From 65713410129988448b76b69590a65a3bc41bfcbe Mon Sep 17 00:00:00 2001 From: Katon Minhas Date: Tue, 7 May 2024 21:12:29 -0700 Subject: [PATCH] Table formatting for code improvement --- src/bottom_up_funcs.py | 67 +++-- src/config.py | 14 +- src/postprocess.py | 14 + src/preprocess.py | 13 - src/table_funcs.py | 43 +++- src/test.ipynb | 566 +++++++++++++++++++++++++++++------------ 6 files changed, 519 insertions(+), 198 deletions(-) diff --git a/src/bottom_up_funcs.py b/src/bottom_up_funcs.py index 3205d1c..461c9f8 100644 --- a/src/bottom_up_funcs.py +++ b/src/bottom_up_funcs.py @@ -8,6 +8,7 @@ import claude_funcs import preprocess import dict_operations import postprocess +import table_funcs def run_bottom_up_lesser(d, text_dict, tokens=8000): @@ -44,37 +45,45 @@ def run_bottom_up_secondary(answer_dicts, text_dict, tokens): temp_dicts = [] for d in answer_dicts: # Bottom Up Lesser - lesser_object = run_bottom_up_lesser(d.copy(), text_dict.copy(), tokens) - temp_dicts.append(lesser_object[1]) # Add original object from d - if lesser_object[0]: temp_dicts.append(lesser_object[0]) # If lesser, add lesser object + if config.RUN_LESSER: + lesser_object = run_bottom_up_lesser(d.copy(), text_dict.copy(), tokens) + temp_dicts.append(lesser_object[1]) # Add original object from d + if lesser_object[0]: temp_dicts.append(lesser_object[0]) # If lesser, add lesser object + else: + temp_dicts.append(d) # Add additional fields to each row final_dicts = [] for d in temp_dicts: if d is not None: page_num = d['page_num'] + # Bottom Up Methodology - prompt = prompts.BOTTOM_UP_METHODOLOGY(d) - methodology_answer = claude_funcs.invoke_claude_3(prompt, max_tokens=100) - d['REIMBURSEMENT_METHODOLOGY'] = methodology_answer + if config.RUN_METHODOLOGY: + prompt = prompts.BOTTOM_UP_METHODOLOGY(d) + methodology_answer = claude_funcs.invoke_claude_3(prompt, max_tokens=100) + d['REIMBURSEMENT_METHODOLOGY'] = methodology_answer # # Bottom Up FS - prompt = prompts.BOTTOM_UP_FS(d) - fs_answer = claude_funcs.invoke_claude_3(prompt, model_id=config.MODEL_ID_CLAUDE3_HAIKU, max_tokens=tokens) - fs_dict = dict_operations.secondary_string_to_dict(fs_answer) - d.update(fs_dict) + if config.RUN_FS: + prompt = prompts.BOTTOM_UP_FS(d) + fs_answer = claude_funcs.invoke_claude_3(prompt, model_id=config.MODEL_ID_CLAUDE3_HAIKU, max_tokens=tokens) + fs_dict = dict_operations.secondary_string_to_dict(fs_answer) + d.update(fs_dict) # # Bottom Up Exception/Escalator - prompt = prompts.BOTTOM_UP_EXCEPT_ESC(d, text_dict[page_num]) - exc_answer = claude_funcs.invoke_claude_3(prompt, model_id=config.MODEL_ID_CLAUDE3_HAIKU, max_tokens=tokens) - exc_dict = dict_operations.secondary_string_to_dict(exc_answer) - d.update(exc_dict) + if config.RUN_EXCEPTION: + prompt = prompts.BOTTOM_UP_EXCEPT_ESC(d, text_dict[page_num]) + exc_answer = claude_funcs.invoke_claude_3(prompt, model_id=config.MODEL_ID_CLAUDE3_HAIKU, max_tokens=tokens) + exc_dict = dict_operations.secondary_string_to_dict(exc_answer) + d.update(exc_dict) # # Bottom Up Codes - prompt = prompts.BOTTOM_UP_CODES(d, text_dict[page_num]) - codes_answer = claude_funcs.invoke_claude_3(prompt, max_tokens=tokens) - codes_dict = dict_operations.secondary_string_to_dict(codes_answer) - d.update(codes_dict) + if config.RUN_CODES: + prompt = prompts.BOTTOM_UP_CODES(d, text_dict[page_num]) + codes_answer = claude_funcs.invoke_claude_3(prompt, max_tokens=tokens) + codes_dict = dict_operations.secondary_string_to_dict(codes_answer) + d.update(codes_dict) final_dicts.append(d) @@ -103,14 +112,15 @@ def consolidate_lob(lob_dicts, results_dicts): final_dicts.append(d) return final_dicts + def bottom_up(file_object): - #### PREPROCESS #### filename, contract_text = file_object if config.VERBOSE: print(f"Processing {filename}...") + #### PREPROCESS #### contract_text = preprocess.clean_newlines(contract_text) text_dict = preprocess.split_text(contract_text) - text_dict = preprocess.align_tables(text_dict) + text_dict = table_funcs.align_and_format_tables(text_dict) text_dict = preprocess.highlight_rates(text_dict) #### PROMPT #### @@ -120,22 +130,27 @@ def bottom_up(file_object): answer_dicts = postprocess.primary_filter(answer_dicts) # Bottom Up LOB - CONTRACT_LOB, CONTRACT_PROGRAM, CONTRACT_PRODUCT, PROV_TYPE - lob_dicts = run_bottom_up_lob(answer_dicts, text_dict, 4000) - + if config.RUN_LOB: + lob_dicts = run_bottom_up_lob(answer_dicts, text_dict, 4000) + # Bottom Up Secondary results_dicts = run_bottom_up_secondary(answer_dicts, text_dict, 8000) # Append LOB - final_dicts = consolidate_lob(lob_dicts, results_dicts) - - #### POSTPROCESS #### - #answer_dicts = append_secondary(answer_dicts) + if config.RUN_LOB: + final_dicts = consolidate_lob(lob_dicts, results_dicts) + else: + final_dicts = results_dicts for d in final_dicts: d['Filename'] = filename answer_df = pd.DataFrame(final_dicts) + #### POSTPROCESS #### + #answer_dicts = append_secondary(answer_dicts) + answer_df = postprocess.bottom_up_postprocess(answer_df) + # Write output if config.WRITE_OUTPUT: if config.OUTPUT_MODE == '_INDIVIDUAL_': diff --git a/src/config.py b/src/config.py index ee57efd..75bba8d 100644 --- a/src/config.py +++ b/src/config.py @@ -16,10 +16,22 @@ OUTPUT_MODE = '_INDIVIDUAL_' # or'_CONSOLIDATED_' # Multithread Settings MAX_WORKERS = 20 +# Prompt Debugging +RUN_PRIMARY = True # Always True +RUN_LOB = True +RUN_LESSER = True +RUN_METHODOLOGY = True +RUN_FS = True +RUN_EXCEPTION = True +RUN_CODES = True + # AWS Keys +AWS_ACCESS_KEY_ID="ASIAZTMXAXNXAOY7QOHS" +AWS_SECRET_ACCESS_KEY="U3zdt9cAgCFVdy48uwktZSx2owC4QXo4/mtWCwdQ" +AWS_SESSION_TOKEN="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" # File Paths -LOCAL_PATH = 'docs/test/' # Replace with local +LOCAL_PATH = '../docs/test/' # Replace with local # S3 Settings S3_CLIENT = boto3.client('s3', diff --git a/src/postprocess.py b/src/postprocess.py index fc46135..e890b87 100644 --- a/src/postprocess.py +++ b/src/postprocess.py @@ -10,3 +10,17 @@ def primary_filter(answer_dict): else: filtered_dicts.append(d) return filtered_dicts + + +def bottom_up_postprocess(df): + # Remove Unnamed columns + df = df[[col for col in df.columns if 'UNNAMED' not in col.upper()]] + + # Reimbursement Flat Fee + df.loc[:, 'REIMBURSEMENT_FLAT_FEE'] = df['REIMBURSEMENT_FLAT_FEE'].astype(str).str.replace(r'[^\d.]', '', regex=True) + + # Reimbursement Rate + df.loc[:, 'REIMBURSEMENT_RATE'] = df['REIMBURSEMENT_RATE'].astype(str).str.replace(r'%|<<<|>>>|[^\d.]', '', regex=True) + + return df + diff --git a/src/preprocess.py b/src/preprocess.py index 8ae48d7..e76d580 100644 --- a/src/preprocess.py +++ b/src/preprocess.py @@ -10,19 +10,6 @@ def split_text(text): text_dict = {page.split()[0] : page for page in text_list} return text_dict -def align_tables(text_dict): - pattern = re.compile(r'-------Table Start--------(.*?)-------Table End--------', re.DOTALL) - for page, text in text_dict.items(): - tables = pattern.findall(text) - for table in tables: - pre_table = table.split('{')[0].strip() # Get the pretable text for alignment - text = text.replace(table, '') # Remove full table - text = text.replace(pre_table, table) # replace remaining pretable text with full table - text = text.replace('-------Table Start--------', '') - text = text.replace('-------Table End--------', '') - text_dict[page] = text - return text_dict - def highlight_rates(text_dict): for page, text in text_dict.items(): words = text.split() diff --git a/src/table_funcs.py b/src/table_funcs.py index 996fa6f..7ae937d 100644 --- a/src/table_funcs.py +++ b/src/table_funcs.py @@ -17,4 +17,45 @@ def extract_all_tables(input_dict): tables_dict = {} for filename, filetext in input_dict.items(): tables_dict[filename] = extract_tables(filetext) - return tables_dict \ No newline at end of file + return tables_dict + +def format_table(table): + table = table.replace('>>>', '').replace('<<<', '') + table_dict = eval(table) + + keys = list(table_dict.keys()) + # If values are lists + if isinstance(table_dict[keys[0]], list): + final_string = "" + for i in range(len(table_dict[keys[0]])): + for k in keys: + key_string = k + ': ' + table_dict[k][i] + ', ' + final_string += key_string + final_string += '|\n' + else: + # If values are not lists + final_string = "" + for k in keys: + key_string = k + ': ' + table_dict[k] + ', ' + final_string += key_string + final_string += '|\n' + return final_string + +def align_and_format_tables(text_dict): + pattern = re.compile(r'-------Table Start--------(.*?)-------Table End--------', re.DOTALL) + for page, text in text_dict.items(): + tables = pattern.findall(text) + for table in tables: + pre_table = table.split('{')[0].strip() # Get the pretable text for alignment + text = text.replace(table, '') # Remove full table + table_only = table.replace(pre_table, '') + try: + formatted_table = format_table(table_only) + except: + formatted_table = table + text = text.replace(pre_table, pre_table + formatted_table) # replace remaining pretable text with full table + text = text.replace('-------Table Start--------', '') + text = text.replace('-------Table End--------', '') + text_dict[page] = text + return text_dict + diff --git a/src/test.ipynb b/src/test.ipynb index 2e51ada..56219a7 100644 --- a/src/test.ipynb +++ b/src/test.ipynb @@ -2,215 +2,467 @@ "cells": [ { "cell_type": "code", - "execution_count": 11, + "execution_count": 1, "metadata": {}, "outputs": [], "source": [ "import utils\n", "import preprocess\n", - "import re" + "import re\n", + "import pandas as pd\n", + "import bottom_up_funcs\n", + "import dict_operations\n", + "import postprocess\n", + "import prompts\n", + "import claude_funcs\n", + "\n", + "pd.set_option('display.max_rows', None)\n", + "pd.set_option('display.max_columns', None)" ] }, { "cell_type": "code", - "execution_count": 4, + "execution_count": 2, + "metadata": {}, + "outputs": [], + "source": [ + "input_dict = utils.read_input()" + ] + }, + { + "cell_type": "code", + "execution_count": 9, "metadata": {}, "outputs": [ { "data": { "text/plain": [ - "dict_keys(['050540697 Deepak Nanda 2017 PHSP MU.txt', '133923495 CAIPA 2015 PHSP.txt'])" + "dict_keys(['133923495 CAIPA 2015 PHSP.txt'])" ] }, - "execution_count": 4, + "execution_count": 9, "metadata": {}, "output_type": "execute_result" } ], "source": [ - "input_dict = utils.read_input()\n", "input_dict.keys()" ] }, { "cell_type": "code", - "execution_count": 53, + "execution_count": 30, "metadata": {}, "outputs": [], "source": [ - "def clean_newlines(contract_text):\n", - " cleaned_text = re.sub(r'(?>>', '').replace('<<<', '')\n", + " table_dict = eval(table)\n", + " \n", + " keys = list(table_dict.keys())\n", + " # If values are lists\n", + " if isinstance(table_dict[keys[0]], list):\n", + " final_string = \"\"\n", + " for i in range(len(table_dict[keys[0]])):\n", + " for k in keys:\n", + " key_string = k + ': ' + table_dict[k][i] + ', '\n", + " final_string += key_string\n", + " final_string += '|\\n'\n", + " else:\n", + " # If values are not lists\n", + " final_string = \"\"\n", + " for k in keys:\n", + " key_string = k + ': ' + table_dict[k] + ', '\n", + " final_string += key_string\n", + " final_string += '|\\n'\n", + " return final_string\n", "\n", - "def align_tables(text):\n", + "def align_and_format_tables(text_dict):\n", " pattern = re.compile(r'-------Table Start--------(.*?)-------Table End--------', re.DOTALL)\n", - " tables = pattern.findall(text)\n", - " for table in tables:\n", - " pre_table = table.split('{')[0].strip() # Get the pretable text for alignment\n", - " text = text.replace(table, '') # Remove full table\n", - " text = text.replace(pre_table, table) # replace remaining pretable text with full table\n", - " text = text.replace('-------Table Start--------', '')\n", - " text = text.replace('-------Table End--------', '') \n", - " return text" + " for page, text in text_dict.items():\n", + " tables = pattern.findall(text)\n", + " for table in tables:\n", + " pre_table = table.split('{')[0].strip() # Get the pretable text for alignment\n", + " text = text.replace(table, '') # Remove full table\n", + " table_only = table.replace(pre_table, '')\n", + " try:\n", + " formatted_table = format_table(table_only)\n", + " except:\n", + " formatted_table = table\n", + " text = text.replace(pre_table, pre_table + formatted_table) # replace remaining pretable text with full table\n", + " text = text.replace('-------Table Start--------', '')\n", + " text = text.replace('-------Table End--------', '') \n", + " text_dict[page] = text\n", + " return text_dict" ] }, { "cell_type": "code", - "execution_count": 54, - "metadata": {}, - "outputs": [], - "source": [ - "for filename, contract_text in input_dict.items():\n", - " if filename == '133923495 CAIPA 2015 PHSP.txt':\n", - " contract_text = clean_newlines(contract_text)\n", - " contract_text = align_tables(contract_text)" - ] - }, - { - "cell_type": "code", - "execution_count": 55, + "execution_count": 31, "metadata": {}, "outputs": [ { "name": "stdout", "output_type": "stream", "text": [ - "Document Index DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 1 Fifth Amendment to the Agreement by and between 1Managed Health, Inc. and Independent Practice Association 1 WITNESSETH: 1 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 2 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 3 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 4 EXHIBIT C 4 Compensation Schedule 4 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 5 5 IPA Network Access and Administrative Fees. 5 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 6 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 7 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 8 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 9 WITNESSETH: 9 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 10 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 11 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 12 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 13 COMPENSATION SCHEDULE 13 Reimbursement to IPA Providers 13 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 14 14 IPA Network Access and Administrative Fees. 14 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 15 Additional Compensation to IPA in the form of Surplus Distribution. 15 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 16 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 17 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 18 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 19 Fifth Amendment to the Agreement by and between 19Managed Health, Inc. and Independent Practice Association 19 WITNESSETH: 19 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 20 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 21 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 22 EXHIBIT C 22 Compensation Schedule 22 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 23 23 IPA Network Access and Administrative Fees. 23 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 24 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 25 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 26 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 27 Second Amendment to the Agreement 27 by and between 27Healthfirst PHSP, Inc. and Independent Practice Association 27 WITNESSETH: 27 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 28 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 29 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 30 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 31 COMPENSATION SCHEDULE 31 Reimbursement to IPA Providers 31 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 32 32 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 33 Additional Compensation to IPA in the form of Surplus Distribution. 33 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 34 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 35 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 36\n", - "\n", - "\n", - "\n", - "Start of Page No. = 1 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE Fifth Amendment to the Agreement by and between Managed Health, Inc. and Independent Practice Association This Amendment to the Agreement between Managed Health, Inc. (\"Healthfirst\"), and Chinese American Independent Practice Association, Inc. (\"Provider\") is effective January 1, 2015. WITNESSETH: WHEREAS, Healthfirst and Provider have entered into an Agreement (the \"Agreement\") for the provision of Health Care Services to Enrollees; and WHEREAS, Healthfirst and Provider desire to amend that Agreement to delegate credentialing to Provider : NOW, THEREFORE, in consideration of the mutual covenants and agreements herein contained, Healthfirst and Provider hereby agree to amend the Agreement as follows: 1. A new Section 2.8 entitled Credentialing of Affiliated Providers is added to the Agreement as follows: 2.8 Credentialing of Affiliated Providers. 2.8.1 Delegation. Healthfirst delegates to Provider and Provider agrees to accept the responsibility for credentialing potential Affiliated Providers employed by or affiliated with Provider; provided however, that such delegation shall be limited to i) those categories and types of providers which Provider credentials as part of Provider's regular credentialing process and ii) those providers who have or seek medical staff privileges with Provider. Provider shall not be required to credential Participating Providers which provider does not regularly credential or which do not have or seek medical staff privileges with Provider. Healthfirst shall retain sole responsibility for credentialing such Participating Providers. Healthfirst acknowledges and agrees that Healthfirst has reviewed Provider's credentialing process and that such process meets the requirements of this Agreement, including this Section 2.8 as of the Effective or at the time of Healthfirst's final approval of the credentialing process, whichever is later. 2.8.2 Provider shall have a formal application and review process for such Providers which includes, but is not limited to, a signed application and attestation. Such review shall be conducted by a Provider credentials committee in consultation with the Healthfirst credentials committee. Provider shall have Credentialing Policies and Procedures that defines the following: 2.8.2.1 scope of Affiliated Providers covered; 2.8.2.2 criteria for primary source verification of information; 2.8.2.3 the process used to make credentialing decisions; 2.8.2.4 the extent of any delegated credentialing/recredentialing arrangements; FED. TAX ID: 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015\n", - "\n", - "Start of Page No. = 2 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 2.8.2.5 the right of Affiliated Providers to review the information submitted in support of their credentialing application; 2.8.2.6 the process of notification to a Affiliated Provider of any information obtained during the credentialing process that varies substantially from the information provided by the Affiliated Provider; 2.8.2.7 the Affiliated Provider's right to correct erroneous information; 2.8.2.8 the Provider's medical director's direct responsibility and participation in the credentialing program; and 2.8.2.9 the process used to ensure confidentiality of all information obtained in the credentialing process, except otherwise provided by law. 2.8.3 Credentialing Criteria. The Provider's Credentials Committee shall determine the criteria for selection, which shall be consistent with Healthfirst's credentialing policies and procedures, as may be modified by Healthfirst from time to time. Provider's credentialing and recredentialing criteria and procedure, its procedure for selection and termination of Providers, and its Provider grievance mechanism shall be subject to review and approval by Healthfirst, which approval shall not be unreasonably withheld. At a minimum, Provider's credentialing and recredentialing criteria and procedure shall be consistent with The Joint Commission (\"TJC\") and applicable standards required under Article 28 of the New York State Public Health law and shall include requiring Affiliated Providers to be licensed and qualified to provide the services specified and to maintain such license in good standing. Provider shall include further credentialing requirements in addition to the TJC reasonably required by Healthfirst and acceptable to Provider. Notwithstanding any provision foregoing, Healthfirst shall retain final authority concerning the credentialing of Affiliated Providers and his/her participation in the Healthfirst network. 2.8.4 Cooperation. Provider shall cooperate with Healthfirst to determine if the credentialing and recredentialing criteria and procedures used by Provider are consistent with Healthfirst's and TJC's credentialing and recredentialing criteria and procedures. In the event that Provider's credentialing and recredentialing criteria and procedures are inconsistent with Healthfirst's credentialing and recredentialing criteria and procedures then Healthfirst, after good faith negotiations with Provider, may adjust the compensation payable to Provider under this Agreement to compensate Healthfirst for the reasonable cost of credentialing and recredentialing potential Affiliated Providers employed by or affiliated with Provider. 2.8.5 Oversight by Healthfirst. To allow Healthfirst to oversee and monitor the delegation of credentialing to Provider, Provider, upon the reasonable request of Healthfirst and on an ongoing basis, shall (i) permit Healthfirst to conduct on-site audits of Provider credentialing policies and procedures and credentialing files, upon reasonable notice; (ii) to provide to Healthfirst no less than annually, rosters of Healthfirst Providers and such written verification or other substantiation as requested by Healthfirst that Affiliated Providers employed by or on the medical staff of Provider are currently and fully credentialed in accordance with TJC and Healthfirst standards; (iii) to provide to Healthfirst, upon request, copies of credentialing files excluding peer review documentation; and, (iv) FED. TAX ID: 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015\n", - "\n", - "Start of Page No. = 3 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE and to provide Healthfirst with Affiliated Providers' initial appointment date, reappointment start date and reappointment end date. Provider shall retain the right to terminate immediately its agreements with, or the employment of, any Affiliated Provider, subject to applicable appeals, if the Affiliated Provider is no longer a member of the Provider's medical staff, if the license to practice or DEA permit or any controlled substances registration of said Affiliated Provider is suspended, otherwise restricted or revoked, or if said Affiliated Provider is excluded or terminated from either the Medicare or Medicaid programs, or if said Affiliated Provider is not covered by insurance as provided pursuant to this Agreement or is convicted of any crime (either a misdemeanor or a felony). Provider shall notify Healthfirst, immediately, but in any event within forty-eight (48) hours of receipt of notice, if any Affiliated Provider employed by or affiliated with Provider has his or her license to practice or DEA permit or any controlled substances registration suspended or otherwise restricted or revoked or is excluded or terminated from either the Medicare or Medicaid programs, or is not covered by insurance as required pursuant to this Agreement below or is convicted of any crime related to the provision of health care services. Notwithstanding any other provision of this Section to the contrary, it is expressly understood and agreed that Provider shall not be responsible for conducting individual site visits at provider sites other than at facilities operated by Provider. 2.8.6 Confidentiality. The foregoing provisions of this Section and the other provisions of this Agreement shall not require the release or other disclosure by any person of any records or other documents or information to the extent that such release or other disclosure is prohibited by or otherwise contrary to any applicable law. 2. A new Exhibit C setting forth the reimbursement to be paid by MHI to IPA and IPA Providers for the provision of Covered Services to Enrollees, a copy of which is attached to this Amendment, added to the Agreement. The reimbursement set forth in the Exhibit C attached to this amendment shall apply to dates of service on and after January 1, 2015. Prior Exhibits C and the Letter of Agreement effective July 1, 2006 shall continue to apply to dates of service prior to that date. This Amendment supersedes the July 1, 2006 Letter of Agreement setting forth an administrative fee. 3. All other terms and conditions of the Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the Effective Date above. {'Managed Health, Inc.': ['DocuSigned by: By: Paul E. Portsmore', '441CEAD8E502476 Name: Paul E. Portsmore Print Name', 'Title: SVP', 'Date: 12/31/2014 18:32:28 ET'], 'Provider: Chinese American Independent Practice Association, Inc.': ['By: family', 'Name: PEGGY SHENG Print Name', 'Chief Operating Officer Title:', 'Date: Dec. 26, 2015']} {'Managed Health, Inc.': ['By:', 'Name: Print Name', 'Title:', 'Date:'], 'Provider: Chinese American Independent Practice Association, Inc.': ['By:', 'Name: Print Name', 'Title:', 'Date:']} FED. TAX ID: 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015\n", - "\n", - "\n", - "\n", - "\n", - "Start of Page No. = 4 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE EXHIBIT C Compensation Schedule Reimbursement to IPA Providers I. Medicare and Commercial Enrollees 1. Except for the Covered Services set forth below, MHI shall directly reimburse IPA Providers who provide Covered Services on a fee-for-service basis in an amount equal to 100% of the maximum allowable Region I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments under the Medicare program. 2. MHI shall reimburse IPA Providers for the following Covered Services as follows: a. Physical Therapy services shall be reimbursed at a flat rate of $55 per date of service if provided in a multi-specialty office or facility. If provided by an individually-operated Physical Therapist office (solely physical therapy services), physical therapy services set forth below shall be reimbursed at a rate of $65 per service. These services, which shall be updated from time to time, shall include: {'Code Range': ['97001-97006', '97010-97028', '97032-97039', '97110-97546', '97750-97755'], 'Code Range Description': ['Physical Medicine Assessments', 'Physical Therapy Treatment Modalities: Supervised', 'Physical Therapy Treatment Modalities: Constant Attendance', 'Other Therapeutic Techniques With Direct Patient Contact', 'Physical performance test & Assistive technology assessment']} {'Code Range': ['97001-97006', '97010-97028', '97032-97039', '97110-97546', '97750-97755'], 'Code Range Description': ['Physical Medicine Assessments', 'Physical Therapy Treatment Modalities: Supervised', 'Physical Therapy Treatment Modalities: Constant Attendance', 'Other Therapeutic Techniques With Direct Patient Contact', 'Physical performance test & Assistive technology assessment']} b. Services provided by Physical Medicine and Rehabilitation specialists shall be reimbursed on a fee-for-service basis in an amount equal to 70% of the maximum allowable Region I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments under the Medicare program, except for physical therapy services which will be reimbursed as noted in \"a.\" above. C. The following services, when rendered in an \"Office Based Surgery\" (OBS) accredited office (as mandated by the New York State Department of Health), will be reimbursed on a fee-for- service basis in an amount equal to 100% of the maximum allowable Region I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments under the Medicare program. FED. TAX ID: 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015\n", - "\n", - "\n", - " a. Physical Therapy services shall be reimbursed at a flat rate of $55 per date of service if provided in a multi-specialty office or facility. If provided by an individually-operated Physical Therapist office (solely physical therapy services), physical therapy services set forth below shall be reimbursed at a rate of $65 per service. These services, which shall be updated from time to time, shall include: {'Code Range': ['97001-97006', '97010-97028', '97032-97039', '97110-97546', '97750-97755'], 'Code Range Description': ['Physical Medicine Assessments', 'Physical Therapy Treatment Modalities: Supervised', 'Physical Therapy Treatment Modalities: Constant Attendance', 'Other Therapeutic Techniques With Direct Patient Contact', 'Physical performance test & Assistive technology assessment']} {'Code Range': ['97001-97006', '97010-97028', '97032-97039', '97110-97546', '97750-97755'], 'Code Range Description': ['Physical Medicine Assessments', 'Physical Therapy Treatment Modalities: Supervised', 'Physical Therapy Treatment Modalities: Constant Attendance', 'Other Therapeutic Techniques With Direct Patient Contact', 'Physical performance test & Assistive technology assessment']} C. The following services, when rendered in an \"Office Based Surgery\" (OBS) accredited office (as mandated by the New York State Department of Health), will be reimbursed on a fee-for- service basis in an amount equal to 100% of the maximum allowable Region I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments under the Medicare program. {'CPT Code': ['43235', '43239', '45378', '45380', '45385'], 'CPT Description': ['Upper gastrointestinal endoscopy', 'Upper gastrointestinal endoscopy, with biopsy', 'Colonoscopy, diagnostic', 'Colonoscopy, with biopsies', 'Colonoscopy, removal of tumor']} \n", - "\n", - "Start of Page No. = 5 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE e. Hearing Aids. IPA Providers shall be reimbursed for the cost of hearing aids at eighty percent (80%) of the manufacturer's suggested retail price. II. Where rates in any fee schedule described in this Agreement make reference to Medicare or Medicaid rates, any Medicare or Medicaid rates enacted by the federal Centers for Medicare and Medicaid Services (\"CMS\") or the New York State Department of Health (\"SDOH\"), including updates, shall apply to dates of service occurring on the later of (a) the effective date of such rates or (b) upon forty five calendar days following the date on which CMS or SDOH publishes such rates. IPA Network Access and Administrative Fees. For Medicare Advantage members only, Healthfirst shall compensate IPA $5.00 per Member per month for the following administrative services,: Access to IPA's network of Participating IPA Providers Credentialing of Participating IPA Providers Reporting on Health Care Services provided to Enrollees as reasonably requested by Healthfirst Administrative services relating to quality improvement and Enrollee satisfaction Education of Participating IPA Providers regarding Healthfirst's policies and procedures and quality improvement programs. FED. TAX ID: 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015\n", - "\n", - "\n", - "\n", - "\n", - "Start of Page No. = 6 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE Risk Sharing with IPA 1 Definitions. For the purposes of this Agreement and Compensation Schedule, the following terms shall have the indicated meanings: 1.1 \"Adjusted Premiums\" shall mean premiums Healthfirst receives for Risk Enrollees, adjusted by any risk score or premium adjustment published by CMS, SDOH or other payor as such adjustment is reasonably applied by Healthfirst. 