Common use of SPECIFIC PLAN OFFERINGS Clause in Contracts

SPECIFIC PLAN OFFERINGS. MAO shall operate one (1) Dual Eligible Special Needs Plans under CMS contract number H5587. MAO shall enroll individuals into offered Plan Benefit Packages (PBPs) in accordance with federal and state guidelines, and the terms of this Agreement. A Full Benefit Dual Eligible Member’s eligibility for each particular plan benefit package (PBP) is described below: 4.6.1. H5587-002 (HIDE SNP status) is a Dual Eligible Subset plan open to only those individuals eligible to enroll pursuant to the following eligibility requirements: 4.6.1.1. The individual must be currently enrolled in the AHCCCS Complete Care (ACC) companion program in accordance with paragraph 4.1.1 and Attachment 7; Participant Health Choice Arizona, Inc. d/b/a Health Choice Pathway AHCCCS AGREEMENT # YH23-0010-03 4.6.1.2. The individual must live within the appropriate county that corresponds with the specific service area of their AHCCCS Complete Care (ACC) companion program enrollment in accordance with paragraph 4.1.2; 4.6.1.3. The individual must be entitled to participate in Medicare; and 4.6.1.4. The individual must reside within the CMS-approved service area county for this PBP in accordance with paragraph 4.5.1. Participant Health Choice Arizona, Inc. d/b/a Health Choice Pathway AHCCCS AGREEMENT # YH23-0010-03 5. NAME OF MAO: Health Choice Arizona, Inc. d/b/a Health Choice Pathway 6. ARIZONA SYSTEM HEALTH CARE COST CONTAINMENT [ THIS PAGE INTENTIONALLY LEFT BLANK ] ATTACHMENT 1: CHART OF DELIVERABLES Area Timeframe Report When Due Agreement Section Agreement Paragraph Reference/ Policy Send To Submitted Via MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND ATTACHMENT 2 – AHCCCS COVERED SERVICES – PHYSICAL HEALTH SERVICES (pages 40-42) MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND ATTACHMENT 3 – AHCCCS COVERED SERVICES - BEHAVIORAL HEALTH SERVICES (pages 43-45) Title XIX Title XIX MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND Title XIX Title XIX MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND Title XIX Title XIX MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND ATTACHMENT 4 – ALTCS ELDERLY and PHYSICALLY DISABLED COVERED MLTSS (pages 46- 48) ALTERNATIVE RESIDENTIAL SETTINGS MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND HOSPICE SERVICES HOME AND COMMUNITY BASED SERVICES MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND ATTACHMENT 5 – DEFAULT ENROLLMENT PROCESS REPORTING REQUIREMENTS

SPECIFIC PLAN OFFERINGS. MAO shall operate one (1) Dual Eligible Special Needs Plans Plan under CMS contract number H5587H5430. MAO shall enroll individuals into offered Plan Benefit Packages (PBPs) in accordance with federal and state guidelines, and the terms of this Agreement. A Full Benefit Dual Eligible Member’s eligibility for each particular plan benefit package (PBP) is described below: 4.6.14.7.1. H5587H5430-002 (HIDE SNP status) 001 is a Dual Eligible Subset plan open to only those individuals eligible to enroll pursuant to the following eligibility requirements: 4.6.1.14.7.1.1. The individual must be currently enrolled in the AHCCCS Complete Care (ACC) companion program in accordance with paragraph 4.1.1 and Attachment 7; Participant Health Choice Arizona, Inc. d/b/a Health Choice Pathway AHCCCS AGREEMENT # YH23-0010-034.1.1; 4.6.1.24.7.1.2. The individual must live within the appropriate county that corresponds with the specific service area of their AHCCCS Complete Care (ACC) companion program enrollment in accordance with paragraph 4.1.2; 4.6.1.34.7.1.3. The individual must be entitled to participate in Medicare; and 4.6.1.44.7.1.4. The individual must reside within the CMS-approved service area county for this PBP in accordance with paragraph 4.5.14.6.1. Participant ONECare by Care1st Health Choice Plan of Arizona, Inc. d/b/a Health Choice Pathway WellCare Liberty AHCCCS AGREEMENT # YH23YH20-0010-03 5. NAME OF MAO: 03 Participant ONECare by Care1st Health Choice Plan of Arizona, Inc. d/b/a WellCare Liberty AHCCCS AGREEMENT # YH20-0010-03 DHCM OPERATIONS Upon execution of initial Agreement Default Enrollment Process – Initial Approval 120 days prior to Effective Date of Agreement Section 2: Program Requirements 2.1.11 42 CFR 422.66(g) DHCM Operations Compliance Officer for Medicare Email notification DHCM OPERATIONS Minimum every 5 years after most recent approval Default Enrollment Process – Renewal Approval Within 10 calendar days of receipt Section 2: Program Requirements 2.1.11 42 CFR 422.66(g) DHCM Operations Compliance Officer for Medicare Email notification DHCM CLINICAL QUALITY MANAGEMENT Annually Medicare Health Choice Pathway 6. ARIZONA SYSTEM HEALTH CARE COST CONTAINMENT [ THIS PAGE INTENTIONALLY LEFT BLANK ] ATTACHMENT 1Risk Assessment Tool January 1st Section 2: CHART OF DELIVERABLES Program Requirements 2.1.5 N/A DHCM Operations Compliance Officer for Medicare Email notification DHCM OPERATIONS Monthly Default Enrollment 