Services Addendum No.1A (Healthcare Project Services)

SERVICES ADDENDUM NO.1A (HEALTHCARE PROJECT SERVICES)

This Services Addendum No. 1A is made and entered into by and between INDIANA 211 PARTNERSHIP, INC., an Indiana non-profit corporation (“Partnership”)and ______, an IN211 Center (“Agency”) pursuant to the Master Services Agreement entered into by and between Partnership and Agency and datedDecember 9, 2013.

RECITALS

1.Indiana 211 Partnership, Inc. proposed to provide outreachand data reporting plan activities for healthcare options under Indiana’s implementation of the Affordable Care Act. Healthcare options may include private health insurance, the Marketplace, Medicaid, Children’s Health Insurance Program, Healthy Indiana Plan, health plans for special populations (Medicare, VA, etc.), and safety net programs for the uninsured and underinsured. See Attachment A for Proposal to The Health Foundation of Greater Indianapolis for a summary.

2.The Partnership’s plan activities are intended 1) to inform households about the availability, eligibility requirements, application procedures and benefits ofhealthcare options, particularly of health insurance options, and 2) to provide key stakeholders data about the resources, needs, gaps and trends.

3.Agencyis in a position to provide certain services in connection with the Partnership’s performance of the outreach plan activities.

SERVICES

Agency shall provide the following Services in accordance with processes and procedures developed by the Partnership:

(a) Verify the accuracy of information for healthcare-related referral resources shown in the database provided to Agency by Partnership;

(b) Supplement the information concerning healthcare-related referral resources that Agency may identify;

(d) Assess whether individuals seeking assistance concerning a healthcare-related need and a subset of all callers have health insurance for all members of the household;

(e) Screen individuals seeking assistance concerning a healthcare-related need to determine potential eligibility for healthcare options;

(f) Provide to individuals determined to be potentially eligible to participate in the healthcare optionsa detailed referral for completing an application to do so;

(g) Provide, if needed, additional assistance to individuals receiving a follow-up contact;

(h) Document certaininformation concerning Agency’s performance of the Services described in subparagraphs (c) through (g) above;

(i) Provide to Partnership by the end of business each Tuesday a report for the immediately preceding week describing the quantity, demographics and outcomes concerning (a) through (h) above, quantity and types of database updates as requested from time to time by Partnership, detailed budget expenditure and revenue source information and periodic reports with analysis regarding specific indicators;

(j) Provide such other services as may be reasonably requested from time to time by Partnership in order to permit the Partnership to successfully perform the contracted outreach plan activities required of it.

COMPENSATION

Agency will receive compensation for its performance of the Services based on the documented performance of the tasks listed on Attachment B. Estimates for each of the tasks that will be basis for the Agency’s compensation are shown on Attachment B.The Partnership shall revise the amounts shown on Attachment to reflect the availability of funds. The Partnership in the exercise of its reasonable discretion shall determine the documentation necessary to justify a payment and nothing in the manner in which the payments are calculated shall release Agency from the obligation to provide the Services in accordance with the Agreement. Payments will be made monthly in arrears.

TERM AND TERMINATION

The term of this Services Addendum shall commence on December 9, 2013 and, unless sooner terminated pursuant to the provisions of theMaster Services Agreement or any Services Addendum to it, shall terminate at 12:00 a.m. onSeptember 30, 2014. Notwithstanding the foregoing, the Partnership may extend the term of this Services Addendum No. 1 for up to 1 yearupon giving Agency notice of the extension at least thirty (30) days before the expiration of the term hereof. Termination of the Master Services Agreement shall automatically terminate the term of this Services Addendum.

OTHER

______

AGENCY: PARTNERSHIP:

______INDIANA 211 PARTNERSHIP, INC.

By: ______By: ______

Printed: _ Printed: ______

Title: Title: ______

Date: ______Date: ______

ATTACHMENT A

ATTACHMENT B

The Agency’s compensation for the Services shall be determined based on the payment rates set forth below.

I.Training

(1)For each completed healthcare-related training

sessionapproved by the Partnership$55

II.Database

(1)For each coded record of a healthcare enrollment related

referralresource recordadded or updated by Agency

toPartnership’s database, as approved by the Partnership$8.75

III.IVR Messaging and/or auto-attendant features related to healthcare options

(Message and options must be approved by the Partnership.)

(1) For each month of special IVR messaging and/or auto-attendant

Features specific to healthcare options where report is submitted$100/month

(2) For each special report and additional features, as approved by the

Partnershipup to $500

IV.Participation

(1)For each coded record of a caller being asked

and answering the “yes/no” healthcareinsurance question$0.90

(2)For each coded record for a caller being asked the health insurance

questionand answering “application pending” andcontact

information is collected in the caller record for follow-up$1.14

V.Prescreening and Referral

(1)Per each coded record of a caller being prescreened

and referred to aresourcefor completion of healthcare insurance

application (must show caller’s name and telephone number)$15

The rates identified in Sections IV and V above shall be reduced to $.45 and $7.50, respectively,for any month that the Agency does not reach 75% of its monthly goal for asking and recording the response to the health insurance question described in Section IV above. The Agency’s monthly goal for asking and recording the response to the yes/no question is shown on Attachment C.

ATTACHMENT C

AgencyMonthly Y/N/PMonthly PRP Goal

Area 9693

C2H5312212

Lafayette1687

NICA32613

UWAC765 + 57231 + 23

UWBC27911

UWHC28111

UWSI43417

Metro643

UWGC633