Amendment number 2 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
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EX-10.1 2 exhibit_10-1.htm EXHIBIT 10.1 Exhibit 10.1
RETURN AMENDMENT TO:
Back to Form 8-K
Exhibit 10.1
STATE OF MISSOURI
OFFICE OF ADMINISTRATION
DIVISION OF PURCHASING AND MATERIALS MANAGEMENT (DPMM)
CONTRACT AMENDMENT
| AMENDMENT NO.: 002 | REQ NO.: NR 886 ###-###-#### |
| CONTRACT NO.: C306118005 | BUYER: Laura Ortmeyer |
| TITLE: Medicaid Managed Care - Eastern Region | PHONE NO.: (573) 751-4579 |
| ISSUE DATE: 02/23/07 | E-MAIL: ***@*** |
TO: HARMONY HEALTH PLAN INC
23 PUBLIC SQUARE STE 400
BELLEVILLE, IL 62220
RETURN AMENDMENT NO LATER THAN: March 7, 2007 AT 5:00 PM CENTRAL TIME
RETURN AMENDMENT TO:
| (U.S. Mail) Div of Purchasing & Matls Mgt (DPMM) OR PO BOX 809 JEFFERSON CITY MO 65102-0809 | (Courier Service) Div of Purchasing & Matls Mgt (DPMM) 301 WEST HIGH STREET, ROOM 630 JEFFERSON CITY MO 65101 |
OR FAX TO: (573) 526-9817 (either mail or fax, not both)
DELIVER SUPPLIES/SERVICES FOB (Free On Board) DESTINATION TO THE FOLLOWING ADDRESS:
Missouri Department of Social Service
Division of Medical Services
P.O. Box 6500
Jefferson City, MO 65102-6500
SIGNATURE REQUIRED
| DOING BUSINESS AS (DBA) NAME 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, Illinois 62220 | CITY, STATE, ZIP CODE Chicago, Illinois 60606 |
| CONTACT PERSON Tina Gallagher | EMAIL ADDRESS ***@*** | ||
| PHONE NUMBER (800 ###-###-#### | FAX NUMBER 1 ###-###-#### | ||
| TAXPAYER ID NUMBER (TIN) 36 ###-###-#### | TAXPAYER ID (TIN) TYPE (CHECK ONE) _X__ 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/ Thaddeus Bereday | DATE March 22, 2007 | ||
| PRINTED NAME Thaddeus Bereday | TITLE Secretary | ||
AMENDMENT #002 TO CONTRACT C306118005
CONTRACT TITLE: Medicaid Managed Care - Eastern Region
CONTRACT PERIOD:July 1, 2006 through June 30, 2007
The State of Missouri hereby desires to amend the above-referenced contract, as follows, effective July 1, 2006:
In order to determine the impact of the eligibility changes implemented effective with fiscal year 2007 on the overall birth rate, the state agency’s actuary consultant conducted an analysis specific to the female child bearing rate cells in order to ensure the actuarially soundness of the rates. The attached Pricing Page reflects the actuarially sound rates determined as a result of the analysis.
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. 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, including all prices, 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.
| 5.3 East Region - Firm Fixed Net Capitation Pricing Page | ||||
| Category of Aid | Age | Sex | State's Maximum Net | Firm Fixed Net |
| | | Capitation Rate | Capitation Rate | |
| (Per Member Per Month) | (Per Member Per Month) | |||
| 1 | Newborn < 01 | Male and Female | $ 777.07 | $ 777.07 |
| 1 | 01 - 06 | Male and Female | $ 113.59 | $ 113.59 |
| 1 | 07 - 13 | Male and Female | $ 90.07 | $ 90.07 |
| 1 | 14 - 20 | Female | $ 269.72 | $ 269.72 |
| 1 | 14 - 20 | Male | $ 114.66 | $ 114.66 |
| 1 | 21 - 44 | Female | $ 368.27 | $ 368.27 |
| 1 | 21 - 44 | Male | $ 172.85 | $ 172.85 |
| 1 | 45 - 99 | Male and Female | $ 399.40 | $ 399.40 |
| 4 | 00 - 20 | Male and Female | $ 207.76 | $ 207.76 |
| | | | | |
| 5 | 00 - 06 | Male and Female | $ 140.03 | $ 140.03 |
| 5 | 07 - 13 | Male and Female | $ 108.12 | $ 108.12 |
| 5 | 14 - 18 | Male and Female | $ 158.18 | $ 158.18 |
