STATE OF ILLINOIS DEPARTMENT OF PUBLIC AID
EX-10.7.9 2 w20799exv10w7w9.htm EX-10.7.9 exv10w7w9
Exhibit 10.7.9
STATE OF ILLINOIS
DEPARTMENT OF PUBLIC AID
DEPARTMENT OF PUBLIC AID
AMENDMENT NO. 3 TO THE
CONTRACT FOR FURNISHING HEALTH SERVICES
CONTRACT FOR FURNISHING HEALTH SERVICES
BY A
MANAGED CARE ORGANIZATION
2004-24-001-KA3
MANAGED CARE ORGANIZATION
2004-24-001-KA3
Whereas, the parties to the Contract for Furnishing Health Services by a Managed Care Organization (CONTRACT), the Illinois Department of Healthcare & Family Services (formerly Public Aid), 201 South Grand Avenue East, Springfield, Illinois ###-###-#### (herein referred to as Department), acting by and through its Director, and AMERIGROUP Illinois, Inc., 211 West Wacker Drive, Suite 1350, Chicago, IL 60606 (hereinafter referred to as Contractor), desire to amend the CONTRACT; and
WHEREAS, pursuant to Article 9, Section 9.9 (a) of the CONTRACT, the CONTRACT may be modified or amended by the mutual consent of the parties; and
WHEREAS, the Departments actuary has certified that the Contract and rates resulting from this amendment are actuarially sound;
NOW THEREFORE, the parties agree to amend the contract as follows:
1. | First Amended Attachment I shall be deleted and replaced by the attached Second Amended Attachment I. Each reference to Attachment I or First Amended Attachment I in the Contract shall be replaced with a reference to Second Amended Attachment I. |
All other terms and conditions of the CONTRACT shall remain in full force and effect.
IN WITNESS WHEREOF, the parties have hereunto caused this agreement to amend the CONTRACT to be executed by their duly authorized representatives, effective January 1, 2006.
DEPARTMENT OF HEALTHCARE & FAMILY SERVICES | AMERIGROUP ILLINOIS, INC. | ||||||||||
By: | By: | /s/ Jared Rosenthal | |||||||||
Printed Name: | JARED ROSENTHAL | ||||||||||
Title: | Director | Title: | CEO | ||||||||
Date: | Date: | 12/28/05 | |||||||||
Fein: | 54-1761812 | ||||||||||
Page 1 of 1
SECOND AMENDED ATTACHMENT I
RATE SHEETS
(a) | Contractor Name: | AMERIGROUP Illinois, Inc. | ||
Address: | 211 West Wacker Drive, Suite 1350 | |||
Chicago, IL 60606 | ||||
(b) | Contracting Area(s) Covered by the Contractor and Enrollment Limit: |
Contracting Area | Enrollment Limit | |
Region IV | 100,000 | |
(c) | Total Enrollment Limit for all Contracting Areas: 100,000 | |
(d) | Threshold Review Levels: 80,000 | |
(e) | Standard Capitation Rates for Enrollees, effective August 1, 2003 through July 31, 2005: |
Region I | Region II | Region III | Region IV | Region V | ||||||||||||||||
Age/Gender | (N.W. | (Central | (Southern | (Cook | (Collar | |||||||||||||||
Mo = month | Illinois) | Illinois) | Illinois) | County) | Counties) | |||||||||||||||
Yr = year | PMPM | PMPM | PMPM | PMPM | PMPM | |||||||||||||||
0-3Mo | $ | 1,152.25 | $ | 1,178.77 | $ | 1,242.71 | $ | 1,244.64 | $ | 854.58 | ||||||||||
4Mo-1Yr | 127.81 | 117.63 | 165.94 | 125.04 | 108.35 | |||||||||||||||
2Yr-5Yr | 63.77 | 67.81 | 71.74 | 58.67 | 56.28 | |||||||||||||||