30 calendar days after month end Section 2: Program Requirements 2.1.12 N/A DHCM Operations Compliance Officer for Medicare Email notification DHCM FINANCE Quarterly Financial Reporting 60 days after the end of the quarter Section 2: Program Requirements 2.7.1.2 AHCCCS Financial Reporting Guide(s) DHCM- Finance Program Compliance Auditor FTP server with email notification Area Timeframe Report When Due Agreement Section Agreement Paragraph Reference/ Policy Send To Submitted Via MEDICARE ADVANTAGE ORGANIZATION DHCM OPERATIONS Monthly Member Appeals Summary and Outcomes First day of the second month following the month being reported Section 2: Program Requirements 2.9 AHCCCS Grievance System Reporting Guide DHCM Operations Compliance Officer for Medicare Secure email notification DHCM OPERATIONS Annually CMS Notification of MAO FIDE Status (as applicable) 10 calendar days of receipt Section 2: Program Requirements 2.12.7 N/A DHCM Operations Compliance Officer for Medicare Secure email notification DHCM OPERATIONS Annually CMS Notification of MAO Star Ratings 10 calendar days of receipt Section 2: Program Requirements 2.11 N/A DHCM Operations Compliance Officer for Medicare Secure email notification DHCM OPERATIONS Per Occurrence Change of Designated Care Coordinator 10 calendar days of change Section 2: Program Requirements 2.1.8 N/A DHCM Operations Medical Management Unit and Compliance Officer for Medicare FTP server with email notification Area Timeframe Report When Due Agreement Section Agreement Paragraph Reference/ Policy Send To Submitted Via DHCM CLINICAL QUALITY MANAGEMENT Per Occurrence Quality of Care Inquiry Responses When requested Section 2: Program Requirements 2.1.10 N/A DHCM Clinical Quality Management Unit FTP server with secure email notification to ▇▇▇@▇▇▇▇▇▇▇▇.▇▇▇ with notification to CQM Administrator CONTRACTS AND PURCHASING Per Occurrence Advertising, Property of the State Advance written approvals Section 3: Terms and Conditions 2.8, 3.10 N/A Contracting Officer Email notification DHCM OPERATIONS Per Occurrence MAO Contract Changes with and Notifications from CMS 10 calendar days of notice or change Section 2: Program Requirements 2.10 N/A DHCM Operations Compliance Officer for Medicare Secure email notification DHCM OPERATIONS Per Occurrence Notification of Potential Conflict(s) of Interest Advance written approval Section 3: Terms and Conditions 3.8 N/A DHCM Operations Compliance Officer for Medicare Secure email notification CONTRACTS AND PURCHASING Per Occurrence Notices to AHCCCS Per Occurrence Section 3: Terms and Conditions 4.8 N/A Contracting Officer Email notification DHCM DATA ANALYSIS AND RESEARCH UNIT (DAR) Per Schedule Medicare Encounter Data Per schedule Section 2: Program Requirements 2.6 N/A DHCM DAR designated Sr. Business Analyst Established PMMIS transmission protocols with email notification Participant ONECare by Care1st Health Plan of Arizona, Inc. d/b/a WellCare Liberty AHCCCS AGREEMENT BETWEEN AHCCCS AND # YH20-0010-03 ATTACHMENT 2 – AHCCCS COVERED SERVICES – PHYSICAL HEALTH SERVICES PHYSICAL HEALTH SERVICES (pages 40-42IN ACCORDANCE WITH APPLICABLE CONTRACT AND POLICY TERMS, CONDITIONS AND LIMITATIONS) MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND TITLE XIX Audiology X X Behavioral Health SEE ATTACHMENT 3 Breast Reconstruction After Mastectomy X X Chiropractic Services X Cochlear Implants X Diagnostic Testing X X Emergency Dental Services X ALTCS only Preventive & Therapeutic Dental Services X Limited Medical and Surgical Services by a Dentist (for Members Age 21 and older) X Dialysis X X Emergency Services X X Emergency Eye Exam X X Vision Exam/Prescriptive Lenses X Lens Post Cataract Surgery X X Treatment for Medical Conditions of the Eye X X Health Risk Assessment & Screening Tests (for Members Age 21 and Older) X Preventive Examinations in the Absence of any Known Disease or Symptom X X HIV/AIDS Antiretroviral Therapy X X High Frequency Chest Wall Oscillation Therapy X X Home Health Services X X Hospice X X Hospital Inpatient X X Hospital Observation X X PHYSICAL HEALTH SERVICES (IN ACCORDANCE WITH APPLICABLE CONTRACT AND POLICY TERMS, CONDITIONS AND LIMITATIONS) TITLE XIX Hospital Outpatient X X Hysterectomy (Medically Necessary) X X Immunizations X X Laboratory X X Maternity Services X X Family Planning X X Early and Periodic Screening, Diagnosis and Treatment (Medical Services) X Medical Foods X X Medical Equipment and Appliances X X Medical Supplies X X Prosthetic X X Orthotic Devices X X Negative Pressure Wound Therapy X X Nursing Facilities (up to 90 days) X X Non-Physician First Surgical Assistant X X Physician Services X X Foot and Ankle Services X X Prescription Drugs X X Primary Care Provider Services X X Private Duty Nursing X X Radiology and Medical Imaging X X Occupational Therapy – AHCCCS COVERED Inpatient X X Occupational Therapy – Outpatient X X Physical Therapy – Inpatient X X Physical Therapy – Outpatient X X Sleep Studies (Polysomnography) X X Speech Therapy – Inpatient X X PHYSICAL HEALTH SERVICES (IN ACCORDANCE WITH APPLICABLE CONTRACT AND POLICY TERMS, CONDITIONS AND LIMITATIONS) TITLE XIX Speech Therapy – Outpatient X ALTCS only Respiratory Therapy X X Total Outpatient Parental Nutrition X X Non-Experimental transplants approved for Title XIX reimbursement (See Policy Regarding Specific Transplant Coverage) X X Transplant Related immunosuppressant drugs X X Transportation – Emergency X X Transportation - Non-emergency X X Triage X X BEHAVIORAL HEALTH SERVICES (pages 43IN ACCORDANCE WITH APPLICABLE CONTRACT AND POLICY TERMS, CONDITIONS AND LIMITATIONS, INCLUDING THOSE SERVICES LISTED IN THE AHCCCS BEHAVIORAL HEALTH SERVICES MATRIX ON THE AHCCCS WEBSITE) ACC ALTCS TITLE XIX TITLE XIX Behavioral Health Counseling and Therapy - Individual X X X X Behavioral Health Counseling and Therapy – Group and Family X X X X Behavioral Health Screening Services X X X X Behavioral Health Assessment Services X X X X Behavioral Health Testing Services X X X X Behavioral Health Evaluation Services X X X X Other Professional Services – Alcohol and/or Drug Services X X X X Other Professional Services – Multisystemic Therapy for Juveniles X X Other Professional Services – Mental Health Services (fka Traditional Healing) Non-45TXIX funds if available Non-TXIX funds if available Non-TXIX funds if available Non-TXIX funds if available Other Professional Services – Auricular Acupuncture Non-TXIX funds if available Non-TXIX funds if available Non-TXIX funds if available Non-TXIX funds if available Skills, Training and Development, and Psychosocial Rehabilitation (Living Skills Training) Title X X X X Cognitive Rehabilitation X X X X Health Promotion Services (Behavioral Health Prevention/Promotion Education, Medication Training, and Support Services) X X X X Psycho Educational Services and Ongoing Support to Maintain Employment X X X X Medical Services X X X X BEHAVIORAL HEALTH SERVICES (IN ACCORDANCE WITH APPLICABLE CONTRACT AND POLICY TERMS, CONDITIONS AND LIMITATIONS, INCLUDING THOSE SERVICES LISTED IN THE AHCCCS BEHAVIORAL HEALTH SERVICES MATRIX ON THE AHCCCS WEBSITE) ACC ALTCS TITLE XIX Title TITLE XIX MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN Laboratory, Radiology and Medical Imaging X X X X Medical Management X X X X Electro-Convulsive Therapy X X X X Case Management X X X X Personal Care Services X X X X Home Care Training – Family X X X X Home Care Training – to Home Care Client X X X X Self-Help/Peer Services X X X X Unskilled Respite Care X X X X Supported Housing Non-TXIX funds if available Non-TXIX funds if available Non-TXIX funds if available Non-TXIX funds if available Transportation – Emergency X X X X Transportation – Non-Emergency X X X X Crisis Intervention Services – Mobile X X X X Crisis Intervention Services – Facility-Based X X X X Hospital Services X X X X Sub-Acute Facility X X X X Residential Treatment Center X X X X Behavioral Health Residential Facility (without Room and Board) X X X X Mental Health Services NOS (Room and Board) Non-TXIX funds if available Non-TXIX funds if available Non-TXIX funds if available Non-TXIX funds if available Supervised Behavioral Health Treatment and Day Programs X X X X BEHAVIORAL HEALTH SERVICES (IN ACCORDANCE WITH APPLICABLE CONTRACT AND POLICY TERMS, CONDITIONS AND LIMITATIONS, INCLUDING THOSE SERVICES LISTED IN THE AHCCCS AND Title BEHAVIORAL HEALTH SERVICES MATRIX ON THE AHCCCS WEBSITE) ACC ALTCS TITLE XIX Title TITLE XIX MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN Therapeutic Behavioral Health Services and Day Programs X X X X Community Psychiatric Supportive Treatment and Medical Day Programs X X X X Community Psychiatric Supportive Treatment and Medical Day Programs – by telephone X X X X Intermediate Care Facility (DD Dual Eligible Members only) Nursing Facility – Level I Nursing Facility – Level II Nursing Facility – Level III Nursing Facility – Level IV Nursing Facility – Respite Bed Hold – Therapeutic Leave Bed Hold – Hospital Admission Assisted Living Home Assisted Living Center Adult ▇▇▇▇▇▇ Care Habilitation – Residential (DD Group Homes only) Level II Behavioral Health Residential (May be appropriate for stays of any length) Behavioral Health Therapeutic Home • Home Care Training to Home Care Client (Child) • Home Care Training to Home Care Client (Adult) • Home Care Training to Home Care Client (Adult Geriatric) Routine Home Care Continuous Home Care General Inpatient Care Adult Day Health Care Attendant Care Companion Care Community Transition Service Emergency Alert System Habilitation • Day Treatment & Training • Supported Employment Home Delivered Meals Home Health Services/Nursing Home Health Services/Home Health Aide Homemaker Home Modification Personal Care Respite • Short Term In-Home • Continuous In-Home • Group Respite MAO shall report monthly each of the following six (6) default enrollment process data elements to AHCCCS, as per the requirements of Attachment 1: Chart of Deliverables. a. Number of individuals (potential Dual Eligible Members) identified by MAO as eligible for default enrollment based on age or disability. b. Number of beneficiaries (potential Dual Eligible Members), separated by eligibility based on age or disability, that were noticed by MAO at least sixty (60) calendar days prior to the effective date of default enrollment. c. Number of beneficiaries (potential Dual Eligible Members) who opt out of (decline) default enrollment prior to the effective date. Differentiate between those who opt out by telephone or in writing, as well as eligibility based on age or disability. d. At the end of the first month of enrollment, specify the number of rapid disenrollments (the number of Dual Eligible Members who disenroll within their first month of default enrollment). Continue to track for rapid disenrollments within the first three months of a Dual Eligible Member’s default enrollment effective date. e. Provide information regarding any complaints received internally, including grievances relating to default enrollment. For complaints with a Medicare Advantage Complaint Tracking Module (CTM) identification number, please also list the CTM number with the complaint. Provide this information in an Excel spreadsheet. f. Indicate if MAO has identified any individuals (potential Dual Eligible Members) for which it was unable to identify for default enrolment in the required timeframe (minimum 60 calendar days prior) for notification of default enrollment, and an explanation of why they were excluded from the default enrollment process. AZ Complete Health ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇- us.html ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Contact Us Form at ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇- us.html Banner-University Family Care ▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇/▇▇▇▇▇- us/contact-us ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Care1st Health Plan Arizona ▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇/▇▇▇▇▇▇▇/▇▇▇▇▇▇▇. asp ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Email Form at ▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇/▇▇▇▇▇▇▇/▇▇▇▇▇▇▇.▇▇▇ Magellan Complete Care ▇▇▇.▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇/▇▇▇▇▇▇▇-▇▇/ ▇-▇▇▇-▇▇▇-▇▇▇▇ Email Form at ▇▇▇.▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇/▇▇▇▇▇▇▇-▇▇/ Mercy Care (1) ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇/▇▇▇▇▇▇ tecare-formembers/contact ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Contact Us Form at ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇/▇▇▇▇▇▇▇▇▇ are-formembers/contact ▇▇▇▇▇▇▇ Health Choice Arizona ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇ t 1-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Link: ▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇.▇▇▇ UnitedHealthcare Community Plan (1) ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇/▇▇▇▇▇▇ id/ahcccs.html ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Banner-University Family Care LTC ▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇/▇▇▇▇▇- us/contact-us ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Mercy Care LTC ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇/▇▇▇- formembers/contact ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Contact Us Form at ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇/▇▇▇- formembers/contact UnitedHealthcare Community Plan LTC ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇/▇▇▇▇▇▇ id/long-term-care.html ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 AZ Complete Health ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇- us.html ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Contact Us Form at ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇- us.html Mercy Care RBHA ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇/▇▇▇▇- formembers/contact ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Contact Us Form at ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇/▇▇▇▇- formembers/contact ▇▇▇▇▇▇▇ Health Choice Arizona ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇- wellness/behavioral health/ 1-800-640-2123 TTY 711 Link: ▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇.▇▇▇ AHCCCS AND Title XIX Title XIX MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND ATTACHMENT 4 – ALTCS ELDERLY and PHYSICALLY DISABLED COVERED MLTSS Fee-for Service Programs ▇▇▇.▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇/▇▇▇▇▇▇▇▇▇▇▇ cts.html ▇-▇▇▇-▇▇▇-▇▇▇▇ State Health Insurance Assistance Program (pages 46- 48SHIP) ALTERNATIVE RESIDENTIAL SETTINGS MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND HOSPICE SERVICES HOME AND COMMUNITY BASED SERVICES MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND ATTACHMENT 5 – DEFAULT ENROLLMENT PROCESS REPORTING REQUIREMENTS▇▇▇▇▇://▇▇▇.▇▇.▇▇▇/services/older- adults/medicare-assistance ▇-▇▇▇-▇▇▇-▇▇▇▇ (1) Available also to Dual Eligible Members enrolled in respective DD health plan.

