SIGNED FINAL_Both Parties_ iCare SERVICE AGREEMENT AMENDMENT #1 1-25-2023

AMENDMENT # 1
to the
PROVIDER SERVICE AGREEMENT BETWEEN
INDEPENDENT CARE HEALTH PLAN
and
COUNTY OF SAUK DBA SAUK COUNTY HEALTH DEPARTMENT
This first Amendment (Amendment #1) is to the Provider Service Agreement (the “Agreement”) entered 
into by and between County of Sauk dba Sauk County Health Department (hereinafter Provider) and 
Independent Care Health Plan (hereinafter iCare) effective February 28, 2020. The effective date of 
this Amendment #1 is January 1, 2023.
RECITALS
Provider and iCare desire to add and/or modify certain terms and conditions contained in the 
Agreement as provided in this Amendment.
AGREEMENT
In consideration of the mutual promises herein and in the Agreement, Provider and iCare agree as 
follows:

1.  Attachment B Provider Services, is hereby deleted in its entirety and replaced with the 
attached Attachment B. 

2.  Except as modified by this Amendment and to the extent not inconsistent herewith, all terms and 
conditions of the Agreement shall remain in full force and effect. The Amendment may only be 
modified by a written agreement signed by authorized representatives of each party.  This 
Amendment, the Agreement and all attachments thereto constitute the entire agreement between the 
parties, with respect to the subject matter contain therein, and supersede all prior agreements 
between the parties, whether written or oral.

3.  Each party represents and warrants that it has the necessary power and authority to enter into 
this Amendment and to consummate the transactions contemplated hereby. The parties have caused this 
Amendment to be executed by their duly authorized representatives as of the date set forth above.

IN WITNESS WHEREOF, the parties have executed this Amendment on the dates indicated below with 
their respective signatures, to be effective as of the date specified above.
INDEPENDENT CARE HEALTH PLAN     COUNTY OF SAUK DBA SAUK COUNTY HEALTH
DEPARTMENT

Signature:   Signature:               

Printed Name: Tony Mollica    Printed Name:              

Title:    VP, Medicaid Regional President           Title:                 

Date:    Date:                 

County of Sauk dba Sauk County Health Department, Amendment #1                            January 
1, 2023
ATTACHMENT B PROVIDER SERVICES-

All Medically Necessary Covered Services that are appropriate for PROVIDER and if applicable, its 
Participating Providers’ capabilities and within the scope of PROVIDER’s or Participating 
Providers’
license(s) and/or certification(s) for iCare Enrollees.