1.2 \"Cost of Risk Services\" shall mean the the cost of claims paid for Risk plus a reasonable reserve for incurred but not received (\"IBNR\") claims for Risk Services. 1.3 \"Deficit\" shall be the amount that the Cost of Risk Services exceeds the Risk Target following Reconciliation. 1.4 \"Upside Risk Limit\" shall be equal to seventy eight percent (78__%) of Risk Target. 1.5 \"Reconciliation\" shall mean the quarterly reconciliation by Healthfirst to determine Surpluses and Deficits. 1.6 \"Risk Enrollee\" shall mean Enrollees in Healthfirst's Medicare Advantage plans who select an IPA Provider as their Primary Care Provider. 1.7 \"Risk Services\" shall mean all Health Care Services provided to Enrollees regardless of whether such Services were provided by IPA Providers or other health care providers. 1.8 \"Risk Target\" shall be equal to eighty three percent (83%) of Adjusted Premiums 1.9 \"Surplus\" shall be the amount that Cost of Risk Services is less than the Risk Target following Reconciliation. 1.10 \"Downside Risk Limit\" shall mean one hundred threepercent (103__%) of Risk Target. 2 Risk Sharing. 2.1 Risk Sharing and Cooperation. Healthfirst and IPA shall share the financial risk for Risk Services rendered to Risk Enrollees as set forth below. IPA shall assume upside risk for the cost of Risk Services provided to Risk Enrollees to the extent that IPA may receive portion of any Surplus. IPA shall assume downside risk for the cost of Risk Services to the extent that IPA is required to repay Healthfirst a portion of any Deficit. Healthfirst and IPA shall cooperate in the implementation and administration of Healthfirst's utilization and case management programs, the sharing of utilization data, and education of IPA Providers regarding utilization trends and the provision of quality and medically appropriate services. 2.2 Limited Risk Transfer. IPA shall not assume risk for the cost of Health Care Services other than through the receipt of Surpluses and payment of Deficits. Under no circumstances shall IPA FED. TAX ID: 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015\n", - "\n", - "Start of Page No. = 7 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE be required to pay claims for Health Care Services, including Risk Services, to any IPA Provider or health care provider. In all instances, including any termination or expiration of this Agreement, Healthfirst shall remain solely responsible for paying claims for Health Care Services, including Risk Services, to IPA Providers and other health care providers. 3 Regulatory Approval. The parties understand and acknowledge that this risk sharing arrangement may be subject to the prior review and approval of CMS, SDOH or other regulatory agency having jurisdiction over this Agreement as required by applicable statutes and regulation. No payments shall be made by either party, prior to receiving such regulatory approval. The failure to obtain regulatory shall not be grounds for either party to terminate this Agreement which shall otherwise remain in effect. 4 Quarterly Reconciliation. Within one-hundred and twenty days (120) after the end of each calendar year quarter, Healthfirst shall determine the amount of the Surplus or Deficit, for all preceding quarters during the applicable calendar year. For purposes of calculating Surplus and Deficits, the measurement period shall commence on the later of a) January 1, 2010 or b) the date of any required regulatory approval. 5 Risk Sharing; Distribution of Surplus and Payment of Deficits. 5.1 Surpluses. In the event that Healthfirst determines that a Surplus exists following Reconciliation Healthfirst shall, within thirty days of the Reconciliation, make a payment to IPA equal to the lesser of i) fifty percent (50%) of the Surplus or ii) fifty percent (50%) of the difference between the Risk Target and the Upside Risk Limit. 5.2 Deficits. 5.2.1 In the event that Healthfirst determines that a Deficit exists following Reconciliation, IPA shall, within thirty days of the Reconciliation, make a payment to Healthfirst equal to the lesser of i) fifty percent (50%) of the Deficit or ii) fifty percent (50%) of the difference between the Risk Target and the Downside Risk Limit. 5.2.2 In the event that IPA fails to timely pay any amount due under Section 5.2.1, any such amounts shall be offset against up to one hundred percent (100%) percent of surplus amounts due to IPA by Managed Health, Inc. Any amounts remaining following such offset will be offset against future amounts due to IPA in the succeeding calendar year quarter. 5.2.3 In the event that this Agreement terminates, is not renewed or expires, regardless of the reason, IPA shall reimburse Healthfirst for any Deficit amounts due Healthfirst at the time of such termination, expiration or non-renewal. 6 Compliance with Physician Incentive Plan (\"PIP\") Regulations. IPA, in its sole discretion, may use any compensation methodology to reimburse IPA Providers for Health Care Services; provided, however, that no payments shall be made by IPA to IPA Providers who are physicians in a manner or amount, either separately or in combination with any compensation formulas which would place IPA Providers at substantial financial risk for the provision of referral services, as determined by the applicable federal PIP regulations contained in 42 CFR 417.479. IPA shall provide information FED. TAX ID: 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015\n", - "\n", - "Start of Page No. = 8 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE reasonably requested by Healthfirst establishing i) the manner and extent to which any Surplus amounts paid to IPA pursuant to this Agreement are paid to IPA Providers and ii) IPA's compliance with the federal PIP regulations. FED. TAX ID: 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015\n", - "\n", - "Start of Page No. = 9 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE Second Amendment to the Agreement by and between Healthfirst PHSP, Inc. and Independent Practice Association This Amendment shall be effective January 1, 2015 by and between Chinese American Independent Practice Association, Inc. (\"IPA\") and Healthfirst PHSP, Inc. (\"Healthfirst\"). WITNESSETH: WHEREAS, Healthfirst and IPA entered into an Agreement on July 1, 2010, for the provision of Covered Services to certain Healthfirst Enrollees; and WHEREAS, Healthfirst and IPA desire to amend that Agreement to change the compensation which Healthfirst pays to IPA. NOW, THEREFORE, in consideration of the mutual covenants and agreements herein contained, Healthfirst and IPA hereby agree to amend the Agreement as follows: 1. Section 2.1 of the Agreement titled Provision of Health Care Services is deleted in its entirety and replaced Section 2.1. 2.1 Provision of Health Care Services. IPA shall arrange for IPA Providers to provide Health Care Services to Enrollees pursuant to the terms of this Agreement, the Provider Manual, and the applicable Plan Contract(s) for those Plan(s) identified by IPA in Exhibit 2.1. IPA shall not offer participation with Healthfirst pursuant to this Agreement to any health care provider who is a member of IPA or has a contract with IPA, nor disclose share the terms and conditions of this Agreement included rates of reimbursement, without first obtaining the written consent of Healthfirst. Healthfirst shall have the right to refuse the participation of any particular health care provider under this Agreement. Healthfirst's determination to offer participation to any health care provider pursuant to this Agreement or to refuse to accept any health care provider for participation shall be based on Healthfirst's business needs as determined solely by Healthfirst. Healthfirst's Vice-President, Network Management or Executive Vice-President/Chief Operating Officer shall have sole authority issue consent under this Section 2.1. IPA shall provide Healthfirst with the name, addresses, telephone numbers and other information regarding IPA Providers reasonably requested by Healthfirst. IPA shall permit, and require IPA Providers to permit, Healthfirst to use such information in Healthfirst advertising and provider directories. 2. A new Section 2.8 entitled Credentialing of Affiliated Providers is added to the Agreement as follows: 2.8 Credentialing of Affiliated Providers. 2.8.1 Delegation. Healthfirst delegates to Provider and Provider agrees to accept the responsibility for credentialing potential Affiliated Providers employed by or affiliated with Provider; provided however, that such delegation shall be limited to i) those categories and types of providers which Provider credentials as part of Provider's regular credentialing process and ii) those providers FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 1 of 10\n", - "\n", - "Start of Page No. = 10 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE who have or seek medical staff privileges with Provider. Provider shall not be required to credential Participating Providers which provider does not regularly credential or which do not have or seek medical staff privileges with Provider. Healthfirst shall retain sole responsibility for credentialing such Participating Providers. Healthfirst acknowledges and agrees that Healthfirst has reviewed Provider's credentialing process and that such process meets the requirements of this Agreement, including this Section 2.8 as of the Effective Date or at the time of Healthfirst's final approval of the credentialing process, whichever is later. 2.8.2 Provider shall have a formal application and review process for such Providers which includes, but is not limited to, a signed application and attestation. Such review shall be conducted by a Provider credentials committee in consultation with the Healthfirst credentials committee. Provider shall have Credentialing Policies and Procedures that defines the following: 2.8.2.1 scope of Affiliated Providers covered; 2.8.2.2 criteria for primary source verification of information; 2.8.2.3 the process used to make credentialing decisions; 2.8.2.4 the extent of any delegated credentialing/recredentialing arrangements; 2.8.2.5 the right of Affiliated Providers to review the information submitted in support of their credentialing application; 2.8.2.6 the process of notification to a Affiliated Provider of any information obtained during the credentialing process that varies substantially from the information provided by the Affiliated Provider; 2.8.2.7 the Affiliated Provider's right to correct erroneous information; 2.8.2.8 the Provider's medical director's direct responsibility and participation in the credentialing program; and 2.8.2.9 the process used to ensure confidentiality of all information obtained in the credentialing process, except otherwise provided by law. 2.8.3 Credentialing Criteria. The Provider's Credentials Committee shall determine the criteria for selection, which shall be consistent with Healthfirst's credentialing policies and procedures, as may be modified by Healthfirst from time to time. Provider's credentialing and recredentialing criteria and procedure, its procedure for selection and termination of Providers, and its Provider grievance mechanism shall be subject to review and approval by Healthfirst, which approval shall not be unreasonably withheld. At a minimum, Provider's credentialing and recredentialing criteria and procedure shall be consistent with The Joint Commission (\"TJC\") and applicable standards required under Article 28 of the New York State Public Health law and shall include requiring Affiliated Providers to be licensed and qualified to provide the services specified and to maintain such license in good standing. Provider shall include further credentialing requirements in addition to the TJC FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 2 of 10\n", - "\n", - "Start of Page No. = 11 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE reasonably required by Healthfirst and acceptable to Provider. Notwithstanding any provision foregoing, Healthfirst shall retain final authority concerning the credentialing of Affiliated Providers and his/her participation in the Healthfirst network. 2.8.4 Cooperation. Provider shall cooperate with Healthfirst to determine if the credentialing and recredentialing criteria and procedures used by Provider are consistent with Healthfirst's and TJC's credentialing and recredentialing criteria and procedures. In the event that Provider's credentialing and recredentialing criteria and procedures are inconsistent with Healthfirst's credentialing and recredentialing criteria and procedures then Healthfirst, after good faith negotiations with Provider, may adjust the compensation payable to Provider under this Agreement to compensate Healthfirst for the reasonable cost of credentialing and recredentialing potential Affiliated Providers employed by or affiliated with Provider. 2.8.5 Oversight by Healthfirst. To allow Healthfirst to oversee and monitor the delegation of credentialing to Provider, Provider, upon the reasonable request of Healthfirst and on an ongoing basis, shall (i) permit Healthfirst to conduct on-site audits of Provider credentialing policies and procedures and credentialing files, upon reasonable notice; (ii) to provide to Healthfirst no less than annually, rosters of Healthfirst Providers and such written verification or other substantiation as requested by Healthfirst that Affiliated Providers employed by or on the medical staff of Provider are currently and fully credentialed in accordance with TJC and Healthfirst standards; (iii) to provide to Healthfirst, upon request, copies of credentialing files excluding peer review documentation; and, (iv) and to provide Healthfirst with Affiliated Providers' initial appointment date, reappointment start date and reappointment end date. Provider shall retain the right to terminate immediately its agreements with, or the employment of, any Affiliated Provider, subject to applicable appeals, if the Affiliated Provider is no longer a member of the Provider's medical staff, if the license to practice or DEA permit or any controlled substances registration of said Affiliated Provider is suspended, otherwise restricted or revoked, or if said Affiliated Provider is excluded or terminated from either the Medicare or Medicaid programs, or if said Affiliated Provider is not covered by insurance as provided pursuant to this Agreement or is convicted of any crime (either a misdemeanor or a felony). Provider shall notify Healthfirst, immediately, but in any event within forty-eight (48) hours of receipt of notice, if any Affiliated Provider employed by or affiliated with Provider has his or her license to practice or DEA permit or any controlled substances registration suspended or otherwise restricted or revoked or is excluded or terminated from either the Medicare or Medicaid programs, or is not covered by insurance as required pursuant to this Agreement below or is convicted of any crime related to the provision of health care services. Notwithstanding any other provision of this Section to the contrary, it is expressly understood and agreed that Provider shall not be responsible for conducting individual site visits at provider sites other than at facilities operated by Provider. 2.8.6 Confidentiality. The foregoing provisions of this Section and the other provisions of this Agreement shall not require the release or other disclosure by any person of any records or other documents or information to the extent that such release or other disclosure is prohibited by or otherwise contrary to any applicable law. 3 A new Exhibit 4.1 setting forth the reimbursement to be paid by Healthfirst to IPA Providers for the provision of Health Care Services to Enrollees and IPA for the provision of certain FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 3 of 10\n", - "\n", - "Start of Page No. = 12 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE administrative services, a copy of which is attached to this Amendment, is added to the Agreement. The reimbursement set forth in the Exhibit 4.1 attached to this Amendment shall apply to dates of service on and after January 1, 2015. Prior Exhibits 4.1 shall continue to apply to dates of service prior to that date. 4 All other terms and conditions of the Agreement shall remain in full force and effect. {'Healthfirst PHSP, Inc.': ['DocuSigned by: By: Paul E. Portsmore', '441CEAD8E502476. Name: Paul E. Portsmore Print Name', 'Title: SVP -', 'Date: 12/31/2014 I 18:32:28 ET -'], 'Chinese American Independent Practice Association, Inc.': ['By: f Sear', 'Name: PEGGY SHENG Print Name', 'Title: Chief Operating Officer', 'Date: December 26, 2014']} {'Healthfirst PHSP, Inc.': ['By: Name: Print Name', 'Title:', 'Date: -'], 'Chinese American Independent Practice Association, Inc.': ['By: Name: Print Name', 'Title:', 'Date:']} FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 4 of 10\n", - "\n", - "\n", - "\n", - "\n", - "Start of Page No. = 13 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE EXHIBIT 4.1 COMPENSATION SCHEDULE Reimbursement to IPA Providers 1. Except for the Health Care Services set forth below, Healthfirst shall directly reimburse IPA Providers who provide Health Care Services on a fee-for-service basis in an amount equal to 90% of the maximum allowable Region I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments under the Medicare program. 2. Healthfirst shall reimburse IPA Providers for the Health Care Services set forth below as follows: a. Physical Therapy Services. Physical therapy services set forth below shall be reimbursed at a rate of $45 per service if provided in a multi-specialty office or facility. If provided by an individually- operated Physical Therapist office (solely physical therapy services), physical therapy services set forth below shall be reimbursed at a rate of $60 per service. {'CPT Code': ['43235', '43239', '45378', '45380', '45385'], 'CPT Description': ['Upper gastrointestinal endoscopy', 'Upper gastrointestinal endoscopy, with biopsy', 'Colonoscopy, diagnostic', 'Colonoscopy, with biopsy', 'Colonoscopy, removal of tumor']} {'Code Range': ['97001-97004', '97010-97028', '97032-97039', '97110-97546', '97750-97755'], 'Code Range Description': ['Physical Medicine Assessments', 'Physical Therapy Treatment Modalities: Supervised', 'Physical Therapy Treatment Modalities: Constant Attendance', 'Other Therapeutic Techniques With Direct Patient Contact', 'Physical performance test & Assistive technology assessment']} {'CPT Code': ['43235', '43239', '45378', '45380', '45385'], 'CPT Description': ['Upper gastrointestinal endoscopy', 'Upper gastrointestinal endoscopy, with biopsy', 'Colonoscopy, diagnostic', 'Colonoscopy, with biopsy', 'Colonoscopy, removal of tumor']} {'Code Range': ['97001-97004', '97010-97028', '97032-97039', '97110-97546', '97750-97755'], 'Code Range Description': ['Physical Medicine Assessments', 'Physical Therapy Treatment Modalities: Supervised', 'Physical Therapy Treatment Modalities: Constant Attendance', 'Other Therapeutic Techniques With Direct Patient Contact', 'Physical performance test & Assistive technology assessment']} b. Physical Medicine and Rehabilitation Services. Physical medicine and rehabilitation services shall be reimbursed on a fee-for-service basis in an amount equal to 70% of the maximum allowable Region I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments under the Medicare program, except for physical therapy services which will be reimbursed as noted in \"a.\" above. C. Gastroenterology Services. The following services, when rendered in an \"Office Based Surgery\" (OBS) accredited office (as mandated by the New York State Department of Health), will be reimbursed on a fee-for-service basis in an amount equal to 100% of the maximum allowable Region I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments under the Medicare program. FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 5 of 10\n", - "\n", - "\n", - " a. Physical Therapy Services. Physical therapy services set forth below shall be reimbursed at a rate of $45 per service if provided in a multi-specialty office or facility. If provided by an individually- operated Physical Therapist office (solely physical therapy services), physical therapy services set forth below shall be reimbursed at a rate of $60 per service. {'CPT Code': ['43235', '43239', '45378', '45380', '45385'], 'CPT Description': ['Upper gastrointestinal endoscopy', 'Upper gastrointestinal endoscopy, with biopsy', 'Colonoscopy, diagnostic', 'Colonoscopy, with biopsy', 'Colonoscopy, removal of tumor']} {'Code Range': ['97001-97004', '97010-97028', '97032-97039', '97110-97546', '97750-97755'], 'Code Range Description': ['Physical Medicine Assessments', 'Physical Therapy Treatment Modalities: Supervised', 'Physical Therapy Treatment Modalities: Constant Attendance', 'Other Therapeutic Techniques With Direct Patient Contact', 'Physical performance test & Assistive technology assessment']} {'CPT Code': ['43235', '43239', '45378', '45380', '45385'], 'CPT Description': ['Upper gastrointestinal endoscopy', 'Upper gastrointestinal endoscopy, with biopsy', 'Colonoscopy, diagnostic', 'Colonoscopy, with biopsy', 'Colonoscopy, removal of tumor']} {'Code Range': ['97001-97004', '97010-97028', '97032-97039', '97110-97546', '97750-97755'], 'Code Range Description': ['Physical Medicine Assessments', 'Physical Therapy Treatment Modalities: Supervised', 'Physical Therapy Treatment Modalities: Constant Attendance', 'Other Therapeutic Techniques With Direct Patient Contact', 'Physical performance test & Assistive technology assessment']} {'CPT Code': ['43235', '43239', '45378', '45380', '45385'], 'CPT Description': ['Upper gastrointestinal endoscopy', 'Upper gastrointestinal endoscopy, with biopsy', 'Colonoscopy, diagnostic', 'Colonoscopy, with biopsy', 'Colonoscopy, removal of tumor']} \n", - "\n", - "Start of Page No. = 14 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE e. Hearing Aids. IPA Providers shall be reimbursed for the cost of hearing aids at eighty percent (80%) of the manufacturer's suggested retail price. IPA Network Access and Administrative Fees. Healthfirst shall pay IPA an administrative fee of $2.50 per Member per month for administrative services relating to quality improvement and education of Participating IPA Providers regarding Healthfirst's quality improvement programs. IPA and Healthfirst understand and agree that IPA shall not provide any management services, as that term is defined in 11 NYCRR 98, to Healthfirst pursuant to this Agreement. In the event that IPA or an affiliated of IPA provides management services, the parties shall execute a separate management agreement approved by SDOH pursuant to 11 NYCRR 98. FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 6 of 10\n", - "\n", - "\n", - "\n", - "\n", - "Start of Page No. = 15 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE Additional Compensation to IPA in the form of Surplus Distribution. 1. Limited Risk Transfer/No Transfer of Financial Risk 1.1. IPA shall be entitled to Additional Compensation under this Agreement on an annual basis in the form of a Surplus (as defined below) distribution, to the extent that any available Surplus funds exist, as specified below. 1.2. Use of Additional Compensation. IPA represents and warrants that Additional Compensation paid to IPA, if any, shall be distributed to Participating IPA Providers or used by IPA in a manner designed to improve the quality of care received by Enrollees and Enrollee satisfaction. On request by Healthfirst, IPA shall provide Healthfirst with financial records accounting in detail all funds received from Healthfirst and the disbursement of all such funds as set forth in 10 NYCRR 98-1.18(d). 2. Definitions. Capitalized terms used in this Exhibit 4.1(b) shall have the meaning given in this Exhibit or, if any term is not defined in this Exhibit 4.1(b), it shall have the meaning given in the Agreement to which this Exhibit is attached. 2.1. \"Additional Compensation\" shall mean the portion of any Surplus paid to IPA pursuant to Section 5 of this Exhibit 4.1(b). 2.2. \"Adjusted Premiums\" shall mean the premiums received by Healthfirst for Risk Enrollees, as adjusted by any risk score or other adjustment to premiums pursuant to the applicable Plan Contract and applicable to Risk Enrollees as reasonably determined and applied by Healthfirst. 2.3. \"Administrative Deduction\" shall mean the deduction from Adjusted Premiums equal to Healthfirst's administrative costs as reasonably determined by Healthfirst. 2.4. \"Final Reconciliation\" shall mean the final the accounting, as set forth in Section 3, of Medical Revenue, claims paid for Health Care Services and other expenses to determine Surpluses or Deficits conducted twelve months following the expiration, non-renewal or termination of this Exhibit. 2.5. \"Medical Revenue\" shall mean the balance of Adjusted Premiums after subtracting the Administrative Deduction and any Quality Incentive Deduction. 2.6. \"Quality Incentive Deduction\" shall mean an amount taken from Adjusted Premiums for programs in which IPA and IPA Providers participate to improve the quality of Health Care Services which Risk Enrollees receive. 2.7. \"Reconciliation\" shall mean the accounting, as set forth in Section 3, of Medical Revenue, claims paid for Health Care Services and other expenses to determine Surpluses or Deficits. 2.8. \"Risk Enrollee\" shall mean an Enrollee who has selected, or been assigned to, a primary care provider who is a Participating IPA Provider. FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 7 of 10\n", - "\n", - "Start of Page No. = 16 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 2.9. \"Surplus\" or \"Deficit\" shall mean the balance of Medical Revenue following Reconciliation 3. Reconciliation of Medical Revenue to Determine Surpluses and Deficits. During each Reconciliation, Healthfirst shall make the following deductions from Medical Revenue and determine the amount of any Surplus of Deficit: 3.1. the costs of claims paid for Health Care Services rendered to Risk Enrollees by Participating IPA Providers, Participating Providers and all other health care providers. 3.2. a reasonable reserve for the cost of claims for Health Care Services rendered to Risk Enrollees but not yet received; 3.3. other costs associated with the provision of Health Care Services to Risk Enrollees including but not limited to the net cost of reinsurance and any internal aggregate risk sharing programs. 3.4. accruals for any risk adjustment applicable to Adjusted Premiums. 4. Reconciliation Schedule. 4.1. Interim Quarterly Reconciliation and Distribution. Within one-hundred and twenty days (120) after the end of each calendar year quarter, Healthfirst shall determine the amount of any Surplus or Deficit for all preceding quarters during that calendar year. In the event that Healthfirst determines that a Surplus has been achieved for the preceding quarters during the calendar year, Healthfirst shall make an interim payment to IPA of Additional Compensation as set forth in Section 5 below. In the event that Healthfirst determines that a Deficit has been achieved for the preceding quarters druing the calendar year, Healthfirst not make an interim payment to IPA of Additional Compensation and the Deficit shall be handled as set forth in Section 6 below. 4.2. Annual Reconciliation and Distribution. Within one-hundred and twenty days (120) after the end of each calendar year, Healthfirst shall determine the amount of any Surplus for all quarters for that calendar year. In the event that Healthfirst determines that a Surplus has been achieved for that calendar year, Healthfirst shall make a final payment to IPA of Additional Compensation as set forth in Section 5 below. In the event that Healthfirst determines that a Deficit has been achieved for that Calendar Year, Healthfirst not make a final payment to IPA of Additional Compensation and the Deficit shall be handled as set forth in Section 6 below. 5. Payment of Additional Compensation. In the event that Healthfirst determines that a Surplus has been achieved as set forth Section 3 above, Healthfirst shall pay to IPA Additional Compensation which shall be the lesser of the following: 5.1. Ten percent (10%) of the Surplus for the calendar year, or 5.2. An amount such that the Additional Compensation equals twenty-five percent (25%) of the sum of i) the total compensation to Participating IPA Providers for Health Care Services rendered to FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 8 of 10\n", - "\n", - "Start of Page No. = 17 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE Risk Enrollees pursuant to Exhibit 4.1(a); any compensation paid to IPA pursuant to Exhibit 4.1(a) and iii) the Additional Compensation. 5.3. Healthfirst shall pay any Additional Compensation, within thirty days of each Reconciliation. Healthfirst shall, in no event, advance to IPA any Additional Compensation. 6. Treatment of Deficits. 6.1. Deficits Rolled Forward. In the event that a Deficit remains following any Reconciliation or a Final Reconciliation, the Deficit equal to the percentage set forth in Section 5.1 above shall be rolled forward to reduce any Surplus that may accrue under this Agreement in the succeeding calendar year. 6.2. Deficits at Termination, Expiration or Non-Renewal. In the event that this Agreement terminates, is not renewed or expires, regardless of the reason, Provider shall not be required to reimburse Healthfirst for any Deficits which may exist at the time of such termination, expiration or non-renewal. 