Amendment No. 17 to Contract YH8-0001-05 Between Arizona Health Care Cost Containment System and Health Choice Arizona

Summary

This amendment updates the contract between the Arizona Health Care Cost Containment System (AHCCCS) and Health Choice Arizona. Effective April 1, 2002, it establishes new capitation rates for the Title XIX Waiver Group, specifying payment amounts for services in Pima and Maricopa counties. All other terms of the original contract remain unchanged. Both parties have signed to confirm their agreement to these new rates.

EX-10.1 3 g77704exv10w1.txt AMENDMENT NO.17 TO CONTRACT EXHIBIT 10.1 Contract/RFP N. YH8-0001 Page 1 of 2 ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM [AHCCCS LOGO] ADMINISTRATION DIVISION OF BUSINESS AND FINANCE CONTRACT AMENDMENT - ------------------------------------------------------------------------------- 1. AMENDMENT 2. CONTRACT 3. EFFECTIVE DATE OF 4. PROGRAM: NUMBER: NO: AMENDMENT: 17 YH8-0001-05 April 1, 2002 OMC - ------------------------------------------------------------------------------- 5. CONTRACTOR'S NAME AND ADDRESS: HEALTH CHOICE ARIZONA 1600 W. BROADWAY SUITE 260 TEMPE AZ ###-###-#### - ------------------------------------------------------------------------------- 6. PURPOSE OF AMENDMENT: TO ESTABLISH NEW CAPITATION RATES FOR TITLE XIX WAIVER GROUP EFFECTIVE APRIL 1, 2002. - ------------------------------------------------------------------------------- 7. THE CONTRACT REFERENCED ABOVE IS AMENDED AS FOLLOWS: A. New Capitation Rates for Title XIX Waiver Group are changed to the rates provided on page two (2) of this amendment effective April 1, 2002. NOTE: PLEASE SIGN AND DATE BOTH AND THEN RETURN ONE TO: MICHAEL VEIT, MD 5700 AHCCCS CONTRACTS AND PURCHASING 701 E. JEFFERSON STREET PHOENIX, AZ 85034 - ------------------------------------------------------------------------------- 8. EXCEPT AS PROVIDED FOR HEREIN, ALL TERMS AND CONDITIONS OF THE ORIGINAL CONTRACT NOT HERETOFORE CHANGED AND/OR AMENDED REMAIN UNCHANGED AND IN FULL EFFECT. IN WITNESS WHEREOF THE PARTIES HERETO SIGN THEIR NAMES IN AGREEMENT. - ------------------------------------------------------------------------------- 9. SIGNATURE OF AUTHORIZED 10. SIGNATURE OF AHCCCSA CONTRACTING REPRESENTATIVE: OFFICER: /s/ Carolyn Rose /s/ Michael Veit - ------------------------------------------------------------------------------- TYPED NAME: CAROLYN ROSE MICHAEL VEIT - ------------------------------------------------------------------------------- TITLE: CHIEF EXECUTIVE OFFICER- CONTRACTS & PURCHASING HEALTH CHOICE ARIZONA ADMINISTRATOR - ------------------------------------------------------------------------------- DATE: DATE: 5-17-02 MAY 14 2002 - ------------------------------------------------------------------------------- Page 2 of 2 ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM CAPITATION RATE SUMMARY - ACUTE RATES HEALTH CHOICE ARIZONA CYE '02 (AS OF 4/01/02)