EIGHTH AMENDMENT TO MANAGED CARE ALLIANCE AGREEMENT
Exhibit 10.29
EIGHTH AMENDMENT TO
MANAGED CARE ALLIANCE AGREEMENT
THIS AMENDMENT (the “Amendment”) is entered into this 12th day of March, 2007 by and between CIGNA Health Corporation, for and on behalf of its CIGNA Affiliates (individually and collectively, “CIGNA”) and Gentiva CareCentrix, Inc. (“MCA”).
WITNESSETH
WHEREAS, CIGNA and MCA entered into a Managed Care Alliance Agreement which became effective January 1, 2004, as amended from time to time, (the “Agreement”) whereby MCA agreed to provide or arrange for the provision of certain home health care services to Participants, as that term is defined in the Agreement;
WHEREAS, the parties wish to amend the Agreement to adjust DME/HME Respiratory rates to reflect a change in the Disetronics Insulin Pump effective March 15, 2007.
NOW THEREFORE, CIGNA and MCA agree to amend the Agreement as follows:
| 1. | This Amendment shall be effective on March 15, 2007. |
| 2. | DME/HME Respiratory Rates: HMO Rates effective February 1, 2006 – January 31, 2009 of Exhibit A HMO Program Attachment – Fee for Service Reimbursement For Other Services is hereby deleted and replaced with a new DME/HME Respiratory Rates: HMO Rates effective March 15, 2007 – January 31, 2009 of Exhibit A HMO Program Attachment – Fee for Service Reimbursement For Other Services attached hereto. These rates shall be effective through January 31, 2009 or the date that the Agreement is amended to reflect new rates, whichever is later. |
| 3. | DME/HME Respiratory Rates: PPO and Indemnity Rates effective February 1, 2006 – January 31, 2009 of Exhibit A PPO & Indemnity Program Attachment – Fee for Service Reimbursement For Other Services is hereby deleted and replaced with a new DME/HME Respiratory Rates: PPO and Indemnity Rates Effective March 15, 2007 – January 31, 2009 of Exhibit A PPO & Indemnity Program Attachment Reimbursement For Other Services attached hereto. These rates shall be effective through January 31, 2009 or the date that the Agreement is amended to reflect new rates, whichever is later. |
| 4. | DME/HME Respiratory Rates: Gatekeeper Rates effective February 1, 2006 – January 31, 2009 of Exhibit A Gatekeeper Program Attachment – Fee for Service Reimbursement For Other Services is hereby deleted and replaced with a new DME/HME Respiratory Rates: Gatekeeper Rates effective March 15, 2007 |
| – January 31, 2009 of Exhibit A Gatekeeper Program Attachment – Fee for Service Reimbursement For Other Services attached hereto. These rates shall be effective through January 31, 2009 or the date that the Agreement is amended to reflect new rates, whichever is later. |
| 5. | To the extent that the provisions in the Agreement, including any prior amendments, conflict with the terms of this Amendment (including the exhibits and schedules hereto), the terms in this Amendment shall supersede and control. All other terms and conditions of the Agreement, including the Program Attachments and the Exhibits attached thereto, shall remain the same and in full force and effect. Capitalized terms not defined herein but defined in the Agreement shall have the same meaning as defined in the Agreement. |
IN WITNESS WHEREOF, CIGNA and MCA have caused their duly authorized representatives to execute this Amendment as of the date first written above.
