Therapist/Counselor (Remote) Applicant Summary

HEALTH CARE SERVICES AGREEMENT

BETWEEN

SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP

AND

PATRICIA ALICE, L.C.S.W.

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TABLE OF CONTENTS

INTRODUCTIONS & RECITALS 6

ARTICLE 1. DEFINITIONS 6

1.1 Authorization

1.2 Claim

1.3 Clean Claim

1.4 CMS

1.5 Complaint

1.6 Confidential Information

1.7 Covered Benefit(s)

1.8 Covered Service(s)

1.9 Emergency Medical Condition

1.10 Emergency Services

1.11 Essential Permit

1.12 Facility(ies)

1.13 HIPAA

1.14 Kaiser

1.15 Kaiser Administrative Services Organization or Kaiser ASO 1.16 Knox Keene Laws

1.17 KP

1.18 Law

1.19 Medi-Cal Contracts

1.20 Member

1.21 Member Cost Share

1.22 Membership Agreement

1.23 Official(s)

1.24 Payor

1.23.1 Kaiser Payor

1.23.2 Other Payor

1.25 Policies

1.26 Practitioner

1.27 Services

1.28 Subcontractor

ARTICLE 2. SERVICES 9

2.1 Provision of Services

2.2 Non-Exclusivity; No Volume Guarantee

2.3 Operational Responsibilities

2.3.1 Verification

2.3.2 Emergency Services

2.3.3 Nondiscrimination

2.3.4 Drug Formulary

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2.4 Practitioners and Facilities

2.4.1 Qualifications and Standards

2.4.2 KP Credentialing

2.4.3 Subcontracts

2.4.4 Specialty (-ies)

2.5 Suspension or Exclusion of Participation of a Practitioner or Facility 2.5.1 Suspension or Exclusion Without Cause

2.5.2 Suspension or Exclusion With Cause

2.6 Quality Improvement and Utilization Management 2.6.1 Quality Assurance and Quality Improvement (collectively, “QI”) 2.6.2 Utilization Management and Review (collectively “UM”) 2.6.3 QI/UM Information

2.7 Delegation

2.8 Relationship with Members

2.8.1 Communication

2.8.2 Notification of Termination

2.9 Notice of Changes in Contract Status

2.10 Prohibition of Offshore Contracting

ARTICLE 3. BILLING AND PAYMENT 14 3.1 Payment of Compensation

3.2 Adjustments to Payment

3.3 Denials

3.4 Member Hold Harmless

3.5 Billing Members for Non-Covered Benefits; Services Not Authorized 3.6 Liens and Third Party Claims

3.7 Other Coverage

3.7.1 Primary Coverage

3.7.2 Secondary Coverage

3.7.3 Cooperation with COB Rules

ARTICLE 4. TERM AND TERMINATION 16 4.1 Term

4.2 Termination of this Agreement

4.2.1 Termination Without Cause

4.2.2 Termination With Cause

4.2.3 Immediate Termination

4.3 Effect of Termination

4.3.1 Continuation of Care Obligations

4.3.2 Cooperation in Transfer of Members

4.3.3 Termination of Services Provided to Certain Members 4.4 Survival of Obligations

ARTICLE 5. DISPUTE RESOLUTION 18 5.1 Disputes Between KP and Contractor Generally

5.1.1 Provider Appeals Process

5.1.2 Meet and Confer

5.1.3 Mediation

5.1.4 Arbitration

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5.1.5 Fair Hearing Rights Regarding Practitioner Credentialing Disputes 5.2 Disputes Between Member and Contractor

