Amendment number 8 to Missouri HealthNet Managed Care Eastern Region contract between the State of Missouri Office of Administration Division of Purchasing and Materials Management and Harmony Health Plan of Illinois, Inc. d/b/a Harmony Health Plan of Missouri
Contract Categories:
Business Operations
- Administration Agreements
EX-10.1 2 exhibit10-1.htm AMENDMENT NO. 8 TO MISSOURI MEDICAID CONTRACT exhibit10-1.htm
Back to Form 8-K
Exhibit 10.1
NOTICE OF AWARD
State Of Missouri
Office Of Administration
Division Of Purchasing and Materials Management
PO Box 809
Jefferson City, MO 65102
http://www.oa.mo.gov/purch
| CONTRACT NUMBER C306118005 | CONTRACT TITLE Medicaid Managed Care-Eastern Region |
| AMENDMENT NUMBER Amendment #008 | CONTRACT PERIOD July 1, 2008 through June 30, 2009 |
| REQUISITION NUMBER NR 886 ###-###-#### | VENDOR NUMBER 3640504950 1 |
| CONTRACTOR NAME AND ADDRESS Harmony Health Plan Inc 23 Public Square Ste 400 Belleville IL 62220 | STATE AGENCY’S NAME AND ADDRESS Dept of Social Services MO HealthNet Division PO Box 6500 Jefferson City, MO ###-###-#### |
| ACCEPTED BY THE STATE OF MISSOURI AS FOLLOWS: Contract C306118005 is hereby amended pursuant to the attached Amendment #008 dated 05/02/08. | |
| BUYER Laura Ortmeyer | BUYER CONTACT INFORMATION Email: ***@*** Phone: (573) 751-4579 Fax ###-###-#### |
| SIGNATURE OF BUYER Laura Ortmeyer | DATE 5/7/08 |
| DIRECTOR OF PURCHASING AND MATERIALS MANAGEMENT /s/ James Miluski James Miluski | |
STATE OF MISSOURI
OFFICE OF ADMINISTRATION
DIVISION OF PURCHASING AND MATERIALS MANAGEMENT (DPMM)
CONTRACT AMENDMENT
| AMENDMENT NO.: 008 | REQ NO.: NR 886 ###-###-#### |
| CONTRACT NO.: C306118005 | BUYER: Laura Ortmeyer |
| TITLE: Mo Health Net Managed Care - Eastern Region | PHONE NO.: (573) 751-4579 |
| ISSUE DATE: 4/22/08 | E-MAIL: ***@*** |
| TO: | HARMONY HEALTH PLAN OF MISSOURI 23 PUBLIC SQUARE STE 400 BELLEVILLE, IL 62220 |
RETURN AMENDMENT NO LATER THAN: APRIL 29, 2008 AT 5:00 PM CENTRAL TIME
RETURN AMENDMENT TO:
| (U.S. Mail) | (Courier Service) | |
| Div of Purchasing & Matls Mgt (DPMM) | Div of Purchasing & Matls Mgt (DPMM) | |
| PO BOX 809 | OR | 301 WEST HIGH STREET, ROOM 630 |
| JEFFERSON CITY MO 65102-0809 | JEFFERSON CITY MO 65101-1517 | |
OR FAX TO: (573) 526-9817 (either mail or fax, not both)
DELIVER SUPPLIES/SERVICES FOB (Free On Board) DESTINATION TO THE FOLLOWING ADDRESS:
Department of Social Services, MO HealthNet Division
Post Office Box 6500
Jefferson City MO 65102-6500
SIGNATURE REQUIRED
| DOING BUSINESS AS (DBA) NAME: Harmony Health Plan of Illinois, Inc. d/b/a Harmony Health Plan of Missouri | LEGAL NAME OF ENTITY/INDIVIDUAL FILED WITH IRS FOR THIS TAX ID NO.: Harmony Health Plan of Illinois, Inc. | ||
| MAILING ADDRESS: 23 Public Square, Suite 400 | IRS FORM 1099 MAILING ADDRESS 200 West Adams Street, Suite 800 | ||
| CITY, STATE, ZIP CODE Belleville, IL 62220 | CITY, STATE, ZIP CODE Chicago, IL 60606 | ||
| CONTACT PERSON Ms. Tina Gallagher | EMAIL ADDRESS ***@*** | ||
| PHONE NUMBER (800) 608-8158 Ext. 2405 | FAX NUMBER (800 ###-###-#### | ||
| TAXPAYER ID NUMBER (TIN) 36 ###-###-#### | TAXPAYER ID (TIN) TYPE (CHECK ONE) FEIN SSN | VENDOR NUMBER (IF KNOWN) 3640504950 1 | |
| VENDOR TAX FILING TYPE WITH IRS (CHECK ONE) (NOTE: LLC IS NOT A VALID TAX FILING TYPE.) X Corporation Individual State/Local Government Partnership Sole Proprietor Other | |||
| AUTHORIZED SIGNATURE /s/ Heath Schiesser | DATE May 2, 2008 | ||
| PRINTED NAME Heath Schiesser | TITLE President and CEO | ||
AMENDMENT #008 TO CONTRACT C306118005
CONTRACT TITLE: MO Health Net Managed Care – Eastern Region
CONTRACT PERIOD: July 1, 2008 through June 30, 2009
The State of Missouri hereby exercises its option to renew and desires to amend the above-referenced contract.
