AMENDMENT TO HEALTH OPTIONS, INC. PARTICIPATION AGREEMENT (CAPITATION)
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AMENDMENT TO HEALTH OPTIONS, INC. PARTICIPATION AGREEMENT
(CAPITATION)
WHEREAS, the parties have entered into a Health Options, Inc. Participation Agreement (Capitation)("the Agreement") with initial effective date of June 1, 1997; and
WHEREAS, the parties are in the process of finalizing the terms of a new provider agreement to replace this Agreement given the anticipated enhanced utilization by HEALTH OPTIONS of the services of Provider going forward; and
WHEREAS, since the parties have agreed that the role of Provider under this Agreement has been modified to such an extent that it is necessary to amend this Agreement;
IT IS THEREFORE agreed as follows:
- 1.
- Attachment
A to this document, this attachment entitled "PAYMENT SCHEDULE," is made a part of this Agreement and hereby amends the Agreement as of 4/1/01; and
- 2.
- To the extent of any inconsistency between the terms of this document and the Agreement, the terms of this document control.
By signing below the parties hereby execute this document which so amends the Agreement.
PROVIDER | HEALTH OPTIONS, INC. | |||||
By: |
/s/ XXXXX XXX Its Authorized Agent |
By: |
/s/ XXXXXXX X. XXXXXX Its Authorized Agent |
|||
Date Signed: |
3/29/01 |
Date Signed: |
7/3/01 |
*A Confidential Treatment Request pursuant to Rule 24(B)-2 under the Securities Exchange Act Of 1934, as amended, for certain information in this document has been filed with the Securities and Exchange Commission. The information for which treatment has been sought has been deleted from such exhibit and the deleted text replaced by an asterisk (*).
BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.
AND
HEALTH OPTIONS, INC.
PHARMACY SERVICES AGREEMENT
I. CAPITATION
The amount of the Capitation Payment, prior to adjustments under this Agreement, for each Service Area Member shall be as follows:
Commercial Members; | $* per member per month | |
Medicare and More Members | $* per member per month |
Service Area members = Health Options Inc. and Medicare and More members located in the following counties:
Broward
Xxxx
Xxxxxx
Okeechobee
Palm Beach
St. Lucie
THE FOLLOWING SERVICES WILL BE INCLUDED IN THE CAPITATION RATE:
*
THE FOLLOWING ARE NOT INCLUDED IN THE CAPITATION RATE (PAID UNDER FEE FOR SERVICE PAYMENT RATE):
*
II. FEE FOR SERVICE PAYMENT RATE.
- •
- *
= AWP less *
- •
- *
= AWP less *
- •
- All
other injectible drugs (not including in the capitated arrangement) = AWP less *
- •
- *
will be reimbursed manually to OptionMed by Blue Cross and Blue Shield of Florida at * for the medication.
- •
- The
above prices include all supplies necessary for the administration of medications under this agreement
- •
- All
orphan and low availability drugs will be negotiated on a case by case basis.
- •
- The products and medications (for which industry accepted data exist to allow dispensing or distributing for administration in exact doses) will be provided and billed at the exact quantities prescribed by the physicians. Examples of such medications are Epogen, Neupogen and Procrit.
THE FOLLOWING ARE NOT INCLUDED UNDER THIS CONTRACT:
- •
- Nursing
Services
- •
- IDPN/Furrlicit
to Dialysis Centers
- •
- Services/items/drugs
not covered by the plan
- •
- Wound
care supplies
- •
- PICC
line supplies/Nursing
- •
- Synchromed Nursing
AMENDMENT TO HEALTH OPTIONS, INC. PARTICIPATION AGREEMENT (CAPITATION)
BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. AND HEALTH OPTIONS, INC. PHARMACY SERVICES AGREEMENT
ATTACHMENT A
PAYMENT SCHEDULE