| CIGNA HEALTH CORPORATION | ||
| By: | /s/ Xxxxxx X. Xxxxxxx, III | |
| Its: | VP Network Strategy & Development | |
| Dated: | 03/14/2007 | |
| GENTIVA CARECENTRIX, INC. | ||
| By: | /s/ Xxxxxx Xxxxxxx | |
| Its: | Sr. Vice President | |
| Dated: | 03/09/2007 | |
DME / HME RESPIRATORY RATES:
HMO RATES EFFECTIVE MARCH 15, 2007
| CAT |
TYPE |
HCPCS |
CHC CODE |
CareCentrix |
DESCRIPTION |
PURCHASE |
RENTAL |
DAILY | ||||||||
| HME |
DIAB | A4230 | A4230 | 8009 | INFUSION SET FOR EXT INSULIN PUMP, NON NEEDLE TYPE (A4230) | ** | ||||||||||
| HME |
DIAB | A4231 | A4231 | 8012 | INFUSION SET FOR EXTERNAL INSULIN PUMP, NEEDLE TYPE (A4231) | ** | ||||||||||
| HME |
DIAB | A4232 | A4232 | 8013 | SYRINGE WITH NEEDLE FOR EXT INSULIN PUMP, STERILE, 3CC (A4232) | ** | ||||||||||
| HME |
DIAB | A4632 | A4632 | 8528 | REPLACEMENT BATTERY FOR EXT INFUSION PUMP, ANY TYPE, EA (A4632) | ** | ||||||||||
| HME |
DIAB | A4245 | A4245 | 8527 | ALCOHOL SWAB / SKIN BARRIER WIPES, BOX 50 (A4245) | ** | ||||||||||
| HME |
DIAB | A6257 | A6257 | 8529 | DRESSING <=16 SQ IN TRANSPARENT FILM, EA (A6257) | ** | ||||||||||
| HME |
INSULPP | E0784 | E0784 | 2158 | PUMP (E0784), EXT AMBULATORY INFUSION, MINIMED, INSULIN | ** | ||||||||||
| HME |
INSULPP | E0784 | E0784 | 8563 | PUMP DISETRONIC ACCU-CHEK SPIRIT, INSULIN (E0784) | ** | ||||||||||
| HME |
INSULPP | E0784 | E0784 | 7704 | PUMP, EXT INFUSION, XXXX DIABECARE, INSULIN (E0784) | ** | ||||||||||
| HME |
INSULPP | E0784 | E0784 | 7731 | PUMP, EXT INFUSION, ANIMAS, INSULIN (E0784) | ** | ||||||||||
| HME |
INSULPP | E0784 | E0784 | 7773 | PUMP (E0784), EXT AMBULATORY INFUSION, DELTEC, INSULIN | ** | ||||||||||
| HME |
OTHER | E0746 | DM570 | 2109 | ELECTROMYOGRAPHY (EMG) (E0746), BIOFEEDBACK DEVICE | ** | ** | |||||||||
| HME |
OTHER | E0935 | E0935 | 2125 | PASSIVE MOTION (E0935) EXERCISE DEVICE | ** | ||||||||||
| HME |
OTHER | E0935 | E0935 | 2857 | PASSIVE MOTION (E0935) EXERCISE DEVICE, HAND | ** | ||||||||||
| HME |
OTHER | E0935 | E0935 | 2858 | PASSIVE MOTION (E0935) EXERCISE DEVICE, SHOULDER | ** | ||||||||||
| HME |
OTHER | E0935 | E0935 | 2859 | PASSIVE MOTION (E0935) EXERCISE DEVICE, ANKLE | ** | ||||||||||
| HME |
OTHER | E0935 | E0935 | 2860 | PASSIVE MOTION (E0935) EXERCISE DEVICE, ELBOW | ** | ||||||||||
| HME |
OTHER | E0935 | E0935 | 2861 | PASSIVE MOTION (E0935) EXERCISE DEVICE, WRIST | ** | ||||||||||
| HME |
OTHER | E1300 | DM570 | 2062 | WHIRLPOOL (E1300), PORT (OVERTUB TYPE) | ** | ||||||||||
| HME |
OTHER | E1310 | DM570 | 2061 | WHIRLPOOL (E1399), NON-PORT (BUILT-IN TYPE) | ** | ||||||||||
| HME |
OTHER | E1399 | E1399 | 2327 | DURABLE MEDICAL EQUIP (E1399), MISCELLANEOUS | ** | ||||||||||
| HME |
STIM_BO | E0747 | DM570 | 6875 | STIMULATOR, OSTEOGENIC, ULTRASOUND | ** | ||||||||||
| HME |