| 1. | Paragraph 2.7.1 h. is hereby amended effective July 1, 2008 as follows: |
| | h. | Pharmacy benefits excluding protease inhibitors - pharmacy benefits services shall be the responsibility of the health plan unless (1) pharmacy services were not included in the health plan's awarded proposal, or (2) if the health plan chooses to exclude pharmacy services from the MO HealthNet Managed Care benefit package effective July 1, 2008. |
| 2. | Paragraph 2.12.7 is hereby amended effective July 1, 2008 as follows: |
| 2.12.7 | Pharmacy Services: Pharmacy services (including physician injections) shall be reimbursed by the state agency on a fee-for-service basis according to the terms and conditions of the MO HealthNet program if pharmacy services were not included in the health plan's awarded proposal or if the health plan chooses to exclude pharmacy services from the MO HealthNet Managed Care benefit package effective July 1, 2008. |
| 3. | Section 5 is hereby amended effective July 1, 2008. |
| 4. | Attachment 13 is hereby revised effective July 1, 2008. |
The contractor shall indicate on the attached Pricing Page, any changes to the firm, fixed prices of the contract for performing the required services in accordance with the terms, conditions, and provisions of the contract. Column 1A on the Pricing Page lists the State's Maximum Net Capitation Rate for each Category of Aid rate subgroup with pharmacy service costs included in the MO HealthNet Managed Care benefit package. Column 2A on the Pricing Page lists the State's Maximum Net Capitation Rate for each Category of Aid rate subgroup with pharmacy service costs excluded in the MO HealthNet Managed Care benefit package. The contractor shall also provide a firm, fixed Per Member Per Delivery (PMPD) Net Capitated Rate for each Category of Aid Supplemental Delivery Event. The contractor's firm, fixed PMPM Net Capitation Rate for Each Category of Aid (COA) Rate subgroup must not exceed the State's Maximum Net Capitation Rate listed in Column 1.
The contractor must furnish a performance security deposit in accordance with the terms and conditions stated in the original contract in the amount of $1,000,000.00 for each region. The performance security deposit must specify the contract number and contract period.
All other terms, conditions and provisions of the previous contract period shall remain and apply hereto. The contractor shall sign and return this document, along with completed pricing and the applicable bond, on or before the date indicated.
5. PRICING PAGES
| 5.1 | Instructions for Completing Pricing Page: The offeror shall provide firm, fixed prices for providing all required services for all specified counties within a region pursuant to the requirements of this Request for Proposal. The offeror must choose to include Pharmacy services as a MO HealthNet managed care benefit or choose to exclude Pharmacy services from the MO HealthNet managed care benefit package. The offeror shall provide either a firm, fixed Per Member Per Month (PMPM) Net Capitated Rate for each Category of Aid rate subgroup with Pharmacy services included in the MO HealthNet managed care benefit package or a firm, fixed PMPM Net Capitated Rate for each Category of Aid rate subgroup with Pharmacy services excluded from the MO HealthNet managed care benefit package, which are non-delivery related. The offeror shall also provide a firm, fixed Per Member Per Delivery (PMPD) Net Capitated Rate for each Category of Aid Supplemental Delivery Event. All costs associated with providing the required services shall be included in the offeror's quoted rates. |
If the offeror is proposing to provide services for the Western region, the offeror must complete Pricing Page 5.2.