SPECIFIC PLAN OFFERINGS. MAO shall operate one (1) Dual Eligible Special Needs Plans Plan under CMS contract number H5587H8845. MAO shall enroll individuals into offered Plan Benefit Packages (PBPs) in accordance with federal and state guidelines, and the terms of this Agreement. A Full Benefit Dual Eligible Member’s eligibility for each particular plan benefit package (PBP) is described below: 4.6.14.7.1. H5587H8845-002 (HIDE SNP status) 001 is a Dual Eligible Subset plan open to only those individuals eligible to enroll pursuant to the following eligibility requirements: 4.6.1.14.7.1.1. The individual must be currently enrolled in the AHCCCS Complete Care (ACC) companion program in accordance with paragraph 4.1.1 and Attachment 7; Participant Health Choice Arizona, Inc. d/b/a Health Choice Pathway AHCCCS AGREEMENT # YH23-0010-034.1.1; 4.6.1.24.7.1.2. The individual must live within the appropriate county that corresponds with the specific service area of their AHCCCS Complete Care (ACC) companion program enrollment in accordance with paragraph 4.1.2; 4.6.1.34.7.1.3. The individual must be entitled to participate in Medicare; and 4.6.1.44.7.1.4. The individual must reside within the CMS-approved service area county for this PBP in accordance with paragraph 4.5.14.6.1. Participant DHCM OPERATIONS Upon execution of initial Agreement Default Enrollment Process – Initial Approval 120 days prior to Effective Date of Agreement Section 2: Program Requirements 2.1.11 42 CFR 422.66(g) DHCM Operations Compliance Officer for Medicare Email notification DHCM OPERATIONS Minimum every 5 years after most recent approval Default Enrollment Process – Renewal Approval Within 10 calendar days of receipt Section 2: Program Requirements 2.1.11 42 CFR 422.66(g) DHCM Operations Compliance Officer for Medicare Email notification DHCM CLINICAL QUALITY MANAGEMENT Annually Medicare Health Choice Arizona, Inc. dRisk Assessment Tool January 1st Section 2: Program Requirements 2.1.5 N/bA DHCM Operations Compliance Officer for Medicare Email notification DHCM OPERATIONS Monthly Default Enrollment 30 calendar days after month end Section 2: Program Requirements 2.1.12 N/a Health Choice Pathway A DHCM Operations Compliance Officer for Medicare Email notification DHCM FINANCE Quarterly Financial Reporting 60 days after the end of the quarter Section 2: Program Requirements 2.7.1.2 AHCCCS AGREEMENT # YH23-0010-03 5. NAME OF MAO: Health Choice Arizona, Inc. d/b/a Health Choice Pathway 6. ARIZONA SYSTEM HEALTH CARE COST CONTAINMENT [ THIS PAGE INTENTIONALLY LEFT BLANK ] ATTACHMENT 1: CHART OF DELIVERABLES Financial Reporting Guide(s) DHCM- Finance Program Compliance Auditor FTP server with email notification Area Timeframe Report When Due Agreement Section Agreement Paragraph Reference/ Policy Send To Submitted Via MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN DHCM OPERATIONS Monthly Member Appeals Summary and Outcomes First day of the second month following the month being reported Section 2: Program Requirements 2.9 AHCCCS Grievance System Reporting Guide DHCM Operations Compliance Officer for Medicare Secure email notification DHCM OPERATIONS Annually CMS Notification of MAO FIDE Status (as applicable) 10 calendar days of receipt Section 2: Program Requirements 2.12.7 N/A DHCM Operations Compliance Officer for Medicare Secure email notification DHCM OPERATIONS Annually CMS Notification of MAO Star Ratings 10 calendar days of receipt Section 2: Program Requirements 2.11 N/A DHCM Operations Compliance Officer for Medicare Secure email notification DHCM OPERATIONS Per Occurrence Change of Designated Care Coordinator 10 calendar days of change Section 2: Program Requirements 2.1.8 N/A DHCM Operations Medical Management Unit and Compliance Officer for Medicare FTP server with email notification Area Timeframe Report When Due Agreement Section Agreement Paragraph Reference/ Policy Send To Submitted Via DHCM CLINICAL QUALITY MANAGEMENT Per Occurrence Quality of Care Inquiry Responses When requested Section 2: Program Requirements 2.1.10 N/A DHCM Clinical Quality Management Unit FTP server with secure email notification to ▇▇▇@▇▇▇▇▇▇▇▇.▇▇▇ with notification to CQM Administrator CONTRACTS AND PURCHASING Per Occurrence Advertising, Property of the State Advance written approvals Section 3: Terms and Conditions 2.8, 3.10 N/A Contracting Officer Email notification DHCM OPERATIONS Per Occurrence MAO Contract Changes with and Notifications from CMS 10 calendar days of notice or change Section 2: Program Requirements 2.10 N/A DHCM Operations Compliance Officer for Medicare Secure email notification DHCM OPERATIONS Per Occurrence Notification of Potential Conflict(s) of Interest Advance written approval Section 3: Terms and Conditions 3.8 N/A DHCM Operations Compliance Officer for Medicare Secure email notification CONTRACTS AND PURCHASING Per Occurrence Notices to AHCCCS Per Occurrence Section 3: Terms and Conditions 4.8 N/A Contracting Officer Email notification DHCM DATA ANALYSIS AND RESEARCH UNIT (DAR) Per Schedule Medicare Encounter Data Per schedule Section 2: Program Requirements 2.6 N/A DHCM DAR designated Sr. Business Analyst Established PMMIS transmission protocols with email notification ATTACHMENT 2 – AHCCCS COVERED SERVICES – PHYSICAL HEALTH SERVICES PHYSICAL HEALTH SERVICES (pages 40-42IN ACCORDANCE WITH APPLICABLE CONTRACT AND POLICY TERMS, CONDITIONS AND LIMITATIONS) MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND TITLE XIX Audiology X X Behavioral Health SEE ATTACHMENT 3 Breast Reconstruction After Mastectomy X X Chiropractic Services X Cochlear Implants X Diagnostic Testing X X Emergency Dental Services X ALTCS only Preventive & Therapeutic Dental Services X Limited Medical and Surgical