STIM_BO | E0747 | DM570 | 8386 | STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, EBI | ** | ||||||||||
| HME |
STIM_BO | E0747 | DM570 | 8387 | STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, ORTHOFIX | ** | ||||||||||
| HME |
STIM_BO | E0747 | DM570 | 8388 | STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, ORTHOLOGIC | ** | ||||||||||
| HME |
STIM_BO | E0748 | DM570 | 2124 | STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL APPLICATIONS | ** | ||||||||||
| HME |
STIM_BO | E0748 | DM570 | 8389 | STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, EBI | ** | ||||||||||
| HME |
STIM_BO | E0748 | DM570 | 8390 | STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, ORTHOFIX | ** | ||||||||||
| HME |
STIM_BO | E0748 | DM570 | 8391 | STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, ORTHOLOGIC | ** | ||||||||||
| HME |
WDSUCT | K0538 | DM570 | 6873 | WOUND SUCTION DEVICE (K0538) | ** | ||||||||||
| HME |
WDSUCT | K0539 | DM570 | 7914 | DRESSING SET, FOR WOUND SUCTION DEVICE (K0539) | ** | ||||||||||
| HME |
WDSUCT | K0540 | DM570 | 7915 | CANISTER SET, FOR WOUND SUCTION DEVICE (K0540) | ** | ||||||||||
| The following may be charged under extraordinary circumstances: | ||||||||||||||||
| HME |
SUP | E1399 | E1399 | 4551 | LABOR/SERVICE/SHIPPING CHARGES | ** | ||||||||||
| HME |
SUP | E1399 | E1399 | 2731 | SHIPPING AND HANDLING FEES | ** | ||||||||||
| The following may be charged if over and above routine on rental equipment: | ||||||||||||||||
| RESP |
EQUIP | E1350 | E1350 | 2382 | REPAIR OR NON-ROUTINE (E1350) SERVICE REQUIRING SKILL OF A TECH | ** | ||||||||||
| HME |
SUP | E1399 | E1399 | 4552 | MISCELLANEOUS SUPPLIES | ** | ** | |||||||||
NOTES:
| 1. | Whether rental or purchase, rates include all shipping, labor and set-up. |
| 2. | If item is rented, rates include all supplies to enable the equipment to function effectively with the exception Suction and CPM. Such exception supplies will be billed at **. |
| 3. | If item is rented, rates include repair and maintenance costs. |
| ** | Confidential Treatment Requested. |
DME / HME RESPIRATORY RATES:
PPO and INDEMNITY RATES EFFECTIVE MARCH 15, 2007
| CAT |
TYPE |
HCPCS |
CHC |
CareCentrix |
DESCRIPTION |
PURCHASE |
RENTAL |
DAILY | ||||||||
| HME |
DIAB | A4230 | A4230 | 8009 | INFUSION SET FOR EXT INSULIN PUMP, NON NEEDLE TYPE (A4230) | ** | ||||||||||
| HME |
DIAB | A4231 | A4231 | 8012 | INFUSION SET FOR EXTERNAL INSULIN PUMP, NEEDLE TYPE (A4231) | ** | ||||||||||
| HME |
DIAB | A4232 | A4232 | 8013 | SYRINGE WITH NEEDLE FOR EXTINSULIN PUMP, STERILE, 3CC (A4232) | ** | ||||||||||
| HME |
DIAB | A4632 | A4632 | 8528 | REPLACEMENT BATTERY FOR EXT INFUSION PUMP, ANY TYPE, EA (A4632) | ** | ||||||||||
| HME |
DIAB | A4245 | A4245 | 8527 | ALCOHOL SWAB / SKIN BARRIER WIPES, BOX 50 (A4245) | ** | ||||||||||
| HME |