7. Compliance with Regulatory Provisions Regarding Risk Transfer 7.1. SDOH Provider Contract Guidelines. Healthfirst and IPA shall comply with the applicable requirements of SDOH regarding transfer of financial risk to IPAs as set forth in SDOH's Provider Contracting Guidelines, as amended by SDOH from time to time. In the event that the amount financial risk transferred to IPA constitutes a Level 4 risk transfer pursuant to the Providing Contracting Guidelines, IPA shall demonstrate financial viability and establish a financial security deposit as required by SDOH. 7.2. Physician Incentive Plan (\"PIP\") Regulations. Healthfirst and IPA shall comply with the applicable requirements of the federal PIP regulations contained in 42 CFR 422.208, including the placement of stop loss insurance if applicable. 7.3. Financial Stability Monitoring and Reporting. Notwithstanding any other provision of this Agreement Healthfirst shall regularly monitor Provider's financial condition to ensure that Provider remains financially able to perform its obligations under this Agreement and meet any financial solvency requirements of SDOH or DFS. IPA shall promptly advise Healthfirst of any material developments which may impair its ability to perform its obligations under this Agreement. In addition, IPA shall provide Healthfirst with the reports and information as required by 10 NYCRR 98-1.18(e), which shall include but not be limited to IPA's quarterly and annual financial statements. IPA shall also maintain, as required by 10 NYCRR 98-1.18(d), financial records accounting in detail all funds received from Healthfirst and the disbursement of all such funds. IPA shall provide such accounting of funds and disbursements to Healthfirst on request. 8. Termination or Amendment of Additional Compensation Healthfirst may on, thirty (30) days prior notice to IPA, amend the terms and conditions pursuant to which Additional Compensation is determined and paid to IPA as well as eliminate the payment of Additional Compensation to IPA; provided however, that unless IPA or IPA Providers have breached FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 9 of 10\n", - "\n", - "Start of Page No. = 18 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE the Agreement such amendment or termination shall not change any Additional Compensation calculated or paid prior to the effective date of such amendment or termination. 9. Termination, Non-Renewal or Expiration of the Agreement. For a period of twelve months following any termination, non-renewal or expiration of this Agreement, regardless of the cause Healthfirst will conduct Reconciliations of Medical Revenue pursuant to this Agreement until the Final Reconciliation; provided, however, that payments to IPA of Additional Compensation shall be suspended. These Reconciliations shall be on based Health Care Services rendered to Risk Enrollees prior to the termination, non-renewal or expiration of this Agreement. Healthfirst shall pay to any Additional Compensation existing at the Final Reconciliation within thirty days of the Final Reconciliation. FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 10 of 10\n", - "\n", - "Start of Page No. = 19 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE Fifth Amendment to the Agreement by and between Managed Health, Inc. and Independent Practice Association This Amendment to the Agreement between Managed Health, Inc. (\"Healthfirst\"), and Chinese American Independent Practice Association, Inc. (\"Provider\") is effective January 1, 2015. WITNESSETH: WHEREAS, Healthfirst and Provider have entered into an Agreement (the \"Agreement\") for the provision of Health Care Services to Enrollees; and WHEREAS, Healthfirst and Provider desire to amend that Agreement to delegate credentialing to Provider : NOW, THEREFORE, in consideration of the mutual covenants and agreements herein contained, Healthfirst and Provider hereby agree to amend the Agreement as follows: 1. A new Section 2.8 entitled Credentialing of Affiliated Providers is added to the Agreement as follows: 2.8 Credentialing of Affiliated Providers. 2.8.1 Delegation. Healthfirst delegates to Provider and Provider agrees to accept the responsibility for credentialing potential Affiliated Providers employed by or affiliated with Provider; provided however, that such delegation shall be limited to i) those categories and types of providers which Provider credentials as part of Provider's regular credentialing process and ii) those providers who have or seek medical staff privileges with Provider. Provider shall not be required to credential Participating Providers which provider does not regularly credential or which do not have or seek medical staff privileges with Provider. Healthfirst shall retain sole responsibility for credentialing such Participating Providers. Healthfirst acknowledges and agrees that Healthfirst has reviewed Provider's credentialing process and that such process meets the requirements of this Agreement, including this Section 2.8 as of the Effective or at the time of Healthfirst's final approval of the credentialing process, whichever is later. 2.8.2 Provider shall have a formal application and review process for such Providers which includes, but is not limited to, a signed application and attestation. Such review shall be conducted by a Provider credentials committee in consultation with the Healthfirst credentials committee. Provider shall have Credentialing Policies and Procedures that defines the following: 2.8.2.1 scope of Affiliated Providers covered; 2.8.2.2 criteria for primary source verification of information; 2.8.2.3 the process used to make credentialing decisions; 2.8.2.4 the extent of any delegated credentialing/recredentialing arrangements; FED. TAX ID: 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015\n", - "\n", - "Start of Page No. = 20 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 2.8.2.5 the right of Affiliated Providers to review the information submitted in support of their credentialing application; 2.8.2.6 the process of notification to a Affiliated Provider of any information obtained during the credentialing process that varies substantially from the information provided by the Affiliated Provider; 2.8.2.7 the Affiliated Provider's right to correct erroneous information; 2.8.2.8 the Provider's medical director's direct responsibility and participation in the credentialing program; and 2.8.2.9 the process used to ensure confidentiality of all information obtained in the credentialing process, except otherwise provided by law. 2.8.3 Credentialing Criteria. The Provider's Credentials Committee shall determine the criteria for selection, which shall be consistent with Healthfirst's credentialing policies and procedures, as may be modified by Healthfirst from time to time. Provider's credentialing and recredentialing criteria and procedure, its procedure for selection and termination of Providers, and its Provider grievance mechanism shall be subject to review and approval by Healthfirst, which approval shall not be unreasonably withheld. At a minimum, Provider's credentialing and recredentialing criteria and procedure shall be consistent with The Joint Commission (\"TJC\") and applicable standards required under Article 28 of the New York State Public Health law and shall include requiring Affiliated Providers to be licensed and qualified to provide the services specified and to maintain such license in good standing. Provider shall include further credentialing requirements in addition to the TJC reasonably required by Healthfirst and acceptable to Provider. Notwithstanding any provision foregoing, Healthfirst shall retain final authority concerning the credentialing of Affiliated Providers and his/her participation in the Healthfirst network. 2.8.4 Cooperation. Provider shall cooperate with Healthfirst to determine if the credentialing and recredentialing criteria and procedures used by Provider are consistent with Healthfirst's and TJC's credentialing and recredentialing criteria and procedures. In the event that Provider's credentialing and recredentialing criteria and procedures are inconsistent with Healthfirst's credentialing and recredentialing criteria and procedures then Healthfirst, after good faith negotiations with Provider, may adjust the compensation payable to Provider under this Agreement to compensate Healthfirst for the reasonable cost of credentialing and recredentialing potential Affiliated Providers employed by or affiliated with Provider. 2.8.5 Oversight by Healthfirst. To allow Healthfirst to oversee and monitor the delegation of credentialing to Provider, Provider, upon the reasonable request of Healthfirst and on an ongoing basis, shall (i) permit Healthfirst to conduct on-site audits of Provider credentialing policies and procedures and credentialing files, upon reasonable notice; (ii) to provide to Healthfirst no less than annually, rosters of Healthfirst Providers and such written verification or other substantiation as requested by Healthfirst that Affiliated Providers employed by or on the medical staff of Provider are currently and fully credentialed in accordance with TJC and Healthfirst standards; (iii) to provide to Healthfirst, upon request, copies of credentialing files excluding peer review documentation; and, (iv) FED. TAX ID: 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015\n", - "\n", - "Start of Page No. = 21 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE and to provide Healthfirst with Affiliated Providers' initial appointment date, reappointment start date and reappointment end date. Provider shall retain the right to terminate immediately its agreements with, or the employment of, any Affiliated Provider, subject to applicable appeals, if the Affiliated Provider is no longer a member of the Provider's medical staff, if the license to practice or DEA permit or any controlled substances registration of said Affiliated Provider is suspended, otherwise restricted or revoked, or if said Affiliated Provider is excluded or terminated from either the Medicare or Medicaid programs, or if said Affiliated Provider is not covered by insurance as provided pursuant to this Agreement or is convicted of any crime (either a misdemeanor or a felony). Provider shall notify Healthfirst, immediately, but in any event within forty-eight (48) hours of receipt of notice, if any Affiliated Provider employed by or affiliated with Provider has his or her license to practice or DEA permit or any controlled substances registration suspended or otherwise restricted or revoked or is excluded or terminated from either the Medicare or Medicaid programs, or is not covered by insurance as required pursuant to this Agreement below or is convicted of any crime related to the provision of health care services. Notwithstanding any other provision of this Section to the contrary, it is expressly understood and agreed that Provider shall not be responsible for conducting individual site visits at provider sites other than at facilities operated by Provider. 2.8.6 Confidentiality. The foregoing provisions of this Section and the other provisions of this Agreement shall not require the release or other disclosure by any person of any records or other documents or information to the extent that such release or other disclosure is prohibited by or otherwise contrary to any applicable law. 2. A new Exhibit C setting forth the reimbursement to be paid by MHI to IPA and IPA Providers for the provision of Covered Services to Enrollees, a copy of which is attached to this Amendment, added to the Agreement. The reimbursement set forth in the Exhibit C attached to this amendment shall apply to dates of service on and after January 1, 2015. Prior Exhibits C and the Letter of Agreement effective July 1, 2006 shall continue to apply to dates of service prior to that date. This Amendment supersedes the July 1, 2006 Letter of Agreement setting forth an administrative fee. 3. All other terms and conditions of the Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the Effective Date above. {'Managed Health, Inc.': ['DocuSigned by: By: Paul E. Portsmore', '441CEAD8E502476 Name: Paul E. Portsmore Print Name', 'Title: SVP', 'Date: 12/31/2014 18:32:28 ET'], 'Provider: Chinese American Independent Practice Association, Inc.': ['By: family', 'Name: PEGGY SHENG Print Name', 'Chief Operating Officer Title:', 'Date: Dec. 26, 2015']} {'Managed Health, Inc.': ['By:', 'Name: Print Name', 'Title:', 'Date:'], 'Provider: Chinese American Independent Practice Association, Inc.': ['By:', 'Name: Print Name', 'Title:', 'Date:']} FED. TAX ID: 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015\n", - "\n", - "\n", - " IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the Effective Date above. {'Managed Health, Inc.': ['DocuSigned by: By: Paul E. Portsmore', '441CEAD8E502476 Name: Paul E. Portsmore Print Name', 'Title: SVP', 'Date: 12/31/2014 18:32:28 ET'], 'Provider: Chinese American Independent Practice Association, Inc.': ['By: family', 'Name: PEGGY SHENG Print Name', 'Chief Operating Officer Title:', 'Date: Dec. 26, 2015']} {'Managed Health, Inc.': ['By:', 'Name: Print Name', 'Title:', 'Date:'], 'Provider: Chinese American Independent Practice Association, Inc.': ['By:', 'Name: Print Name', 'Title:', 'Date:']} {'Managed Health, Inc.': ['DocuSigned by: By: Paul E. Portsmore', '441CEAD8E502476 Name: Paul E. Portsmore Print Name', 'Title: SVP', 'Date: 12/31/2014 18:32:28 ET'], 'Provider: Chinese American Independent Practice Association, Inc.': ['By: family', 'Name: PEGGY SHENG Print Name', 'Chief Operating Officer Title:', 'Date: Dec. 26, 2015']} \n", - "\n", - "Start of Page No. = 22 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE EXHIBIT C Compensation Schedule Reimbursement to IPA Providers I. Medicare and Commercial Enrollees 1. Except for the Covered Services set forth below, MHI shall directly reimburse IPA Providers who provide Covered Services on a fee-for-service basis in an amount equal to 100% of the maximum allowable Region I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments under the Medicare program. 2. MHI shall reimburse IPA Providers for the following Covered Services as follows: a. Physical Therapy services shall be reimbursed at a flat rate of $55 per date of service if provided in a multi-specialty office or facility. If provided by an individually-operated Physical Therapist office (solely physical therapy services), physical therapy services set forth below shall be reimbursed at a rate of $65 per service. These services, which shall be updated from time to time, shall include: {'Code Range': ['97001-97006', '97010-97028', '97032-97039', '97110-97546', '97750-97755'], 'Code Range Description': ['Physical Medicine Assessments', 'Physical Therapy Treatment Modalities: Supervised', 'Physical Therapy Treatment Modalities: Constant Attendance', 'Other Therapeutic Techniques With Direct Patient Contact', 'Physical performance test & Assistive technology assessment']} {'Code Range': ['97001-97006', '97010-97028', '97032-97039', '97110-97546', '97750-97755'], 'Code Range Description': ['Physical Medicine Assessments', 'Physical Therapy Treatment Modalities: Supervised', 'Physical Therapy Treatment Modalities: Constant Attendance', 'Other Therapeutic Techniques With Direct Patient Contact', 'Physical performance test & Assistive technology assessment']} b. Services provided by Physical Medicine and Rehabilitation specialists shall be reimbursed on a fee-for-service basis in an amount equal to 70% of the maximum allowable Region I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments under the Medicare program, except for physical therapy services which will be reimbursed as noted in \"a.\" above. C. The following services, when rendered in an \"Office Based Surgery\" (OBS) accredited office (as mandated by the New York State Department of Health), will be reimbursed on a fee-for- service basis in an amount equal to 100% of the maximum allowable Region I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments under the Medicare program. FED. TAX ID: 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015\n", - "\n", - "\n", - " Physical Therapy services shall be reimbursed at a flat rate of $55 per date of service if provided in a multi-specialty office or facility. If provided by an individually-operated Physical Therapist office (solely physical therapy services), physical therapy services set forth below shall be reimbursed at a rate of $65 per service. These services, which shall be updated from time to time, shall include: {'Code Range': ['97001-97006', '97010-97028', '97032-97039', '97110-97546', '97750-97755'], 'Code Range Description': ['Physical Medicine Assessments', 'Physical Therapy Treatment Modalities: Supervised', 'Physical Therapy Treatment Modalities: Constant Attendance', 'Other Therapeutic Techniques With Direct Patient Contact', 'Physical performance test & Assistive technology assessment']} C. The following services, when rendered in an \"Office Based Surgery\" (OBS) accredited office (as mandated by the New York State Department of Health), will be reimbursed on a fee-for- service basis in an amount equal to 100% of the maximum allowable Region I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments under the Medicare program. {'CPT Code': ['43235', '43239', '45378', '45380', '45385'], 'CPT Description': ['Upper gastrointestinal endoscopy', 'Upper gastrointestinal endoscopy, with biopsy', 'Colonoscopy, diagnostic', 'Colonoscopy, with biopsies', 'Colonoscopy, removal of tumor']} \n", - "\n", - "Start of Page No. = 23 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE e. Hearing Aids. IPA Providers shall be reimbursed for the cost of hearing aids at eighty percent (80%) of the manufacturer's suggested retail price. II. Where rates in any fee schedule described in this Agreement make reference to Medicare or Medicaid rates, any Medicare or Medicaid rates enacted by the federal Centers for Medicare and Medicaid Services (\"CMS\") or the New York State Department of Health (\"SDOH\"), including updates, shall apply to dates of service occurring on the later of (a) the effective date of such rates or (b) upon forty five calendar days following the date on which CMS or SDOH publishes such rates. IPA Network Access and Administrative Fees. For Medicare Advantage members only, Healthfirst shall compensate IPA $5.00 per Member per month for the following administrative services,: Access to IPA's network of Participating IPA Providers Credentialing of Participating IPA Providers Reporting on Health Care Services provided to Enrollees as reasonably requested by Healthfirst Administrative services relating to quality improvement and Enrollee satisfaction Education of Participating IPA Providers regarding Healthfirst's policies and procedures and quality improvement programs. FED. TAX ID: 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015\n", - "\n", - "\n", - "\n", - "\n", - "Start of Page No. = 24 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE Risk Sharing with IPA 1 Definitions. For the purposes of this Agreement and Compensation Schedule, the following terms shall have the indicated meanings: 1.1 \"Adjusted Premiums\" shall mean premiums Healthfirst receives for Risk Enrollees, adjusted by any risk score or premium adjustment published by CMS, SDOH or other payor as such adjustment is reasonably applied by Healthfirst. 1.2 \"Cost of Risk Services\" shall mean the the cost of claims paid for Risk plus a reasonable reserve for incurred but not received (\"IBNR\") claims for Risk Services. 1.3 \"Deficit\" shall be the amount that the Cost of Risk Services exceeds the Risk Target following Reconciliation. 1.4 \"Upside Risk Limit\" shall be equal to seventy eight percent (78__%) of Risk Target. 1.5 \"Reconciliation\" shall mean the quarterly reconciliation by Healthfirst to determine Surpluses and Deficits. 1.6 \"Risk Enrollee\" shall mean Enrollees in Healthfirst's Medicare Advantage plans who select an IPA Provider as their Primary Care Provider. 1.7 \"Risk Services\" shall mean all Health Care Services provided to Enrollees regardless of whether such Services were provided by IPA Providers or other health care providers. 1.8 \"Risk Target\" shall be equal to eighty three percent (83%) of Adjusted Premiums 1.9 \"Surplus\" shall be the amount that Cost of Risk Services is less than the Risk Target following Reconciliation. 1.10 \"Downside Risk Limit\" shall mean one hundred threepercent (103__%) of Risk Target. 2 Risk Sharing. 2.1 Risk Sharing and Cooperation. Healthfirst and IPA shall share the financial risk for Risk Services rendered to Risk Enrollees as set forth below. IPA shall assume upside risk for the cost of Risk Services provided to Risk Enrollees to the extent that IPA may receive portion of any Surplus. IPA shall assume downside risk for the cost of Risk Services to the extent that IPA is required to repay Healthfirst a portion of any Deficit. Healthfirst and IPA shall cooperate in the implementation and administration of Healthfirst's utilization and case management programs, the sharing of utilization data, and education of IPA Providers regarding utilization trends and the provision of quality and medically appropriate services. 2.2 Limited Risk Transfer. IPA shall not assume risk for the cost of Health Care Services other than through the receipt of Surpluses and payment of Deficits. Under no circumstances shall IPA FED. TAX ID: 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015\n", - "\n", - "Start of Page No. = 25 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE be required to pay claims for Health Care Services, including Risk Services, to any IPA Provider or health care provider. In all instances, including any termination or expiration of this Agreement, Healthfirst shall remain solely responsible for paying claims for Health Care Services, including Risk Services, to IPA Providers and other health care providers. 3 Regulatory Approval. The parties understand and acknowledge that this risk sharing arrangement may be subject to the prior review and approval of CMS, SDOH or other regulatory agency having jurisdiction over this Agreement as required by applicable statutes and regulation. No payments shall be made by either party, prior to receiving such regulatory approval. The failure to obtain regulatory shall not be grounds for either party to terminate this Agreement which shall otherwise remain in effect. 4 Quarterly Reconciliation. Within one-hundred and twenty days (120) after the end of each calendar year quarter, Healthfirst shall determine the amount of the Surplus or Deficit, for all preceding quarters during the applicable calendar year. For purposes of calculating Surplus and Deficits, the measurement period shall commence on the later of a) January 1, 2010 or b) the date of any required regulatory approval. 5 Risk Sharing; Distribution of Surplus and Payment of Deficits. 5.1 Surpluses. In the event that Healthfirst determines that a Surplus exists following Reconciliation Healthfirst shall, within thirty days of the Reconciliation, make a payment to IPA equal to the lesser of i) fifty percent (50%) of the Surplus or ii) fifty percent (50%) of the difference between the Risk Target and the Upside Risk Limit. 5.2 Deficits. 5.2.1 In the event that Healthfirst determines that a Deficit exists following Reconciliation, IPA shall, within thirty days of the Reconciliation, make a payment to Healthfirst equal to the lesser of i) fifty percent (50%) of the Deficit or ii) fifty percent (50%) of the difference between the Risk Target and the Downside Risk Limit. 5.2.2 In the event that IPA fails to timely pay any amount due under Section 5.2.1, any such amounts shall be offset against up to one hundred percent (100%) percent of surplus amounts due to IPA by Managed Health, Inc. Any amounts remaining following such offset will be offset against future amounts due to IPA in the succeeding calendar year quarter. 5.2.3 In the event that this Agreement terminates, is not renewed or expires, regardless of the reason, IPA shall reimburse Healthfirst for any Deficit amounts due Healthfirst at the time of such termination, expiration or non-renewal. 6 Compliance with Physician Incentive Plan (\"PIP\") Regulations. IPA, in its sole discretion, may use any compensation methodology to reimburse IPA Providers for Health Care Services; provided, however, that no payments shall be made by IPA to IPA Providers who are physicians in a manner or amount, either separately or in combination with any compensation formulas which would place IPA Providers at substantial financial risk for the provision of referral services, as determined by the applicable federal PIP regulations contained in 42 CFR 417.479. IPA shall provide information FED. TAX ID: 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015\n", - "\n", - "Start of Page No. = 26 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE reasonably requested by Healthfirst establishing i) the manner and extent to which any Surplus amounts paid to IPA pursuant to this Agreement are paid to IPA Providers and ii) IPA's compliance with the federal PIP regulations. FED. TAX ID: 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015\n", - "\n", - "Start of Page No. = 27 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE Second Amendment to the Agreement by and between Healthfirst PHSP, Inc. and Independent Practice Association This Amendment shall be effective January 1, 2015 by and between Chinese American Independent Practice Association, Inc. (\"IPA\") and Healthfirst PHSP, Inc. (\"Healthfirst\"). WITNESSETH: WHEREAS, Healthfirst and IPA entered into an Agreement on July 1, 2010, for the provision of Covered Services to certain Healthfirst Enrollees; and WHEREAS, Healthfirst and IPA desire to amend that Agreement to change the compensation which Healthfirst pays to IPA. NOW, THEREFORE, in consideration of the mutual covenants and agreements herein contained, Healthfirst and IPA hereby agree to amend the Agreement as follows: 1. Section 2.1 of the Agreement titled Provision of Health Care Services is deleted in its entirety and replaced Section 2.1. 2.1 Provision of Health Care Services. IPA shall arrange for IPA Providers to provide Health Care Services to Enrollees pursuant to the terms of this Agreement, the Provider Manual, and the applicable Plan Contract(s) for those Plan(s) identified by IPA in Exhibit 2.1. IPA shall not offer participation with Healthfirst pursuant to this Agreement to any health care provider who is a member of IPA or has a contract with IPA, nor disclose share the terms and conditions of this Agreement included rates of reimbursement, without first obtaining the written consent of Healthfirst. Healthfirst shall have the right to refuse the participation of any particular health care provider under this Agreement. Healthfirst's determination to offer participation to any health care provider pursuant to this Agreement or to refuse to accept any health care provider for participation shall be based on Healthfirst's business needs as determined solely by Healthfirst. Healthfirst's Vice-President, Network Management or Executive Vice-President/Chief Operating Officer shall have sole authority issue consent under this Section 2.1. IPA shall provide Healthfirst with the name, addresses, telephone numbers and other information regarding IPA Providers reasonably requested by Healthfirst. IPA shall permit, and require IPA Providers to permit, Healthfirst to use such information in Healthfirst advertising and provider directories. 2. A new Section 2.8 entitled Credentialing of Affiliated Providers is added to the Agreement as follows: 2.8 Credentialing of Affiliated Providers. 2.8.1 Delegation. Healthfirst delegates to Provider and Provider agrees to accept the responsibility for credentialing potential Affiliated Providers employed by or affiliated with Provider; provided however, that such delegation shall be limited to i) those categories and types of providers which Provider credentials as part of Provider's regular credentialing process and ii) those providers FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 1 of 10\n", - "\n", - "Start of Page No. = 28 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE who have or seek medical staff privileges with Provider. Provider shall not be required to credential Participating Providers which provider does not regularly credential or which do not have or seek medical staff privileges with Provider. Healthfirst shall retain sole responsibility for credentialing such Participating Providers. Healthfirst acknowledges and agrees that Healthfirst has reviewed Provider's credentialing process and that such process meets the requirements of this Agreement, including this Section 2.8 as of the Effective Date or at the time of Healthfirst's final approval of the credentialing process, whichever is later. 2.8.2 Provider shall have a formal application and review process for such Providers which includes, but is not limited to, a signed application and attestation. Such review shall be conducted by a Provider credentials committee in consultation with the Healthfirst credentials committee. Provider shall have Credentialing Policies and Procedures that defines the following: 2.8.2.1 scope of Affiliated Providers covered; 2.8.2.2 criteria for primary source verification of information; 2.8.2.3 the process used to make credentialing decisions; 2.8.2.4 the extent of any delegated credentialing/recredentialing arrangements; 2.8.2.5 the right of Affiliated Providers to review the information submitted in support of their credentialing application; 2.8.2.6 the process of notification to a Affiliated Provider of any information obtained during the credentialing process that varies substantially from the information provided by the Affiliated Provider; 2.8.2.7 the Affiliated Provider's right to correct erroneous information; 2.8.2.8 the Provider's medical director's direct responsibility and participation in the credentialing program; and 2.8.2.9 the process used to ensure confidentiality of all information obtained in the credentialing process, except otherwise provided by law. 2.8.3 Credentialing Criteria. The Provider's Credentials Committee shall determine the criteria for selection, which shall be consistent with Healthfirst's credentialing policies and procedures, as may be modified by Healthfirst from time to time. Provider's credentialing and recredentialing criteria and procedure, its procedure for selection and termination of Providers, and its Provider grievance mechanism shall be subject to review and approval by Healthfirst, which approval shall not be unreasonably withheld. At a minimum, Provider's credentialing and recredentialing criteria and procedure shall be consistent with The Joint Commission (\"TJC\") and applicable standards required under Article 28 of the New York State Public Health law and shall include requiring Affiliated Providers to be licensed and qualified to provide the services specified and to maintain such license in good standing. Provider shall include further credentialing requirements in addition to the TJC FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 2 of 10\n", - "\n", - "Start of Page No. = 29 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE reasonably required by Healthfirst and acceptable to Provider. Notwithstanding any provision foregoing, Healthfirst shall retain final authority concerning the credentialing of Affiliated Providers and his/her participation in the Healthfirst network. 