If the offeror is proposing to provide services for the Eastern region, the offeror must complete Pricing Page 5.3.
If the offeror is proposing to provide services for the Central region, the offeror must complete Pricing Page 5.4.
| 5.1.1 | Requirements promulgated by the federal government stipulate that the State of Missouri can only contract for services at rates that are actuarially sound. Column 1A on the Pricing Pages lists the State’s Maximum Net Capitation Rate for each Category of Aid rate subgroup with Pharmacy service costs included in the MO HealthNet managed care benefit package and each Category of Aid Supplemental Delivery Event. Each rate listed in Column 1A is actuarially sound, compliant with federal regulations, and is the maximum amount that the State will allow. Column 2A on the Pricing Pages lists the State's maximum Net Capitation Rate for each Category of Aid rate subgroup with Pharmacy service costs excluded from the MO HealthNet managed care benefit package and each Category of Aid Supplemental Delivery Event. Each rate listed in the Column 2A is actuarially sound, compliant with federal regulations, and is the maximum amount that the State will allow. |
| 5.1.2 | To assist the offeror in completion of the Pricing Page, the offeror should use the information provided in Attachment 9. However, the offeror is advised that this information should not be used as the only source of information in making pricing decisions. The offeror is solely responsible for research, preparation, and documentation of the offeror’s proposal including the offeror’s rates as quoted on the Pricing Page. |
| 5.1.3 | The offeror must complete either Column 1B or 2B on the Pricing Page by providing a firm, fixed PMPM rate for each Category of Aid rate subgroup and a firm, fixed PMPD for each Category of Aid Supplemental Delivery Event. |
| | a. | The offeror’s firm, fixed rates must not include: |
| | 1) | Estimates for services which are not the offeror’s responsibility. |
| | 2) | Cost of marketing as an administrative expense. |
| | 3) | Cost for Pharmacy services, if the offeror chooses to exclude Pharmacy services from the MO HealthNet managed care benefit package. |
| b. | The offeror’s firm, fixed rates shall be net of Third Party Liability recoveries. | |
| | c. | The offeror should calculate medical expenses by specific Category of Aid rate subgroup and make adjustments for administrative, profit, and contingency and risk charges to obtain the proposed Firm Fixed Net Capitation rates. |
| | d. | The offeror’s firm, fixed PMPM Net Capitated Rate for each Category of Aid rate subgroup and firm, fixed PMPD Net Capitated Rate for each Category of Aid Supplemental Delivery Event must not exceed the State’s Maximum Net Capitation Rate listed in Column 1A or 2A. The State shall not consider awarding a contract to an offeror with any quoted rate which exceeds the State’s Maximum Net Capitation Rate list in Column 1A or 2A. |
| 5.3 East Region - Firm Fixed Net Capitation Pricing Page | |||||||||||||||||||||||
| COLUMN 1 | COLUMN 2 | ||||||||||||||||||||||
