Salt Lake City, Utah
EX-10.13 4 c92860exv10w13.htm EXHIBIT 10.13 Exhibit 10.13
Exhibit 10.13
 | ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION DIVISION OF BUSINESS AND FINANCE SECTION A: CONTRACT |
1. AMENDMENT NUMBER: | 2. CONTRACT NO.: | 3. EFFECTIVE DATE OF AMENDMENT: | 4. PROGRAM | |||
4 | YH09-0001-04 | August 1, 2009 | DHCM — ACUTE |
5. CONTRACTOR’S NAME AND ADDRESS:
Health Choice Arizona
410 N. 44th Street, Suite 900
Phoenix, AZ 85008
410 N. 44th Street, Suite 900
Phoenix, AZ 85008
6. PURPOSE OF AMENDMENT: To amend Section B, Capitation Rates, effective October 1, 2008 and May 1, 2009.
7. THE CONTRACT REFERENCED ABOVE FOLLOWS
To amend Section B, Capitation Rates, effective October 1, 2008 and 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: | |
| /s/ Carolyn Rose | /s/ Michael Veit | |
TYPED NAME: CAROLYN ROSE | MICHAEL VEIT | |
TITLE: CHIEF EXECUTIVE OFFICER | CONTRACTS & PURCHASING ADMINISTRATOR | |
DATE: 7/8/2009 | DATE: |
Contract Rates 27 — HCA
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
REVISED CAPITATION RATE SUMMARY — ACUTE RATES
Health Choice Arizona
10/01/2008-9/30/2009
REVISED CAPITATION RATE SUMMARY — ACUTE RATES
Health Choice Arizona
10/01/2008-9/30/2009
| Effective 10/01/08-4/30/09 | ||||||||||||||||||||||||||||||||
| TANF | TANF | TANF | TANF | TANF | SSI | SSI | ||||||||||||||||||||||||||
| Title XIX and KidsCare Rates: | <1, M/F | 1-13, M/F | 14-44, F | 14-44, M | 45+, M/F | w/ Med | w/o Med | Non-MED | ||||||||||||||||||||||||
2 Yuma/La Paz | $ | 453.20 | $ | 103.35 | $ | 199.61 | $ | 119.61 | $ | 341.83 | $ | 165.83 | $ | 658.72 | $ | 431.08 | ||||||||||||||||
4 Apache/Coconino/Mohave/Navajo | $ | 475.32 | $ | 113.25 | $ | 278.74 | $ | 161.12 | $ | 425.28 | $ | 167.82 | $ | 801.67 | $ | 598.27 | ||||||||||||||||
10 Pima/Santa Cruz | $ | 439.11 | $ | 102.38 | $ | 234.44 | $ | 129.37 | $ | 403.87 | $ | 144.10 | $ | 714.67 | $ | 489.61 | ||||||||||||||||
12 Maricopa | $ | 560.63 | $ | 112.55 | $ | 234.65 | $ | 141.03 | $ | 399.17 | $ | 143.29 | $ | 725.26 | $ | 608.77 | ||||||||||||||||
| Effective 5/01/09-9/30/09 | ||||||||||||||||||||||||||||||||
| TANF | TANF | TANF | TANF | TANF | SSI | SSI | ||||||||||||||||||||||||||
| PPC Rates: | <1, M/F | 1-13, M/F | 14-44, F | 14-44, M | 45+, M/F | w/ Med | w/o Med | Non-MED | ||||||||||||||||||||||||
2 Yuma/La Paz | $ | 448.09 | $ | 101.83 | $ | 196.55 | $ | 118.05 | $ | 336.42 | $ | 163.00 | $ | 651.89 | $ | 425.51 | ||||||||||||||||
4 Apache/Coconino/Mohave/Navajo | $ | 470.51 | $ | 112.00 | $ | 275.06 | $ | 159.38 | $ | 419.72 | $ | 165.04 | $ | 795.45 | $ | 592.00 | ||||||||||||||||
10 Pima/Santa Cruz | $ | 434.20 | $ | 101.19 | $ | 231.05 | $ | 127.92 | $ | 398.31 | $ | 141.90 | $ | 708.50 | $ | 484.03 | ||||||||||||||||
12 Maricopa | $ | 555.13 | $ | 111.15 | $ | 231.43 | $ | 139.53 | $ | 393.96 | $ | 141.40 | $ | 719.08 | $ | 602.64 | ||||||||||||||||
