Amendment No.17 to Contract
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)
