AMENDMETN #2 TO CONTRACT NO. 0653 BETWEEN GEORGIA DEPARTMENT OF COMMUNITY HEALTH AND PEACH STATE HEALTH PLAN
Exhibit
10.1b
AMENDMETN #2 TO CONTRACT NO. 0653
BETWEEN
GEORGIA DEPARTMENT OF COMMUNITY
HEALTH AND
PEACH STATE HEALTH
PLAN
This Amendment is between the Georgia
Department of Community Health (hereinafter referred to as “DCH” or the
“Department”) and Peach State Health Plan (hereinafter referred to as
“Contractor”) and is made effective this 28th day of January, 2008 (hereinafter
referred to as the “Effective Date”). Other than the changes,
modifications and additions specifically articulated in this Amendment #2 to
Contract # 0653, RFP#00000-000-0000000000, the original Contract shall remain in
effect and binding on and against DCH and Contractor. Unless
expressly modified or added in this Amendment #2 as if completely restated
herein.
WHEREAS, DCH and Contractor
executed a contract for the provision of services to Georgia Healthy Families;
and,
WHEREAS, pursuant to Section 4.8.17.1, Network Changes, DCH
and Contractor have agreed that Contractor shall notify DCH within seven (7)
Business Days of any significant changes to the Provider network or, if
applicable, to any Subcontractor’s Provider Network; and,
WHEREAS, pursuant to Section 32.0, Amendments in Writing,
DCH and Contractor desire to amend the above-referenced Contract by adding
additional funding as set forth below.
NOW THEREFORE, for and in
consideration of the mutual promises of the Parties, the terms, provisions and
conditions of this Amendment and other good and valuable consideration, the
sufficiency of which is hereby acknowledged, DCH and Contractor hereby agree as
follows:
|
I.
|
To
delete the current Attachment H, Capitation
Payment, in its entirety and replace with the new Attachment H, Capitation
Payment, contained at Exhibit 1 to this
Amendment.
|
|
II.
|
To
amend the Contract by adding Section 4.8.17.6, which
reads as follows:
|
|
4.8.17.6
|
If
the Contractor fails to comply with the provisions of Section 4.8.17.1,
the per member per month capitation rate, used by DCH to compensate the
Contractor, will be reduced by 3.1% for the remaining term of the
Contract, including any renewals.
|
|
III.
|
To
amend the Contract by adding Section 4.8.17.7, which reads as
follows:
|
|
4.8.17.7
|
DCH
and Contractor acknowledge that any failure by Contractor to comply with
the terms of Section 4.8.17.1 would constitute a material failure to
implement the terms of the Contract and RFP. If liquidated
damages are assessed against the Contractor due to its failure to comply
with Section 4.8.17.1, the damages will be assessed in accordance with
Section 23.2.1 (Category 1).
|
|
IV.
|
DCH
and Contractor agree that they have assumed an obligation to perform the
covenants, agreements, duties and obligations of the Contract, as modified
and amended herein, and agree to abide by all the provisions, terms and
conditions contained in the Contract as modified and
amended.
|
|
V.
|
This
Amendment shall be binding and inure to the benefit of the parties hereto,
their heirs, representatives, successors and assigns. Whenever
the provisions of this Amendment and the Contract are in conflict, the
provisions of this Amendment shall take precedence and
control.
|
|
VI.
|
It
is understood by the Parties hereto that, if any part, term, or provision
of this Amendment or this entire Amendment is held to be illegal or in
conflict with any law of this State, then DCH, at its sole option, may
enforce the remaining unaffected portions or provisions of this amendment
or of the Contract and the rights and obligations of the parties shall be
construed and enforced as if the Contract or Amendment did not contain the
particular part, term or provision held to be
invalid.
|
|
VII.
|
This
Amendment shall become effective as stated herein and shall remain
effective for so long as the Contract is in
effect.
|
|
VIII.
|
This
Amendment shall be construed in accordance with the laws of the State of
Georgia.
|
|
IX.
|
All
other terms and conditions contained in the Contract and any amendment
thereto, not amended by this Amendment, shall remain in full force and
effect.
|
- SIGNATURES ON THE FOLLOWING PAGE
-
|
|
IN WITNESS WHEREOF, DCH
and Contractor, through their authorized officers and agents, have caused
this Amendment to be executed on their behalf as of the date
indicated.
|
GEORGIA DEPARTMENT OF COMMUNITY
HEALTH
| /s/ Xx. Xxxxxx X. Xxxxxx, M.D. | 1/28/08 | |
|
Xx.