5.3 Disputes Between an Other Payor and Contractor ARTICLE 6. RECORDS AND CONFIDENTIALITY 19 6.1 Maintenance of Records

6.2 Access to Records

6.3 Access for and Disclosure to Officials

6.4 Inspection

6.5 Incorporation of Prior Medical Data

6.6 Confidentiality of Information

6.7 HIPAA

6.8 Certification of Accuracy of Data

ARTICLE 7. COMPLIANCE 21

7.1 Compliance with Laws

7.2 Medicare/Medicaid

7.3 Government Contractor

7.4 Compliance with Policies

7.5 ERISA

ARTICLE 8. INSURANCE AND INDEMNIFICATION 23 8.1 Insurance

8.2 Standards

8.3 Tail Coverage

8.4 Indemnification

8.4.1 Contractor Indemnification

8.4.2 Reciprocal Indemnification

8.4.3 Health Plan Obligations

8.5 Cooperation of Parties

ARTICLE 9. MISCELLANEOUS 24

9.1 Assignment and Delegation

9.2 Legally Required Modification

9.3 Active Encouragement

9.4 No Third Party Beneficiaries

9.5 Independent Contractor

9.6 Force Majeure

9.7 Use of Name

9.8 Publicity

9.9 Governing Law

9.10 Procedure for Giving Notice

9.11 Interpretation of the Agreement

9.12 Entire Agreement

9.13 Waiver

9.14 Severability

9.15 Statutory and Other References

9.16 Counterparts

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9.17 Remedies Cumulative

EXHIBIT 1: BILLING AND PAYMENT 30 EXHIBIT 2: MEDIATION AND ARBITRATION 33 EXHIBIT 3: FEDERAL PROGRAM COMPLIANCE 36 EXHIBIT 4: PAYORS 44

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HEALTH CARE SERVICES AGREEMENT

This Health Care Services Agreement (“Agreement”) is entered into between Southern California Permanente Medical Group, a California partnership (“Permanente”) and Patricia Alice, L.C.S.W.

(“Contractor”) and is effective as of October 1, 2012 (“Effective Date”). RECITALS

A. Kaiser Foundation Health Plan, Inc., a California nonprofit public benefit corporation

(“Health Plan”) operates health care benefit plans and provides or arranges for the provision of medically necessary health care services to Members (as defined below). B. Health Plan has entered into an agreement with Kaiser Foundation Hospitals, a California nonprofit public benefit corporation (“KFH”), under which KFH agrees to provide or arrange for certain medically necessary hospital or facility services for Members. C. Health Plan has entered into an agreement with Permanente under which Permanente agrees to provide or arrange for certain medically necessary professional and outpatient services for Members.

D. Permanente desires to arrange for the provision of certain health care services to Members by contracting with Contractor. Contractor desires to provide Services (as defined below) to Members in accord with the terms of this Agreement. AGREEMENT

NOW THEREFORE, the parties agree as follows:

ARTICLE 1. DEFINITIONS

Following are definitions of terms used in this Agreement. There may be additional terms defined in the body of the Agreement, the Recitals and the Exhibits (which are incorporated herein by this reference).

1.1 Authorization means KP’s (as defined below) approval for the provision of Covered Benefits to Members (i) by persons designated to provide such approval, (ii) pursuant to KP’s Utilization Management programs, and (iii) in accordance with Policies. Further,

“Authorization” also means the document or electronic documentation indicating KP’s approval, as the context requires. “Authorized” means provided pursuant to and in compliance with an Authorization.

1.2 Claim means a request for payment for Services rendered to a Member submitted in accordance with the terms of this Agreement and Policies. 1.3 Clean Claim means an itemized Claim that (i) is submitted for payment of Covered Services, (ii) is completed with all data elements, (iii) contains no defect or error that prevents timely adjudication, and (iv) complies with applicable Law (defined below). Standard Alice/August 20, 2012/JVF

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1.4 CMS means the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services, or any successor entity. 1.5 Complaint means any verbal or written expression of a Member’s dissatisfaction with a Practitioner or Facility that is not amenable to prompt resolution at the point of service and requires follow-up and investigation (for example, a grievance). 1.6 Confidential Information means (i) the terms of this Agreement, (ii) any patient information, including a Member’s name, address and health records; (iii) information concerning any matter relating to the business of the other, including the other party’s employees, products, services, membership, prices, operations, business systems, planning and finance, policies, procedures and practice guidelines; and/or (iv) materials, data, data elements, records or other information obtained from the other party during the course of or pursuant to this Agreement.

1.7 Covered Benefit(s) mean(s) the health care services and benefits that a Member may be entitled to receive under the applicable Membership Agreement, as determined by Health Plan (or the applicable Payor).