2.8.4 Cooperation. Provider shall cooperate with Healthfirst to determine if the credentialing and recredentialing criteria and procedures used by Provider are consistent with Healthfirst's and TJC's credentialing and recredentialing criteria and procedures. In the event that Provider's credentialing and recredentialing criteria and procedures are inconsistent with Healthfirst's credentialing and recredentialing criteria and procedures then Healthfirst, after good faith negotiations with Provider, may adjust the compensation payable to Provider under this Agreement to compensate Healthfirst for the reasonable cost of credentialing and recredentialing potential Affiliated Providers employed by or affiliated with Provider. 2.8.5 Oversight by Healthfirst. To allow Healthfirst to oversee and monitor the delegation of credentialing to Provider, Provider, upon the reasonable request of Healthfirst and on an ongoing basis, shall (i) permit Healthfirst to conduct on-site audits of Provider credentialing policies and procedures and credentialing files, upon reasonable notice; (ii) to provide to Healthfirst no less than annually, rosters of Healthfirst Providers and such written verification or other substantiation as requested by Healthfirst that Affiliated Providers employed by or on the medical staff of Provider are currently and fully credentialed in accordance with TJC and Healthfirst standards; (iii) to provide to Healthfirst, upon request, copies of credentialing files excluding peer review documentation; and, (iv) and to provide Healthfirst with Affiliated Providers' initial appointment date, reappointment start date and reappointment end date. Provider shall retain the right to terminate immediately its agreements with, or the employment of, any Affiliated Provider, subject to applicable appeals, if the Affiliated Provider is no longer a member of the Provider's medical staff, if the license to practice or DEA permit or any controlled substances registration of said Affiliated Provider is suspended, otherwise restricted or revoked, or if said Affiliated Provider is excluded or terminated from either the Medicare or Medicaid programs, or if said Affiliated Provider is not covered by insurance as provided pursuant to this Agreement or is convicted of any crime (either a misdemeanor or a felony). Provider shall notify Healthfirst, immediately, but in any event within forty-eight (48) hours of receipt of notice, if any Affiliated Provider employed by or affiliated with Provider has his or her license to practice or DEA permit or any controlled substances registration suspended or otherwise restricted or revoked or is excluded or terminated from either the Medicare or Medicaid programs, or is not covered by insurance as required pursuant to this Agreement below or is convicted of any crime related to the provision of health care services. Notwithstanding any other provision of this Section to the contrary, it is expressly understood and agreed that Provider shall not be responsible for conducting individual site visits at provider sites other than at facilities operated by Provider. 2.8.6 Confidentiality. The foregoing provisions of this Section and the other provisions of this Agreement shall not require the release or other disclosure by any person of any records or other documents or information to the extent that such release or other disclosure is prohibited by or otherwise contrary to any applicable law. 3 A new Exhibit 4.1 setting forth the reimbursement to be paid by Healthfirst to IPA Providers for the provision of Health Care Services to Enrollees and IPA for the provision of certain FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 3 of 10\n", - "\n", - "Start of Page No. = 30 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE administrative services, a copy of which is attached to this Amendment, is added to the Agreement. The reimbursement set forth in the Exhibit 4.1 attached to this Amendment shall apply to dates of service on and after January 1, 2015. Prior Exhibits 4.1 shall continue to apply to dates of service prior to that date. 4 All other terms and conditions of the Agreement shall remain in full force and effect. {'Healthfirst PHSP, Inc.': ['DocuSigned by: By: Paul E. Portsmore', '441CEAD8E502476. Name: Paul E. Portsmore Print Name', 'Title: SVP -', 'Date: 12/31/2014 I 18:32:28 ET -'], 'Chinese American Independent Practice Association, Inc.': ['By: f Sear', 'Name: PEGGY SHENG Print Name', 'Title: Chief Operating Officer', 'Date: December 26, 2014']} {'Healthfirst PHSP, Inc.': ['By: Name: Print Name', 'Title:', 'Date: -'], 'Chinese American Independent Practice Association, Inc.': ['By: Name: Print Name', 'Title:', 'Date:']} FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 4 of 10\n", - "\n", - "\n", - " 4 All other terms and conditions of the Agreement shall remain in full force and effect. {'Healthfirst PHSP, Inc.': ['DocuSigned by: By: Paul E. Portsmore', '441CEAD8E502476. Name: Paul E. Portsmore Print Name', 'Title: SVP -', 'Date: 12/31/2014 I 18:32:28 ET -'], 'Chinese American Independent Practice Association, Inc.': ['By: f Sear', 'Name: PEGGY SHENG Print Name', 'Title: Chief Operating Officer', 'Date: December 26, 2014']} {'Healthfirst PHSP, Inc.': ['By: Name: Print Name', 'Title:', 'Date: -'], 'Chinese American Independent Practice Association, Inc.': ['By: Name: Print Name', 'Title:', 'Date:']} {'Healthfirst PHSP, Inc.': ['DocuSigned by: By: Paul E. Portsmore', '441CEAD8E502476. Name: Paul E. Portsmore Print Name', 'Title: SVP -', 'Date: 12/31/2014 I 18:32:28 ET -'], 'Chinese American Independent Practice Association, Inc.': ['By: f Sear', 'Name: PEGGY SHENG Print Name', 'Title: Chief Operating Officer', 'Date: December 26, 2014']} \n", - "\n", - "Start of Page No. = 31 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE EXHIBIT 4.1 COMPENSATION SCHEDULE Reimbursement to IPA Providers 1. Except for the Health Care Services set forth below, Healthfirst shall directly reimburse IPA Providers who provide Health Care Services on a fee-for-service basis in an amount equal to 90% of the maximum allowable Region I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments under the Medicare program. 2. Healthfirst shall reimburse IPA Providers for the Health Care Services set forth below as follows: a. Physical Therapy Services. Physical therapy services set forth below shall be reimbursed at a rate of $45 per service if provided in a multi-specialty office or facility. If provided by an individually- operated Physical Therapist office (solely physical therapy services), physical therapy services set forth below shall be reimbursed at a rate of $60 per service. {'CPT Code': ['43235', '43239', '45378', '45380', '45385'], 'CPT Description': ['Upper gastrointestinal endoscopy', 'Upper gastrointestinal endoscopy, with biopsy', 'Colonoscopy, diagnostic', 'Colonoscopy, with biopsy', 'Colonoscopy, removal of tumor']} {'Code Range': ['97001-97004', '97010-97028', '97032-97039', '97110-97546', '97750-97755'], 'Code Range Description': ['Physical Medicine Assessments', 'Physical Therapy Treatment Modalities: Supervised', 'Physical Therapy Treatment Modalities: Constant Attendance', 'Other Therapeutic Techniques With Direct Patient Contact', 'Physical performance test & Assistive technology assessment']} {'CPT Code': ['43235', '43239', '45378', '45380', '45385'], 'CPT Description': ['Upper gastrointestinal endoscopy', 'Upper gastrointestinal endoscopy, with biopsy', 'Colonoscopy, diagnostic', 'Colonoscopy, with biopsy', 'Colonoscopy, removal of tumor']} {'Code Range': ['97001-97004', '97010-97028', '97032-97039', '97110-97546', '97750-97755'], 'Code Range Description': ['Physical Medicine Assessments', 'Physical Therapy Treatment Modalities: Supervised', 'Physical Therapy Treatment Modalities: Constant Attendance', 'Other Therapeutic Techniques With Direct Patient Contact', 'Physical performance test & Assistive technology assessment']} b. Physical Medicine and Rehabilitation Services. Physical medicine and rehabilitation services shall be reimbursed on a fee-for-service basis in an amount equal to 70% of the maximum allowable Region I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments under the Medicare program, except for physical therapy services which will be reimbursed as noted in \"a.\" above. C. Gastroenterology Services. The following services, when rendered in an \"Office Based Surgery\" (OBS) accredited office (as mandated by the New York State Department of Health), will be reimbursed on a fee-for-service basis in an amount equal to 100% of the maximum allowable Region I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments under the Medicare program. FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 5 of 10\n", - "\n", - "\n", - " a. Physical Therapy Services. Physical therapy services set forth below shall be reimbursed at a rate of $45 per service if provided in a multi-specialty office or facility. If provided by an individually- operated Physical Therapist office (solely physical therapy services), physical therapy services set forth below shall be reimbursed at a rate of $60 per service. {'CPT Code': ['43235', '43239', '45378', '45380', '45385'], 'CPT Description': ['Upper gastrointestinal endoscopy', 'Upper gastrointestinal endoscopy, with biopsy', 'Colonoscopy, diagnostic', 'Colonoscopy, with biopsy', 'Colonoscopy, removal of tumor']} {'Code Range': ['97001-97004', '97010-97028', '97032-97039', '97110-97546', '97750-97755'], 'Code Range Description': ['Physical Medicine Assessments', 'Physical Therapy Treatment Modalities: Supervised', 'Physical Therapy Treatment Modalities: Constant Attendance', 'Other Therapeutic Techniques With Direct Patient Contact', 'Physical performance test & Assistive technology assessment']} {'CPT Code': ['43235', '43239', '45378', '45380', '45385'], 'CPT Description': ['Upper gastrointestinal endoscopy', 'Upper gastrointestinal endoscopy, with biopsy', 'Colonoscopy, diagnostic', 'Colonoscopy, with biopsy', 'Colonoscopy, removal of tumor']} {'Code Range': ['97001-97004', '97010-97028', '97032-97039', '97110-97546', '97750-97755'], 'Code Range Description': ['Physical Medicine Assessments', 'Physical Therapy Treatment Modalities: Supervised', 'Physical Therapy Treatment Modalities: Constant Attendance', 'Other Therapeutic Techniques With Direct Patient Contact', 'Physical performance test & Assistive technology assessment']} {'CPT Code': ['43235', '43239', '45378', '45380', '45385'], 'CPT Description': ['Upper gastrointestinal endoscopy', 'Upper gastrointestinal endoscopy, with biopsy', 'Colonoscopy, diagnostic', 'Colonoscopy, with biopsy', 'Colonoscopy, removal of tumor']} \n", - "\n", - "Start of Page No. = 32 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE e. Hearing Aids. IPA Providers shall be reimbursed for the cost of hearing aids at eighty percent (80%) of the manufacturer's suggested retail price. IPA Network Access and Administrative Fees. Healthfirst shall pay IPA an administrative fee of $2.50 per Member per month for administrative services relating to quality improvement and education of Participating IPA Providers regarding Healthfirst's quality improvement programs. IPA and Healthfirst understand and agree that IPA shall not provide any management services, as that term is defined in 11 NYCRR 98, to Healthfirst pursuant to this Agreement. In the event that IPA or an affiliated of IPA provides management services, the parties shall execute a separate management agreement approved by SDOH pursuant to 11 NYCRR 98. FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 6 of 10\n", - "\n", - "\n", - "\n", - "\n", - "Start of Page No. = 33 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE Additional Compensation to IPA in the form of Surplus Distribution. 1. Limited Risk Transfer/No Transfer of Financial Risk 1.1. IPA shall be entitled to Additional Compensation under this Agreement on an annual basis in the form of a Surplus (as defined below) distribution, to the extent that any available Surplus funds exist, as specified below. 1.2. Use of Additional Compensation. IPA represents and warrants that Additional Compensation paid to IPA, if any, shall be distributed to Participating IPA Providers or used by IPA in a manner designed to improve the quality of care received by Enrollees and Enrollee satisfaction. On request by Healthfirst, IPA shall provide Healthfirst with financial records accounting in detail all funds received from Healthfirst and the disbursement of all such funds as set forth in 10 NYCRR 98-1.18(d). 2. Definitions. Capitalized terms used in this Exhibit 4.1(b) shall have the meaning given in this Exhibit or, if any term is not defined in this Exhibit 4.1(b), it shall have the meaning given in the Agreement to which this Exhibit is attached. 2.1. \"Additional Compensation\" shall mean the portion of any Surplus paid to IPA pursuant to Section 5 of this Exhibit 4.1(b). 2.2. \"Adjusted Premiums\" shall mean the premiums received by Healthfirst for Risk Enrollees, as adjusted by any risk score or other adjustment to premiums pursuant to the applicable Plan Contract and applicable to Risk Enrollees as reasonably determined and applied by Healthfirst. 2.3. \"Administrative Deduction\" shall mean the deduction from Adjusted Premiums equal to Healthfirst's administrative costs as reasonably determined by Healthfirst. 2.4. \"Final Reconciliation\" shall mean the final the accounting, as set forth in Section 3, of Medical Revenue, claims paid for Health Care Services and other expenses to determine Surpluses or Deficits conducted twelve months following the expiration, non-renewal or termination of this Exhibit. 2.5. \"Medical Revenue\" shall mean the balance of Adjusted Premiums after subtracting the Administrative Deduction and any Quality Incentive Deduction. 2.6. \"Quality Incentive Deduction\" shall mean an amount taken from Adjusted Premiums for programs in which IPA and IPA Providers participate to improve the quality of Health Care Services which Risk Enrollees receive. 2.7. \"Reconciliation\" shall mean the accounting, as set forth in Section 3, of Medical Revenue, claims paid for Health Care Services and other expenses to determine Surpluses or Deficits. 2.8. \"Risk Enrollee\" shall mean an Enrollee who has selected, or been assigned to, a primary care provider who is a Participating IPA Provider. FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 7 of 10\n", - "\n", - "Start of Page No. = 34 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 2.9. \"Surplus\" or \"Deficit\" shall mean the balance of Medical Revenue following Reconciliation 3. Reconciliation of Medical Revenue to Determine Surpluses and Deficits. During each Reconciliation, Healthfirst shall make the following deductions from Medical Revenue and determine the amount of any Surplus of Deficit: 3.1. the costs of claims paid for Health Care Services rendered to Risk Enrollees by Participating IPA Providers, Participating Providers and all other health care providers. 3.2. a reasonable reserve for the cost of claims for Health Care Services rendered to Risk Enrollees but not yet received; 3.3. other costs associated with the provision of Health Care Services to Risk Enrollees including but not limited to the net cost of reinsurance and any internal aggregate risk sharing programs. 3.4. accruals for any risk adjustment applicable to Adjusted Premiums. 4. Reconciliation Schedule. 4.1. Interim Quarterly Reconciliation and Distribution. Within one-hundred and twenty days (120) after the end of each calendar year quarter, Healthfirst shall determine the amount of any Surplus or Deficit for all preceding quarters during that calendar year. In the event that Healthfirst determines that a Surplus has been achieved for the preceding quarters during the calendar year, Healthfirst shall make an interim payment to IPA of Additional Compensation as set forth in Section 5 below. In the event that Healthfirst determines that a Deficit has been achieved for the preceding quarters druing the calendar year, Healthfirst not make an interim payment to IPA of Additional Compensation and the Deficit shall be handled as set forth in Section 6 below. 4.2. Annual Reconciliation and Distribution. Within one-hundred and twenty days (120) after the end of each calendar year, Healthfirst shall determine the amount of any Surplus for all quarters for that calendar year. In the event that Healthfirst determines that a Surplus has been achieved for that calendar year, Healthfirst shall make a final payment to IPA of Additional Compensation as set forth in Section 5 below. In the event that Healthfirst determines that a Deficit has been achieved for that Calendar Year, Healthfirst not make a final payment to IPA of Additional Compensation and the Deficit shall be handled as set forth in Section 6 below. 5. Payment of Additional Compensation. In the event that Healthfirst determines that a Surplus has been achieved as set forth Section 3 above, Healthfirst shall pay to IPA Additional Compensation which shall be the lesser of the following: 5.1. Ten percent (10%) of the Surplus for the calendar year, or 5.2. An amount such that the Additional Compensation equals twenty-five percent (25%) of the sum of i) the total compensation to Participating IPA Providers for Health Care Services rendered to FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 8 of 10\n", - "\n", - "Start of Page No. = 35 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE Risk Enrollees pursuant to Exhibit 4.1(a); any compensation paid to IPA pursuant to Exhibit 4.1(a) and iii) the Additional Compensation. 5.3. Healthfirst shall pay any Additional Compensation, within thirty days of each Reconciliation. Healthfirst shall, in no event, advance to IPA any Additional Compensation. 6. Treatment of Deficits. 6.1. Deficits Rolled Forward. In the event that a Deficit remains following any Reconciliation or a Final Reconciliation, the Deficit equal to the percentage set forth in Section 5.1 above shall be rolled forward to reduce any Surplus that may accrue under this Agreement in the succeeding calendar year. 6.2. Deficits at Termination, Expiration or Non-Renewal. In the event that this Agreement terminates, is not renewed or expires, regardless of the reason, Provider shall not be required to reimburse Healthfirst for any Deficits which may exist at the time of such termination, expiration or non-renewal. 7. Compliance with Regulatory Provisions Regarding Risk Transfer 7.1. SDOH Provider Contract Guidelines. Healthfirst and IPA shall comply with the applicable requirements of SDOH regarding transfer of financial risk to IPAs as set forth in SDOH's Provider Contracting Guidelines, as amended by SDOH from time to time. In the event that the amount financial risk transferred to IPA constitutes a Level 4 risk transfer pursuant to the Providing Contracting Guidelines, IPA shall demonstrate financial viability and establish a financial security deposit as required by SDOH. 7.2. Physician Incentive Plan (\"PIP\") Regulations. Healthfirst and IPA shall comply with the applicable requirements of the federal PIP regulations contained in 42 CFR 422.208, including the placement of stop loss insurance if applicable. 7.3. Financial Stability Monitoring and Reporting. Notwithstanding any other provision of this Agreement Healthfirst shall regularly monitor Provider's financial condition to ensure that Provider remains financially able to perform its obligations under this Agreement and meet any financial solvency requirements of SDOH or DFS. IPA shall promptly advise Healthfirst of any material developments which may impair its ability to perform its obligations under this Agreement. In addition, IPA shall provide Healthfirst with the reports and information as required by 10 NYCRR 98-1.18(e), which shall include but not be limited to IPA's quarterly and annual financial statements. IPA shall also maintain, as required by 10 NYCRR 98-1.18(d), financial records accounting in detail all funds received from Healthfirst and the disbursement of all such funds. IPA shall provide such accounting of funds and disbursements to Healthfirst on request. 8. Termination or Amendment of Additional Compensation Healthfirst may on, thirty (30) days prior notice to IPA, amend the terms and conditions pursuant to which Additional Compensation is determined and paid to IPA as well as eliminate the payment of Additional Compensation to IPA; provided however, that unless IPA or IPA Providers have breached FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 9 of 10\n", - "\n", - "Start of Page No. = 36 DocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE the Agreement such amendment or termination shall not change any Additional Compensation calculated or paid prior to the effective date of such amendment or termination. 9. Termination, Non-Renewal or Expiration of the Agreement. For a period of twelve months following any termination, non-renewal or expiration of this Agreement, regardless of the cause Healthfirst will conduct Reconciliations of Medical Revenue pursuant to this Agreement until the Final Reconciliation; provided, however, that payments to IPA of Additional Compensation shall be suspended. These Reconciliations shall be on based Health Care Services rendered to Risk Enrollees prior to the termination, non-renewal or expiration of this Agreement. Healthfirst shall pay to any Additional Compensation existing at the Final Reconciliation within thirty days of the Final Reconciliation. FED. TAX ID # 133923495 CONTRACT EFFECTIVE DATE: January 1, 2015 SDOH 4814 10 of 10\n" + "Managed Health, Inc.: By:, Provider: Chinese American Independent Practice Association, Inc.: By:, |\n", + "Managed Health, Inc.: Name: Print Name, Provider: Chinese American Independent Practice Association, Inc.: Name: Print Name, |\n", + "Managed Health, Inc.: Title:, Provider: Chinese American Independent Practice Association, Inc.: Title:, |\n", + "Managed Health, Inc.: Date:, Provider: Chinese American Independent Practice Association, Inc.: Date:, |\n", + "\n", + "Code Range: 97001-97006, Code Range Description: Physical Medicine Assessments, |\n", + "Code Range: 97010-97028, Code Range Description: Physical Therapy Treatment Modalities: Supervised, |\n", + "Code Range: 97032-97039, Code Range Description: Physical Therapy Treatment Modalities: Constant Attendance, |\n", + "Code Range: 97110-97546, Code Range Description: Other Therapeutic Techniques With Direct Patient Contact, |\n", + "Code Range: 97750-97755, Code Range Description: Physical performance test & Assistive technology assessment, |\n", + "\n", + "CPT Code: 43235, CPT Description: Upper gastrointestinal endoscopy, |\n", + "CPT Code: 43239, CPT Description: Upper gastrointestinal endoscopy, with biopsy, |\n", + "CPT Code: 45378, CPT Description: Colonoscopy, diagnostic, |\n", + "CPT Code: 45380, CPT Description: Colonoscopy, with biopsies, |\n", + "CPT Code: 45385, CPT Description: Colonoscopy, removal of tumor, |\n", + "\n", + "CPT Code: 99381, CPT Description: Initial visit, new patient, infant (under 1 year), Amount: $65.00, |\n", + "CPT Code: 99382, CPT Description: Initial visit, new patient, early childhood (age 1-4), Amount: $61.00, |\n", + "CPT Code: 99383, CPT Description: Initial visit, new patient, late childhood (age 5-11), Amount: $60.00, |\n", + "CPT Code: 99384, CPT Description: Initial visit, new patient, adolescent (age 12-17), Amount: $65.00, |\n", + "CPT Code: 99385, CPT Description: Initial visit, new patient, age 18-39, Amount: $74.00, |\n", + "CPT Code: 99386, CPT Description: Initial visit, new patient, age 40-64, Amount: $80.00, |\n", + "CPT Code: 99387, CPT Description: Initial visit, new patient, age 65 and older, Amount: $118.00, |\n", + "CPT Code: 99391, CPT Description: Periodic visit, established patient, infant (under 1 year), Amount: $61.00, |\n", + "CPT Code: 99392, CPT Description: Periodic visit, established patient, early childhood (age 1-4), Amount: $61.00, |\n", + "CPT Code: 99393, CPT Description: Periodic visit, established patient, late childhood (age 5-11), Amount: $60.00, |\n", + "CPT Code: 99394, CPT Description: Periodic visit, established patient, adolescent (age 12-17), Amount: $60.00, |\n", + "CPT Code: 99395, CPT Description: Periodic visit, established patient, age 18-39, Amount: $75.00, |\n", + "CPT Code: 99396, CPT Description: Periodic visit, established patient, age 40-64, Amount: $90.00, |\n", + "CPT Code: 99397, CPT Description: Periodic visit, established patient, age 65 and older, Amount: $99.00, |\n", + "CPT Code: 99401, CPT Description: Preventive medicine counseling, Individual, approx 15 minutes, Amount: $31.00, |\n", + "CPT Code: 99402, CPT Description: Preventive medicine counseling, Individual, approx 30 minutes, Amount: $40.00, |\n", + "CPT Code: 99403, CPT Description: Preventive medicine counseling, Individual, approx 45 minutes, Amount: $60.00, |\n", + "CPT Code: 99404, CPT Description: Preventive medicine counseling, Individual, approx 60 minutes, Amount: $79.00, |\n", + "CPT Code: 99411, CPT Description: Preventive medicine counseling, Group, approx 30 minutes, Amount: $28.00, |\n", + "CPT Code: 99412, CPT Description: Preventive medicine counseling, Group, approx 60 minutes, Amount: $57.00, |\n", + "\n", + "Healthfirst PHSP, Inc.: By: Name: Print Name, Chinese American Independent Practice Association, Inc.: By: Name: Print Name, |\n", + "Healthfirst PHSP, Inc.: Title:, Chinese American Independent Practice Association, Inc.: Title:, |\n", + "Healthfirst PHSP, Inc.: Date: -, Chinese American Independent Practice Association, Inc.: Date:, |\n", + "\n", + "Code Range: 97001-97004, Code Range Description: Physical Medicine Assessments, |\n", + "Code Range: 97010-97028, Code Range Description: Physical Therapy Treatment Modalities: Supervised, |\n", + "Code Range: 97032-97039, Code Range Description: Physical Therapy Treatment Modalities: Constant Attendance, |\n", + "Code Range: 97110-97546, Code Range Description: Other Therapeutic Techniques With Direct Patient Contact, |\n", + "Code Range: 97750-97755, Code Range Description: Physical performance test & Assistive technology assessment, |\n", + "\n", + "CPT Code: 43235, CPT Description: Upper gastrointestinal endoscopy, |\n", + "CPT Code: 43239, CPT Description: Upper gastrointestinal endoscopy, with biopsy, |\n", + "CPT Code: 45378, CPT Description: Colonoscopy, diagnostic, |\n", + "CPT Code: 45380, CPT Description: Colonoscopy, with biopsy, |\n", + "CPT Code: 45385, CPT Description: Colonoscopy, removal of tumor, |\n", + "\n", + "CPT Code/Modifier: 99205-P1, CPT Description: PCAP Initial Visit, Amount: $196.07, |\n", + "CPT Code/Modifier: 99212-P2, CPT Description: PCAP Prenatal Visit, Amount: $130.00, |\n", + "CPT Code/Modifier: 99215-P3, CPT Description: PCAP Post partum Visit, Amount: $163.00, |\n", + "CPT Code/Modifier: 59409, CPT Description: Vaginal Delivery, Amount: $1500.00, |\n", + "CPT Code/Modifier: 59514, CPT Description: Cesarean Delivery, Amount: $1500.00, |\n", + "CPT Code/Modifier: 99381, CPT Description: Initial visit, new patient, infant (under 1 year), Amount: $65.00, |\n", + "CPT Code/Modifier: 99382, CPT Description: Initial visit, new patient, early childhood (age 1-4), Amount: $61.00, |\n", + "CPT Code/Modifier: 99383, CPT Description: Initial visit, new patient, late childhood (age 5-11), Amount: $60.00, |\n", + "CPT Code/Modifier: 99384, CPT Description: Initial visit, new patient, adolescent (age 12-17), Amount: $65.00, |\n", + "CPT Code/Modifier: 99385, CPT Description: Initial visit, new patient, age 18-39, Amount: $74.00, |\n", + "CPT Code/Modifier: 99386, CPT Description: Initial visit, new patient, age 40-64, Amount: $80.00, |\n", + "CPT Code/Modifier: 99387, CPT Description: Initial visit, new patient, age 65 and older, Amount: $118.00, |\n", + "CPT Code/Modifier: 99391, CPT Description: Periodic visit, established patient, infant (under 1 year), Amount: $61.00, |\n", + "CPT Code/Modifier: 99392, CPT Description: Periodic visit, established patient, early childhood (age 1-4), Amount: $61.00, |\n", + "CPT Code/Modifier: 99393, CPT Description: Periodic visit, established patient, late childhood (age 5-11), Amount: $60.00, |\n", + "CPT Code/Modifier: 99394, CPT Description: Periodic visit, established patient, adolescent (age 12-17), Amount: $60.00, |\n", + "CPT Code/Modifier: 99395, CPT Description: Periodic visit, established patient, age 18-39, Amount: $75.00, |\n", + "CPT Code/Modifier: 99396, CPT Description: Periodic visit, established patient, age 40-64, Amount: $90.00, |\n", + "CPT Code/Modifier: 99397, CPT Description: Periodic visit, established patient, age 65 and older, Amount: $99.00, |\n", + "CPT Code/Modifier: 99401, CPT Description: Preventive medicine counseling, Individual, approx 15 minutes, Amount: $31.00, |\n", + "CPT Code/Modifier: 99402, CPT Description: Preventive medicine counseling, Individual, approx 30 minutes, Amount: $40.00, |\n", + "CPT Code/Modifier: 99403, CPT Description: Preventive medicine counseling, Individual, approx 45 minutes, Amount: $60.00, |\n", + "CPT Code/Modifier: 99404, CPT Description: Preventive medicine counseling, Individual, approx 60 minutes, Amount: $79.00, |\n", + "CPT Code/Modifier: 99411, CPT Description: Preventive medicine counseling, Group, approx 30 minutes, Amount: $28.00, |\n", + "CPT Code/Modifier: 99412, CPT Description: Preventive medicine counseling, Group, approx 60 minutes, Amount: $57.00, |\n", + "\n", + "Managed Health, Inc.: DocuSigned by: By: Paul E. Portsmore, Provider: Chinese American Independent Practice Association, Inc.: By: family, |\n", + "Managed Health, Inc.: 441CEAD8E502476 Name: Paul E. Portsmore Print Name, Provider: Chinese American Independent Practice Association, Inc.: Name: PEGGY SHENG Print Name, |\n", + "Managed Health, Inc.: Title: SVP, Provider: Chinese American Independent Practice Association, Inc.: Chief Operating Officer Title:, |\n", + "Managed Health, Inc.: Date: 12/31/2014 18:32:28 ET, Provider: Chinese American Independent Practice Association, Inc.: Date: Dec. 