Xxxxxx X. Xxxxxx, M.D.
Commissioner
|
Date
|
PEACH STATE HELATH
PLAN
|
BY:
|
Xxxxxxx Xxxxxx | Nov. 16, 2007 | |
|
*
SIGNATURE
|
Date
|
||
|
Xxxxxxx
Xxxxxx
|
|
AFFIX
CORPORATE SEAL HERE
(Corporations
without a seal, attach a Certificate of Corporate
Resolution)
|
|
ATTEST:
|
/s/ Xxxx Rock | ||
|
**
SIGNATURE
|
|||
|
VP,
Compliance & Regulatory Affairs
|
_____________________________________________________________________________
* Must be President, Vice President, CEO or Other Authorized Officer
* Must be President, Vice President, CEO or Other Authorized Officer
** Must
be Corporate Secretary
CONFIDENTIAL
– NOT FOR CIRCULATION
ATTACHMENT H
Attachment
H is a table displaying the contracted rates by rate cell for each contracted
region. These rates will be the basis for calculating capitation
payments in each contracted Region.
(The
table is displayed on the following page.)
Georgia
Department of Community Health
Fiscal
Year 2008 CMO Rates
|
PeachState
|
PeachState
|
|||
|
QA Fee:
|
6.00%
|
5.50%
|
||
|
Region
|
Aid
Category
|
Age/Gender
Group
|
July - Dec
2007
|
Jan - Jun
2008
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
0 -
2 Months, Male and Female
|
1,686.95
|
1,678.99
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
3 -
11 Months, Male and Female
|
175.88
|
175.05
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
119.24
|
118.68
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
6 -
13 Years, Male and Female
|
107.85
|
107.34
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Female
|
172.10
|
171.28
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Male
|
126.45
|
125.85
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Female
|
249.62
|
248.45
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Male
|
252.83
|
251.63
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
438.16
|
436.10
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
471.36
|
469.14
|
|
|
PeachCare
|
0 -
2 Months, Male and Female
|
179.39
|
178.55
|
|
|
PeachCare
|
3 -
11 Months, Male and Female
|
179.39
|
178.55
|
|
|
PeachCare
|
1 -
5 Years, Male and Female
|
104.48
|
103.98
|
|
|
PeachCare
|
6 -
13 Years, Male and Female
|
108.68
|
108.17
|
|
|
PeachCare
|
14
- 20 Years, Female
|
127.11
|
126.51
|
|
|
PeachCare
|
14
- 20 Years, Male
|
119.01
|
118.45
|
|
|
Breast
and Cervical Cancer
|
All
Ages
|
1,264.81
|
1,258.84
|
|
|
Maternity
Delivery/Kick Payment
|
6,777.77
|
6,745.80
|
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
0 -
2 Months, Male and Female
|
1,761.72
|
1,753.41
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
3 -
11 Months, Male and Female
|
215.31
|
214.29
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
127.66
|
127.06
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
6 -
13 Years, Male and Female
|
115.61
|
115.07
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Female
|
168.58
|
167.78
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Male
|
121.55
|
120.97
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Female
|
274.58
|
273.29
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Male
|
310.79
|
309.33
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
498.45
|
496.10
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
604.05
|
601.21
|
|
|
PeachCare
|
0 -
2 Months, Male and Female
|
183.03
|
182.16
|
|
|
PeachCare
|
3 -
11 Months, Male and Female
|
183.03
|
182.16
|
|
|
PeachCare
|
1 -
5 Years, Male and Female
|
120.36
|
119.79
|
|
|
PeachCare
|
6 -
13 Years, Male and Female
|
119.69
|
119.13
|
|
|
PeachCare
|
14
- 20 Years, Female
|
148.84
|
148.14
|
|
|
PeachCare
|
14
- 20 Years, Male
|
124.72
|
124.14
|
|
|
Breast
and Cervical Cancer
|
All
Ages
|
1,161.84
|
1,156.36
|
|
|
Maternity
Delivery/Kick Payment
|
6,631.61
|
6,600.33
|
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