Services by a Dentist (for Members Age 21 and older) X Dialysis X X Emergency Services X X Emergency Eye Exam X X Vision Exam/Prescriptive Lenses X Lens Post Cataract Surgery X X Treatment for Medical Conditions of the Eye X X Health Risk Assessment & Screening Tests (for Members Age 21 and Older) X Preventive Examinations in the Absence of any Known Disease or Symptom X X HIV/AIDS Antiretroviral Therapy X X High Frequency Chest Wall Oscillation Therapy X X Home Health Services X X Hospice X X Hospital Inpatient X X Hospital Observation X X PHYSICAL HEALTH SERVICES (IN ACCORDANCE WITH APPLICABLE CONTRACT AND POLICY TERMS, CONDITIONS AND LIMITATIONS) TITLE XIX Hospital Outpatient X X Hysterectomy (Medically Necessary) X X Immunizations X X Laboratory X X Maternity Services X X Family Planning X X Early and Periodic Screening, Diagnosis and Treatment (Medical Services) X Medical Foods X X Medical Equipment and Appliances X X Medical Supplies X X Prosthetic X X Orthotic Devices X X Negative Pressure Wound Therapy X X Nursing Facilities (up to 90 days) X X Non-Physician First Surgical Assistant X X Physician Services X X Foot and Ankle Services X X Prescription Drugs X X Primary Care Provider Services X X Private Duty Nursing X X Radiology and Medical Imaging X X Occupational Therapy – AHCCCS COVERED Inpatient X X Occupational Therapy – Outpatient X X Physical Therapy – Inpatient X X Physical Therapy – Outpatient X X Sleep Studies (Polysomnography) X X Speech Therapy – Inpatient X X PHYSICAL HEALTH SERVICES (IN ACCORDANCE WITH APPLICABLE CONTRACT AND POLICY TERMS, CONDITIONS AND LIMITATIONS) TITLE XIX Speech Therapy – Outpatient X ALTCS only Respiratory Therapy X X Total Outpatient Parental Nutrition X X Non-Experimental transplants approved for Title XIX reimbursement (See Policy Regarding Specific Transplant Coverage) X X Transplant Related immunosuppressant drugs X X Transportation – Emergency X X Transportation - Non-emergency X X Triage X X BEHAVIORAL HEALTH SERVICES (pages 43IN ACCORDANCE WITH APPLICABLE CONTRACT AND POLICY TERMS, CONDITIONS AND LIMITATIONS, INCLUDING THOSE SERVICES LISTED IN THE AHCCCS BEHAVIORAL HEALTH SERVICES MATRIX ON THE AHCCCS WEBSITE) ACC ALTCS TITLE XIX TITLE XIX Behavioral Health Counseling and Therapy - Individual X X X X Behavioral Health Counseling and Therapy – Group and Family X X X X Behavioral Health Screening Services X X X X Behavioral Health Assessment Services X X X X Behavioral Health Testing Services X X X X Behavioral Health Evaluation Services X X X X Other Professional Services – Alcohol and/or Drug Services X X X X Other Professional Services – Multisystemic Therapy for Juveniles X X Other Professional Services – Mental Health Services (fka Traditional Healing) Non-45TXIX funds if available Non-TXIX funds if available Non-TXIX funds if available Non-TXIX funds if available Other Professional Services – Auricular Acupuncture Non-TXIX funds if available Non-TXIX funds if available Non-TXIX funds if available Non-TXIX funds if available Skills, Training and Development, and Psychosocial Rehabilitation (Living Skills Training) Title X X X X Cognitive Rehabilitation X X X X Health Promotion Services (Behavioral Health Prevention/Promotion Education, Medication Training, and Support Services) X X X X Psycho Educational Services and Ongoing Support to Maintain Employment X X X X Medical Services X X X X BEHAVIORAL HEALTH SERVICES (IN ACCORDANCE WITH APPLICABLE CONTRACT AND POLICY TERMS, CONDITIONS AND LIMITATIONS, INCLUDING THOSE SERVICES LISTED IN THE AHCCCS BEHAVIORAL HEALTH SERVICES MATRIX ON THE AHCCCS WEBSITE) ACC ALTCS TITLE XIX Title TITLE XIX MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN Laboratory, Radiology and Medical Imaging X X X X Medical Management X X X X Electro-Convulsive Therapy X X X X Case Management X X X X Personal Care Services X X X X Home Care Training – Family X X X X Home Care Training – to Home Care Client X X X X Self-Help/Peer Services X X X X Unskilled Respite Care X X X X Supported Housing Non-TXIX funds if available Non-TXIX funds if available Non-TXIX funds if available Non-TXIX funds if available Transportation – Emergency X X X X Transportation – Non-Emergency X X X X Crisis Intervention Services – Mobile X X X X Crisis Intervention Services – Facility-Based X X X X Hospital Services X X X X Sub-Acute Facility X X X X Residential Treatment Center X X X X Behavioral Health Residential Facility (without Room and Board) X X X X Mental Health Services NOS (Room and Board) Non-TXIX funds if available Non-TXIX funds if available Non-TXIX funds if available Non-TXIX funds if available Supervised Behavioral Health Treatment and Day Programs X X X X BEHAVIORAL HEALTH SERVICES (IN ACCORDANCE WITH APPLICABLE CONTRACT AND POLICY TERMS, CONDITIONS AND LIMITATIONS, INCLUDING THOSE SERVICES LISTED IN THE AHCCCS AND Title BEHAVIORAL HEALTH SERVICES MATRIX ON THE AHCCCS WEBSITE) ACC ALTCS TITLE XIX Title TITLE XIX MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN Therapeutic Behavioral Health Services and Day Programs X X X X Community Psychiatric Supportive Treatment and Medical Day Programs X X X X Community Psychiatric Supportive Treatment and Medical Day Programs – by telephone X X X X Intermediate Care Facility (DD Dual Eligible Members only) Nursing Facility – Level I Nursing Facility – Level II Nursing Facility – Level III Nursing Facility – Level IV Nursing Facility – Respite Bed Hold – Therapeutic Leave Bed Hold – Hospital Admission Assisted Living Home Assisted Living Center Adult ▇▇▇▇▇▇ Care Habilitation – Residential (DD Group Homes only) Level II Behavioral Health Residential (May be appropriate for stays of any length) Behavioral Health Therapeutic Home • Home Care Training to Home Care