1 +1 @@ -Contract Name,Field Name,SF_DB_COL_NAME,Snippet,Page Number,Field Extracted Value,Actual Value,Imputed Value +Filename,Agreement_Name (Contract Title),PAYER NAME,Health Plan State,Affiliate (Y/N),Credentialing Application Indicator,Term Clause,"Evergreen, Fixed or Hard Term",Termination Date,Termination Upon Notice - Days,Termination With Cause - Days,Amend Contract Upon notice Flag (Y/N),Timeframe  to Object - Days,Assignments Clause  (Y/N),Contract Effective Date,IRS #,IRS_Name,NPI (10-digits),NPI_NAME,PROV_GROUP_TIN_SIGNATORY,PROV_TIN_OTHER,PROV_NPI_OTHER,Notice to Provider Name,Notice to Provider Address,Sequestration Language,"Sequestration Reductions, included [Medicare only] (Y/N)",PROV_TIN_OTHER.1,PROV_NPI_OTHER.1,Parent Agreement Code,Pages,page_num,Attachment/Exhibit,Line of Business,Provider Type,Provider Type - Level 2,Service Type,Plan Type,"Lesser of Logic Language, included (Y/N)",Lesser of Rate,Reimb. Methodology,Reimb. Methodology_short,If rate is % of Payer or MCR [STANDARD],If rate is % of Payer or MCR [STANDARD]_Short,If rate is Flat Fee [STANDARD],Default Term,Default Rate,"Inclusion of essential RBRVS ""Fee Source"" Language (Y/N)","CDM Neutralization Language, included (Y/N)",Chargemaster Protection Language,Exclusions,Not to Exceed,Escalator or COLA (Y/N),"Escalator I, Eff. Date",IP/OP,"IP - DSH/IME/UC, included (Y/N)",IP - Stoploss Catastrophic Threshold,Imputed Value