Amendment number 7 to the Medicaid 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

Contract Categories: Business Operations - Administration Agreements
EX-10.3 4 exhibit10-3.htm AMENDMENT NO. 7 TO MO CONTRACT exhibit10-3.htm
 
Back to Form 8-K
Exhibit 10.3

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 #007 Revised
CONTRACT PERIOD
July 1, 2007 through June 30, 2008
 
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 65102-6500
 
ACCEPTED BY THE STATE OF MISSOURI AS FOLLOWS:
Contract C306118005 is hereby amended pursuant to the attached Amendment #007 Revised dated 03/26/08.
 
BUYER
Laura Ortmeyer
 
BUYER CONTACT INFORMATION
Email: ***@***
Phone: (573) 751-4579  Fax ###-###-####
 
SIGNATURE OF BUYER
 /s/  Laura Ortmeyer  
 
DATE
3/25/08
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.: 007 (Revised)
REQ NO.: NR 886 ###-###-####
CONTRACT NO.: C306118005
BUYER: Laura Ortmeyer
TITLE: Medicaid Managed Care -Eastern Region
PHONE NO.: (573) 751-4579
ISSUE DATE: 3/21/08
E-MAIL: ***@***

  TO:  
HARMONY HEALTH PLAN INC
23 PUBLIC SQUARE STE 400
BELLEVILLE, IL 62220

RETURN AMENDMENT NO LATER THAN: MARCH 26, 2008 AT 12:00 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) 608-8157
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
March 26, 2008
PRINTED NAME
Heath Schiesser
TITLE
President and CEO
 
 

 
 
 
 

AMENDMENT #007 (Revised) TO CONTRACT C306118005


CONTRACT TITLE:  MO HealthNet Managed Care – Eastern Region

CONTRACT PERIOD:   July 1, 2007 through June 30, 2008


The State of Missouri hereby amends the above-referenced contract in accordance with the following:

1.
Subparagraphs a. through c. of paragraph 1.1.1 of the RFP portion of the contract is hereby amended effective January 1, 2008 as follows:

 
1.1.1
This document constitutes a request for competitive, sealed proposals from the health plan provider community for becoming providers in the Missouri managed care program, hereinafter referred to as "MC+ managed care" in the following regions of the State of Missouri:

 
a.
Central Region:  Audrain, Benton, Boone, Callaway, Camden, Charition, Cole, Cooper, Gasconade, Howard, Laclede, Linn, Macon, Maries, Marion, Miller, Moniteau, Monroe, Montgomery, Morgan, Osage, Pettis, Phelps, Pulaski, Ralls, Randolph, Saline, and Shelby counties.

 
b.
Eastern Region:  Franklin, Jefferson, Lincoln, Madison, Perry , Pike, St. Charles, St. Francois, Ste. Genevieve, St. Louis, Warren and Washington counties and St. Louis, City.

2.
Paragraph 1.5.1 of the RFP portion of the contract is hereby amended effective January 1, 2008 as follows:

 
1.5.1
Effective July 1, 2006, the State of Missouri will continue a health care delivery program in Audrain, Boone, Callaway, Camden, Cass, Chariton, Clay, Cole, Cooper, Franklin, Gasconade, Henry, Howard, Jackson, Jefferson, Johnson, Lafayette, Lincoln, Miller, Moniteau, Monroe, Montgomery, Morgan, Osage, Pettis, Platte, Randolph, Ray, Saline, St. Charles, St. Clair, St. Francois, Ste, Genevieve, St. Louis, Warren and Washington counties and St. Louis City to serve MO HealthNet Managed Care eligibles meeting specified eligibility criteria.  Effective January 1, 2008, the State of Missouri will introduce the MO HealthNet Managed Care Program in seventeen (17) counties contiguous to the existing MO HealthNet Managed Care regions.  The new counties are:  Bates, Benton, Cedar, Laclede, Linn, Macon, Madison, Maries, Marion, Perry, Phelps, Pike, Polk, Pulaski, Ralls, Shelby, and Vernon.  The goal is to improve the accessibility and quality of health care services for MO HealthNet Managed Care and State aid eligible populations, while controlling the program's rate of cost increase.