Client (Child) • Home Care Training to Home Care Client (Adult) • Home Care Training to Home Care Client (Adult Geriatric) Routine Home Care Continuous Home Care General Inpatient Care Adult Day Health Care Attendant Care Companion Care Community Transition Service Emergency Alert System Habilitation • Day Treatment & Training • Supported Employment Home Delivered Meals Home Health Services/Nursing Home Health Services/Home Health Aide Homemaker Home Modification Personal Care Respite • Short Term In-Home • Continuous In-Home • Group Respite MAO shall report monthly each of the following six (6) default enrollment process data elements to AHCCCS, as per the requirements of Attachment 1: Chart of Deliverables. a. Number of individuals (potential Dual Eligible Members) identified by MAO as eligible for default enrollment based on age or disability. b. Number of beneficiaries (potential Dual Eligible Members), separated by eligibility based on age or disability, that were noticed by MAO at least sixty (60) calendar days prior to the effective date of default enrollment. c. Number of beneficiaries (potential Dual Eligible Members) who opt out of (decline) default enrollment prior to the effective date. Differentiate between those who opt out by telephone or in writing, as well as eligibility based on age or disability. d. At the end of the first month of enrollment, specify the number of rapid disenrollments (the number of Dual Eligible Members who disenroll within their first month of default enrollment). Continue to track for rapid disenrollments within the first three months of a Dual Eligible Member’s default enrollment effective date. e. Provide information regarding any complaints received internally, including grievances relating to default enrollment. For complaints with a Medicare Advantage Complaint Tracking Module (CTM) identification number, please also list the CTM number with the complaint. Provide this information in an Excel spreadsheet. f. Indicate if MAO has identified any individuals (potential Dual Eligible Members) for which it was unable to identify for default enrolment in the required timeframe (minimum 60 calendar days prior) for notification of default enrollment, and an explanation of why they were excluded from the default enrollment process. AZ Complete Health ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇- us.html ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Contact Us Form at ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇- us.html Banner-University Family Care ▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇/▇▇▇▇▇-▇▇/▇▇▇▇▇▇▇- us ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Care1st Health Plan Arizona ▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇/▇▇▇▇▇▇▇/▇▇▇▇▇▇▇.▇▇ p ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Email Form at ▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇/▇▇▇▇▇▇▇/▇▇▇▇▇▇▇.▇▇▇ Magellan Complete Care ▇▇▇.▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇/▇▇▇▇▇▇▇-▇▇/ ▇-▇▇▇-▇▇▇-▇▇▇▇ Email Form at ▇▇▇.▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇/▇▇▇▇▇▇▇-▇▇/ Mercy Care (1) ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇/▇▇▇▇▇▇▇▇▇ are-formembers/contact ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Contact Us Form at ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇/▇▇▇▇▇▇▇▇▇ are-formembers/contact ▇▇▇▇▇▇▇ Health Choice Arizona ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇ ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Link: ▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇.▇▇▇ UnitedHealthcare Community Plan (1) ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇/▇▇▇▇▇▇▇▇/ ahcccs.html ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Banner-University Family Care LTC ▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇/▇▇▇▇▇-▇▇/▇▇▇▇▇▇▇- us ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Mercy Care LTC ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇/▇▇▇- formembers/contact ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Contact Us Form at ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇/▇▇▇- formembers/contact UnitedHealthcare Community Plan LTC ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇/▇▇▇▇▇▇▇▇/ long-term-care.html ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 AZ Complete Health ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇- us.html ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Contact Us Form at ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇- us.html Mercy Care RBHA ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇/▇▇▇▇- formembers/contact ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY 711 Contact Us Form at ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇/▇▇▇▇- formembers/contact ▇▇▇▇▇▇▇ Health Choice Arizona ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇- wellness/behavioral health/ 1-800-640-2123 TTY 711 Link: ▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇.▇▇▇ AHCCCS AND Title XIX Title XIX MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND ATTACHMENT 4 – ALTCS ELDERLY and PHYSICALLY DISABLED COVERED MLTSS Fee-for Service Programs ▇▇▇.▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇/▇▇▇▇▇▇▇▇▇▇▇▇▇▇. html ▇-▇▇▇-▇▇▇-▇▇▇▇ State Health Insurance Assistance Program (pages 46- 48SHIP) ALTERNATIVE RESIDENTIAL SETTINGS MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND HOSPICE SERVICES HOME AND COMMUNITY BASED SERVICES MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND ATTACHMENT 5 – DEFAULT ENROLLMENT PROCESS REPORTING REQUIREMENTS▇▇▇▇▇://▇▇▇.▇▇.▇▇▇/services/older- adults/medicare-assistance ▇-▇▇▇-▇▇▇-▇▇▇▇ (1) Available also to Dual Eligible Members enrolled in respective DD health plan.