26, 2015, |\n", + "\n", + "Code Range: 97001-97006, Code Range Description: Physical Medicine Assessments, |\n", + "Code Range: 97010-97028, Code Range Description: Physical Therapy Treatment Modalities: Supervised, |\n", + "Code Range: 97032-97039, Code Range Description: Physical Therapy Treatment Modalities: Constant Attendance, |\n", + "Code Range: 97110-97546, Code Range Description: Other Therapeutic Techniques With Direct Patient Contact, |\n", + "Code Range: 97750-97755, Code Range Description: Physical performance test & Assistive technology assessment, |\n", + "\n", + "CPT Code: 43235, CPT Description: Upper gastrointestinal endoscopy, |\n", + "CPT Code: 43239, CPT Description: Upper gastrointestinal endoscopy, with biopsy, |\n", + "CPT Code: 45378, CPT Description: Colonoscopy, diagnostic, |\n", + "CPT Code: 45380, CPT Description: Colonoscopy, with biopsies, |\n", + "CPT Code: 45385, CPT Description: Colonoscopy, removal of tumor, |\n", + "\n", + "CPT Code: 99381, CPT Description: Initial visit, new patient, infant (under 1 year), Amount: $65.00, |\n", + "CPT Code: 99382, CPT Description: Initial visit, new patient, early childhood (age 1-4), Amount: $61.00, |\n", + "CPT Code: 99383, CPT Description: Initial visit, new patient, late childhood (age 5-11), Amount: $60.00, |\n", + "CPT Code: 99384, CPT Description: Initial visit, new patient, adolescent (age 12-17), Amount: $65.00, |\n", + "CPT Code: 99385, CPT Description: Initial visit, new patient, age 18-39, Amount: $74.00, |\n", + "CPT Code: 99386, CPT Description: Initial visit, new patient, age 40-64, Amount: $80.00, |\n", + "CPT Code: 99387, CPT Description: Initial visit, new patient, age 65 and older, Amount: $118.00, |\n", + "CPT Code: 99391, CPT Description: Periodic visit, established patient, infant (under 1 year), Amount: $61.00, |\n", + "CPT Code: 99392, CPT Description: Periodic visit, established patient, early childhood (age 1-4), Amount: $61.00, |\n", + "CPT Code: 99393, CPT Description: Periodic visit, established patient, late childhood (age 5-11), Amount: $60.00, |\n", + "CPT Code: 99394, CPT Description: Periodic visit, established patient, adolescent (age 12-17), Amount: $60.00, |\n", + "CPT Code: 99395, CPT Description: Periodic visit, established patient, age 18-39, Amount: $75.00, |\n", + "CPT Code: 99396, CPT Description: Periodic visit, established patient, age 40-64, Amount: $90.00, |\n", + "CPT Code: 99397, CPT Description: Periodic visit, established patient, age 65 and older, Amount: $99.00, |\n", + "CPT Code: 99401, CPT Description: Preventive medicine counseling, Individual, approx 15 minutes, Amount: $31.00, |\n", + "CPT Code: 99402, CPT Description: Preventive medicine counseling, Individual, approx 30 minutes, Amount: $40.00, |\n", + "CPT Code: 99403, CPT Description: Preventive medicine counseling, Individual, approx 45 minutes, Amount: $60.00, |\n", + "CPT Code: 99404, CPT Description: Preventive medicine counseling, Individual, approx 60 minutes, Amount: $79.00, |\n", + "CPT Code: 99411, CPT Description: Preventive medicine counseling, Group, approx 30 minutes, Amount: $28.00, |\n", + "CPT Code: 99412, CPT Description: Preventive medicine counseling, Group, approx 60 minutes, Amount: $57.00, |\n", + "\n", + "Healthfirst PHSP, Inc.: DocuSigned by: By: Paul E. Portsmore, Chinese American Independent Practice Association, Inc.: By: f Sear, |\n", + "Healthfirst PHSP, Inc.: 441CEAD8E502476. Name: Paul E. Portsmore Print Name, Chinese American Independent Practice Association, Inc.: Name: PEGGY SHENG Print Name, |\n", + "Healthfirst PHSP, Inc.: Title: SVP -, Chinese American Independent Practice Association, Inc.: Title: Chief Operating Officer, |\n", + "Healthfirst PHSP, Inc.: Date: 12/31/2014 I 18:32:28 ET -, Chinese American Independent Practice Association, Inc.: Date: December 26, 2014, |\n", + "\n", + "Code Range: 97001-97004, Code Range Description: Physical Medicine Assessments, |\n", + "Code Range: 97010-97028, Code Range Description: Physical Therapy Treatment Modalities: Supervised, |\n", + "Code Range: 97032-97039, Code Range Description: Physical Therapy Treatment Modalities: Constant Attendance, |\n", + "Code Range: 97110-97546, Code Range Description: Other Therapeutic Techniques With Direct Patient Contact, |\n", + "Code Range: 97750-97755, Code Range Description: Physical performance test & Assistive technology assessment, |\n", + "\n", + "CPT Code: 43235, CPT Description: Upper gastrointestinal endoscopy, |\n", + "CPT Code: 43239, CPT Description: Upper gastrointestinal endoscopy, with biopsy, |\n", + "CPT Code: 45378, CPT Description: Colonoscopy, diagnostic, |\n", + "CPT Code: 45380, CPT Description: Colonoscopy, with biopsy, |\n", + "CPT Code: 45385, CPT Description: Colonoscopy, removal of tumor, |\n", + "\n", + "CPT Code/Modifier: 99205-P1, CPT Description: PCAP Initial Visit, Amount: $196.07, |\n", + "CPT Code/Modifier: 99212-P2, CPT Description: PCAP Prenatal Visit, Amount: $130.00, |\n", + "CPT Code/Modifier: 99215-P3, CPT Description: PCAP Post partum Visit, Amount: $163.00, |\n", + "CPT Code/Modifier: 59409, CPT Description: Vaginal Delivery, Amount: $1500.00, |\n", + "CPT Code/Modifier: 59514, CPT Description: Cesarean Delivery, Amount: $1500.00, |\n", + "CPT Code/Modifier: 99381, CPT Description: Initial visit, new patient, infant (under 1 year), Amount: $65.00, |\n", + "CPT Code/Modifier: 99382, CPT Description: Initial visit, new patient, early childhood (age 1-4), Amount: $61.00, |\n", + "CPT Code/Modifier: 99383, CPT Description: Initial visit, new patient, late childhood (age 5-11), Amount: $60.00, |\n", + "CPT Code/Modifier: 99384, CPT Description: Initial visit, new patient, adolescent (age 12-17), Amount: $65.00, |\n", + "CPT Code/Modifier: 99385, CPT Description: Initial visit, new patient, age 18-39, Amount: $74.00, |\n", + "CPT Code/Modifier: 99386, CPT Description: Initial visit, new patient, age 40-64, Amount: $80.00, |\n", + "CPT Code/Modifier: 99387, CPT Description: Initial visit, new patient, age 65 and older, Amount: $118.00, |\n", + "CPT Code/Modifier: 99391, CPT Description: Periodic visit, established patient, infant (under 1 year), Amount: $61.00, |\n", + "CPT Code/Modifier: 99392, CPT Description: Periodic visit, established patient, early childhood (age 1-4), Amount: $61.00, |\n", + "CPT Code/Modifier: 99393, CPT Description: Periodic visit, established patient, late childhood (age 5-11), Amount: $60.00, |\n", + "CPT Code/Modifier: 99394, CPT Description: Periodic visit, established patient, adolescent (age 12-17), Amount: $60.00, |\n", + "CPT Code/Modifier: 99395, CPT Description: Periodic visit, established patient, age 18-39, Amount: $75.00, |\n", + "CPT Code/Modifier: 99396, CPT Description: Periodic visit, established patient, age 40-64, Amount: $90.00, |\n", + "CPT Code/Modifier: 99397, CPT Description: Periodic visit, established patient, age 65 and older, Amount: $99.00, |\n", + "CPT Code/Modifier: 99401, CPT Description: Preventive medicine counseling, Individual, approx 15 minutes, Amount: $31.00, |\n", + "CPT Code/Modifier: 99402, CPT Description: Preventive medicine counseling, Individual, approx 30 minutes, Amount: $40.00, |\n", + "CPT Code/Modifier: 99403, CPT Description: Preventive medicine counseling, Individual, approx 45 minutes, Amount: $60.00, |\n", + "CPT Code/Modifier: 99404, CPT Description: Preventive medicine counseling, Individual, approx 60 minutes, Amount: $79.00, |\n", + "CPT Code/Modifier: 99411, CPT Description: Preventive medicine counseling, Group, approx 30 minutes, Amount: $28.00, |\n", + "CPT Code/Modifier: 99412, CPT Description: Preventive medicine counseling, Group, approx 60 minutes, Amount: $57.00, |\n", + "\n" ] } ], "source": [ - "print(contract_text)" + "contract_text = preprocess.clean_newlines(input_dict['133923495 CAIPA 2015 PHSP.txt'])\n", + "text_dict = preprocess.split_text(contract_text)\n", + "text_dict = align_and_format_tables(text_dict)\n", + "text_dict = preprocess.highlight_rates(text_dict)" + ] + }, + { + "cell_type": "code", + "execution_count": 34, + "metadata": {}, + "outputs": [], + "source": [ + "answer_strings = bottom_up_funcs.run_bottom_up_primary({'5' : text_dict['5']}, 4000)\n", + "answer_dicts = dict_operations.primary_string_to_dict(answer_strings)\n", + "answer_dicts = postprocess.primary_filter(answer_dicts)" + ] + }, + { + "cell_type": "code", + "execution_count": 35, + "metadata": {}, + "outputs": [ + { + "data": { + "text/plain": [ + "[{'SERVICE': 'Initial visit, new patient, infant (under 1 year)',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$65.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Initial visit, new patient, early childhood (age 1-4)',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$61.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Initial visit, new patient, late childhood (age 5-11)',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$60.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Initial visit, new patient, adolescent (age 12-17)',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$65.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Initial visit, new patient, age 18-39',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$74.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Initial visit, new patient, age 40-64',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$80.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Initial visit, new patient, age 65 and older',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$118.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Periodic visit, established patient, infant (under 1 year)',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$61.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Periodic visit, established patient, early childhood (age 1-4)',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$61.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Periodic visit, established patient, late childhood (age 5-11)',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$60.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Periodic visit, established patient, adolescent (age 12-17)',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$60.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Periodic visit, established patient, age 18-39',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$75.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Periodic visit, established patient, age 40-64',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$90.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Periodic visit, established patient, age 65 and older',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$99.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Preventive medicine counseling, Individual, approx 15 minutes',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$31.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Preventive medicine counseling, Individual, approx 30 minutes',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$40.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Preventive medicine counseling, Individual, approx 45 minutes',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$60.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Preventive medicine counseling, Individual, approx 60 minutes',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$79.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Preventive medicine counseling, Group, approx 30 minutes',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$28.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Preventive medicine counseling, Group, approx 60 minutes',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$57.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': 'N/A',\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Hearing Aids',\n", + " 'REIMBURSEMENT_FLAT_FEE': 'N/A',\n", + " 'REIMBURSEMENT_RATE': '80%',\n", + " 'FULL_METHODOLOGY': \"IPA Providers shall be reimbursed for the cost of hearing aids at eighty percent (80%) of the manufacturer's suggested retail price.\",\n", + " 'page_num': '5'},\n", + " {'SERVICE': 'Network Access and Administrative Fees for Medicare Advantage members',\n", + " 'REIMBURSEMENT_FLAT_FEE': '$5.00',\n", + " 'REIMBURSEMENT_RATE': 'N/A',\n", + " 'FULL_METHODOLOGY': \"Healthfirst shall compensate IPA $5.00 per Member per month for the following administrative services,: Access to IPA's network of Participating IPA Providers Credentialing of Participating IPA Providers Reporting on Health Care Services provided to Enrollees as reasonably requested by Healthfirst Administrative services relating to quality improvement and Enrollee satisfaction Education of Participating IPA Providers regarding Healthfirst's policies and procedures and quality improvement programs.\",\n", + " 'page_num': '5'}]" + ] + }, + "execution_count": 35, + "metadata": {}, + "output_type": "execute_result" + } + ], + "source": [ + "answer_dicts" + ] + }, + { + "cell_type": "code", + "execution_count": 38, + "metadata": {}, + "outputs": [], + "source": [ + "def BOTTOM_UP_CODES(d, page):\n", + " return f\"\"\"### PAGE START ### {page} ### PAGE END\n", + "\n", + "The above text contains a number of reimbursement terms. For the rest of this request, focus only on the specific term listed below:\n", + "Service: {d['SERVICE']}\n", + "Methodology: {d['FULL_METHODOLOGY']}\n", + "\n", + "Your job is to identify codes associated with this specific term.\n", + "\n", + "Read and analyze the page, then populate a JSON dictionary with the following code types if they are associated with the given Service and Methodology (descriptions provided):\n", + "'REIMBURSEMENT_ADMITTYPE_CODES' : Single-digit codes that indicate the type of admission to a facility.\n", + "'REIMBURSEMENT_DIAG_CODES' : Multi-digit alphanumeric codes related to diagnosis. They may contain a '.' after the first 3 characters. These may be labelled as ICD-10 or ICD-10-CM codes.\n", + "'REIMBURSEMENT_GROUPER_CODES' : 3- or 4-digit codes that may be labelled DRG or or similar.\n", + "'REIMBURSEMENT_GROUPER' : If there are grouper codes, what type are they? They could be MSDRG, APDRG, APRDRG, APC, APG, or EAPG. Choose only from these options.\n", + "'REIMBURSEMENT_PLACEOFSERVICE_CODES' : 2-digit codes related to the place of service.\n", + "'REIMBURSEMENT_PROC_CODES' : 5-digit numeric or alphanumeric codes. They may be labelled as CPT or HCPCS codes. These are related to specific procedures.\n", + "'REIMBURSEMENT_REVENUE_CODES' : 3- or 4-digit numeric or alphanumeric codes related to revenue. They may be labelled as 'Rev' codes.\n", + "'REIMBURSEMENT_STATUS_INDICATOR_CODES' : 1- or 2-digit alphanumeric codes indicating the payment status.\n", + "\n", + "Return a value for each type of code - return N/A for any values not found. Multiple codes for each type may be found. In this case, return them all. They may also present as a range. If so, return the range.\n", + "\n", + "Only return the dictionary, with no other commentary or explanation. Ensure you abide by proper JSON formatting.\n", + "\"\"\"" ] }, { "cell_type": "code", "execution_count": 39, "metadata": {}, - "outputs": [ - { - "data": { - "text/plain": [ - "'Document Index\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 1\\nFifth Amendment to the Agreement by and between 1Managed Health, Inc. and Independent Practice Association 1\\nWITNESSETH: 1\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 2\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 3\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 4\\nEXHIBIT C 4\\nCompensation Schedule 4\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 5\\nd. The following preventive care services will be reimbursed at the rates noted below: 5\\nIPA Network Access and Administrative Fees. 5\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 6\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 7\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 8\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 9\\nWITNESSETH: 9\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 10\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 11\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 12\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 13\\nCOMPENSATION SCHEDULE 13\\nReimbursement to IPA Providers 13\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 14\\nd. The following services will be reimbursed at the rates noted below: 14\\nIPA Network Access and Administrative Fees. 14\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 15\\nAdditional Compensation to IPA in the form of Surplus Distribution. 15\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 16\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 17\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 18\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 19\\nFifth Amendment to the Agreement by and between 19Managed Health, Inc. and Independent Practice Association 19\\nWITNESSETH: 19\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 20\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 21\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 22\\nEXHIBIT C 22\\nCompensation Schedule 22\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 23\\nd. The following preventive care services will be reimbursed at the rates noted below: 23\\nIPA Network Access and Administrative Fees. 23\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 24\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 25\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 26\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 27\\nSecond Amendment to the Agreement 27\\nby and between 27Healthfirst PHSP, Inc. and Independent Practice Association 27\\nWITNESSETH: 27\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 28\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 29\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 30\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 31\\nCOMPENSATION SCHEDULE 31\\nReimbursement to IPA Providers 31\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 32\\nd. The following services will be reimbursed at the rates noted below: 32\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 33\\nAdditional Compensation to IPA in the form of Surplus Distribution. 33\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 34\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 35\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE 36\\n\\n\\n\\nStart of Page No. = 1\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nFifth Amendment to the Agreement by and between\\nManaged Health, Inc. and Independent Practice Association\\nThis Amendment to the Agreement between Managed Health, Inc. (\"Healthfirst\"), and Chinese\\nAmerican Independent Practice Association, Inc. (\"Provider\") is effective January 1, 2015.\\nWITNESSETH:\\nWHEREAS, Healthfirst and Provider have entered into an Agreement (the \"Agreement\") for the\\nprovision of Health Care Services to Enrollees; and\\nWHEREAS, Healthfirst and Provider desire to amend that Agreement to delegate credentialing\\nto Provider :\\nNOW, THEREFORE, in consideration of the mutual covenants and agreements herein\\ncontained, Healthfirst and Provider hereby agree to amend the Agreement as follows:\\n1.\\nA new Section 2.8 entitled Credentialing of Affiliated Providers is added to the\\nAgreement as follows:\\n2.8\\nCredentialing of Affiliated Providers.\\n2.8.1 Delegation. Healthfirst delegates to Provider and Provider agrees to accept the\\nresponsibility for credentialing potential Affiliated Providers employed by or affiliated with Provider;\\nprovided however, that such delegation shall be limited to i) those categories and types of providers\\nwhich Provider credentials as part of Provider\\'s regular credentialing process and ii) those providers\\nwho have or seek medical staff privileges with Provider. Provider shall not be required to credential\\nParticipating Providers which provider does not regularly credential or which do not have or seek\\nmedical staff privileges with Provider. Healthfirst shall retain sole responsibility for credentialing such\\nParticipating Providers. Healthfirst acknowledges and agrees that Healthfirst has reviewed Provider\\'s\\ncredentialing process and that such process meets the requirements of this Agreement, including this\\nSection 2.8 as of the Effective or at the time of Healthfirst\\'s final approval of the credentialing process,\\nwhichever is later.\\n2.8.2 Provider shall have a formal application and review process for such Providers\\nwhich includes, but is not limited to, a signed application and attestation. Such review shall be\\nconducted by a Provider credentials committee in consultation with the Healthfirst credentials\\ncommittee. Provider shall have Credentialing Policies and Procedures that defines the following:\\n2.8.2.1 scope of Affiliated Providers covered;\\n2.8.2.2 criteria for primary source verification of information;\\n2.8.2.3 the process used to make credentialing decisions;\\n2.8.2.4 the extent of any delegated credentialing/recredentialing arrangements;\\nFED. TAX ID: 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\n\\nStart of Page No. = 2\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\n2.8.2.5 the right of Affiliated Providers to review the information submitted in\\nsupport of their credentialing application;\\n2.8.2.6 the process of notification to a Affiliated Provider of any information\\nobtained during the credentialing process that varies substantially from the information provided by the\\nAffiliated Provider;\\n2.8.2.7 the Affiliated Provider\\'s right to correct erroneous information;\\n2.8.2.8 the Provider\\'s medical director\\'s direct responsibility and participation in\\nthe credentialing program; and\\n2.8.2.9 the process used to ensure confidentiality of all information obtained in\\nthe credentialing process, except otherwise provided by law.\\n2.8.3 Credentialing Criteria. The Provider\\'s Credentials Committee shall determine the\\ncriteria for selection, which shall be consistent with Healthfirst\\'s credentialing policies and procedures,\\nas may be modified by Healthfirst from time to time. Provider\\'s credentialing and recredentialing\\ncriteria and procedure, its procedure for selection and termination of Providers, and its Provider\\ngrievance mechanism shall be subject to review and approval by Healthfirst, which approval shall not be\\nunreasonably withheld. At a minimum, Provider\\'s credentialing and recredentialing criteria and\\nprocedure shall be consistent with The Joint Commission (\"TJC\") and applicable standards required\\nunder Article 28 of the New York State Public Health law and shall include requiring Affiliated\\nProviders to be licensed and qualified to provide the services specified and to maintain such license in\\ngood standing. Provider shall include further credentialing requirements in addition to the TJC\\nreasonably required by Healthfirst and acceptable to Provider. Notwithstanding any provision\\nforegoing, Healthfirst shall retain final authority concerning the credentialing of Affiliated Providers and\\nhis/her participation in the Healthfirst network.\\n2.8.4 Cooperation. Provider shall cooperate with Healthfirst to determine if the\\ncredentialing and recredentialing criteria and procedures used by Provider are consistent with\\nHealthfirst\\'s and TJC\\'s credentialing and recredentialing criteria and procedures. In the event that\\nProvider\\'s credentialing and recredentialing criteria and procedures are inconsistent with Healthfirst\\'s\\ncredentialing and recredentialing criteria and procedures then Healthfirst, after good faith negotiations\\nwith Provider, may adjust the compensation payable to Provider under this Agreement to compensate\\nHealthfirst for the reasonable cost of credentialing and recredentialing potential Affiliated Providers\\nemployed by or affiliated with Provider.\\n2.8.5 Oversight by Healthfirst. To allow Healthfirst to oversee and monitor the\\ndelegation of credentialing to Provider, Provider, upon the reasonable request of Healthfirst and on an\\nongoing basis, shall (i) permit Healthfirst to conduct on-site audits of Provider credentialing policies and\\nprocedures and credentialing files, upon reasonable notice; (ii) to provide to Healthfirst no less than\\nannually, rosters of Healthfirst Providers and such written verification or other substantiation as\\nrequested by Healthfirst that Affiliated Providers employed by or on the medical staff of Provider are\\ncurrently and fully credentialed in accordance with TJC and Healthfirst standards; (iii) to provide to\\nHealthfirst, upon request, copies of credentialing files excluding peer review documentation; and, (iv)\\nFED. TAX ID: 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\n\\nStart of Page No. = 3\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nand to provide Healthfirst with Affiliated Providers\\' initial appointment date, reappointment start date\\nand reappointment end date. Provider shall retain the right to terminate immediately its agreements\\nwith, or the employment of, any Affiliated Provider, subject to applicable appeals, if the Affiliated\\nProvider is no longer a member of the Provider\\'s medical staff, if the license to practice or DEA permit\\nor any controlled substances registration of said Affiliated Provider is suspended, otherwise restricted or\\nrevoked, or if said Affiliated Provider is excluded or terminated from either the Medicare or Medicaid\\nprograms, or if said Affiliated Provider is not covered by insurance as provided pursuant to this\\nAgreement or is convicted of any crime (either a misdemeanor or a felony). Provider shall notify\\nHealthfirst, immediately, but in any event within forty-eight (48) hours of receipt of notice, if any\\nAffiliated Provider employed by or affiliated with Provider has his or her license to practice or DEA\\npermit or any controlled substances registration suspended or otherwise restricted or revoked or is\\nexcluded or terminated from either the Medicare or Medicaid programs, or is not covered by insurance\\nas required pursuant to this Agreement below or is convicted of any crime related to the provision of\\nhealth care services. Notwithstanding any other provision of this Section to the contrary, it is expressly\\nunderstood and agreed that Provider shall not be responsible for conducting individual site visits at\\nprovider sites other than at facilities operated by Provider.\\n2.8.6 Confidentiality. The foregoing provisions of this Section and the other provisions\\nof this Agreement shall not require the release or other disclosure by any person of any records or other\\ndocuments or information to the extent that such release or other disclosure is prohibited by or otherwise\\ncontrary to any applicable law.\\n2.\\nA new Exhibit C setting forth the reimbursement to be paid by MHI to IPA and IPA\\nProviders for the provision of Covered Services to Enrollees, a copy of which is attached to this\\nAmendment, added to the Agreement. The reimbursement set forth in the Exhibit C attached to this\\namendment shall apply to dates of service on and after January 1, 2015. Prior Exhibits C and the Letter\\nof Agreement effective July 1, 2006 shall continue to apply to dates of service prior to that date. This\\nAmendment supersedes the July 1, 2006 Letter of Agreement setting forth an administrative fee.\\n3.\\nAll other terms and conditions of the Agreement shall remain in full force and effect.\\nIN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the Effective\\nDate above.\\nFED. TAX ID: 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\n\\n\\n-------Table Start--------THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>\\n IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the Effective Date above.\\n<<<<<<{\\'Managed Health, Inc.\\': [\\'By:\\', \\'Name: Print Name\\', \\'Title:\\', \\'Date:\\'], \\'Provider: Chinese American Independent Practice Association, Inc.\\': [\\'By:\\', \\'Name: Print Name\\', \\'Title:\\', \\'Date:\\']}\\n-------Table End--------\\n\\nStart of Page No. = 4\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nEXHIBIT C\\nCompensation Schedule\\nReimbursement to IPA Providers\\nI.\\nMedicare and Commercial Enrollees\\n1.\\nExcept for the Covered Services set forth below, MHI shall directly reimburse IPA Providers\\nwho provide Covered Services on a fee-for-service basis in an amount equal to 100% of the maximum\\nallowable Region I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\")\\nfor payments under the Medicare program.\\n2.\\nMHI shall reimburse IPA Providers for the following Covered Services as follows:\\na. Physical Therapy services shall be reimbursed at a flat rate of $55 per date of service if provided in a\\nmulti-specialty office or facility. If provided by an individually-operated Physical Therapist office\\n(solely physical therapy services), physical therapy services set forth below shall be reimbursed at a\\nrate of $65 per service. These services, which shall be updated from time to time, shall include:\\nb. Services provided by Physical Medicine and Rehabilitation specialists shall be reimbursed on a\\nfee-for-service basis in an amount equal to 70% of the maximum allowable Region I fee\\nschedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments\\nunder the Medicare program, except for physical therapy services which will be reimbursed as\\nnoted in \"a.\" above.\\nC. The following services, when rendered in an \"Office Based Surgery\" (OBS) accredited office\\n(as mandated by the New York State Department of Health), will be reimbursed on a fee-for-\\nservice basis in an amount equal to 100% of the maximum allowable Region I fee schedule\\nestablished by the Center for Medicaid and Medicare Services (\"CMS\") for payments under the\\nMedicare program.