AMENDMENT NO. 2 TO CONTRACT
EX-10.1 3 g80694exv10w1.txt AMENDMENT NO. 2 TO CONTRACT EXHIBIT 10.1 ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION DIVISION OF BUSINESS AND FINANCE SECTION A. CONTRACT AMENDMENT [AHCCCS Page 1 of 2 LOGO] 1. AMENDMENT 2. CONTRACT 3. EFFECTIVE DATE OF 4. PROGRAM: NUMBER: NO.: AMENDMENT: 20 YH8-0001-05 JANUARY 1, 2003 OMC 5. CONTRACTOR'S NAME AND ADDRESS: HEALTH CHOICE OF ARIZONA 1600 W. BROADWAY, SUITE 260 TEMPE, ARIZONA 85282 6. PURPOSE OF AMENDMENT: TO AMEND SECTION B, CAPITATION RATES TO INCLUDE CAPITATION RATES FOR THE HIFA PARENTS POPULATION, EFFECTIVE JANUARY 1, 2003. 7. THE CONTRACT REFERENCED ABOVE IS AMENDED AS FOLLOWS: A. CAPITATION RATES: The rates on page 2 of this amendment will be paid to Contractors for HIFA parents enrolled with contractors on or after January 1, 2003. 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 ADMINISTRATOR DATE: 12/13/02 NOV 29, 2002
Page 2 of 2 ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM CAPITATION RATE SUMMARY - ACUTE RATES HEALTH CHOICE ARIZONA CYE '03 (EFFECTIVE 1/01/03) HIFA HIFA HIFA HIFA RATES: 14-44, F 14-44, M 45 +, M/F -------- -------- --------- 10 Pima $155.59 $111.06 $297.58 12 Maricopa $142.29 $112.59 $309.50
* Rates have been adjusted for $35,000 Reinsurance Deductible