DIAB | A6257 | A6257 | 8529 | DRESSING <=16 SQ IN TRANSPARENT FILM, EA (A6257) | ** | ||||||||||
| HME |
INSULPP | E0784 | E0784 | 2158 | PUMP (E0784), EXT AMBULATORY INFUSION, MINIMED, INSULIN | ** | ||||||||||
| HME |
INSULPP | E0784 | E0784 | 8563 | PUMP DISETRONIC ACCU-CHEK SPIRIT, INSULIN (E0784) | ** | ||||||||||
| HME |
INSULPP | E0784 | E0784 | 7704 | PUMP, EXT INFUSION, XXXX DIABECARE, INSULIN (E0784) | ** | ||||||||||
| HME |
INSULPP | E0784 | E0784 | 7731 | PUMP, EXT INFUSION, ANIMAS, INSULIN (E0784) | ** | ||||||||||
| HME |
INSULPP | E0784 | E0784 | 7773 | PUMP (E0784), EXT AMBULATORY INFUSION, DELTEC, INSULIN | ** | ||||||||||
| HME |
OTHER | E0746 | DM570 | 2109 | ELECTROMYOGRAPHY (EMG) (E0746), BIOFEEDBACK DEVICE | ** | ** | |||||||||
| HME |
OTHER | E0935 | E0935 | 2125 | PASSIVE MOTION (E0935) EXERCISE DEVICE | ** | ||||||||||
| HME |
OTHER | E0935 | E0935 | 2857 | PASSIVE MOTION (E0935) EXERCISE DEVICE, HAND | ** | ||||||||||
| HME |
OTHER | E0935 | E0935 | 2858 | PASSIVE MOTION (E0935) EXERCISE DEVICE, SHOULDER | ** | ||||||||||
| HME |
OTHER | E0935 | E0935 | 2859 | PASSIVE MOTION (E0935) EXERCISE DEVICE, ANKLE | ** | ||||||||||
| HME |
OTHER | E0935 | E0935 | 2860 | PASSIVE MOTION (E0935) EXERCISE DEVICE, ELBOW | ** | ||||||||||
| HME |
OTHER | E0935 | E0935 | 2861 | PASSIVE MOTION (E0935) EXERCISE DEVICE, WRIST | ** | ||||||||||
| HME |
OTHER | E1300 | DM570 | 2062 | WHIRLPOOL (E1300), PORT (OVERTUB TYPE) | ** | ||||||||||
| HME |
OTHER | E1310 | DM570 | 2061 | WHIRLPOOL (E1399), NON-PORT (BUILT-IN TYPE) | ** | ||||||||||
| HME |
OTHER | E1399 | E1399 | 2327 | DURABLE MEDICAL EQUIP (E1399), MISCELLANEOUS | ** | ||||||||||
| HME |
STIM_BO | E0747 | DM570 | 6875 | STIMULATOR, OSTEOGENIC, ULTRASOUND | ** | ||||||||||
| HME |
STIM_BO | E0747 | DM570 | 8386 | STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, EBI | ** | ||||||||||
| HME |
STIM_BO | E0747 | DM570 | 8387 | STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, ORTHOFIX | ** | ||||||||||
| HME |
STIM_BO | E0747 | DM570 | 8388 | STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, ORTHOLOGIC | ** | ||||||||||
| HME |
STIM_BO | E0748 | DM570 | 2124 | STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL APPLICATIONS | ** | ||||||||||
| HME |
STIM_BO | E0748 | DM570 | 8389 | STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, EBI | ** | ||||||||||
| HME |
STIM_BO | E0748 | DM570 | 8390 | STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, ORTHOFIX | ** | ||||||||||
| HME |
STIM_BO | E0748 | DM570 | 8391 | STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, ORTHOLOGIC | ** | ||||||||||
| HME |
WDSUCT | K0538 | DM570 | 6873 | WOUND SUCTION DEVICE (K0538) | ** | ||||||||||
| HME |
WDSUCT | K0539 | DM570 | 7914 | DRESSING SET, FOR WOUND SUCTION DEVICE (K0539) | ** | ||||||||||
| HME |
