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This LTC WIO – Plan Agreement ("Agreement") is made and entered into as of this ____ day of__________________, 201_ between _________________________("MCO") and _________________________("LTC WIO").

WHEREAS, the Parties named above desire to participate in the Long Term Care Workforce Investment Program, and as such, desire to enter into this Agreement to demonstrate such desire and to provide the terms of such participation; and

NOW THEREFORE, in consideration of the mutual covenants herein contained, the parties to this Agreement (the "Parties") hereto agree as follows:

  1. The Parties agree to the Roles and Responsibilities for Long Term Care Workforce Investment Program ("Program"), which is referenced herein as Appendix A to this Agreement and fully incorporated herein by reference.
  2. The (Name of MCO) agrees to the Agreement entered into with (Name of LTC WIO) to include payment of the moneys awarded by the Department of Health for the purposes of participation in the Program, which such payment is contingent upon continued State availability of funds.
  3. The Program was authorized in New York´s Medicaid Redesign Team 1115 Waiver through the MRT Waiver Amendment. A specific requirement of the Program is that these funds are not to be used to supplant or duplicate existing efforts.
  4. Attach a 2–page document which demonstrates the LTC WIO and Plan partnerships´ capacity and approach to support the achievement of value–based payments (VBP) goals, to establish a baseline measure for sustainability.
  5. Term. The term of this Agreement shall begin as of the date executed and shall continue for a term of ____________________, provided that State funds continue to be available.
  6. Termination. Each party shall have the right to terminate this Agreement upon days prior written notice.

IN WITNESS WHEREOF, the undersigned, intending to be legally bound hereby, have duly executed this Agreement as of the year and date first above written.

MCO                                                                                                                LTC WIO

By:________________________________                                         By:________________________________

Name:________________________________                                  Name:________________________________