1.8 Covered Service(s) mean(s) those Services rendered by Contractor to Members that are

(i) Covered Benefits and (ii) Authorized or otherwise approved for payment. 1.9 Emergency Medical Condition means any of the following (i) a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that a prudent layperson with average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in (a) serious jeopardy to the Member’s health, or in the case of a pregnant woman, the health of the woman or her unborn child, (b) serious impairment to bodily functions, or (c) serious dysfunction of any bodily organ or part; or (ii) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either the Member is an immediate danger to themselves or others, or the Member is not immediately able to provide for or use food, shelter, or clothing, due to the mental disorder, or (iii) with respect to a pregnant woman who is having contractions (a) that there is inadequate time to effect a safe transfer to another hospital before delivery, or (b) that transfer may pose a threat to the health or safety of the woman or her unborn child, or (iv) as otherwise defined by applicable Law, including California Law or the federal Emergency Medical Treatment and Active Labor Act (42 USC 1395dd) and its implementing regulations (collectively referred to as “EMTALA”).

1.10 Emergency Services means those Services necessary to screen, evaluate and stabilize an Emergency Medical Condition in compliance with EMTALA. Emergency Services do not include Post-Stabilization Services.

1.11 Essential Permit means any license, certification, registration, accreditation or clinical privilege of a Practitioner or Facility required to provide Services. 1.12 Facility(ies), if any, means those facilities (including without limitation hospitals, skilled nursing facilities, and dialysis centers), institutions, locations or any other sites (such as medical offices), used by Contractor (or Subcontractors) to provide Covered Services. Standard Alice/August 20, 2012/JVF

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1.13 HIPAA means, collectively, the Health Insurance Portability and Accountability Act of 1996 (Public Law 104-91), the Health Information Technology and Economic and Clinical Health Act (42 USC 300(j)), and all regulations issued thereunder. 1.14 Kaiser means the Kaiser Permanente medical care program, which includes all Kaiser Payors (defined below) except Group Health Cooperative. 1.15 Kaiser Administrative Services Organization or Kaiser ASO means Health Plan, KFH, and/or Permanente, and any entity controlled by or under common control with Health Plan, KFH and/or Permanente or having an exclusive contract with such entities for the provision of health care services to Members or another entity that has contracted to perform certain administrative and/or management services on behalf of an Other Payor (defined below).

1.16 Kaiser Permanente (or “KP “) means Health Plan for the Southern California Region, KP Cal, LLC for the Southern California Region (which offers Medicaid plans), KFH for the Southern California Region, or Permanente, or any combination of one or more of them, as applicable.

1.17 Knox Keene Laws means the Knox-Keene Health Care Service Plan Act of 1975 (Cal. Health and Safety Code Section 1340 et seq.) and all regulations promulgated thereunder

(California Code of Regulations Title 28 Section 1300 et seq.). 1.18 Law means local, state or federal law, regulation, rule, or executive order, or CMS instructions, as applicable.

1.19 Medi-Cal Contracts means all prepaid Medi-Cal program contracts (i) between Health Plan (or KP Cal) and the State of California or (ii) between Health Plan and an organization under contract to the State of California, or (iii) between Kaiser and the Medicaid agency in any state other than California under which Members are enrolled. 1.20 Member means an individual entitled to health care services (at the time such services are rendered) under a Membership Agreement issued by a Payor, or another arrangement with a Kaiser Payor.

1.21 Member Cost Share means a copayment, deductible, coinsurance or any other charge payable by a Member for Covered Services pursuant to the Member’s Membership Agreement.

1.22 Membership Agreement means any arrangement pursuant to which a Member is entitled to receive health care services and that is issued, sponsored or underwritten by a Payor, including, without limitation, the relevant service agreement, evidence of coverage or other description of coverage, summary plan description or benefit summary. 1.23 Official(s) mean(s) (i) individuals who represent, in an official capacity, a local, state or federal government agency or regulatory body with jurisdiction over KP or Contractor,

(ii) representatives of any accreditation agency or organization (such as the National Committee for Quality Assurance (“NCQA”) or a peer review body or other peer review or professional organization applicable to KP or Contractor, (iii) such other officials entitled by Law or pursuant to government contracts with KP (including Medicare Advantage contracts, Federal Employees Health Benefits Program (“FEHBP”) contracts, Standard Alice/August 20, 2012/JVF

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and Medicaid Contracts) to monitor health care services provided to Members; and (iv) the designees of any of the above.

1.24 Payor means Kaiser Payor and/or Other Payor.

1.24.1 Kaiser Payor means a KP affiliate having responsibility for the provision or arrangement of health care services to Members under a plan regulated by a state insurance commissioner, including: (i) a corporation or other organization owned or controlled, either directly or through subsidiary corporations, by Kaiser Foundation Health Plan, Inc. or under common control with Kaiser Foundation Health Plan, Inc., (ii) any regional Permanente Medical Group; and (iii) Group Health Cooperative; including, without limitation, those entities listed on Exhibit 4 as “Kaiser Payors.”