WDSUCT | K0540 | DM570 | 7915 | CANISTER SET, FOR WOUND SUCTION DEVICE (K0540) | ** | ||||||||||
| The following may be charged under extraordinary circumstances: | ||||||||||||||||
| HME |
SUP | E1399 | E1399 | 4551 | LABOR/SERVICE/SHIPPING CHARGES | ** | ||||||||||
| HME |
SUP | E1399 | E1399 | 2731 | SHIPPING AND HANDLING FEES | ** | ||||||||||
| The following may be charged if over and above routine on rental equipment: | ||||||||||||||||
| RESP |
EQUIP | E1350 | E1350 | 2382 | REPAIR OR NON-ROUTINE (E1350) SERVICE REQUIRING SKILL OF A TECH | ** | ||||||||||
| HME | SUP | E1399 | E1399 | 4552 | MISCELLANEOUS SUPPLIES | ** | ** | |||||||||
NOTES:
| 1. | Whether rental or purchase, rates include all shipping, labor and set-up. |
| 2. | If item is rented, rates include all supplies to enable the equipment to function effectively with the exception Suction and CPM. Such exception supplies will be billed at **. |
| 3. | If item is rented, rates include repair and maintenance costs. |
| ** | Confidential Treatment Requested. |
DME / HME RESPIRATORY RATES:
GATEKEEPER RATES EFFECTIVE MARCH 15, 2007
| CAT |
TYPE |
HCPCS |
CHC |
CareCentrix |
DESCRIPTION |
PURCHASE |
RENTAL |
DAILY | ||||||||
| HME |
DIAB | A4230 | A4230 | 8009 | INFUSION SET FOR EXT INSULIN PUMP, NON NEEDLE TYPE (A4230) | ** | ||||||||||
| HME |
DIAB | A4231 | A4231 | 8012 | INFUSION SET FOR EXTERNAL INSULIN PUMP, NEEDLE TYPE (A4231) | ** | ||||||||||
| HME |
DIAB | A4232 | A4232 | 8013 | SYRINGE WITH NEEDLE FOR EXTINSULIN PUMP, STERILE, 3CC (A4232) | ** | ||||||||||
| HME |
DIAB | A4632 | A4632 | 8528 | REPLACEMENT BATTERY FOR EXT INFUSION PUMP, ANY TYPE, EA (A4632) | ** | ||||||||||
| HME |
DIAB | A4245 | A4245 | 8527 | ALCOHOL SWAB / SKIN BARRIER WIPES, BOX 50 (A4245) | ** | ||||||||||
| HME |
DIAB | A6257 | A6257 | 8529 | DRESSING <=16 SQ IN TRANSPARENT FILM, EA (A6257) | ** | ||||||||||
| HME |
INSULPP | E0784 | E0784 | 2158 | PUMP (E0784), EXT AMBULATORY INFUSION, MINIMED, INSULIN | ** | ||||||||||
| HME |
INSULPP | E0784 | E0784 | 8563 | PUMP DISETRONIC ACCU-CHEK SPIRIT, INSULIN (E0784) | ** | ||||||||||
| HME |
INSULPP | E0784 | E0784 | 7704 | PUMP, EXT INFUSION, XXXX DIABECARE, INSULIN (E0784) | ** | ||||||||||
| HME |
INSULPP | E0784 | E0784 | 7731 | PUMP, EXT INFUSION, ANIMAS, INSULIN (E0784) | ** | ||||||||||
| HME |
INSULPP | E0784 | E0784 | 7773 | PUMP (E0784), EXT AMBULATORY INFUSION, DELTEC, INSULIN | ** | ||||||||||
| HME |
OTHER | E0746 | DM570 | 2109 | ELECTROMYOGRAPHY (EMG) (E0746), BIOFEEDBACK DEVICE | ** | ** | |||||||||
| HME |
OTHER | E0935 | E0935 | 2125 | PASSIVE MOTION (E0935) EXERCISE DEVICE | ** | ||||||||||
| HME |
OTHER | E0935 | E0935 | 2857 | PASSIVE MOTION (E0935) EXERCISE DEVICE, HAND | ** | ||||||||||
| HME |
OTHER | E0935 | E0935 | 2858 | PASSIVE MOTION (E0935) EXERCISE DEVICE, SHOULDER | ** | ||||||||||