\\nFED. TAX ID: 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\n\\n\\n-------Table Start--------THIS IS PRETABLE TEXT>>>\\n a. Physical Therapy services shall be reimbursed at a flat rate of $55 per date of service if provided in a multi-specialty office or facility. If provided by an individually-operated Physical Therapist office (solely physical therapy services), physical therapy services set forth below shall be reimbursed at a rate of $65 per service. These services, which shall be updated from time to time, shall include:\\n<<<{\\'Code Range\\': [\\'97001-97006\\', \\'97010-97028\\', \\'97032-97039\\', \\'97110-97546\\', \\'97750-97755\\'], \\'Code Range Description\\': [\\'Physical Medicine Assessments\\', \\'Physical Therapy Treatment Modalities: Supervised\\', \\'Physical Therapy Treatment Modalities: Constant Attendance\\', \\'Other Therapeutic Techniques With Direct Patient Contact\\', \\'Physical performance test & Assistive technology assessment\\']}\\n-------Table End--------\\n-------Table Start--------THIS IS PRETABLE TEXT>>>\\n a. Physical Therapy services shall be reimbursed at a flat rate of $55 per date of service if provided in a multi-specialty office or facility. If provided by an individually-operated Physical Therapist office (solely physical therapy services), physical therapy services set forth below shall be reimbursed at a rate of $65 per service. These services, which shall be updated from time to time, shall include: C. The following services, when rendered in an \"Office Based Surgery\" (OBS) accredited office (as mandated by the New York State Department of Health), will be reimbursed on a fee-for- service basis in an amount equal to 100% of the maximum allowable Region I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments under the Medicare program.\\n<<<{\\'CPT Code\\': [\\'43235\\', \\'43239\\', \\'45378\\', \\'45380\\', \\'45385\\'], \\'CPT Description\\': [\\'Upper gastrointestinal endoscopy\\', \\'Upper gastrointestinal endoscopy, with biopsy\\', \\'Colonoscopy, diagnostic\\', \\'Colonoscopy, with biopsies\\', \\'Colonoscopy, removal of tumor\\']}\\n-------Table End--------\\n\\nStart of Page No. = 5\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nd. The following preventive care services will be reimbursed at the rates noted below:\\ne.\\nHearing Aids. IPA Providers shall be reimbursed for the cost of hearing aids at eighty percent\\n(80%) of the manufacturer\\'s suggested retail price.\\nII.\\nWhere rates in any fee schedule described in this Agreement make reference to Medicare or\\nMedicaid rates, any Medicare or Medicaid rates enacted by the federal Centers for Medicare and\\nMedicaid Services (\"CMS\") or the New York State Department of Health (\"SDOH\"), including updates,\\nshall apply to dates of service occurring on the later of (a) the effective date of such rates or (b) upon\\nforty five calendar days following the date on which CMS or SDOH publishes such rates.\\nIPA Network Access and Administrative Fees.\\nFor Medicare Advantage members only, Healthfirst shall compensate IPA $5.00 per Member per month\\nfor the following administrative services,:\\nAccess to IPA\\'s network of Participating IPA Providers\\nCredentialing of Participating IPA Providers\\nReporting on Health Care Services provided to Enrollees as reasonably requested by Healthfirst\\nAdministrative services relating to quality improvement and Enrollee satisfaction\\nEducation of Participating IPA Providers regarding Healthfirst\\'s policies and procedures and\\nquality improvement programs.\\nFED. TAX ID: 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\n\\n\\n-------Table Start--------THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>\\n d. The following preventive care services will be reimbursed at the rates noted below:\\n<<<<<<{\\'CPT Code\\': [\\'99381\\', \\'99382\\', \\'99383\\', \\'99384\\', \\'99385\\', \\'99386\\', \\'99387\\', \\'99391\\', \\'99392\\', \\'99393\\', \\'99394\\', \\'99395\\', \\'99396\\', \\'99397\\', \\'99401\\', \\'99402\\', \\'99403\\', \\'99404\\', \\'99411\\', \\'99412\\'], \\'CPT Description\\': [\\'Initial visit, new patient, infant (under 1 year)\\', \\'Initial visit, new patient, early childhood (age 1-4)\\', \\'Initial visit, new patient, late childhood (age 5-11)\\', \\'Initial visit, new patient, adolescent (age 12-17)\\', \\'Initial visit, new patient, age 18-39\\', \\'Initial visit, new patient, age 40-64\\', \\'Initial visit, new patient, age 65 and older\\', \\'Periodic visit, established patient, infant (under 1 year)\\', \\'Periodic visit, established patient, early childhood (age 1-4)\\', \\'Periodic visit, established patient, late childhood (age 5-11)\\', \\'Periodic visit, established patient, adolescent (age 12-17)\\', \\'Periodic visit, established patient, age 18-39\\', \\'Periodic visit, established patient, age 40-64\\', \\'Periodic visit, established patient, age 65 and older\\', \\'Preventive medicine counseling, Individual, approx 15 minutes\\', \\'Preventive medicine counseling, Individual, approx 30 minutes\\', \\'Preventive medicine counseling, Individual, approx 45 minutes\\', \\'Preventive medicine counseling, Individual, approx 60 minutes\\', \\'Preventive medicine counseling, Group, approx 30 minutes\\', \\'Preventive medicine counseling, Group, approx 60 minutes\\'], \\'Amount\\': [\\'$65.00\\', \\'$61.00\\', \\'$60.00\\', \\'$65.00\\', \\'$74.00\\', \\'$80.00\\', \\'$118.00\\', \\'$61.00\\', \\'$61.00\\', \\'$60.00\\', \\'$60.00\\', \\'$75.00\\', \\'$90.00\\', \\'$99.00\\', \\'$31.00\\', \\'$40.00\\', \\'$60.00\\', \\'$79.00\\', \\'$28.00\\', \\'$57.00\\']}\\n-------Table End--------\\n\\nStart of Page No. = 6\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nRisk Sharing with IPA\\n1\\nDefinitions. For the purposes of this Agreement and Compensation Schedule, the following\\nterms shall have the indicated meanings:\\n1.1\\n\"Adjusted Premiums\" shall mean premiums Healthfirst receives for Risk Enrollees,\\nadjusted by any risk score or premium adjustment published by CMS, SDOH or other payor as such\\nadjustment is reasonably applied by Healthfirst.\\n1.2\\n\"Cost of Risk Services\" shall mean the the cost of claims paid for Risk plus a reasonable\\nreserve for incurred but not received (\"IBNR\") claims for Risk Services.\\n1.3\\n\"Deficit\" shall be the amount that the Cost of Risk Services exceeds the Risk Target\\nfollowing Reconciliation.\\n1.4\\n\"Upside Risk Limit\" shall be equal to seventy eight percent (78__%) of Risk Target.\\n1.5\\n\"Reconciliation\" shall mean the quarterly reconciliation by Healthfirst to determine\\nSurpluses and Deficits.\\n1.6\\n\"Risk Enrollee\" shall mean Enrollees in Healthfirst\\'s Medicare Advantage plans who\\nselect an IPA Provider as their Primary Care Provider.\\n1.7\\n\"Risk Services\" shall mean all Health Care Services provided to Enrollees regardless of\\nwhether such Services were provided by IPA Providers or other health care providers.\\n1.8\\n\"Risk Target\" shall be equal to eighty three percent (83%) of Adjusted Premiums\\n1.9\\n\"Surplus\" shall be the amount that Cost of Risk Services is less than the Risk Target\\nfollowing Reconciliation.\\n1.10\\n\"Downside Risk Limit\" shall mean one hundred threepercent (103__%) of Risk Target.\\n2\\nRisk Sharing.\\n2.1\\nRisk Sharing and Cooperation. Healthfirst and IPA shall share the financial risk for Risk\\nServices rendered to Risk Enrollees as set forth below. IPA shall assume upside risk for the cost of Risk\\nServices provided to Risk Enrollees to the extent that IPA may receive portion of any Surplus. IPA shall\\nassume downside risk for the cost of Risk Services to the extent that IPA is required to repay Healthfirst\\na portion of any Deficit. Healthfirst and IPA shall cooperate in the implementation and administration\\nof Healthfirst\\'s utilization and case management programs, the sharing of utilization data, and education\\nof IPA Providers regarding utilization trends and the provision of quality and medically appropriate\\nservices.\\n2.2\\nLimited Risk Transfer. IPA shall not assume risk for the cost of Health Care Services\\nother than through the receipt of Surpluses and payment of Deficits. Under no circumstances shall IPA\\nFED. TAX ID: 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\n\\nStart of Page No. = 7\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nbe required to pay claims for Health Care Services, including Risk Services, to any IPA Provider or\\nhealth care provider. In all instances, including any termination or expiration of this Agreement,\\nHealthfirst shall remain solely responsible for paying claims for Health Care Services, including Risk\\nServices, to IPA Providers and other health care providers.\\n3\\nRegulatory Approval.\\nThe parties understand and acknowledge that this risk sharing\\narrangement may be subject to the prior review and approval of CMS, SDOH or other regulatory agency\\nhaving jurisdiction over this Agreement as required by applicable statutes and regulation. No payments\\nshall be made by either party, prior to receiving such regulatory approval. The failure to obtain\\nregulatory shall not be grounds for either party to terminate this Agreement which shall otherwise\\nremain in effect.\\n4\\nQuarterly Reconciliation. Within one-hundred and twenty days (120) after the end of each\\ncalendar year quarter, Healthfirst shall determine the amount of the Surplus or Deficit, for all preceding\\nquarters during the applicable calendar year. For purposes of calculating Surplus and Deficits, the\\nmeasurement period shall commence on the later of a) January 1, 2010 or b) the date of any required\\nregulatory approval.\\n5\\nRisk Sharing; Distribution of Surplus and Payment of Deficits.\\n5.1\\nSurpluses. In the event that Healthfirst determines that a Surplus exists following\\nReconciliation Healthfirst shall, within thirty days of the Reconciliation, make a payment to IPA equal\\nto the lesser of i) fifty percent (50%) of the Surplus or ii) fifty percent (50%) of the difference between\\nthe Risk Target and the Upside Risk Limit.\\n5.2\\nDeficits.\\n5.2.1 In the event that Healthfirst determines that a Deficit exists following\\nReconciliation, IPA shall, within thirty days of the Reconciliation, make a payment to Healthfirst equal\\nto the lesser of i) fifty percent (50%) of the Deficit or ii) fifty percent (50%) of the difference between\\nthe Risk Target and the Downside Risk Limit.\\n5.2.2\\nIn the event that IPA fails to timely pay any amount due under Section 5.2.1, any\\nsuch amounts shall be offset against up to one hundred percent (100%) percent of surplus amounts due\\nto IPA by Managed Health, Inc. Any amounts remaining following such offset will be offset against\\nfuture amounts due to IPA in the succeeding calendar year quarter.\\n5.2.3 In the event that this Agreement terminates, is not renewed or expires, regardless\\nof the reason, IPA shall reimburse Healthfirst for any Deficit amounts due Healthfirst at the time of such\\ntermination, expiration or non-renewal.\\n6\\nCompliance with Physician Incentive Plan (\"PIP\") Regulations. IPA, in its sole discretion, may\\nuse any compensation methodology to reimburse IPA Providers for Health Care Services; provided,\\nhowever, that no payments shall be made by IPA to IPA Providers who are physicians in a manner or\\namount, either separately or in combination with any compensation formulas which would place IPA\\nProviders at substantial financial risk for the provision of referral services, as determined by the\\napplicable federal PIP regulations contained in 42 CFR 417.479. IPA shall provide information\\nFED. TAX ID: 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\n\\nStart of Page No. = 8\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nreasonably requested by Healthfirst establishing i) the manner and extent to which any Surplus amounts\\npaid to IPA pursuant to this Agreement are paid to IPA Providers and ii) IPA\\'s compliance with the\\nfederal PIP regulations.\\nFED. TAX ID: 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\n\\nStart of Page No. = 9\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nSecond Amendment to the Agreement\\nby and between\\nHealthfirst PHSP, Inc. and Independent Practice Association\\nThis Amendment shall be effective January 1, 2015 by and between Chinese American\\nIndependent Practice Association, Inc. (\"IPA\") and Healthfirst PHSP, Inc. (\"Healthfirst\").\\nWITNESSETH:\\nWHEREAS, Healthfirst and IPA entered into an Agreement on July 1, 2010, for the provision of\\nCovered Services to certain Healthfirst Enrollees; and\\nWHEREAS, Healthfirst and IPA desire to amend that Agreement to change the compensation\\nwhich Healthfirst pays to IPA.\\nNOW, THEREFORE, in consideration of the mutual covenants and agreements herein\\ncontained, Healthfirst and IPA hereby agree to amend the Agreement as follows:\\n1.\\nSection 2.1 of the Agreement titled Provision of Health Care Services is deleted in its\\nentirety and replaced Section 2.1.\\n2.1\\nProvision of Health Care Services. IPA shall arrange for IPA Providers to provide Health\\nCare Services to Enrollees pursuant to the terms of this Agreement, the Provider Manual, and the\\napplicable Plan Contract(s) for those Plan(s) identified by IPA in Exhibit 2.1. IPA shall not offer\\nparticipation with Healthfirst pursuant to this Agreement to any health care provider who is a\\nmember of IPA or has a contract with IPA, nor disclose share the terms and conditions of this\\nAgreement included rates of reimbursement, without first obtaining the written consent of\\nHealthfirst. Healthfirst shall have the right to refuse the participation of any particular health care\\nprovider under this Agreement. Healthfirst\\'s determination to offer participation to any health care\\nprovider pursuant to this Agreement or to refuse to accept any health care provider for participation\\nshall be based on Healthfirst\\'s business needs as determined solely by Healthfirst. Healthfirst\\'s\\nVice-President, Network Management or Executive Vice-President/Chief Operating Officer shall\\nhave sole authority issue consent under this Section 2.1. IPA shall provide Healthfirst with the\\nname, addresses, telephone numbers and other information regarding IPA Providers reasonably\\nrequested by Healthfirst. IPA shall permit, and require IPA Providers to permit, Healthfirst to use\\nsuch information in Healthfirst advertising and provider directories.\\n2.\\nA new Section 2.8 entitled Credentialing of Affiliated Providers is added to the\\nAgreement as follows:\\n2.8\\nCredentialing of Affiliated Providers.\\n2.8.1 Delegation. Healthfirst delegates to Provider and Provider agrees to accept the\\nresponsibility for credentialing potential Affiliated Providers employed by or affiliated with Provider;\\nprovided however, that such delegation shall be limited to i) those categories and types of providers\\nwhich Provider credentials as part of Provider\\'s regular credentialing process and ii) those providers\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n1 of 10\\n\\nStart of Page No. = 10\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nwho have or seek medical staff privileges with Provider. Provider shall not be required to credential\\nParticipating Providers which provider does not regularly credential or which do not have or seek\\nmedical staff privileges with Provider. Healthfirst shall retain sole responsibility for credentialing such\\nParticipating Providers. Healthfirst acknowledges and agrees that Healthfirst has reviewed Provider\\'s\\ncredentialing process and that such process meets the requirements of this Agreement, including this\\nSection 2.8 as of the Effective Date or at the time of Healthfirst\\'s final approval of the credentialing\\nprocess, whichever is later.\\n2.8.2 Provider shall have a formal application and review process for such Providers\\nwhich includes, but is not limited to, a signed application and attestation. Such review shall be\\nconducted by a Provider credentials committee in consultation with the Healthfirst credentials\\ncommittee. Provider shall have Credentialing Policies and Procedures that defines the following:\\n2.8.2.1 scope of Affiliated Providers covered;\\n2.8.2.2 criteria for primary source verification of information;\\n2.8.2.3 the process used to make credentialing decisions;\\n2.8.2.4 the extent of any delegated credentialing/recredentialing arrangements;\\n2.8.2.5 the right of Affiliated Providers to review the information submitted in\\nsupport of their credentialing application;\\n2.8.2.6 the process of notification to a Affiliated Provider of any information\\nobtained during the credentialing process that varies substantially from the information provided by the\\nAffiliated Provider;\\n2.8.2.7 the Affiliated Provider\\'s right to correct erroneous information;\\n2.8.2.8 the Provider\\'s medical director\\'s direct responsibility and participation in\\nthe credentialing program; and\\n2.8.2.9 the process used to ensure confidentiality of all information obtained in\\nthe credentialing process, except otherwise provided by law.\\n2.8.3 Credentialing Criteria. The Provider\\'s Credentials Committee shall determine the\\ncriteria for selection, which shall be consistent with Healthfirst\\'s credentialing policies and procedures,\\nas may be modified by Healthfirst from time to time. Provider\\'s credentialing and recredentialing\\ncriteria and procedure, its procedure for selection and termination of Providers, and its Provider\\ngrievance mechanism shall be subject to review and approval by Healthfirst, which approval shall not be\\nunreasonably withheld. At a minimum, Provider\\'s credentialing and recredentialing criteria and\\nprocedure shall be consistent with The Joint Commission (\"TJC\") and applicable standards required\\nunder Article 28 of the New York State Public Health law and shall include requiring Affiliated\\nProviders to be licensed and qualified to provide the services specified and to maintain such license in\\ngood standing. Provider shall include further credentialing requirements in addition to the TJC\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n2 of 10\\n\\nStart of Page No. = 11\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nreasonably required by Healthfirst and acceptable to Provider. Notwithstanding any provision\\nforegoing, Healthfirst shall retain final authority concerning the credentialing of Affiliated Providers and\\nhis/her participation in the Healthfirst network.\\n2.8.4 Cooperation. Provider shall cooperate with Healthfirst to determine if the\\ncredentialing and recredentialing criteria and procedures used by Provider are consistent with\\nHealthfirst\\'s and TJC\\'s credentialing and recredentialing criteria and procedures. In the event that\\nProvider\\'s credentialing and recredentialing criteria and procedures are inconsistent with Healthfirst\\'s\\ncredentialing and recredentialing criteria and procedures then Healthfirst, after good faith negotiations\\nwith Provider, may adjust the compensation payable to Provider under this Agreement to compensate\\nHealthfirst for the reasonable cost of credentialing and recredentialing potential Affiliated Providers\\nemployed by or affiliated with Provider.\\n2.8.5 Oversight by Healthfirst. To allow Healthfirst to oversee and monitor the\\ndelegation of credentialing to Provider, Provider, upon the reasonable request of Healthfirst and on an\\nongoing basis, shall (i) permit Healthfirst to conduct on-site audits of Provider credentialing policies and\\nprocedures and credentialing files, upon reasonable notice; (ii) to provide to Healthfirst no less than\\nannually, rosters of Healthfirst Providers and such written verification or other substantiation as\\nrequested by Healthfirst that Affiliated Providers employed by or on the medical staff of Provider are\\ncurrently and fully credentialed in accordance with TJC and Healthfirst standards; (iii) to provide to\\nHealthfirst, upon request, copies of credentialing files excluding peer review documentation; and, (iv)\\nand to provide Healthfirst with Affiliated Providers\\' initial appointment date, reappointment start date\\nand reappointment end date. Provider shall retain the right to terminate immediately its agreements\\nwith, or the employment of, any Affiliated Provider, subject to applicable appeals, if the Affiliated\\nProvider is no longer a member of the Provider\\'s medical staff, if the license to practice or DEA permit\\nor any controlled substances registration of said Affiliated Provider is suspended, otherwise restricted\\nor\\nrevoked, or if said Affiliated Provider is excluded or terminated from either the Medicare or Medicaid\\nprograms, or if said Affiliated Provider is not covered by insurance as provided pursuant to this\\nAgreement or is convicted of any crime (either a misdemeanor or a felony). Provider shall notify\\nHealthfirst, immediately, but in any event within forty-eight (48) hours of receipt of notice, if any\\nAffiliated Provider employed by or affiliated with Provider has his or her license to practice or DEA\\npermit or any controlled substances registration suspended or otherwise restricted or revoked or is\\nexcluded or terminated from either the Medicare or Medicaid programs, or is not covered by insurance\\nas required pursuant to this Agreement below or is convicted of any crime related to the provision of\\nhealth care services. Notwithstanding any other provision of this Section to the contrary, it is expressly\\nunderstood and agreed that Provider shall not be responsible for conducting individual site visits at\\nprovider sites other than at facilities operated by Provider.\\n2.8.6 Confidentiality. The foregoing provisions of this Section and the other provisions\\nof this Agreement shall not require the release or other disclosure by any person of any records or other\\ndocuments or information to the extent that such release or other disclosure is prohibited by or otherwise\\ncontrary to any applicable law.\\n3\\nA new Exhibit 4.1 setting forth the reimbursement to be paid by Healthfirst to IPA\\nProviders for the provision of Health Care Services to Enrollees and IPA for the provision of certain\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n3 of 10\\n\\nStart of Page No. = 12\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nadministrative services, a copy of which is attached to this Amendment, is added to the Agreement.\\nThe reimbursement set forth in the Exhibit 4.1 attached to this Amendment shall apply to dates of\\nservice on and after January 1, 2015. Prior Exhibits 4.1 shall continue to apply to dates of service\\nprior to that date.\\n4\\nAll other terms and conditions of the Agreement shall remain in full force and effect.\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n4 of 10\\n\\n\\n-------Table Start--------THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>\\n 4 All other terms and conditions of the Agreement shall remain in full force and effect.\\n<<<<<<{\\'Healthfirst PHSP, Inc.\\': [\\'By: Name: Print Name\\', \\'Title:\\', \\'Date: -\\'], \\'Chinese American Independent Practice Association, Inc.\\': [\\'By: Name: Print Name\\', \\'Title:\\', \\'Date:\\']}\\n-------Table End--------\\n\\nStart of Page No. = 13\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nEXHIBIT 4.1\\nCOMPENSATION SCHEDULE\\nReimbursement to IPA Providers\\n1.\\nExcept for the Health Care Services set forth below, Healthfirst shall directly reimburse IPA\\nProviders who provide Health Care Services on a fee-for-service basis in an amount equal to 90% of the\\nmaximum allowable Region I fee schedule established by the Center for Medicaid and Medicare\\nServices (\"CMS\") for payments under the Medicare program.\\n2.\\nHealthfirst shall reimburse IPA Providers for the Health Care Services set forth below as\\nfollows:\\na. Physical Therapy Services. Physical therapy services set forth below shall be reimbursed at a rate of\\n$45 per service if provided in a multi-specialty office or facility. If provided by an individually-\\noperated Physical Therapist office (solely physical therapy services), physical therapy services set\\nforth below shall be reimbursed at a rate of $60 per service.\\nb.\\nPhysical Medicine and Rehabilitation Services. Physical medicine and rehabilitation services shall\\nbe reimbursed on a fee-for-service basis in an amount equal to 70% of the maximum allowable\\nRegion I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for\\npayments under the Medicare program, except for physical therapy services which will be\\nreimbursed as noted in \"a.\" above.\\nC.\\nGastroenterology Services. The following services, when rendered in an \"Office Based Surgery\"\\n(OBS) accredited office (as mandated by the New York State Department of Health), will be\\nreimbursed on a fee-for-service basis in an amount equal to 100% of the maximum allowable Region\\nI fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments\\nunder the Medicare program.\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n5 of 10\\n\\n\\n-------Table Start--------THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>\\n a. Physical Therapy Services. Physical therapy services set forth below shall be reimbursed at a rate of $45 per service if provided in a multi-specialty office or facility. If provided by an individually- operated Physical Therapist office (solely physical therapy services), physical therapy services set forth below shall be reimbursed at a rate of $60 per service.\\n<<<<<<<<<<<<{\\'Code Range\\': [\\'97001-97004\\', \\'97010-97028\\', \\'97032-97039\\', \\'97110-97546\\', \\'97750-97755\\'], \\'Code Range Description\\': [\\'Physical Medicine Assessments\\', \\'Physical Therapy Treatment Modalities: Supervised\\', \\'Physical Therapy Treatment Modalities: Constant Attendance\\', \\'Other Therapeutic Techniques With Direct Patient Contact\\', \\'Physical performance test & Assistive technology assessment\\']}\\n-------Table End--------\\n-------Table Start--------THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>\\n a. Physical Therapy Services. Physical therapy services set forth below shall be reimbursed at a rate of $45 per service if provided in a multi-specialty office or facility. If provided by an individually- operated Physical Therapist office (solely physical therapy services), physical therapy services set forth below shall be reimbursed at a rate of $60 per service.\\n<<<<<<<<<<<<{\\'CPT Code\\': [\\'43235\\', \\'43239\\', \\'45378\\', \\'45380\\', \\'45385\\'], \\'CPT Description\\': [\\'Upper gastrointestinal endoscopy\\', \\'Upper gastrointestinal endoscopy, with biopsy\\', \\'Colonoscopy, diagnostic\\', \\'Colonoscopy, with biopsy\\', \\'Colonoscopy, removal of tumor\\']}\\n-------Table End--------\\n\\nStart of Page No. = 14\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nd. The following services will be reimbursed at the rates noted below:\\ne. Hearing Aids. IPA Providers shall be reimbursed for the cost of hearing aids at eighty percent (80%)\\nof the manufacturer\\'s suggested retail price.\\nIPA Network Access and Administrative Fees.\\nHealthfirst shall pay IPA an administrative fee of $2.50 per Member per month for administrative\\nservices relating to quality improvement and education of Participating IPA Providers regarding\\nHealthfirst\\'s quality improvement programs. IPA and Healthfirst understand and agree that IPA shall\\nnot provide any management services, as that term is defined in 11 NYCRR 98, to Healthfirst pursuant\\nto this Agreement. In the event that IPA or an affiliated of IPA provides management services, the\\nparties shall execute a separate management agreement approved by SDOH pursuant to 11 NYCRR 98.\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n6 of 10\\n\\n\\n-------Table Start--------THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>\\n d. The following services will be reimbursed at the rates noted below:\\n<<<<<<{\\'CPT Code/Modifier\\': [\\'99205-P1\\', \\'99212-P2\\', \\'99215-P3\\', \\'59409\\', \\'59514\\', \\'99381\\', \\'99382\\', \\'99383\\', \\'99384\\', \\'99385\\', \\'99386\\', \\'99387\\', \\'99391\\', \\'99392\\', \\'99393\\', \\'99394\\', \\'99395\\', \\'99396\\', \\'99397\\', \\'99401\\', \\'99402\\', \\'99403\\', \\'99404\\', \\'99411\\', \\'99412\\'], \\'CPT Description\\': [\\'PCAP Initial Visit\\', \\'PCAP Prenatal Visit\\', \\'PCAP Post partum Visit\\', \\'Vaginal Delivery\\', \\'Cesarean Delivery\\', \\'Initial visit, new patient, infant (under 1 year)\\', \\'Initial visit, new patient, early childhood (age 1-4)\\', \\'Initial visit, new patient, late childhood (age 5-11)\\', \\'Initial visit, new patient, adolescent (age 12-17)\\', \\'Initial visit, new patient, age 18-39\\', \\'Initial visit, new patient, age 40-64\\', \\'Initial visit, new patient, age 65 and older\\', \\'Periodic visit, established patient, infant (under 1 year)\\', \\'Periodic visit, established patient, early childhood (age 1-4)\\', \\'Periodic visit, established patient, late childhood (age 5-11)\\', \\'Periodic visit, established patient, adolescent (age 12-17)\\', \\'Periodic visit, established patient, age 18-39\\', \\'Periodic visit, established patient, age 40-64\\', \\'Periodic visit, established patient, age 65 and older\\', \\'Preventive medicine counseling, Individual, approx 15 minutes\\', \\'Preventive medicine counseling, Individual, approx 30 minutes\\', \\'Preventive medicine counseling, Individual, approx 45 minutes\\', \\'Preventive medicine counseling, Individual, approx 60 minutes\\', \\'Preventive medicine counseling, Group, approx 30 minutes\\', \\'Preventive medicine counseling, Group, approx 60 minutes\\'], \\'Amount\\': [\\'$196.07\\', \\'$130.00\\', \\'$163.00\\', \\'$1500.00\\', \\'$1500.00\\', \\'$65.00\\', \\'$61.00\\', \\'$60.00\\', \\'$65.00\\', \\'$74.00\\', \\'$80.00\\', \\'$118.00\\', \\'$61.00\\', \\'$61.00\\', \\'$60.00\\', \\'$60.00\\', \\'$75.00\\', \\'$90.00\\', \\'$99.00\\', \\'$31.00\\', \\'$40.00\\', \\'$60.00\\', \\'$79.00\\', \\'$28.00\\', \\'$57.00\\']}\\n-------Table End--------\\n\\nStart of Page No. = 15\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nAdditional Compensation to IPA in the form of Surplus Distribution.\\n1.\\nLimited Risk Transfer/No Transfer of Financial Risk\\n1.1.\\nIPA shall be entitled to Additional Compensation under this Agreement on an annual\\nbasis in the form of a Surplus (as defined below) distribution, to the extent that any available Surplus\\nfunds exist, as specified below.\\n1.2.\\nUse of Additional Compensation. IPA represents and warrants that Additional\\nCompensation paid to IPA, if any, shall be distributed to Participating IPA Providers or used by IPA in a\\nmanner designed to improve the quality of care received by Enrollees and Enrollee satisfaction. On\\nrequest by Healthfirst, IPA shall provide Healthfirst with financial records accounting in detail all funds\\nreceived from Healthfirst and the disbursement of all such funds as set forth in 10 NYCRR 98-1.18(d).\\n2.\\nDefinitions. Capitalized terms used in this Exhibit 4.1(b) shall have the meaning given in this\\nExhibit or, if any term is not defined in this Exhibit 4.1(b), it shall have the meaning given in the\\nAgreement to which this Exhibit is attached.\\n2.1.\\n\"Additional Compensation\" shall mean the portion of any Surplus paid to IPA pursuant\\nto Section 5 of this Exhibit 4.1(b).\\n2.2.