6Yr-13Yr | 72.08 | 79.78 | 75.18 | 58.18 | 57.47 | |||||||||||||||
14Yr-20Yr, Male | 115.93 | 135.96 | 131.18 | 90.67 | 142.60 | |||||||||||||||
14Yr-20Y, Female | 148.51 | 157.40 | 155.15 | 112.48 | 119.82 | |||||||||||||||
21Yr-44Yr, Male | 161.79 | 216.53 | 201.90 | 164.23 | 159.43 | |||||||||||||||
21Yr-44Yr, Female | 217.61 | 228.14 | 237.13 | 185.81 | 184.20 | |||||||||||||||
45Yr+ Male and Female | 437.86 | 486.40 | 476.29 | 359.61 | 409.17 |
Att. I - 1
Standard Capitation Rates for Enrollees, effective August 1, 2005 through December 31, 2005:
Region I | Region II | Region III | Region IV | Region V | ||||||||||||||||
Age/Gender | (N.W. | (Central | (Southern | (Cook | (Collar | |||||||||||||||
Mo = month | Illinois) | Illinois) | Illinois) | County) | Counties) | |||||||||||||||
Yr = year | PMPM | PMPM | PMPM | PMPM | PMPM | |||||||||||||||
0-3Mo | $ | 1,342.61 | $ | 1,178.83 | $ | 1,271.32 | $ | 1,369.28 | $ | 948.46 | ||||||||||
4Mo-1Yr | 121.62 | 109.83 | 154.41 | 117.41 | 99.27 | |||||||||||||||
2Yr-5Yr | 53.51 | 57.02 | 59.41 | 51.49 | 49.60 | |||||||||||||||
6Yr-13Yr | 49.37 | 51.29 | 52.22 | 45.53 | 42.00 | |||||||||||||||
14Yr-20Yr, Male | 85.90 | 92.02 | 85.37 | 70.16 | 100.73 | |||||||||||||||
14Yr-20Y, Female | 127.53 | 128.58 | 123.97 | 94.84 | 98.76 | |||||||||||||||
21Yr-44Yr, Male | 113.28 | 161.06 | 139.13 | 121.91 | 110.33 | |||||||||||||||
21 Yr-44Yr, Female | 164.91 | 167.03 | 168.42 | 148.97 | 141.81 | |||||||||||||||
45Yr+ Male and Female | 277.48 | 310.00 | 275.75 | 258.08 | 273.13 |
Standard Capitation Rates for Enrollees, effective January 1, 2006 through July 31, 2006:
Region I | Region II | Region III | Region IV | Region V | ||||||||||||||||
Age/Gender | (N.W. | (Central | (Southern | (Cook | (Collar | |||||||||||||||
Mo = month | Illinois) | Illinois) | Illinois) | County) | Counties) | |||||||||||||||
Yr = year | PMPM | PMPM | PMPM | PMPM | PMPM | |||||||||||||||
0-3Mo | $ | 1,361.60 | $ | 1,193.95 | $ | 1,283.86 | $ | 1,379.13 | $ | 967.15 | ||||||||||
4Mo-1Yr | 131.76 | 117.74 | 161.46 | 124.11 | 109.20 | |||||||||||||||
2Yr-5Yr | 57.39 | 60.36 | 62.06 | 54.89 | 53.37 | |||||||||||||||
6Yr-13Yr | 51.57 | 53.28 | 53.69 | 47.37 | 43.96 | |||||||||||||||
14Yr-20Yr, Male | 87.51 | 93.46 | 86.43 | 71.41 | 102.00 | |||||||||||||||
14Yr-20Y, Female | 129.71 | 130.56 | 125.42 | 96.23 | 100.46 | |||||||||||||||
21Yr-44Yr, Male | 113.43 | 161.32 | 139.61 | 122.11 | 110.39 | |||||||||||||||
21 Yr-44Yr, Female | 165.30 | 167.59 | 169.54 | 149.54 | 142.11 | |||||||||||||||
45Yr+ Male and Female | 277.85 | 310.54 | 276.86 | 258.60 | 273.38 |
(f) | Hospital Delivery Case Rate, effective August 1, 2003 through July 31, 2005: |
Hospital Delivery Case | ||||||||||||||||||||
Rate | $ | 3,196.12 | $ | 3,104.66 | $ | 3,281.22 | $ | 3,748.33 | $ | 3,276.03 | ||||||||||
(per delivery) |
Hospital Delivery Case Rate, effective August 1, 2005 through July 31, 2006:
Hospital Delivery Case | ||||||||||||||||||||
Rate | $ | 3,008.88 | $ | 2,900.77 | $ | 3,100.59 | $ | 3,431.08 | $ | 3,113.07 | ||||||||||
(per delivery) |
Att. I - 2