SPECIFIC PLAN OFFERINGS. MAO shall operate one (1) Dual Eligible Special Needs Plans under CMS contract number H5587H8845. MAO shall enroll individuals into offered Plan Benefit Packages (PBPs) in accordance with federal and state guidelines, and the terms of this Agreement. A Full Benefit Dual Eligible Member’s eligibility for each particular plan benefit package (PBP) is described below: 4.6.1. H5587H8845-002 001 (HIDE SNP status) is a Dual Eligible Subset plan open to only those individuals eligible to enroll pursuant to the following eligibility requirements: 4.6.1.1. The individual must be currently enrolled in the AHCCCS Complete Care (ACC) companion program in accordance with paragraph 4.1.1 and Attachment 7; Participant Health Choice Arizona, Inc. d/b/a Health Choice Pathway AHCCCS AGREEMENT # YH23-0010-03; 4.6.1.2. The individual must live within the appropriate county that corresponds with the specific service area of their AHCCCS Complete Care (ACC) companion program enrollment in accordance with paragraph 4.1.2; 4.6.1.3. The individual must be entitled to participate in Medicare; and 4.6.1.4. The individual must reside within the CMS-approved service area county for this PBP in accordance with paragraph 4.5.1. Participant Health Choice ▇▇▇▇▇▇ Healthcare of Arizona, Inc. d/b/a Health Choice Pathway ▇▇▇▇▇▇ Medicare Complete Care AHCCCS AGREEMENT # YH23-0010-03 05 Details of medically necessary AHCCCS-covered Medicaid managed long-term support services (MLTSS) under the terms of this Agreement are further described in paragraph 2.2 of this Agreement and the ALTCS Elderly and Physically Disabled (E-PD) contract YH18- 0001, as amended: • Section D, Paragraph 11: Scope of Services (including long-term support services) • Section D, Paragraph 13: Behavioral Health Services Delivery ▇▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇▇.▇▇▇/Resources/OversightOfHealthPlans/SolicitationsAndContra cts/contracts.html Intermediate Care Facility (DD Dual Eligible Members only) Nursing Facility – Level I Nursing Facility – Level II Nursing Facility – Level III Nursing Facility – Level IV Nursing Facility – Respite Bed Hold – Therapeutic Leave Bed Hold – Hospital Admission Assisted Living Home Assisted Living Center Adult ▇▇▇▇▇▇ Care Habilitation – Residential (DD Group Homes only) Level II Behavioral Health Residential (May be appropriate for stays of any length) Behavioral Health Therapeutic Home • Home Care Training to Home Care Client (Child) • Home Care Training to Home Care Client (Adult) • Home Care Training to Home Care Client (Adult Geriatric) Routine Home Care Continuous Home Care Inpatient Respite Care General Inpatient Care Adult Day Health Care Attendant Care Companion Care Community Transition Service Emergency Alert System Habilitation • Day Treatment & Training • Supported Employment Home Delivered Meals Home Health Services/Nursing Home Health Services/Home Health Aide Homemaker Home Modification Personal Care Respite • Short Term In-Home • Continuous In-Home • Group Respite MAO shall report quarterly (by month) each of the following five (5. NAME OF MAO: Health Choice Arizona) default enrollment process data elements to AHCCCS, Inc. d/b/a Health Choice Pathway 6. ARIZONA SYSTEM HEALTH CARE COST CONTAINMENT [ THIS PAGE INTENTIONALLY LEFT BLANK ] ATTACHMENT as per the requirements of Attachment 1: CHART OF DELIVERABLES Area Timeframe Report When Due Agreement Section Agreement Paragraph Reference/ Policy Send To Submitted Via MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND ATTACHMENT 2 – AHCCCS COVERED SERVICES – PHYSICAL HEALTH SERVICES (pages 40-42) MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND ATTACHMENT 3 – AHCCCS COVERED SERVICES - BEHAVIORAL HEALTH SERVICES (pages 43-45) Title XIX Title XIX MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND Title XIX Title XIX MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND Title XIX Title XIX MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND ATTACHMENT 4 – ALTCS ELDERLY and PHYSICALLY DISABLED COVERED MLTSS (pages 46- 48) ALTERNATIVE RESIDENTIAL SETTINGS MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND HOSPICE SERVICES HOME AND COMMUNITY BASED SERVICES MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND ATTACHMENT 5 – DEFAULT ENROLLMENT PROCESS REPORTING REQUIREMENTSChart of Deliverables.