Contract Amendment Number 3, executed on April 6, 2009, but effective as of May 1, 2009, to the Arizona Health Care Cost Containment System Administration Contract No. YH09-0001-07 between VHS Phoenix Health Plan, LLC and the Arizona Health Care Cost Containment System
EXHIBIT 10.1
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION
DIVISION OF BUSINESS AND FINANCE
SECTION A: CONTRACT
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| 2. CONTRACT NO.: | 3. EFFECTIVE DATE OF CONTRACT: | 4. PROGRAM: | |||
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VHS Phoenix Health Plan, LLC | ||||||
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| THE CONTRACT REFERENCED ABOVE FOLLOWS |
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| To amend Section B, Capitation Rates, effective May 1, 2009. | |||
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| NOTE: Please sign and date all copies and then return one executed original to: Mark Held | |||||
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| 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. | |||||
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| IN WITNESS WHEREOF THE PARTIES HERETO SIGN THEIR NAMES IN AGREEMENT | |||||
| 9. SIGNATURE OF AUTHORIZED REPRESENTATIVE: |
| 10. SIGNATURE OF AHCCCSA CONTRACTING OFFICER: |
| /a/ Nancy Novick |
| /s/ Pat Wathimson for Michael Veit |
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| TYPED NAME: NANCY NOVICK |
| MICHAEL VEIT |
| TITLE: CHIEF EXECUTIVE OFFICER |
| CONTRACTS & PURCHASING ADMINISTRATOR |
| DATE: 4/6/09 |
| DATE: 3-30-09 |
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, 200 through September 30,
2009. See attached revised rates.
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ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM | ||||||||||||
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| Title XIX and KidsCare Rates 1: | TANF | TANF | TANF | TANF | TANF | SSI | SSI | SFP | Maternity | Non-MED | MED | |
| 4 | Apache/Coconino/Mohave/Navajo | $474.47 | $111.58 | $273.18 | $157.95 | $409.52 | $161.19 | $776.11 | $19.02 | $6,248.22 | $578.66 | $1,434.36 |
| 6 | Yavapai | $507.50 | $116.03 | $270.46 | $180.56 | $427.88 | $141.69 | $758.61 | $18.30 | $6,871.52 | $627.38 | $1,160.64 |
| 8 | Gila/Pinal | $578.37 | $108.22 | $256.73 | $172.31 | $358.20 | $139.85 | $737.91 | $12.43 | $6,594.24 | $487.17 | $1,673.46 |
| 10 | Pima | $493.42 | $101.61 | $239.36 | $127.59 | $408.04 | $146.24 | $772.28 | $21.96 | $6,627.59 | $492.92 | $1,356.27 |
| 12 | Maricopa | $550.49 | $117.35 | $241.92 | $151.74 | $422.47 | $158.80 | $749.25 | $18.79 | $6,694.65 | $630.48 | $1,423.69 |
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| PPC Rates: | TANF | TANF | TANF | TANF | TANF | SSI | SSI | Non-MED | MED | |||
| 4 | Apache/Coconino/Mohave/Navajo | $1,190.99 | $62.12 | $264.37 | $215.09 | $439.52 | $135.86 | $405.68 | $1,127.75 | $7,407.25 | ||
| 6 | Yavapai | $1,210.79 | 465.92 | $262.35 | $223.35 | $442.10 | $133.86 | $407.50 | $1.116/81 | $7,418.82 | ||
| 8 | Gila/Pinal | $1,200.37 | $66.67 | $253.25 | $212.60 | $444.30 | $134.33 | $407.29 | $1,100.13 | $7,521.76 | ||
| 10 | Pima | $1,195.05 | $56.40 | $248.23 | $197.36 | $440.40 | $132.96 | $408.89 | $889.79 | $7,402.50 | ||
| 12 | Maricopa | $1,221.70 | $66.27 | $256.92 | $225.36 | $448.09 | $133.45 | $426.87 | $1,323.84 | $7,696.96 | ||
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| Other Rates: | Option 1 | Option 2 | ||||||||||
| 4 | Apache/Coconino/Mohave/Navajo | $40.00 | $40.00 | |||||||||
| 6 | Yavapai | $40.00 | $40.00 | |||||||||
| 8 | Gila/Pinal | $40.00 | $40.00 | |||||||||
| 10 | Pima | $40.00 | $40.00 | |||||||||
| 12 | Maricopa | $40.00 | $40.00 | |||||||||
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1. Rates have been adjusted for $50,000 Reinsurance Deductible