0 -
2 Months, Male and Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
3 -
11 Months, Male and Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
6 -
13 Years, Male and Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Male
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Male
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
-
|
-
|
|
|
PeachCare
|
0 -
2 Months, Male and Female
|
-
|
-
|
|
|
PeachCare
|
3 -
11 Months, Male and Female
|
-
|
-
|
|
|
PeachCare
|
1 -
5 Years, Male and Female
|
-
|
-
|
|
|
PeachCare
|
6 -
13 Years, Male and Female
|
-
|
-
|
|
|
PeachCare
|
14
- 20 Years, Female
|
-
|
-
|
|
|
PeachCare
|
14
- 20 Years, Male
|
-
|
-
|
|
|
Breast
and Cervical Cancer
|
All
Ages
|
-
|
-
|
|
|
Maternity
Delivery/Kick Payment
|
-
|
-
|
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
0 -
2 Months, Male and Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
3 -
11 Months, Male and Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
6 -
13 Years, Male and Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Male
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Male
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
-
|
-
|
|
|
PeachCare
|
0 -
2 Months, Male and Female
|
-
|
-
|
|
|
PeachCare
|
3 -
11 Months, Male and Female
|
-
|
-
|
|
|
PeachCare
|
1 -
5 Years, Male and Female
|
-
|
-
|
|
|
PeachCare
|
6 -
13 Years, Male and Female
|
-
|
-
|
|
|
PeachCare
|
14
- 20 Years, Female
|
-
|
-
|
|
|
PeachCare
|
14
- 20 Years, Male
|
-
|
-
|
|
|
Breast
and Cervical Cancer
|
All
Ages
|
-
|
-
|
|
|
Maternity
Delivery/Kick Payment
|
-
|
-
|
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
0 -
2 Months, Male and Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
3 -
11 Months, Male and Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
6 -
13 Years, Male and Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Male
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Male
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
-
|
-
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
-
|
-
|
|
|
PeachCare
|
0 -
2 Months, Male and Female
|
-
|
-
|
|
|
PeachCare
|
3 -
11 Months, Male and Female
|
-
|
-
|
|
|
PeachCare
|
1 -
5 Years, Male and Female
|
-
|
-
|
|
|
PeachCare
|
6 -
13 Years, Male and Female
|
-
|
-
|
|
|
PeachCare
|
14
- 20 Years, Female
|
-
|
-
|
|
|
PeachCare
|
14
- 20 Years, Male
|
-
|
-
|
|
|
Breast
and Cervical Cancer
|
All
Ages
|
-
|
-
|
|
|
Maternity
Delivery/Kick Payment
|
-
|
-
|
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
0 -
2 Months, Male and Female
|
1,766.20
|
1,757.87
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
3 -
11 Months, Male and Female
|
242.09
|
240.95
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
145.16
|
144.48
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
6 -
13 Years, Male and Female
|
119.44
|
118.88
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Female
|
187.18
|
186.30
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Male
|
121.48
|
120.90
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Female
|
287.41
|
286.05
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Male
|
287.79
|
286.44
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
500.44
|
498.08
|
|
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
594.62
|
591.81
|
|
|
PeachCare
|
0 -
2 Months, Male and Female
|
183.74
|
182.87
|
|
|
PeachCare
|
3 -
11 Months, Male and Female
|
191.63
|
190.73
|
|
|
PeachCare
|
1 -
5 Years, Male and Female
|
129.04
|
128.43
|
|
|
PeachCare
|
6 -
13 Years, Male and Female
|
127.79
|
127.19
|
|
|
PeachCare
|
14
- 20 Years, Female
|
144.83
|
144.15
|
|
|
PeachCare
|
14
- 20 Years, Male
|
127.16
|
126.56
|
|
|
Breast
and Cervical Cancer
|
All
Ages
|
1,167.98
|
1,162.47
|
|
|
Maternity
Delivery/Kick Payment
|
6,679.51
|
6,648.01
|
|
