EX-10.3 AMENDMENT NO.14 TO CONTRACT

EX-10.3 5 g01280exv10w3.txt EX-10.3 AMENDMENT NO.14 TO CONTRACT Exhibit 10.3 (AHCCCS LOGO) ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION DIVISION OF BUSINESS AND FINANCE CONTRACT AMENDMENT 1. AMENDMENT NO.: 14 2. CONTRACT NO.: YH04-0001-03 3. EFFECTIVE DATE OF AMENDMENT: OCTOBER 1, 2005 4. PROGRAM: DHCM 5. CONTRACTOR/PROVIDER NAME AND ADDRESS: HEALTH CHOICE ARIZONA 1600 W. BROADWAY, SUITE 260 TEMPE, ARIZONA ###-###-#### 6. PURPOSE: To incorporate the changes below and to amend capitation rates. 7. The previous amendment of the above referenced contract is hereby amended as follows: SECTION B, CAPITATION RATES See rate sheet attached for the revised capitation rates effective October 1, 2005 through December 31, 2005 and the amounts to be paid to the rural hospitals. Insert the following language before "SEE ATTACHED.": "The Contractor will be paid the attached Contractor specific capitation rates retroactively, per member per month, for the period of October 1, 2005 through December 31, 2005. Only the impacted rates are included on the attachment. All other rates remain unchanged. The Administration requires that the Contractor then make one-time payments to each rural hospital as prescribed on the attached schedule, pursuant to ARS Section 36-2905.02, to increase inpatient reimbursement to these small rural hospitals. The retroactive capitation rate payment will be paid with the June 2006 capitation rates. The Contractor shall make the prescribed payments to the rural hospitals during June 2006 and submit proof of payment to the Finance Unit of the Division of Health Care Management by June 30, 2006. The capitation rates for the period January 1, 2006 through September 30, 2006 are not impacted by this amendment." NOTE: Please sign and Michael Veit Contracts & Purchasing Administrator date both and return AHCCCS Contracts and Purchasing one original to: 701 E. Jefferson, MD 5700 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. NAME OF CONTRACTOR: HEALTH CHOICE ARIZONA SIGNATURE OF AUTHORIZED INDIVIDUAL: /s/ Carolyn Rose - ------------------------------------- TYPED NAME: CAROLYN ROSE TITLE: CHIEF EXECUTIVE OFFICER DATE 4/28/06 10. ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM SIGNATURE: /s/ Michael Veit - ------------------------------------- TYPED NAME: MICHAEL VEIT TITLE: CONTRACTS AND PURCHASING ADMINISTRATOR DATE: APR 20 2006

Two percent Premium tax is included in the Capitation Rates. Payments stated without Premium Tax.