| HME |
OTHER | E0935 | E0935 | 2859 | PASSIVE MOTION (E0935) EXERCISE DEVICE, ANKLE | ** | ||||||||||
| HME |
OTHER | E0935 | E0935 | 2860 | PASSIVE MOTION (E0935) EXERCISE DEVICE, ELBOW | ** | ||||||||||
| HME |
OTHER | E0935 | E0935 | 2861 | PASSIVE MOTION (E0935) EXERCISE DEVICE, WRIST | ** | ||||||||||
| HME |
OTHER | E1300 | DM570 | 2062 | WHIRLPOOL (E1300), PORT (OVERTUB TYPE) | ** | ||||||||||
| HME |
OTHER | E1310 | DM570 | 2061 | WHIRLPOOL (E1399), NON-PORT (BUILT-IN TYPE) | ** | ||||||||||
| HME |
OTHER | E1399 | E1399 | 2327 | DURABLE MEDICAL EQUIP (E1399), MISCELLANEOUS | ** | ||||||||||
| HME |
STIM_BO | E0747 | DM570 | 6875 | STIMULATOR, OSTEOGENIC, ULTRASOUND | ** | ||||||||||
| HME |
STIM_BO | E0747 | DM570 | 8386 | STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, EBI | ** | ||||||||||
| HME |
STIM_BO | E0747 | DM570 | 8387 | STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, ORTHOFIX | ** | ||||||||||
| HME |
STIM_BO | E0747 | DM570 | 8388 | STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, ORTHOLOGIC | ** | ||||||||||
| HME |
STIM_BO | E0748 | DM570 | 2124 | STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL APPLICATIONS | ** | ||||||||||
| HME |
STIM_BO | E0748 | DM570 | 8389 | STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, EBI | ** | ||||||||||
| HME |
STIM_BO | E0748 | DM570 | 8390 | STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, ORTHOFIX | ** | ||||||||||
| HME |
STIM_BO | E0748 | DM570 | 8391 | STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, ORTHOLOGIC | ** | ||||||||||
| HME |
WDSUCT | K0538 | DM570 | 6873 | WOUND SUCTION DEVICE (K0538) | ** | ||||||||||
| HME |
WDSUCT | K0539 | DM570 | 7914 | DRESSING SET, FOR WOUND SUCTION DEVICE (K0539) | ** | ||||||||||
| HME |
WDSUCT | K0540 | DM570 | 7915 | CANISTER SET, FOR WOUND SUCTION DEVICE (K0540) | ** | ||||||||||
| The following may be charged under extraordinary circumstances: | ||||||||||||||||
| HME |
SUP | E1399 | E1399 | 4551 | LABOR/SERVICE/SHIPPING CHARGES | ** | ||||||||||
| HME |
SUP | E1399 | E1399 | 2731 | SHIPPING AND HANDLING FEES | ** | ||||||||||
| The following may be charged if over and above routine on rental equipment: | ||||||||||||||||
| RESP |
EQUIP | E1350 | E1350 | 2382 | REPAIR OR NON-ROUTINE (E1350) SERVICE REQUIRING SKILL OF A TECH | ** | ||||||||||
| HME |
SUP | E1399 | E1399 | 4552 | MISCELLANEOUS SUPPLIES | ** | ** | |||||||||
NOTES:
| 1. | Whether rental or purchase, rates include all shipping, labor and set-up. |
| 2. | If item is rented, rates include all supplies to enable the equipment to function effectively with the exception Suction and CPM. Such exception supplies will be billed at **. |
| 3. | If item is rented, rates include repair and maintenance costs. |
| ** | Confidential Treatment Requested. |