1.24.2 Other Payor means any public or private entity that (i) sponsors, administers, and/or funds a plan of health benefits coverage or is otherwise responsible for the arrangement for health care services rendered to Members under a Membership Agreement and (ii) enters into an administrative and/or management service agreement with a Kaiser ASO; including, without limitation, those entities listed on Exhibit 4 as

“Other Payors.”

1.25 Policies means all policies, procedures, guidelines and, as applicable, formularies, of Payors as set forth from time to time in manuals, letters, bulletins and newsletters, whether made available to Contractor by mail, email, website, or other media. 1.26 Practitioner means those health care practitioners (including without limitation physicians, nurses, physician assistants, nurse practitioners, and therapists) who, by way of ownership of, employment by, or contracts with Contractor (or Subcontractors) provide Covered Services.

1.27 Services means those services, supplies and facilities that Contractor or Subcontractors customarily provide for the delivery of health care services, including all consults, studies, tests and procedures that are ordinary and necessary for the diagnosis and treatment of Contractor’s patients. Services also include all administrative services provided by Contractor (or Subcontractor) pursuant to this Agreement. 1.28 Subcontractor means any person or entity, including a facility, individual practitioner

(other than an employee of Contractor), practitioner group, or any other individual

(including a substitute Practitioner), that provides or arranges for Covered Services to Members pursuant to a direct or indirect agreement or other arrangement with Contractor. ARTICLE 2. SERVICES

2.1 Provision of Services. Contractor shall provide or arrange for the provision of Services to Members in accord with this Agreement. Contractor shall ensure that Services are readily available and accessible during normal business hours and, as medically necessary on a same-day basis 24 hours per day, 7 days per week, and shall provide Services in a prompt and efficient manner without delays in appointment scheduling and Standard Alice/August 20, 2012/JVF

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waiting times and consistent with applicable recognized standards of practice, the appropriate standard of care and Policies. References to the responsibilities and obligations of “Contractor” in this Agreement shall be interpreted to apply (i) to all of Contractor’s employees and agents and at all Facilities of Contractor involved in providing Services and (ii) each Subcontractor and its employees, agents and Facilities providing Services.

2.2 Non-Exclusivity; No Volume Guarantee. This is not an exclusive Agreement; Contractor and Kaiser may enter into similar agreements with other parties; and Kaiser reserves the right to arrange for any Services for Members from any other contractor or provider. Kaiser does not represent, warrant or covenant any minimum volume of patients or Members that will be referred to Contractor. 2.3 Operational Responsibilities.

2.3.1 Verification. Contractor shall use its best efforts to verify (i) that a person seeking Services is in fact an eligible Member as of the date of provision of Services, (ii) the Services rendered to such Member are Covered Benefits and are properly Authorized (including the scope and duration of Services) or (iii) are Services for which Authorization is not required. Contractor’s receipt of an identification card issued by a Payor from a person claiming to be a Member shall be indicative but not conclusive of the person’s status as a Member. With respect to Services that are not Emergency Services, if Contractor is unable to verify (i) through (iii) listed above, Contractor may nevertheless provide Services to the person if Contractor notifies the Member that such Services are not Covered Benefits and the Member shall have financial responsibility for such Services; provided, further, that no Payor shall have financial responsibility for such Services. However, if it is subsequently determined that such person was an eligible Member and that such Services were Covered Services, the applicable Payor shall pay for such Services to the extent otherwise provided by this Agreement.

2.3.2 Emergency Services. If Contractor provides Emergency Services to a Member or, following stabilization of an Emergency Medical Condition, other Covered Services, Contractor shall (i) notify KP and (ii) assist KP with the transfer of Members to other Facilities or Practitioners, as directed by KP. To the extent allowable by applicable Law, KP may retrospectively review Claims for Emergency Services to determine whether they meet the criteria for compensation.

