SIGNED FINAL Sauk County Health Dept. Quartz CSP MOU 2022 .SAUK CO HEALTH DEPT 5-18-2022

Sauk County Health Dept. (“Provider”) agrees to provide health checks, lead screenings, and immunizations for enrollees of the Quartz Medicaid SSI and/or BadgerCare Plus program and to share medical record information with the enrollee’s primary care physician in a timely manner as well as with Quartz Health Solutions, Inc. (“Quartz”) upon request.

Quartz will reimburse Provider the lesser of billed charges or 100% of the Wisconsin Medicaid Maximum Allowable Fee at original time of adjudication for each covered health check, immunization administration, and other services listed below.

Provider will be reimbursed the lesser of billed charges or 100% of the Wisconsin Medicaid Maximum Allowable fee for a visit for immunization administration or blood lead services at the five-minute rate with the assurance that the member assessment and education are provided at the visit and if not in conjunction with a health check.

Medical Records and Utilization Date. Provider agrees to provide access to records for compliance with State Medicaid SSI and/or BadgerCare Plus contract for those services provided by the Provider which were specifically approved to determine appropriateness of care, at no charge. Provider agrees to provide utilization data as required in the State Medicaid SSI and/or BadgerCare Plus contract.

This Memorandum of Understanding (MOU) becomes effective on the date indicated and when signed by both parties. This MOU shall continue for a 2-yr cycle and renew annually, except when either party terminates the Memorandum of Understanding in writing with sixty (60) days written notice. This Memorandum of Understanding may be amended with the written consent of both parties. All amendments shall be attached to this Memorandum of Understanding and be made apart thereof.