3.
Paragraph 2.1.3 and subitems a. through m. of the RFP portion of the contract are hereby amended and subitems n. and o. are hereby deleted effective January 1, 2008 as follows:

 
2.1.3
The health plan awarded a contract for the Eastern region shall provide services to individuals determined eligible by the state agency for the Missouri MC+ Managed Care Program in all of the following thirteen areas in the State of Missouri:

 
a.
Franklin County
 
b.
Jefferson County
 
c.
Lincoln County
 
d.
Madison County
 
e.
Perry County
 
f.
Pike  County
 
g.
St. Charles County
 
h.
St. Francois County
 
i.
Ste. Genevieve County
 
j.
St. Louis County
 
k.
Warren County
 
l.
Washington County
 
m.
St. Louis City
 
 

 
4.
Paragraph 2.1.4 and subitems a. through bb. of the RFP portion of the contract are hereby amended and subitems cc. and dd. are hereby deleted effective January 1, 2008 as follows:

 
2.1.4
The health plan awarded a contract for the Central region shall provide services to individuals determined eligible by the state agency for the MO HealthNet Managed Care Program in all of the following twenty-eight areas in the State of Missouri:

 
 a.
Audrain County
 
 b.
Benton County
 
 c.
Boone County
 
 d.
Callaway County
 
 e.
Camden County
 
 f.
Chariton County
 
 g.
Cole County
 
 h.
Cooper County
 
 i.
Gasconade County
 
 j.
Howard County
 
 k.
Laclede County
 
 l.
Linn County
 
 m.
Macon County
 
 n.
Maries County
 
 o.
Marion County
 
 p.
Miller County
 
 q.
Moniteau County
 
 r.
Monroe County
 
 s.
Montgomery County
 
 t.
Morgan County
 
 u.
Osage County
 
 v.
Pettis County
 
 w.
Phelps County
 
 x.
Pulaski County
 
 y.
Ralls County
 
 z.
Randolph County
 
 aa.
Saline County
 
 bb.
Shelby County

5.
Attachment 1 is hereby revised effective January 1, 2008.

6.
Attachment 6, Exhibit 1 is hereby revised effective January 1, 2008.

7.
Attachment 9 is hereby revised effective January 1, 2008.

8.
Attachment 10 is hereby revised effective January 1, 2008.

The contractor shall indicate in Column 2 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, including the above stated changes.  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.

 
All other terms, conditions and provisions of the contract shall remain the same and apply hereto.

The contractor shall sign and return this document, on or before the date indicated, signifying acceptance of the amendment.


 
 
 
 

January 1, 2008
Category of Aid
Age
Sex
Column 1
  
Column 2
     
State's Maximum Net Capitation Rate
(Per Member, Per Month)
Firm Fixed Net Capitation Rate
(Per Member, Per Month)
1
Newborn < 01
Male and Female
$
$902.13
  
$
902.13
1
01 - 06
Male and Female
$
$131.02
  
$
131.02
1
07 - 13
Male and Female
$
$102.52
  
$
102.52
1
14 - 20
Female
$
$320.94
  
$
320.94
1
14 - 20
Male
$
$131.64
  
$
131.64
1
21 - 44
Female
$
$437.92
  
$
437.92
1
21 - 44
Male
$
$199.77
  
$
199.77
1
45 - 99
Male and Female
$
$459.29
  
$
459.29
4
00 - 20
Male and Female
$
$244.16
  
$
244.16
               
5
00 - 06
Male and Female
$
$161.15
  
$
161.15
5
07 - 13
Male and Female
$
$124.74
  
$
124.74
5
14 - 18
Male and Female
$
$183.18
  
$
183.18