| Column 1A | Column 1B | Column 2A | Column 2B | ||||||||||||||||||||
| State Price With Pharmacy | Offeror Proposal With Pharmacy | State Price Without Pharmacy | Offeror Proposal Without Pharmacy | ||||||||||||||||||||
| Category | Firm Fixed Net | Firm Fixed Net | Firm Fixed Net | Firm Fixed Net | |||||||||||||||||||
| of | Capitation Rate | Capitation Rate | Capitation Rate | Capitation Rate | |||||||||||||||||||
| Aid | Age | Sex | (Per Member Per Month) | (Per Member Per Month) | (Per Member Per Month) | (Per Member Per Month) | |||||||||||||||||
| 1 | Newborn < 01 | Male and Female | $ | 973.00 | $ | 973.00 | $ | 959.37 | $ | ||||||||||||||
| 1 | 01 - 06 | Male and Female | $ | 143.71 | $ | 143.71 | $ | 128.56 | $ | ||||||||||||||
| 1 | 07 - 13 | Male and Female | $ | 111.55 | $ | 111.55 | $ | 86.78 | $ | ||||||||||||||
| 1 | 14 - 20 | Female | $ | 216.17 | $ | 216.17 | $ | 193.24 | $ | ||||||||||||||
| 1 | 14 - 20 | Male | $ | 135.65 | $ | 135.65 | $ | 110.12 | $ | ||||||||||||||
| 1 | 21 - 44 | Female | $ | 336.54 | $ | 336.54 | $ | 292.96 | $ | ||||||||||||||
| 1 | 21 - 44 | Male | $ | 236.79 | $ | 236.79 | $ | 194.41 | $ | ||||||||||||||
| 1 | 45 - 99 | Male and Female | $ | 520.80 | $ | 520.80 | $ | 435.22 | $ | ||||||||||||||
| 4 | 00 - 20 | Male and Female | $ | 228.75 | $ | 228.75 | $ | 136.39 | $ | ||||||||||||||
| 1&4 | Delivery Payment | $ | 4,956.37 | $ | 4,956.37 | $ | 4,956.37 | ||||||||||||||||
| 5 | 00 - 06 | Male and Female | $ | 167.47 | $ | 167.47 | $ | 142.60 | $ | ||||||||||||||
| 5 | 07 - 13 | Male and Female | $ | 144.64 | $ | 144.64 | $ | 109.44 | $ | ||||||||||||||
| 5 | 14 - 18 | Male and Female | $ | 189.19 | $ | 189.19 | $ | 154.11 | $ | ||||||||||||||
| 5 | Delivery Payment | $ | 4,956.37 | $ | 4,956.37 | $ | 4,956.37 | $ | |||||||||||||||
ATTACHMENT 13
East Region - EPSDT Withhold Amounts
| NUMBER | AGE | SEX | July 1, 2008 EPSDT WITHHOLD AMOUNT PER % POINT | |||||
| 1 | <1 (NEWBORNS) | MALE AND FEMALE COMBINED | $ | 0.11 | ||||
| 1-6 YEAR OLDS | MALE AND FEMALE COMBINED | $ | 0.02 | |||||
| 7-13 YEAR OLDS | MALE AND FEMALE COMBINED | $ | 0.01 | |||||
| 14-20 YEAR OLDS | FEMALE | $ | 0.03 | |||||
| 14-20 YEAR OLDS | MALE | $ | 0.01 | |||||
| 4 | 0-20 YEAR OLDS | MALE AND FEMALE COMBINED | $ | 0.02 | ||||
| 5 | 0-6 YEAR OLDS | MALE AND FEMALE COMBINED | $ | 0.03 | ||||
| 7-13 YEAR OLDS | MALE AND FEMALE COMBINED | $ | 0.02 | |||||
| 14-18 YEAR OLDS | MALE AND FEMALE COMBINED | $ | 0.02 | |||||
ATTACHMENT 13
East Region - EPSDT Withhold Amounts
Without Pharmacy
| NUMBER | AGE | SEX | July 1, 2008 EPSDT WITHHOLD AMOUNT PER % POINT | |||||
| 1 | <1 (NEWBORNS) | MALE AND FEMALE COMBINED | $ | 0.11 | ||||
| 1-6 YEAR OLDS | MALE AND FEMALE COMBINED | $ | 0.02 | |||||
| 7-13 YEAR OLDS | MALE AND FEMALE COMBINED | $ | 0.01 | |||||
| 14-20 YEAR OLDS | FEMALE | $ | 0.03 | |||||
| 14-20 YEAR OLDS | MALE | $ | 0.01 | |||||
| 4 | 0-20 YEAR OLDS | MALE AND FEMALE COMBINED | $ | 0.02 | ||||
| 5 | 0-6 YEAR OLDS | MALE AND FEMALE COMBINED | $ | 0.03 | ||||
| 7-13 YEAR OLDS | MALE AND FEMALE COMBINED | $ | 0.02 | |||||
| 14-18 YEAR OLDS | MALE AND FEMALE COMBINED | $ | 0.02 | |||||