\\n\"Adjusted Premiums\" shall mean the premiums received by Healthfirst for Risk\\nEnrollees, as adjusted by any risk score or other adjustment to premiums pursuant to the applicable Plan\\nContract and applicable to Risk Enrollees as reasonably determined and applied by Healthfirst.\\n2.3.\\n\"Administrative Deduction\" shall mean the deduction from Adjusted Premiums equal to\\nHealthfirst\\'s administrative costs as reasonably determined by Healthfirst.\\n2.4.\\n\"Final Reconciliation\" shall mean the final the accounting, as set forth in Section 3, of\\nMedical Revenue, claims paid for Health Care Services and other expenses to determine Surpluses or\\nDeficits conducted twelve months following the expiration, non-renewal or termination of this Exhibit.\\n2.5.\\n\"Medical Revenue\" shall mean the balance of Adjusted Premiums after subtracting the\\nAdministrative Deduction and any Quality Incentive Deduction.\\n2.6.\\n\"Quality Incentive Deduction\" shall mean an amount taken from Adjusted Premiums for\\nprograms in which IPA and IPA Providers participate to improve the quality of Health Care Services\\nwhich Risk Enrollees receive.\\n2.7.\\n\"Reconciliation\" shall mean the accounting, as set forth in Section 3, of Medical\\nRevenue, claims paid for Health Care Services and other expenses to determine Surpluses or Deficits.\\n2.8.\\n\"Risk Enrollee\" shall mean an Enrollee who has selected, or been assigned to, a primary\\ncare provider who is a Participating IPA Provider.\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n7 of 10\\n\\nStart of Page No. = 16\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\n2.9.\\n\"Surplus\" or \"Deficit\" shall mean the balance of Medical Revenue following\\nReconciliation\\n3.\\nReconciliation of Medical Revenue to Determine Surpluses and Deficits. During each\\nReconciliation, Healthfirst shall make the following deductions from Medical Revenue and determine\\nthe amount of any Surplus of Deficit:\\n3.1.\\nthe costs of claims paid for Health Care Services rendered to Risk Enrollees by\\nParticipating IPA Providers, Participating Providers and all other health care providers.\\n3.2.\\na\\nreasonable reserve for the cost of claims for Health Care Services rendered to Risk\\nEnrollees but not yet received;\\n3.3.\\nother costs associated with the provision of Health Care Services to Risk Enrollees\\nincluding but not limited to the net cost of reinsurance and any internal aggregate risk sharing programs.\\n3.4.\\naccruals for any risk adjustment applicable to Adjusted Premiums.\\n4.\\nReconciliation Schedule.\\n4.1.\\nInterim Quarterly Reconciliation and Distribution. Within one-hundred and twenty days\\n(120) after the end of each calendar year quarter, Healthfirst shall determine the amount of any Surplus\\nor Deficit for all preceding quarters during that calendar year. In the event that Healthfirst determines\\nthat a Surplus has been achieved for the preceding quarters during the calendar year, Healthfirst shall\\nmake an interim payment to IPA of Additional Compensation as set forth in Section 5 below. In the\\nevent that Healthfirst determines that a Deficit has been achieved for the preceding quarters druing the\\ncalendar year, Healthfirst not make an interim payment to IPA of Additional Compensation and the\\nDeficit shall be handled as set forth in Section 6 below.\\n4.2.\\nAnnual Reconciliation and Distribution. Within one-hundred and twenty days (120) after\\nthe end of each calendar year, Healthfirst shall determine the amount of any Surplus for all quarters for\\nthat calendar year. In the event that Healthfirst determines that a Surplus has been achieved for that\\ncalendar year, Healthfirst shall make a final payment to IPA of Additional Compensation as set forth in\\nSection 5 below. In the event that Healthfirst determines that a Deficit has been achieved for that\\nCalendar Year, Healthfirst not make a final payment to IPA of Additional Compensation and the Deficit\\nshall be handled as set forth in Section 6 below.\\n5.\\nPayment of Additional Compensation. In the event that Healthfirst determines that a Surplus has\\nbeen achieved as set forth Section 3 above, Healthfirst shall pay to IPA Additional Compensation which\\nshall be the lesser of the following:\\n5.1.\\nTen percent (10%) of the Surplus for the calendar year, or\\n5.2.\\nAn amount such that the Additional Compensation equals twenty-five percent (25%) of\\nthe sum of i) the total compensation to Participating IPA Providers for Health Care Services rendered to\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n8 of 10\\n\\nStart of Page No. = 17\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nRisk Enrollees pursuant to Exhibit 4.1(a); any compensation paid to IPA pursuant to Exhibit 4.1(a) and\\niii) the Additional Compensation.\\n5.3.\\nHealthfirst shall pay any Additional Compensation, within thirty days of each\\nReconciliation. Healthfirst shall, in no event, advance to IPA any Additional Compensation.\\n6.\\nTreatment of Deficits.\\n6.1.\\nDeficits Rolled Forward. In the event that a Deficit remains following any Reconciliation\\nor a Final Reconciliation, the Deficit equal to the percentage set forth in Section 5.1 above shall be\\nrolled forward to reduce any Surplus that may accrue under this Agreement in the succeeding calendar\\nyear.\\n6.2.\\nDeficits at Termination, Expiration or Non-Renewal. In the event that this Agreement\\nterminates, is not renewed or expires, regardless of the reason, Provider shall not be required to\\nreimburse Healthfirst for any Deficits which may exist at the time of such termination, expiration or\\nnon-renewal.\\n7.\\nCompliance with Regulatory Provisions Regarding Risk Transfer\\n7.1.\\nSDOH Provider Contract Guidelines. Healthfirst and IPA shall comply with\\nthe\\napplicable requirements of SDOH regarding transfer of financial risk to IPAs as set forth in SDOH\\'s\\nProvider Contracting Guidelines, as amended by SDOH from time to time. In the event that the amount\\nfinancial risk transferred to IPA constitutes a Level 4 risk transfer pursuant to the Providing Contracting\\nGuidelines, IPA shall demonstrate financial viability and establish a financial security deposit as\\nrequired by SDOH.\\n7.2.\\nPhysician Incentive Plan (\"PIP\") Regulations. Healthfirst and IPA shall comply with the\\napplicable requirements of the federal PIP regulations contained in 42 CFR 422.208, including the\\nplacement of stop loss insurance if applicable.\\n7.3.\\nFinancial Stability Monitoring and Reporting. Notwithstanding any other provision of\\nthis Agreement Healthfirst shall regularly monitor Provider\\'s financial condition to ensure that Provider\\nremains financially able to perform its obligations under this Agreement and meet any financial\\nsolvency requirements of SDOH or DFS. IPA shall promptly advise Healthfirst of any material\\ndevelopments which may impair its ability to perform its obligations under this Agreement. In addition,\\nIPA shall provide Healthfirst with the reports and information as required by 10 NYCRR 98-1.18(e),\\nwhich shall include but not be limited to IPA\\'s quarterly and annual financial statements. IPA shall also\\nmaintain, as required by 10 NYCRR 98-1.18(d), financial records accounting in detail all funds received\\nfrom Healthfirst and the disbursement of all such funds. IPA shall provide such accounting of funds and\\ndisbursements to Healthfirst on request.\\n8.\\nTermination or Amendment of Additional Compensation\\nHealthfirst may on, thirty (30) days prior notice to IPA, amend the terms and conditions pursuant to\\nwhich Additional Compensation is determined and paid to IPA as well as eliminate the payment of\\nAdditional Compensation to IPA; provided however, that unless IPA or IPA Providers have breached\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n9 of 10\\n\\nStart of Page No. = 18\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nthe Agreement such amendment or termination shall not change any Additional Compensation\\ncalculated or paid prior to the effective date of such amendment or termination.\\n9.\\nTermination, Non-Renewal or Expiration of the Agreement.\\nFor a period of twelve months following any termination, non-renewal or expiration of this Agreement,\\nregardless of the cause Healthfirst will conduct Reconciliations of Medical Revenue pursuant to this\\nAgreement until the Final Reconciliation; provided, however, that payments to IPA of Additional\\nCompensation shall be suspended. These Reconciliations shall be on based Health Care Services\\nrendered to Risk Enrollees prior to the termination, non-renewal or expiration of this Agreement.\\nHealthfirst shall pay to any Additional Compensation existing at the Final Reconciliation within thirty\\ndays of the Final Reconciliation.\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n10 of 10\\n\\nStart of Page No. = 19\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nFifth Amendment to the Agreement by and between\\nManaged Health, Inc. and Independent Practice Association\\nThis Amendment to the Agreement between Managed Health, Inc. (\"Healthfirst\"), and Chinese\\nAmerican Independent Practice Association, Inc. (\"Provider\") is effective January 1, 2015.\\nWITNESSETH:\\nWHEREAS, Healthfirst and Provider have entered into an Agreement (the \"Agreement\") for the\\nprovision of Health Care Services to Enrollees; and\\nWHEREAS, Healthfirst and Provider desire to amend that Agreement to delegate credentialing\\nto Provider :\\nNOW, THEREFORE, in consideration of the mutual covenants and agreements herein\\ncontained, Healthfirst and Provider hereby agree to amend the Agreement as follows:\\n1.\\nA new Section 2.8 entitled Credentialing of Affiliated Providers is added to the\\nAgreement as follows:\\n2.8\\nCredentialing of Affiliated Providers.\\n2.8.1 Delegation. Healthfirst delegates to Provider and Provider agrees to accept the\\nresponsibility for credentialing potential Affiliated Providers employed by or affiliated with Provider;\\nprovided however, that such delegation shall be limited to i) those categories and types of providers\\nwhich Provider credentials as part of Provider\\'s regular credentialing process and ii) those providers\\nwho have or seek medical staff privileges with Provider. Provider shall not be required to credential\\nParticipating Providers which provider does not regularly credential or which do not have or seek\\nmedical staff privileges with Provider. Healthfirst shall retain sole responsibility for credentialing such\\nParticipating Providers. Healthfirst acknowledges and agrees that Healthfirst has reviewed Provider\\'s\\ncredentialing process and that such process meets the requirements of this Agreement, including this\\nSection 2.8 as of the Effective or at the time of Healthfirst\\'s final approval of the credentialing process,\\nwhichever is later.\\n2.8.2 Provider shall have a formal application and review process for such Providers\\nwhich includes, but is not limited to, a signed application and attestation. Such review shall be\\nconducted by a Provider credentials committee in consultation with the Healthfirst credentials\\ncommittee. Provider shall have Credentialing Policies and Procedures that defines the following:\\n2.8.2.1 scope of Affiliated Providers covered;\\n2.8.2.2 criteria for primary source verification of information;\\n2.8.2.3 the process used to make credentialing decisions;\\n2.8.2.4 the extent of any delegated credentialing/recredentialing arrangements;\\nFED. TAX ID: 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\n\\nStart of Page No. = 20\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\n2.8.2.5 the right of Affiliated Providers to review the information submitted in\\nsupport of their credentialing application;\\n2.8.2.6 the process of notification to a Affiliated Provider of any information\\nobtained during the credentialing process that varies substantially from the information provided by the\\nAffiliated Provider;\\n2.8.2.7 the Affiliated Provider\\'s right to correct erroneous information;\\n2.8.2.8 the Provider\\'s medical director\\'s direct responsibility and participation in\\nthe credentialing program; and\\n2.8.2.9 the process used to ensure confidentiality of all information obtained in\\nthe credentialing process, except otherwise provided by law.\\n2.8.3 Credentialing Criteria. The Provider\\'s Credentials Committee shall determine the\\ncriteria for selection, which shall be consistent with Healthfirst\\'s credentialing policies and procedures,\\nas may be modified by Healthfirst from time to time. Provider\\'s credentialing and recredentialing\\ncriteria and procedure, its procedure for selection and termination of Providers, and its Provider\\ngrievance mechanism shall be subject to review and approval by Healthfirst, which approval shall not be\\nunreasonably withheld. At a minimum, Provider\\'s credentialing and recredentialing criteria and\\nprocedure shall be consistent with The Joint Commission (\"TJC\") and applicable standards required\\nunder Article 28 of the New York State Public Health law and shall include requiring Affiliated\\nProviders to be licensed and qualified to provide the services specified and to maintain such license in\\ngood standing. Provider shall include further credentialing requirements in addition to the TJC\\nreasonably required by Healthfirst and acceptable to Provider. Notwithstanding any provision\\nforegoing, Healthfirst shall retain final authority concerning the credentialing of Affiliated Providers and\\nhis/her participation in the Healthfirst network.\\n2.8.4 Cooperation. Provider shall cooperate with Healthfirst to determine if the\\ncredentialing and recredentialing criteria and procedures used by Provider are consistent with\\nHealthfirst\\'s and TJC\\'s credentialing and recredentialing criteria and procedures. In the event that\\nProvider\\'s credentialing and recredentialing criteria and procedures are inconsistent with Healthfirst\\'s\\ncredentialing and recredentialing criteria and procedures then Healthfirst, after good faith negotiations\\nwith Provider, may adjust the compensation payable to Provider under this Agreement to compensate\\nHealthfirst for the reasonable cost of credentialing and recredentialing potential Affiliated Providers\\nemployed by or affiliated with Provider.\\n2.8.5 Oversight by Healthfirst. To allow Healthfirst to oversee and monitor the\\ndelegation of credentialing to Provider, Provider, upon the reasonable request of Healthfirst and on an\\nongoing basis, shall (i) permit Healthfirst to conduct on-site audits of Provider credentialing policies and\\nprocedures and credentialing files, upon reasonable notice; (ii) to provide to Healthfirst no less than\\nannually, rosters of Healthfirst Providers and such written verification or other substantiation as\\nrequested by Healthfirst that Affiliated Providers employed by or on the medical staff of Provider are\\ncurrently and fully credentialed in accordance with TJC and Healthfirst standards; (iii) to provide to\\nHealthfirst, upon request, copies of credentialing files excluding peer review documentation; and, (iv)\\nFED. TAX ID: 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\n\\nStart of Page No. = 21\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nand to provide Healthfirst with Affiliated Providers\\' initial appointment date, reappointment start date\\nand reappointment end date. Provider shall retain the right to terminate immediately its agreements\\nwith, or the employment of, any Affiliated Provider, subject to applicable appeals, if the Affiliated\\nProvider is no longer a member of the Provider\\'s medical staff, if the license to practice or DEA permit\\nor any controlled substances registration of said Affiliated Provider is suspended, otherwise restricted or\\nrevoked, or if said Affiliated Provider is excluded or terminated from either the Medicare or Medicaid\\nprograms, or if said Affiliated Provider is not covered by insurance as provided pursuant to this\\nAgreement or is convicted of any crime (either a misdemeanor or a felony). Provider shall notify\\nHealthfirst, immediately, but in any event within forty-eight (48) hours of receipt of notice, if any\\nAffiliated Provider employed by or affiliated with Provider has his or her license to practice or DEA\\npermit or any controlled substances registration suspended or otherwise restricted or revoked or is\\nexcluded or terminated from either the Medicare or Medicaid programs, or is not covered by insurance\\nas required pursuant to this Agreement below or is convicted of any crime related to the provision of\\nhealth care services. Notwithstanding any other provision of this Section to the contrary, it is expressly\\nunderstood and agreed that Provider shall not be responsible for conducting individual site visits at\\nprovider sites other than at facilities operated by Provider.\\n2.8.6 Confidentiality. The foregoing provisions of this Section and the other provisions\\nof this Agreement shall not require the release or other disclosure by any person of any records or other\\ndocuments or information to the extent that such release or other disclosure is prohibited by or otherwise\\ncontrary to any applicable law.\\n2.\\nA new Exhibit C setting forth the reimbursement to be paid by MHI to IPA and IPA\\nProviders for the provision of Covered Services to Enrollees, a copy of which is attached to this\\nAmendment, added to the Agreement. The reimbursement set forth in the Exhibit C attached to this\\namendment shall apply to dates of service on and after January 1, 2015. Prior Exhibits C and the Letter\\nof Agreement effective July 1, 2006 shall continue to apply to dates of service prior to that date. This\\nAmendment supersedes the July 1, 2006 Letter of Agreement setting forth an administrative fee.\\n3.\\nAll other terms and conditions of the Agreement shall remain in full force and effect.\\nIN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the Effective\\nDate above.\\nFED. TAX ID: 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\n\\n\\n-------Table Start--------THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>\\n IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the Effective Date above.\\n<<<<<<{\\'Managed Health, Inc.\\': [\\'DocuSigned by: By: Paul E. Portsmore\\', \\'441CEAD8E502476 Name: Paul E. Portsmore Print Name\\', \\'Title: SVP\\', \\'Date: 12/31/2014 18:32:28 ET\\'], \\'Provider: Chinese American Independent Practice Association, Inc.\\': [\\'By: family\\', \\'Name: PEGGY SHENG Print Name\\', \\'Chief Operating Officer Title:\\', \\'Date: Dec. 26, 2015\\']}\\n-------Table End--------\\n\\nStart of Page No. = 22\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nEXHIBIT C\\nCompensation Schedule\\nReimbursement to IPA Providers\\nI.\\nMedicare and Commercial Enrollees\\n1.\\nExcept for the Covered Services set forth below, MHI shall directly reimburse IPA Providers\\nwho provide Covered Services on a fee-for-service basis in an amount equal to 100% of the maximum\\nallowable Region I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\")\\nfor payments under the Medicare program.\\n2.\\nMHI shall reimburse IPA Providers for the following Covered Services as follows:\\na. Physical Therapy services shall be reimbursed at a flat rate of $55 per date of service if provided in a\\nmulti-specialty office or facility. If provided by an individually-operated Physical Therapist office\\n(solely physical therapy services), physical therapy services set forth below shall be reimbursed at a\\nrate of $65 per service. These services, which shall be updated from time to time, shall include:\\nb. Services provided by Physical Medicine and Rehabilitation specialists shall be reimbursed on a\\nfee-for-service basis in an amount equal to 70% of the maximum allowable Region I fee\\nschedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments\\nunder the Medicare program, except for physical therapy services which will be reimbursed as\\nnoted in \"a.\" above.\\nC. The following services, when rendered in an \"Office Based Surgery\" (OBS) accredited office\\n(as mandated by the New York State Department of Health), will be reimbursed on a fee-for-\\nservice basis in an amount equal to 100% of the maximum allowable Region I fee schedule\\nestablished by the Center for Medicaid and Medicare Services (\"CMS\") for payments under the\\nMedicare program.\\nFED. TAX ID: 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\n\\n\\n-------Table Start--------THIS IS PRETABLE TEXT>>>\\n Physical Therapy services shall be reimbursed at a flat rate of $55 per date of service if provided in a multi-specialty office or facility. If provided by an individually-operated Physical Therapist office (solely physical therapy services), physical therapy services set forth below shall be reimbursed at a rate of $65 per service. These services, which shall be updated from time to time, shall include:\\n<<<{\\'Code Range\\': [\\'97001-97006\\', \\'97010-97028\\', \\'97032-97039\\', \\'97110-97546\\', \\'97750-97755\\'], \\'Code Range Description\\': [\\'Physical Medicine Assessments\\', \\'Physical Therapy Treatment Modalities: Supervised\\', \\'Physical Therapy Treatment Modalities: Constant Attendance\\', \\'Other Therapeutic Techniques With Direct Patient Contact\\', \\'Physical performance test & Assistive technology assessment\\']}\\n-------Table End--------\\n-------Table Start--------THIS IS PRETABLE TEXT>>>\\n Physical Therapy services shall be reimbursed at a flat rate of $55 per date of service if provided in a multi-specialty office or facility. If provided by an individually-operated Physical Therapist office (solely physical therapy services), physical therapy services set forth below shall be reimbursed at a rate of $65 per service. These services, which shall be updated from time to time, shall include: C. The following services, when rendered in an \"Office Based Surgery\" (OBS) accredited office (as mandated by the New York State Department of Health), will be reimbursed on a fee-for- service basis in an amount equal to 100% of the maximum allowable Region I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments under the Medicare program.\\n<<<{\\'CPT Code\\': [\\'43235\\', \\'43239\\', \\'45378\\', \\'45380\\', \\'45385\\'], \\'CPT Description\\': [\\'Upper gastrointestinal endoscopy\\', \\'Upper gastrointestinal endoscopy, with biopsy\\', \\'Colonoscopy, diagnostic\\', \\'Colonoscopy, with biopsies\\', \\'Colonoscopy, removal of tumor\\']}\\n-------Table End--------\\n\\nStart of Page No. = 23\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nd. The following preventive care services will be reimbursed at the rates noted below:\\ne. Hearing Aids. IPA Providers shall be reimbursed for the cost of hearing aids at eighty percent\\n(80%) of the manufacturer\\'s suggested retail price.\\nII.\\nWhere rates in any fee schedule described in this Agreement make reference to Medicare or\\nMedicaid rates, any Medicare or Medicaid rates enacted by the federal Centers for Medicare and\\nMedicaid Services (\"CMS\") or the New York State Department of Health (\"SDOH\"), including updates,\\nshall apply to dates of service occurring on the later of (a) the effective date of such rates or (b) upon\\nforty five calendar days following the date on which CMS or SDOH publishes such rates.\\nIPA Network Access and Administrative Fees.\\nFor Medicare Advantage members only, Healthfirst shall compensate IPA $5.00 per Member per month\\nfor the following administrative services,:\\nAccess to IPA\\'s network of Participating IPA Providers\\nCredentialing of Participating IPA Providers\\nReporting on Health Care Services provided to Enrollees as reasonably requested by Healthfirst\\nAdministrative services relating to quality improvement and Enrollee satisfaction\\nEducation of Participating IPA Providers regarding Healthfirst\\'s policies and procedures and\\nquality improvement programs.\\nFED. TAX ID: 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\n\\n\\n-------Table Start--------THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>\\n d. The following preventive care services will be reimbursed at the rates noted below:\\n<<<<<<{\\'CPT Code\\': [\\'99381\\', \\'99382\\', \\'99383\\', \\'99384\\', \\'99385\\', \\'99386\\', \\'99387\\', \\'99391\\', \\'99392\\', \\'99393\\', \\'99394\\', \\'99395\\', \\'99396\\', \\'99397\\', \\'99401\\', \\'99402\\', \\'99403\\', \\'99404\\', \\'99411\\', \\'99412\\'], \\'CPT Description\\': [\\'Initial visit, new patient, infant (under 1 year)\\', \\'Initial visit, new patient, early childhood (age 1-4)\\', \\'Initial visit, new patient, late childhood (age 5-11)\\', \\'Initial visit, new patient, adolescent (age 12-17)\\', \\'Initial visit, new patient, age 18-39\\', \\'Initial visit, new patient, age 40-64\\', \\'Initial visit, new patient, age 65 and older\\', \\'Periodic visit, established patient, infant (under 1 year)\\', \\'Periodic visit, established patient, early childhood (age 1-4)\\', \\'Periodic visit, established patient, late childhood (age 5-11)\\', \\'Periodic visit, established patient, adolescent (age 12-17)\\', \\'Periodic visit, established patient, age 18-39\\', \\'Periodic visit, established patient, age 40-64\\', \\'Periodic visit, established patient, age 65 and older\\', \\'Preventive medicine counseling, Individual, approx 15 minutes\\', \\'Preventive medicine counseling, Individual, approx 30 minutes\\', \\'Preventive medicine counseling, Individual, approx 45 minutes\\', \\'Preventive medicine counseling, Individual, approx 60 minutes\\', \\'Preventive medicine counseling, Group, approx 30 minutes\\', \\'Preventive medicine counseling, Group, approx 60 minutes\\'], \\'Amount\\': [\\'$65.00\\', \\'$61.00\\', \\'$60.00\\', \\'$65.00\\', \\'$74.00\\', \\'$80.00\\', \\'$118.00\\', \\'$61.00\\', \\'$61.00\\', \\'$60.00\\', \\'$60.00\\', \\'$75.00\\', \\'$90.00\\', \\'$99.00\\', \\'$31.00\\', \\'$40.00\\', \\'$60.00\\', \\'$79.00\\', \\'$28.00\\', \\'$57.00\\']}\\n-------Table End--------\\n\\nStart of Page No. = 24\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nRisk Sharing with IPA\\n1\\nDefinitions. For the purposes of this Agreement and Compensation Schedule, the following\\nterms shall have the indicated meanings:\\n1.1\\n\"Adjusted Premiums\" shall mean premiums Healthfirst receives for Risk Enrollees,\\nadjusted by any risk score or premium adjustment published by CMS, SDOH or other payor as such\\nadjustment is reasonably applied by Healthfirst.\\n1.2\\n\"Cost of Risk Services\" shall mean the the cost of claims paid for Risk plus a reasonable\\nreserve for incurred but not received (\"IBNR\") claims for Risk Services.\\n1.3\\n\"Deficit\" shall be the amount that the Cost of Risk Services exceeds the Risk Target\\nfollowing Reconciliation.\\n1.4\\n\"Upside Risk Limit\" shall be equal to seventy eight percent (78__%) of Risk Target.\\n1.5\\n\"Reconciliation\" shall mean the quarterly reconciliation by Healthfirst to determine\\nSurpluses and Deficits.\\n1.6\\n\"Risk Enrollee\" shall mean Enrollees in Healthfirst\\'s Medicare Advantage plans who\\nselect an IPA Provider as their Primary Care Provider.\\n1.7\\n\"Risk Services\" shall mean all Health Care Services provided to Enrollees regardless of\\nwhether such Services were provided by IPA Providers or other health care providers.\\n1.8\\n\"Risk Target\" shall be equal to eighty three percent (83%) of Adjusted Premiums\\n1.9\\n\"Surplus\" shall be the amount that Cost of Risk Services is less than the Risk Target\\nfollowing Reconciliation.\\n1.10\\n\"Downside Risk Limit\" shall mean one hundred threepercent (103__%) of Risk Target.\\n2\\nRisk Sharing.\\n2.1\\nRisk Sharing and Cooperation. Healthfirst and IPA shall share the financial risk for Risk\\nServices rendered to Risk Enrollees as set forth below. IPA shall assume upside risk for the cost of Risk\\nServices provided to Risk Enrollees to the extent that IPA may receive portion of any Surplus. IPA shall\\nassume downside risk for the cost of Risk Services to the extent that IPA is required to repay Healthfirst\\na portion of any Deficit. Healthfirst and IPA shall cooperate in the implementation and administration\\nof Healthfirst\\'s utilization and case management programs, the sharing of utilization data, and education\\nof IPA Providers regarding utilization trends and the provision of quality and medically appropriate\\nservices.\\n2.2\\nLimited Risk Transfer. IPA shall not assume risk for the cost of Health Care Services\\nother than through the receipt of Surpluses and payment of Deficits. Under no circumstances shall IPA\\nFED. TAX ID: 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\n\\nStart of Page No. = 25\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nbe required to pay claims for Health Care Services, including Risk Services, to any IPA Provider or\\nhealth care provider. In all instances, including any termination or expiration of this Agreement,\\nHealthfirst shall remain solely responsible for paying claims for Health Care Services, including Risk\\nServices, to IPA Providers and other health care providers.\\n3\\nRegulatory Approval.\\nThe parties understand and acknowledge that this risk sharing\\narrangement may be subject to the prior review and approval of CMS, SDOH or other regulatory agency\\nhaving jurisdiction over this Agreement as required by applicable statutes and regulation. No payments\\nshall be made by either party, prior to receiving such regulatory approval. The failure to obtain\\nregulatory shall not be grounds for either party to terminate this Agreement which shall otherwise\\nremain in effect.\\n4\\nQuarterly Reconciliation. Within one-hundred and twenty days (120) after the end of each\\ncalendar year quarter, Healthfirst shall determine the amount of the Surplus or Deficit, for all preceding\\nquarters during the applicable calendar year. For purposes of calculating Surplus and Deficits, the\\nmeasurement period shall commence on the later of a) January 1, 2010 or b) the date of any required\\nregulatory approval.\\n5\\nRisk Sharing; Distribution of Surplus and Payment of Deficits.\\n5.1\\nSurpluses. In the event that Healthfirst determines that a Surplus exists following\\nReconciliation Healthfirst shall, within thirty days of the Reconciliation, make a payment to IPA equal\\nto the lesser of i) fifty percent (50%) of the Surplus or ii) fifty percent (50%) of the difference between\\nthe Risk Target and the Upside Risk Limit.\\n5.2\\nDeficits.\\n5.2.1 In the event that Healthfirst determines that a Deficit exists following\\nReconciliation, IPA shall, within thirty days of the Reconciliation, make a payment to Healthfirst equal\\nto the lesser of i) fifty percent (50%) of the Deficit or ii) fifty percent (50%) of the difference between\\nthe Risk Target and the Downside Risk Limit.