2.3.3 Nondiscrimination. Contractor shall provide Services to Members without discrimination on the basis of race, ethnicity, color, gender, sex, creed, religion, ancestry, national origin, age, health status (including medical condition, claims experience, receipt of health care, or medical history), physical or mental disability, genetic information, veteran’s status, marital status, sexual orientation, gender identity, income, source of payment, evidence of insurability (including conditions arising out of acts of domestic violence), status as a Member or as a participant in a publicly financed program, whether a Member has filed a Complaint, whether a Member has executed an advance directive, or other status protected by applicable Laws. Contractor shall make Services available to all Standard Alice/August 20, 2012/JVF

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classes of Members, in the same manner, in accordance with the same standards, and with the same availability, as to Contractor’s other patients. In addition, during the performance of this Agreement, Contractor shall comply with Title VI of the Civil Rights Act of 1964, the Age Discrimination Act of 1975, and the Rehabilitation Act of 1973, all as amended; shall provide reasonable access and accommodation to persons with disability to the extent required of a health services Contractor under the Americans with Disabilities Act, or any applicable state law or regulation.

2.3.4 Drug Formulary. Contractor agrees to prescribe drugs and medications in accord with Kaiser Permanente’s Drug Formulary program and Policies. The Kaiser Permanente Drug Formulary (“Formulary”) can be accessed at the following website: http://online.lexi.com/login.

2.4 Practitioners and Facilities.

2.4.1 Qualifications and Standards. Contractor shall ensure that all Practitioners providing Services under this Agreement are qualified and competent to provide such Services and all Facilities are maintained in good repair. Contractor represents and warrants that it and its Practitioners, Facilities and Subcontractors providing Covered Services shall be and shall remain throughout the term of this Agreement, as applicable, duly licensed by the State of California and accredited by the relevant accreditation organization(s) required by KP, certified by the relevant certification organization(s), and certified by the Medicare and Medicaid programs, under Title XVIII and Title XIX, respectively, of the Social Security Act. Contractor shall comply with the standards of any organization accrediting KP, as they apply to the Covered Services provided by Contractor under this Agreement. In addition, Contractor further represents that each Practitioner providing Covered Services shall, as applicable and as required to provide Services (i) maintain a current, unrestricted license to practice their profession or vocation in the State of California, (ii) provide Covered Services only within the scope of his/her licensure, certification, registration, training and experience, (iii) maintain staff membership at one or more local facilities necessary to perform required Covered Services and (iv) maintain unrestricted clinical privileges at one or more local facilities necessary to perform required Covered Services; and

(v) be certified by the appropriate medical specialty board(s) or by the appropriate vocational or professional board(s) or agency(ies) to provide Covered Services, as required by Law or by Policies. Contractor shall promptly provide documentary evidence of its and Practitioners’ and Facilities’ licensing, certification, registration accreditation and qualifications (i) upon request and (ii) upon any material change to them. Upon request, Contractor shall provide KP with copies of survey reports, investigations, assessments, formal evaluations or citations of Contractor that may materially affect Contractor’s ability to perform its obligations under this Agreement.

2.4.2 KP Credentialing. Contractor, including its Practitioners and Facilities, shall be and shall remain throughout the term of this Agreement, credentialed and privileged, or recredentialed and reprivileged, as applicable, consistent with KP’s Standard Alice/August 20, 2012/JVF

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credentialing requirements prior to providing Covered Services to Members. Contractor and its Subcontractors, Practitioners and Facilities shall cooperate with KP’s credentialing and privileging processes. 2.4.3 Subcontracts. Subject to Section 9.1, if Contractor arranges for the provision of Covered Services to a Member by Subcontractors, Contractor shall enter into a written subcontract with Subcontractors (“Subcontract”) prior to the provision of any Covered Services to Members by Subcontractors. Such Subcontract shall require Subcontractors (and their Practitioners and Facilities) to comply with the same terms applicable to Contractor under this Agreement. Upon request, Contractor shall provide KP access to and copies of Subcontracts. 2.4.4 Specialty(-ies). If Contractor provides Services encompassing the following specialty(-ies) of care - Behavioral Health Treatment (Including, Applied Behavior Analysis Services) as defined by California Health and Safety Code Section 1374.73(c)(1), Speech Therapy, Physical Therapy and Occupational Therapy - Contractor shall provide Behavioral Health Treatment and, as applicable, other Services in accordance with the requirements set forth in California Health and Safety Code Section 1374.73, including providing Services through Qualified Autism Service Providers who supervise and employ Qualified Autism Service Professionals or Qualified Autism Service Paraprofessionals who provide and administer Behavioral Health Treatment (as those terms are defined by California Health and Safety Code Section 1374.73(c)(3)-5). Contractor shall ensure (and provide documentary evidence to KP upon request) that all such Qualified Autism Service Providers, Qualified Autism Service Professionals and Qualified Autism Service Paraprofessionals meet the licensure, certification, experience, competence, approval, training and other requirements set forth in California Health and Safety Code Section 1374.73 in order to provide Behavioral Health Treatment and, if necessary, Contractor shall at its cost provide necessary training and experience to such individuals. 2.5 Suspension or Exclusion of Participation of a Practitioner or Facility. 2.5.1 Suspension or Exclusion Without Cause. Permanente may, at any time and for any reason or no reason, suspend or exclude the participation of a Practitioner or Facility under this Agreement by giving at least sixty (60) days written notice to Contractor.

