Department of Human Services Division of Medical Assistance And Health Services PO Box 712 Jon S. Corzine Trenton NJ ###-###-#### Jennifer VelezGovernor Telephone ###-###-#### Commissioner John R. Guhl May 8, 2008 Director
EX-10.7 2 w63476exv10w7.htm EX-10.7 exv10w7
Exhibit 10.7
 | ||||
| Department of Human Services | ||||
| Division of Medical Assistance And Health Services | ||||
| PO Box 712 | ||||
Jon S. Corzine | Trenton NJ ###-###-#### | Jennifer Velez | ||
Governor | Telephone ###-###-#### | Commissioner | ||
| John R. Guhl | ||||
| May 8, 2008 | Director |
Peter D. Haytaian
President and Chief Executive Officer
AMERIGROUP New Jersey, Inc.
399 Thornall Street, 9th Floor
Edison, NJ 8837
President and Chief Executive Officer
AMERIGROUP New Jersey, Inc.
399 Thornall Street, 9th Floor
Edison, NJ 8837
Dear Mr. Haytaian:
Enclosed is an HMO contract amendment that extends the contract for one year to June 30, 2009 with the new capitation rate, effective July 1, 2008. All other terms of the current contract remain in full force and effect. We are rescinding the previous contract amendment that would have extended the HMO contract for one month to July 31, 2008.
Please review and return five original signed copies to the Office of Managed Health Care by May 21, 2008. If you have any questions, please do not hesitate to call me at ###-###-####.
| Sincerely, | ||||
 | ||||
| Jill Simone, MD | ||||
| Executive Director Office of Managed Health Care | ||||
JS
Enclosure
Enclosure
| c: | John R. Guhl David Lowenthal John Koehn |
New Jersey Is An Equal Opportunity Employer • Printed on Recycled Paper and Recyclable
STATE OF NEW JERSEY
DEPARTMENT OF HUMAN SERVICES
DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES
AND
AMERIGROUP NEW JERSEY, INC.
AGREEMENT TO PROVIDE HMO SERVICES
In accordance with Article 7, sections 7.11.2A, 7.11.2B, and 7.12.1 of the contract between AMERIGROUP New Jersey, Inc. and the State of New Jersey, Department of Human Services, Division of Medical Assistance and Health Services (DMAHS), effective date October 1, 2000, all parties agree that the contract shall be amended, effective July 1, 2008, as follows:
Appendix, Section C, “Capitation Rates” shall be revised as reflected in SFY 2009 Capitation Rates attached hereto and incorporated herein.
All other terms and conditions of the October 1, 2000 contract and subsequent amendments remain unchanged except as noted above.
The contracting parties indicate their agreement by their signature.
| AMERIGROUP NEW JERSEY, INC. | State of New Jersey | |||||||
| Department of Human Services | ||||||||
BY: | BY: | |||||||
| John R. Guhl | ||||||||
TITLE: | President & CEO | TITLE: | DIRECTOR, DMAHS | |||||
DATE: | May 13, 2008 | DATE: | ||||||
| APPROVED AS TO FORM ONLY | ||||
| Anne Milgram | ||||
| ATTORNEY GENERAL | ||||
| STATE OF NEW JERSEY | ||||
BY: | ||||
| Deputy Attorney General | ||||
DATE: | ||||
SFY09 Rates
Contract Period: 07/01/08 - 06/30/09
Contract Period: 07/01/08 - 06/30/09
| Category | Age/Sex | Northern | Central | Southern | Statewide | |||||
AFDC / DYFS / KidCare A / New Jersey Care Children | Newborn | |||||||||
AFDC / DYFS / KidCare A / New Jersey Care Children | 75 dys - 2 yrs M&F | |||||||||
AFDC / DYFS / KidCare A / New Jersey Care Children / NJCPW | 2 - 20.99 M&F | |||||||||
AFDC / NJCPW | 21 - 44.99 Female | |||||||||
AFDC | 21 - 44.99 Male | |||||||||
AFDC / NJCPW | 45+ M&F | |||||||||
Non ABD-DDD (including Home Health Add-On) | All | |||||||||
Aged with Medicare | All | |||||||||
Blind/Disabled with Medicare and Other Dual Eligibles | < 45 M&F | |||||||||
Blind/Disabled with Medicare and Other Dual Eligibles | 45+ M&F | |||||||||
ABD-DDD with Medicare and Other Dual Eligibles | All | |||||||||
| ABD (including AIDS & DDD) without Medicare | All | ***REDACTED*** | ||||||||
KidCare B&C | Newborn | |||||||||
KidCare B&C | < 2 M&F | |||||||||
KidCare B&C | Youth | |||||||||
KidCare D | Newborn | |||||||||
KidCare D | < 2 M&F | |||||||||
KidCare D | Youth | |||||||||
FamilyCare Parents 0-200% / FamilyCare Adults and Health Access / Adult Restricted Aliens | 21 - 44.99 Female | |||||||||
FamilyCare Parents 0-200% / FamilyCare Adults and Health Access / Adult Restricted Aliens | 21 - 44.99 Male | |||||||||
FamilyCare Parents 0-200% / FamilyCare Adults and Health Access /Adult Restricted Aliens | 45+ M&F | |||||||||
AIDS-ABD with Medicare and Other Dual Eligibles | All | |||||||||
AIDS-Non-ABD | All | |||||||||
AIDS-ABD with Medicare and Other Dual Eligibles DDD (Including Behavioral Health Add-On) | All | |||||||||
AIDS-Non-ABD DDD (including Behavioral Health Add-On) | All | |||||||||
Add-On-Behavioral Health-DDD w/ Medicare | All | |||||||||
Add-On-Behavioral Health-DDD w/o Medicare | All | |||||||||
Maternity | All | |||||||||
Note:
The ABD without Medicare rate above assume a 1.00 Risk Adjustment Rate Factor. This SFY09 rates represent the average of the FFS and HMO populations. The expected SFY09 HMO average risk score factors is less than 1.00.
The ABD without Medicare rate above assume a 1.00 Risk Adjustment Rate Factor. This SFY09 rates represent the average of the FFS and HMO populations. The expected SFY09 HMO average risk score factors is less than 1.00.