\\n5.2.2\\nIn the event that IPA fails to timely pay any amount due under Section 5.2.1, any\\nsuch amounts shall be offset against up to one hundred percent (100%) percent of surplus amounts due\\nto IPA by Managed Health, Inc. Any amounts remaining following such offset will be offset against\\nfuture amounts due to IPA in the succeeding calendar year quarter.\\n5.2.3 In the event that this Agreement terminates, is not renewed or expires, regardless\\nof the reason, IPA shall reimburse Healthfirst for any Deficit amounts due Healthfirst at the time of such\\ntermination, expiration or non-renewal.\\n6\\nCompliance with Physician Incentive Plan (\"PIP\") Regulations. IPA, in its sole discretion, may\\nuse any compensation methodology to reimburse IPA Providers for Health Care Services; provided,\\nhowever, that no payments shall be made by IPA to IPA Providers who are physicians in a manner or\\namount, either separately or in combination with any compensation formulas which would place IPA\\nProviders at substantial financial risk for the provision of referral services, as determined by the\\napplicable federal PIP regulations contained in 42 CFR 417.479. IPA shall provide information\\nFED. TAX ID: 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\n\\nStart of Page No. = 26\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nreasonably requested by Healthfirst establishing i) the manner and extent to which any Surplus amounts\\npaid to IPA pursuant to this Agreement are paid to IPA Providers and ii) IPA\\'s compliance with the\\nfederal PIP regulations.\\nFED. TAX ID: 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\n\\nStart of Page No. = 27\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nSecond Amendment to the Agreement\\nby and between\\nHealthfirst PHSP, Inc. and Independent Practice Association\\nThis Amendment shall be effective January 1, 2015 by and between Chinese American\\nIndependent Practice Association, Inc. (\"IPA\") and Healthfirst PHSP, Inc. (\"Healthfirst\").\\nWITNESSETH:\\nWHEREAS, Healthfirst and IPA entered into an Agreement on July 1, 2010, for the provision of\\nCovered Services to certain Healthfirst Enrollees; and\\nWHEREAS, Healthfirst and IPA desire to amend that Agreement to change the compensation\\nwhich Healthfirst pays to IPA.\\nNOW, THEREFORE, in consideration of the mutual covenants and agreements herein\\ncontained, Healthfirst and IPA hereby agree to amend the Agreement as follows:\\n1.\\nSection 2.1 of the Agreement titled Provision of Health Care Services is deleted in its\\nentirety and replaced Section 2.1.\\n2.1\\nProvision of Health Care Services. IPA shall arrange for IPA Providers to provide Health\\nCare Services to Enrollees pursuant to the terms of this Agreement, the Provider Manual, and the\\napplicable Plan Contract(s) for those Plan(s) identified by IPA in Exhibit 2.1. IPA shall not offer\\nparticipation with Healthfirst pursuant to this Agreement to any health care provider who is a\\nmember of IPA or has a contract with IPA, nor disclose share the terms and conditions of this\\nAgreement included rates of reimbursement, without first obtaining the written consent of\\nHealthfirst. Healthfirst shall have the right to refuse the participation of any particular health care\\nprovider under this Agreement. Healthfirst\\'s determination to offer participation to any health care\\nprovider pursuant to this Agreement or to refuse to accept any health care provider for participation\\nshall be based on Healthfirst\\'s business needs as determined solely by Healthfirst. Healthfirst\\'s\\nVice-President, Network Management or Executive Vice-President/Chief Operating Officer shall\\nhave sole authority issue consent under this Section 2.1. IPA shall provide Healthfirst with the\\nname, addresses, telephone numbers and other information regarding IPA Providers reasonably\\nrequested by Healthfirst. IPA shall permit, and require IPA Providers to permit, Healthfirst to use\\nsuch information in Healthfirst advertising and provider directories.\\n2.\\nA new Section 2.8 entitled Credentialing of Affiliated Providers is added to the\\nAgreement as follows:\\n2.8\\nCredentialing of Affiliated Providers.\\n2.8.1 Delegation. Healthfirst delegates to Provider and Provider agrees to accept the\\nresponsibility for credentialing potential Affiliated Providers employed by or affiliated with Provider;\\nprovided however, that such delegation shall be limited to i) those categories and types of providers\\nwhich Provider credentials as part of Provider\\'s regular credentialing process and ii) those providers\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n1 of 10\\n\\nStart of Page No. = 28\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nwho have or seek medical staff privileges with Provider. Provider shall not be required to credential\\nParticipating Providers which provider does not regularly credential or which do not have or seek\\nmedical staff privileges with Provider. Healthfirst shall retain sole responsibility for credentialing such\\nParticipating Providers. Healthfirst acknowledges and agrees that Healthfirst has reviewed Provider\\'s\\ncredentialing process and that such process meets the requirements of this Agreement, including this\\nSection 2.8 as of the Effective Date or at the time of Healthfirst\\'s final approval of the credentialing\\nprocess, whichever is later.\\n2.8.2 Provider shall have a formal application and review process for such Providers\\nwhich includes, but is not limited to, a signed application and attestation. Such review shall be\\nconducted by a Provider credentials committee in consultation with the Healthfirst credentials\\ncommittee. Provider shall have Credentialing Policies and Procedures that defines the following:\\n2.8.2.1 scope of Affiliated Providers covered;\\n2.8.2.2 criteria for primary source verification of information;\\n2.8.2.3 the process used to make credentialing decisions;\\n2.8.2.4 the extent of any delegated credentialing/recredentialing arrangements;\\n2.8.2.5 the right of Affiliated Providers to review the information submitted in\\nsupport of their credentialing application;\\n2.8.2.6 the process of notification to a Affiliated Provider of any information\\nobtained during the credentialing process that varies substantially from the information provided by the\\nAffiliated Provider;\\n2.8.2.7 the Affiliated Provider\\'s right to correct erroneous information;\\n2.8.2.8 the Provider\\'s medical director\\'s direct responsibility and participation in\\nthe credentialing program; and\\n2.8.2.9 the process used to ensure confidentiality of all information obtained in\\nthe credentialing process, except otherwise provided by law.\\n2.8.3 Credentialing Criteria. The Provider\\'s Credentials Committee shall determine the\\ncriteria for selection, which shall be consistent with Healthfirst\\'s credentialing policies and procedures,\\nas may be modified by Healthfirst from time to time. Provider\\'s credentialing and recredentialing\\ncriteria and procedure, its procedure for selection and termination of Providers, and its Provider\\ngrievance mechanism shall be subject to review and approval by Healthfirst, which approval shall not be\\nunreasonably withheld. At a minimum, Provider\\'s credentialing and recredentialing criteria and\\nprocedure shall be consistent with The Joint Commission (\"TJC\") and applicable standards required\\nunder Article 28 of the New York State Public Health law and shall include requiring Affiliated\\nProviders to be licensed and qualified to provide the services specified and to maintain such license in\\ngood standing. Provider shall include further credentialing requirements in addition to the TJC\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n2 of 10\\n\\nStart of Page No. = 29\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nreasonably required by Healthfirst and acceptable to Provider. Notwithstanding any provision\\nforegoing, Healthfirst shall retain final authority concerning the credentialing of Affiliated Providers and\\nhis/her participation in the Healthfirst network.\\n2.8.4 Cooperation. Provider shall cooperate with Healthfirst to determine if the\\ncredentialing and recredentialing criteria and procedures used by Provider are consistent with\\nHealthfirst\\'s and TJC\\'s credentialing and recredentialing criteria and procedures. In the event that\\nProvider\\'s credentialing and recredentialing criteria and procedures are inconsistent with Healthfirst\\'s\\ncredentialing and recredentialing criteria and procedures then Healthfirst, after good faith negotiations\\nwith Provider, may adjust the compensation payable to Provider under this Agreement to compensate\\nHealthfirst for the reasonable cost of credentialing and recredentialing potential Affiliated Providers\\nemployed by or affiliated with Provider.\\n2.8.5 Oversight by Healthfirst. To allow Healthfirst to oversee and monitor the\\ndelegation of credentialing to Provider, Provider, upon the reasonable request of Healthfirst and on an\\nongoing basis, shall (i) permit Healthfirst to conduct on-site audits of Provider credentialing policies and\\nprocedures and credentialing files, upon reasonable notice; (ii) to provide to Healthfirst no less than\\nannually, rosters of Healthfirst Providers and such written verification or other substantiation as\\nrequested by Healthfirst that Affiliated Providers employed by or on the medical staff of Provider are\\ncurrently and fully credentialed in accordance with TJC and Healthfirst standards; (iii) to provide to\\nHealthfirst, upon request, copies of credentialing files excluding peer review documentation; and, (iv)\\nand to provide Healthfirst with Affiliated Providers\\' initial appointment date, reappointment start date\\nand reappointment end date. Provider shall retain the right to terminate immediately its agreements\\nwith, or the employment of, any Affiliated Provider, subject to applicable appeals, if the Affiliated\\nProvider is no longer a member of the Provider\\'s medical staff, if the license to practice or DEA permit\\nor any controlled substances registration of said Affiliated Provider is suspended, otherwise restricted\\nor\\nrevoked, or if said Affiliated Provider is excluded or terminated from either the Medicare or Medicaid\\nprograms, or if said Affiliated Provider is not covered by insurance as provided pursuant to this\\nAgreement or is convicted of any crime (either a misdemeanor or a felony). Provider shall notify\\nHealthfirst, immediately, but in any event within forty-eight (48) hours of receipt of notice, if any\\nAffiliated Provider employed by or affiliated with Provider has his or her license to practice or DEA\\npermit or any controlled substances registration suspended or otherwise restricted or revoked or is\\nexcluded or terminated from either the Medicare or Medicaid programs, or is not covered by insurance\\nas required pursuant to this Agreement below or is convicted of any crime related to the provision of\\nhealth care services. Notwithstanding any other provision of this Section to the contrary, it is expressly\\nunderstood and agreed that Provider shall not be responsible for conducting individual site visits at\\nprovider sites other than at facilities operated by Provider.\\n2.8.6 Confidentiality. The foregoing provisions of this Section and the other provisions\\nof this Agreement shall not require the release or other disclosure by any person of any records or other\\ndocuments or information to the extent that such release or other disclosure is prohibited by or otherwise\\ncontrary to any applicable law.\\n3\\nA new Exhibit 4.1 setting forth the reimbursement to be paid by Healthfirst to IPA\\nProviders for the provision of Health Care Services to Enrollees and IPA for the provision of certain\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n3 of 10\\n\\nStart of Page No. = 30\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nadministrative services, a copy of which is attached to this Amendment, is added to the Agreement.\\nThe reimbursement set forth in the Exhibit 4.1 attached to this Amendment shall apply to dates of\\nservice on and after January 1, 2015. Prior Exhibits 4.1 shall continue to apply to dates of service\\nprior to that date.\\n4\\nAll other terms and conditions of the Agreement shall remain in full force and effect.\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n4 of 10\\n\\n\\n-------Table Start--------THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>\\n 4 All other terms and conditions of the Agreement shall remain in full force and effect.\\n<<<<<<{\\'Healthfirst PHSP, Inc.\\': [\\'DocuSigned by: By: Paul E. Portsmore\\', \\'441CEAD8E502476. Name: Paul E. Portsmore Print Name\\', \\'Title: SVP -\\', \\'Date: 12/31/2014 I 18:32:28 ET -\\'], \\'Chinese American Independent Practice Association, Inc.\\': [\\'By: f Sear\\', \\'Name: PEGGY SHENG Print Name\\', \\'Title: Chief Operating Officer\\', \\'Date: December 26, 2014\\']}\\n-------Table End--------\\n\\nStart of Page No. = 31\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nEXHIBIT 4.1\\nCOMPENSATION SCHEDULE\\nReimbursement to IPA Providers\\n1.\\nExcept for the Health Care Services set forth below, Healthfirst shall directly reimburse IPA\\nProviders who provide Health Care Services on a fee-for-service basis in an amount equal to 90% of the\\nmaximum allowable Region I fee schedule established by the Center for Medicaid and Medicare\\nServices (\"CMS\") for payments under the Medicare program.\\n2.\\nHealthfirst shall reimburse IPA Providers for the Health Care Services set forth below as\\nfollows:\\na. Physical Therapy Services. Physical therapy services set forth below shall be reimbursed at a rate of\\n$45 per service if provided in a multi-specialty office or facility. If provided by an individually-\\noperated Physical Therapist office (solely physical therapy services), physical therapy services set\\nforth below shall be reimbursed at a rate of $60 per service.\\nb.\\nPhysical Medicine and Rehabilitation Services. Physical medicine and rehabilitation services shall\\nbe reimbursed on a fee-for-service basis in an amount equal to 70% of the maximum allowable\\nRegion I fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for\\npayments under the Medicare program, except for physical therapy services which will be\\nreimbursed as noted in \"a.\" above.\\nC.\\nGastroenterology Services. The following services, when rendered in an \"Office Based Surgery\"\\n(OBS) accredited office (as mandated by the New York State Department of Health), will be\\nreimbursed on a fee-for-service basis in an amount equal to 100% of the maximum allowable Region\\nI fee schedule established by the Center for Medicaid and Medicare Services (\"CMS\") for payments\\nunder the Medicare program.\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n5 of 10\\n\\n\\n-------Table Start--------THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>\\n a. Physical Therapy Services. Physical therapy services set forth below shall be reimbursed at a rate of $45 per service if provided in a multi-specialty office or facility. If provided by an individually- operated Physical Therapist office (solely physical therapy services), physical therapy services set forth below shall be reimbursed at a rate of $60 per service.\\n<<<<<<<<<<<<{\\'Code Range\\': [\\'97001-97004\\', \\'97010-97028\\', \\'97032-97039\\', \\'97110-97546\\', \\'97750-97755\\'], \\'Code Range Description\\': [\\'Physical Medicine Assessments\\', \\'Physical Therapy Treatment Modalities: Supervised\\', \\'Physical Therapy Treatment Modalities: Constant Attendance\\', \\'Other Therapeutic Techniques With Direct Patient Contact\\', \\'Physical performance test & Assistive technology assessment\\']}\\n-------Table End--------\\n-------Table Start--------THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>\\n a. Physical Therapy Services. Physical therapy services set forth below shall be reimbursed at a rate of $45 per service if provided in a multi-specialty office or facility. If provided by an individually- operated Physical Therapist office (solely physical therapy services), physical therapy services set forth below shall be reimbursed at a rate of $60 per service.\\n<<<<<<<<<<<<{\\'CPT Code\\': [\\'43235\\', \\'43239\\', \\'45378\\', \\'45380\\', \\'45385\\'], \\'CPT Description\\': [\\'Upper gastrointestinal endoscopy\\', \\'Upper gastrointestinal endoscopy, with biopsy\\', \\'Colonoscopy, diagnostic\\', \\'Colonoscopy, with biopsy\\', \\'Colonoscopy, removal of tumor\\']}\\n-------Table End--------\\n\\nStart of Page No. = 32\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nd. The following services will be reimbursed at the rates noted below:\\ne. Hearing Aids. IPA Providers shall be reimbursed for the cost of hearing aids at eighty percent (80%)\\nof the manufacturer\\'s suggested retail price.\\nIPA Network Access and Administrative Fees.\\nHealthfirst shall pay IPA an administrative fee of $2.50 per Member per month for administrative\\nservices relating to quality improvement and education of Participating IPA Providers regarding\\nHealthfirst\\'s quality improvement programs. IPA and Healthfirst understand and agree that IPA shall\\nnot provide any management services, as that term is defined in 11 NYCRR 98, to Healthfirst pursuant\\nto this Agreement. In the event that IPA or an affiliated of IPA provides management services, the\\nparties shall execute a separate management agreement approved by SDOH pursuant to 11 NYCRR 98.\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n6 of 10\\n\\n\\n-------Table Start--------THIS IS PRETABLE TEXT>>>THIS IS PRETABLE TEXT>>>\\n d. The following services will be reimbursed at the rates noted below:\\n<<<<<<{\\'CPT Code/Modifier\\': [\\'99205-P1\\', \\'99212-P2\\', \\'99215-P3\\', \\'59409\\', \\'59514\\', \\'99381\\', \\'99382\\', \\'99383\\', \\'99384\\', \\'99385\\', \\'99386\\', \\'99387\\', \\'99391\\', \\'99392\\', \\'99393\\', \\'99394\\', \\'99395\\', \\'99396\\', \\'99397\\', \\'99401\\', \\'99402\\', \\'99403\\', \\'99404\\', \\'99411\\', \\'99412\\'], \\'CPT Description\\': [\\'PCAP Initial Visit\\', \\'PCAP Prenatal Visit\\', \\'PCAP Post partum Visit\\', \\'Vaginal Delivery\\', \\'Cesarean Delivery\\', \\'Initial visit, new patient, infant (under 1 year)\\', \\'Initial visit, new patient, early childhood (age 1-4)\\', \\'Initial visit, new patient, late childhood (age 5-11)\\', \\'Initial visit, new patient, adolescent (age 12-17)\\', \\'Initial visit, new patient, age 18-39\\', \\'Initial visit, new patient, age 40-64\\', \\'Initial visit, new patient, age 65 and older\\', \\'Periodic visit, established patient, infant (under 1 year)\\', \\'Periodic visit, established patient, early childhood (age 1-4)\\', \\'Periodic visit, established patient, late childhood (age 5-11)\\', \\'Periodic visit, established patient, adolescent (age 12-17)\\', \\'Periodic visit, established patient, age 18-39\\', \\'Periodic visit, established patient, age 40-64\\', \\'Periodic visit, established patient, age 65 and older\\', \\'Preventive medicine counseling, Individual, approx 15 minutes\\', \\'Preventive medicine counseling, Individual, approx 30 minutes\\', \\'Preventive medicine counseling, Individual, approx 45 minutes\\', \\'Preventive medicine counseling, Individual, approx 60 minutes\\', \\'Preventive medicine counseling, Group, approx 30 minutes\\', \\'Preventive medicine counseling, Group, approx 60 minutes\\'], \\'Amount\\': [\\'$196.07\\', \\'$130.00\\', \\'$163.00\\', \\'$1500.00\\', \\'$1500.00\\', \\'$65.00\\', \\'$61.00\\', \\'$60.00\\', \\'$65.00\\', \\'$74.00\\', \\'$80.00\\', \\'$118.00\\', \\'$61.00\\', \\'$61.00\\', \\'$60.00\\', \\'$60.00\\', \\'$75.00\\', \\'$90.00\\', \\'$99.00\\', \\'$31.00\\', \\'$40.00\\', \\'$60.00\\', \\'$79.00\\', \\'$28.00\\', \\'$57.00\\']}\\n-------Table End--------\\n\\nStart of Page No. = 33\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nAdditional Compensation to IPA in the form of Surplus Distribution.\\n1.\\nLimited Risk Transfer/No Transfer of Financial Risk\\n1.1.\\nIPA shall be entitled to Additional Compensation under this Agreement on an annual\\nbasis in the form of a Surplus (as defined below) distribution, to the extent that any available Surplus\\nfunds exist, as specified below.\\n1.2.\\nUse of Additional Compensation. IPA represents and warrants that Additional\\nCompensation paid to IPA, if any, shall be distributed to Participating IPA Providers or used by IPA in a\\nmanner designed to improve the quality of care received by Enrollees and Enrollee satisfaction. On\\nrequest by Healthfirst, IPA shall provide Healthfirst with financial records accounting in detail all funds\\nreceived from Healthfirst and the disbursement of all such funds as set forth in 10 NYCRR 98-1.18(d).\\n2.\\nDefinitions. Capitalized terms used in this Exhibit 4.1(b) shall have the meaning given in this\\nExhibit or, if any term is not defined in this Exhibit 4.1(b), it shall have the meaning given in the\\nAgreement to which this Exhibit is attached.\\n2.1.\\n\"Additional Compensation\" shall mean the portion of any Surplus paid to IPA pursuant\\nto Section 5 of this Exhibit 4.1(b).\\n2.2.\\n\"Adjusted Premiums\" shall mean the premiums received by Healthfirst for Risk\\nEnrollees, as adjusted by any risk score or other adjustment to premiums pursuant to the applicable Plan\\nContract and applicable to Risk Enrollees as reasonably determined and applied by Healthfirst.\\n2.3.\\n\"Administrative Deduction\" shall mean the deduction from Adjusted Premiums equal to\\nHealthfirst\\'s administrative costs as reasonably determined by Healthfirst.\\n2.4.\\n\"Final Reconciliation\" shall mean the final the accounting, as set forth in Section 3, of\\nMedical Revenue, claims paid for Health Care Services and other expenses to determine Surpluses or\\nDeficits conducted twelve months following the expiration, non-renewal or termination of this Exhibit.\\n2.5.\\n\"Medical Revenue\" shall mean the balance of Adjusted Premiums after subtracting the\\nAdministrative Deduction and any Quality Incentive Deduction.\\n2.6.\\n\"Quality Incentive Deduction\" shall mean an amount taken from Adjusted Premiums for\\nprograms in which IPA and IPA Providers participate to improve the quality of Health Care Services\\nwhich Risk Enrollees receive.\\n2.7.\\n\"Reconciliation\" shall mean the accounting, as set forth in Section 3, of Medical\\nRevenue, claims paid for Health Care Services and other expenses to determine Surpluses or Deficits.\\n2.8.\\n\"Risk Enrollee\" shall mean an Enrollee who has selected, or been assigned to, a primary\\ncare provider who is a Participating IPA Provider.\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n7 of 10\\n\\nStart of Page No. = 34\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\n2.9.\\n\"Surplus\" or \"Deficit\" shall mean the balance of Medical Revenue following\\nReconciliation\\n3.\\nReconciliation of Medical Revenue to Determine Surpluses and Deficits. During each\\nReconciliation, Healthfirst shall make the following deductions from Medical Revenue and determine\\nthe amount of any Surplus of Deficit:\\n3.1.\\nthe costs of claims paid for Health Care Services rendered to Risk Enrollees by\\nParticipating IPA Providers, Participating Providers and all other health care providers.\\n3.2.\\na\\nreasonable reserve for the cost of claims for Health Care Services rendered to Risk\\nEnrollees but not yet received;\\n3.3.\\nother costs associated with the provision of Health Care Services to Risk Enrollees\\nincluding but not limited to the net cost of reinsurance and any internal aggregate risk sharing programs.\\n3.4.\\naccruals for any risk adjustment applicable to Adjusted Premiums.\\n4.\\nReconciliation Schedule.\\n4.1.\\nInterim Quarterly Reconciliation and Distribution. Within one-hundred and twenty days\\n(120) after the end of each calendar year quarter, Healthfirst shall determine the amount of any Surplus\\nor Deficit for all preceding quarters during that calendar year. In the event that Healthfirst determines\\nthat a Surplus has been achieved for the preceding quarters during the calendar year, Healthfirst shall\\nmake an interim payment to IPA of Additional Compensation as set forth in Section 5 below. In the\\nevent that Healthfirst determines that a Deficit has been achieved for the preceding quarters druing the\\ncalendar year, Healthfirst not make an interim payment to IPA of Additional Compensation and the\\nDeficit shall be handled as set forth in Section 6 below.\\n4.2.\\nAnnual Reconciliation and Distribution. Within one-hundred and twenty days (120) after\\nthe end of each calendar year, Healthfirst shall determine the amount of any Surplus for all quarters for\\nthat calendar year. In the event that Healthfirst determines that a Surplus has been achieved for that\\ncalendar year, Healthfirst shall make a final payment to IPA of Additional Compensation as set forth in\\nSection 5 below. In the event that Healthfirst determines that a Deficit has been achieved for that\\nCalendar Year, Healthfirst not make a final payment to IPA of Additional Compensation and the Deficit\\nshall be handled as set forth in Section 6 below.\\n5.\\nPayment of Additional Compensation. In the event that Healthfirst determines that a Surplus has\\nbeen achieved as set forth Section 3 above, Healthfirst shall pay to IPA Additional Compensation which\\nshall be the lesser of the following:\\n5.1.\\nTen percent (10%) of the Surplus for the calendar year, or\\n5.2.\\nAn amount such that the Additional Compensation equals twenty-five percent (25%) of\\nthe sum of i) the total compensation to Participating IPA Providers for Health Care Services rendered to\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n8 of 10\\n\\nStart of Page No. = 35\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nRisk Enrollees pursuant to Exhibit 4.1(a); any compensation paid to IPA pursuant to Exhibit 4.1(a) and\\niii) the Additional Compensation.\\n5.3.\\nHealthfirst shall pay any Additional Compensation, within thirty days of each\\nReconciliation. Healthfirst shall, in no event, advance to IPA any Additional Compensation.\\n6.\\nTreatment of Deficits.\\n6.1.\\nDeficits Rolled Forward. In the event that a Deficit remains following any Reconciliation\\nor a Final Reconciliation, the Deficit equal to the percentage set forth in Section 5.1 above shall be\\nrolled forward to reduce any Surplus that may accrue under this Agreement in the succeeding calendar\\nyear.\\n6.2.\\nDeficits at Termination, Expiration or Non-Renewal. In the event that this Agreement\\nterminates, is not renewed or expires, regardless of the reason, Provider shall not be required to\\nreimburse Healthfirst for any Deficits which may exist at the time of such termination, expiration or\\nnon-renewal.\\n7.\\nCompliance with Regulatory Provisions Regarding Risk Transfer\\n7.1.\\nSDOH Provider Contract Guidelines. Healthfirst and IPA shall comply with\\nthe\\napplicable requirements of SDOH regarding transfer of financial risk to IPAs as set forth in SDOH\\'s\\nProvider Contracting Guidelines, as amended by SDOH from time to time. In the event that the amount\\nfinancial risk transferred to IPA constitutes a Level 4 risk transfer pursuant to the Providing Contracting\\nGuidelines, IPA shall demonstrate financial viability and establish a financial security deposit as\\nrequired by SDOH.\\n7.2.\\nPhysician Incentive Plan (\"PIP\") Regulations. Healthfirst and IPA shall comply with the\\napplicable requirements of the federal PIP regulations contained in 42 CFR 422.208, including the\\nplacement of stop loss insurance if applicable.\\n7.3.\\nFinancial Stability Monitoring and Reporting. Notwithstanding any other provision of\\nthis Agreement Healthfirst shall regularly monitor Provider\\'s financial condition to ensure that Provider\\nremains financially able to perform its obligations under this Agreement and meet any financial\\nsolvency requirements of SDOH or DFS. IPA shall promptly advise Healthfirst of any material\\ndevelopments which may impair its ability to perform its obligations under this Agreement. In addition,\\nIPA shall provide Healthfirst with the reports and information as required by 10 NYCRR 98-1.18(e),\\nwhich shall include but not be limited to IPA\\'s quarterly and annual financial statements. IPA shall also\\nmaintain, as required by 10 NYCRR 98-1.18(d), financial records accounting in detail all funds received\\nfrom Healthfirst and the disbursement of all such funds. IPA shall provide such accounting of funds and\\ndisbursements to Healthfirst on request.\\n8.\\nTermination or Amendment of Additional Compensation\\nHealthfirst may on, thirty (30) days prior notice to IPA, amend the terms and conditions pursuant to\\nwhich Additional Compensation is determined and paid to IPA as well as eliminate the payment of\\nAdditional Compensation to IPA; provided however, that unless IPA or IPA Providers have breached\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n9 of 10\\n\\nStart of Page No. = 36\\nDocuSign Envelope ID: 9C620FF8-D29C-41D1-AC34-A57E55353ABE\\nthe Agreement such amendment or termination shall not change any Additional Compensation\\ncalculated or paid prior to the effective date of such amendment or termination.\\n9.\\nTermination, Non-Renewal or Expiration of the Agreement.\\nFor a period of twelve months following any termination, non-renewal or expiration of this Agreement,\\nregardless of the cause Healthfirst will conduct Reconciliations of Medical Revenue pursuant to this\\nAgreement until the Final Reconciliation; provided, however, that payments to IPA of Additional\\nCompensation shall be suspended. These Reconciliations shall be on based Health Care Services\\nrendered to Risk Enrollees prior to the termination, non-renewal or expiration of this Agreement.\\nHealthfirst shall pay to any Additional Compensation existing at the Final Reconciliation within thirty\\ndays of the Final Reconciliation.\\nFED. TAX ID # 133923495\\nCONTRACT EFFECTIVE DATE: January 1, 2015\\nSDOH 4814\\n10 of 10'" - ] - }, - "execution_count": 39, - "metadata": {}, - "output_type": "execute_result" - } - ], + "outputs": [], "source": [ - "contract_text" + "prompt = BOTTOM_UP_CODES(answer_dicts[0], text_dict['5'])" + ] + }, + { + "cell_type": "code", + "execution_count": null, + "metadata": {}, + "outputs": [], + "source": [ + "code_answer = claude_funcs.invoke_claude_3(prompt, max_tokens=4000)" ] }, {