Financial Statements
EX-10.3 6 c12010exv10w3.htm EXHIBIT 10.3 Exhibit 10.3
EXHIBIT 10.3
 | 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 |
13 | YH09-0001-07 | October 1, 2010 | DHCM — ACUTE |
5. CONTRACTOR’S NAME AND ADDRESS:
VHS Phoenix Health Plan, LLC
7878 N. 16th St., Suite 105
Phoenix, AZ 85020
7878 N. 16th St., Suite 105
Phoenix, AZ 85020
6. PURPOSE OF AMENDMENT: To amend Section B, Capitation Rates, effective October 1, 2010 through September 30, 2011.
7. THE CONTRACT REFERENCED ABOVE FOLLOWS
To amend Section B, Capitation Rates, effective October 1, 2010 through September 30, 2011.
NOTE: Please sign, date, and return executed file by E-Mail to: Mark Held at ***@***
| Sr. Procurement Specialist | ||
| AHCCCS Contracts and Purchasing | ||
| and Stewart McKenzie at | ||
| ***@*** |
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/ Nancy Novick | /s/ Michael Veit | |||
TYPED NAME: NANCY NOVICK | TYPED NAME: MICHAEL VEIT | |||
TITLE: CHIEF EXECUTIVE OFFICER | TITLE: CONTRACTS & PURCHASING ADMINISTRATOR | |||
DATE: 1-17-11 | DATE: JANUARY 5, 2011 |
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
REVISED CAPITATION RATE SUMMARY — CYE 11 ACUTE RATES RISK ADJUSTED WITH 100% OF CYE 10 FACTORS
Phoenix Health Plan
10/1/10-9/30/11
REVISED CAPITATION RATE SUMMARY — CYE 11 ACUTE RATES RISK ADJUSTED WITH 100% OF CYE 10 FACTORS
Phoenix Health Plan
10/1/10-9/30/11
| TANF | TANF | TANF | TANF | TANF | SSI | SSI | ||||||||||||||||||||||||||||
| 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 | Non-MED | ||||||||||||||||||||||||||
4 | Apache/Coconino/Mohave/Navajo | $ | 540.94 | $ | 114.08 | $ | 275.59 | $ | 166.92 | $ | 377.04 | $ | 107.68 | $ | 816.24 | $ | 460.93 | |||||||||||||||||
6 | Yavapai | $ | 553.24 | $ | 113.10 | $ | 284.63 | $ | 179.62 | $ | 415.24 | $ | 133.51 | $ | 875.73 | $ | 566.85 | |||||||||||||||||
8 | Gila/Pinal | $ | 480.12 | $ | 109.26 | $ | 265.40 | $ | 176.95 | $ | 380.79 | $ | 134.34 | $ | 889.56 | $ | 466.00 | |||||||||||||||||
10 | Pima | $ | 542.07 | $ | 89.71 | $ | 210.86 | $ | 122.17 | $ | 325.24 | $ | 102.09 | $ | 814.38 | $ | 390.01 | |||||||||||||||||
12 | Maricopa | $ | 501.68 | $ | 113.20 | $ | 244.34 | $ | 158.81 | $ | 415.73 | $ | 146.66 | $ | 730.40 | $ | 489.53 | |||||||||||||||||
| 1. | Rates have been adjusted for $35,000 Reinsurance Deductible |
