Third Amendment to Capitation Rate Agreement between Arizona Health Care Cost Containment System and Health Choice Arizona (May 2009)

Summary

This amendment updates the contract between the Arizona Health Care Cost Containment System (AHCCCS) and Health Choice Arizona, effective May 1, 2009. It revises the capitation rates—the fixed monthly payments per member—for acute care services provided by Health Choice Arizona through September 30, 2009. All other terms of the original contract remain unchanged. The amendment specifies the new rates for different regions and member categories, ensuring continued healthcare coverage under the state program.

EX-10.12 3 c92860exv10w12.htm EXHIBIT 10.12 Exhibit 10.12

Exhibit 10.12


		ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION DIVISION OF BUSINESS AND FINANCE SECTION A: CONTRACT


1. AMENDMENT	2. CONTRACT	3. EFFECTIVE DATE OF	4. PROGRAM
NUMBER:	NO.:	AMENDMENT:
3	YH09-0001-04	May 1, 2009	DHCM — ACUTE

5. CONTRACTOR’S NAME AND ADDRESS:

Health Choice Arizona

1600 W. Broadway, Suite 260

Tempe, AZ 85282

6. PURPOSE OF AMENDMENT: To amend Section B, Capitation Rates, effective May 1, 2009.

7. THE CONTRACT REFERENCED ABOVE FOLLOWS

To amend Section B, Capitation Rates, effective May 1, 2009.


NOTE: Please sign and date all copies and then return one executed original to:		Mark Held
		Sr. Procurement Specialist
		AHCCCS Contracts
		701 E. Jefferson St., 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. SIGNATURE OF AUTHORIZED REPRESENTATIVE:		10. SIGNATURE OF AHCCCSA CONTRACTING OFFICER:
		[ILLEGIBLE]

/s/ Carolyn Rose		/s/ Pat Watkinson for Michael Veit
TYPED NAME: CAROLYN ROSE		MICHAEL VEIT
TITLE: CHIEF EXECUTIVE OFFICER		CONTRACTS & PURCHASING ADMINISTRATOR
DATE:		DATE: 3-30-09


SECTION B: CAPITATION RATES		Contract/RFP No. YH09-0001

SECTION B: CAPITATION RATES

The Contractor shall provide services as described in this contract. In consideration for these services, the Contractor will be paid Contractor-specific rates per member per month for the term May 1, 2009 through September 30, 2009. See attached revised rates.

CYE ‘09 Acute Care Contract
May 1, 2009

ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
CAPITATION RATE SUMMARY — ACUTE RATES
Health Choice Arizona
05/01/2009-9/30/2009


																	Maternity
	TANF		TANF		TANF		TANF		TANF		SSI		SSI				Delivery
Title XIX and KidsCare Rates ¹:	<1, M/F		1-13, M/F		14-44, F		14-44, M		45+, M/F		w/ Med		w/o Med		SFP		Supplement		Non-MED		MED
2 Yuma/La Paz	$	451.13	$	105.33	$	204.19	$	118.67	$	365.40	$	178.29	$	693.11	$	20.43	$	6,190.52	$	443.94	$	1,636.99
4 Apache/Coconino/Mohave/Navajo	$	474.50	$	111.49	$	270.70	$	157.82	$	409.11	$	160.98	$	775.55	$	19.00	$	6,241.93	$	578.20	$	1,433.37
10 Pima/Santa Cruz	$	448.76	$	100.79	$	230.46	$	127.70	$	396.08	$	145.39	$	734.80	$	20.91	$	6,519.63	$	485.35	$	1,329.96
12 Maricopa	$	558.77	$	114.80	$	239.88	$	150.74	$	410.20	$	157.50	$	744.97	$	18.65	$	6,646.66	$	626.59	$	1,415.16


	TANF		TANF		TANF		TANF		TANF		SSI		SSI
PPC Rates:	<1, MF		1-13, M/F		14-44, F		14-44, M		45+, M/F		w/ Med		w/o Med		Non-MED		MED
2 Yuma/La Paz	$	1,204.81	$	61.66	$	238.16	$	212.19	$	436.74	$	134.22	$	410.31	$	1,075.65	$	7,443.55
4 Apache/Coconino/Mohave/Navajo	$	1,190.43	$	62.09	$	264.19	$	215.00	$	439.32	$	135.74	$	405.56	$	1,127.34	$	7,404.72
10 Pima/Santa Cruz	$	1,192.26	$	56.23	$	247.42	$	196.93	$	439.38	$	132.24	$	408.04	$	887.69	$	7,387.84
12 Maricopa	$	1,217.54	$	66.04	$	255.60	$	224.64	$	446.27	$	132.38	$	425.30	$	1,319.34	$	7,668.50


	Option 1		Option 2
Other Rates:	Transplant		Transplant
2 Yuma/La Paz	$	40.00	$	40.00
4 Apache/Coconino/Mohave/Navajo	$	40.00	$	40.00
10 Pima/Santa Cruz	$	40.00	$	40.00
12 Maricopa	$	40.00	$	40.00


^1.		Rates have been adjusted for $50,000 Reinsurance Deductible