2.5.2 Suspension or Exclusion With Cause. Permanente may immediately suspend or exclude the participation of a Practitioner or Facility under this Agreement

(without terminating the Agreement), as specified in a written notice if: (i) any Official revokes, suspends, restricts or fails to renew any Essential Permit applicable to Practitioner or Facility; or (ii) Practitioner or Facility demonstrates conduct (through act or omission) likely to result in revocation, suspension, restriction or nonrenewal of an Essential Permit applicable to Practitioner or Facility, as determined by KP in good faith; (iii) Practitioner or Facility misrepresents or falsifies information submitted for an Essential Permit; (iv) Contractor, Practitioner or Facility is sanctioned, debarred, suspended, excluded or otherwise deemed ineligible from participation in any federal health care Standard Alice/August 20, 2012/JVF

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programs, including Medicare or Medicaid or criminal charges are filed against a Practitioner or Facility for any act involving professional misconduct or moral turpitude; (v) Practitioner or Facility fails to comply with or rectify noncompliance with any material provision of this Agreement or Policies

(including KP’s QI and UM programs) within a time period acceptable to KP;

(vi) Practitioner or Facility fails to adequately provide or becomes incapable of adequately providing Covered Services; or (vii) Practitioner or Facility demonstrates conduct (through act or omission) that threatens the health, safety or privacy of a Member, as determined by KP in good faith. 2.6 Quality Improvement and Utilization Management. 2.6.1 Quality Assurance and Quality Improvement (collectively, “QI”). Contractor acknowledges that KP is required by Law and by accreditation standards to monitor the QI activities of Contractor. With respect to Covered Services, Contractor shall participate in KP’s QI program as established and amended from time to time. Contractor shall investigate and respond promptly to issues regarding quality of care, accessibility and other Complaints related to Covered Services. Contractor shall use best efforts to remedy promptly any unsatisfactory condition related to the care of Members by a Practitioner or at the Facilities, as determined by KP or any Official. The parties shall work together to resolve promptly problems related to the provision of Covered Services as they arise. If required by Officials or Law, Contractor shall maintain a QI program that, at all times during the term of this Agreement, meets all state and federal licensing, accreditation and certification requirements applicable to Contractor. Contractor acknowledges that it was notified at least fifteen (15) working days prior to signing this Agreement (as required under California Health and Safety Code Section 1375.7) of the requirement that it comply with the Kaiser Permanente quality improvement and utilization review programs as described in this Section and other provisions of this Agreement. 2.6.2 Utilization Management and Review (collectively, “UM”). Contractor shall participate in KP’s UM programs (including prospective, concurrent and retrospective review), as established and amended from time to time, and cooperate with KP’s UM committees and staff. KP UM may conduct routine UM reviews on a daily basis, without prior notification. If a non-routine review is planned, KP staff will provide Contractor with reasonable notification. Contractor acknowledges that UM decision-making is based on the appropriateness of care and service and existence of coverage and that KP does not compensate individuals responsible for UM decision-making with financial incentives that specifically reward them for issuing denials of coverage or service, or that encourage decisions that result in underutilization. 2.6.3 QI/UM Information. Contractor shall supply KP with periodic reports and other information (including Contractor’s policies and procedures, patient care protocols, any mutually agreed upon quality indicators, survey reports, investigations, assessments, formal evaluations or citations) pertaining to Services provided to Members by Contractor in such manner and time frames that enable KP to conduct its QI and UM activities and to meet all federal, state, Standard Alice/August 20, 2012/JVF

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accreditation and contractual reporting requirements (including with respect to QI and UM activities, and Delegated Activities(

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