Exhibit 10.28a
STATE OF NEW JERSEY
DEPARTMENT OF HUMAN SERVICES
DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES
AND
UNIVERSITY HEALTH PLANS, INC.
AGREEMENT TO PROVIDE HMO SERVICES
In accordance with Article 7, section 7.11.2A and 7.11.2B of the contract
between University Health Plans, Inc. and the State of New Jersey, Department
of Human Services, Division of Medical Assistance and Health Services (DMAHS),
effective date October 1, 2000, all parties agree that the contract shall
be amended, effective July 1, 2002, as follows:
1. ARTICLE 1, "DEFINITIONS" SECTION - for the following definitions:
Assignment; Centers for Medicare and Medicaid Services (new definition);
Complaint; Department; Division of Disability Services (new definition);
DHSS or HHS; Drug Utilization Review (new definition); Early and Periodic
Screening, Diagnosis and Treatment/Private Duty Nursing (EPSDT/PDN) (new
definition); GA (deleted); GAAP (deleted); HCFA; Incurred But Not Reported
(IBNR) (moved from A.7.21); Maternity Outcome (moved from A.7.21);
Medicare + Choice Organization; New Jersey State Plan or State Plan; NJ
FamilyCare Plan A; NJ FamilyCare Plan C; NJ FamilyCare Plan D; PMPD
(moved from A.7.21); PMPM (moved from A.7.21); Private Duty Nursing (PDN);
and Risk Pool (moved from A.7.21) shall be amended as reflected in the
relevant pages of Article 1 attached hereto and incorporated herein.
2. ARTICLE 2, "CONDITIONS PRECEDENT", Sections 2.G.1; 2.H; 2.J.2; and 2.K.2(b)
shall be amended as reflected in Article 2, Sections 2.G.1; 2.H; 2.J.2;
2.K.2(b) attached hereto and incorporated herein.
3. ARTICLE 3, "MANAGED CARE MANAGEMENT INFORMATION SYSTEM", paragraph one; and
Sections 3.4.2(A), 3.4.2(B), 3.4.2(C), 3.4.2(E) and 3.9.1(C) shall be
amended as reflected in Article 3, paragraph one; Sections 3.4.2(A),
3.4.2(B), 3.4.2(C), 3.4.2(E), 3.9.1(C) attached hereto and incorporated
herein.
4. ARTICLE 4, "PROVISION OF HEALTH CARE SERVICES", Section 4.1.1(D), 4.1.1(E),
and 4.1.1(J); Section 4.1.5(A); Section 4.1.6(B)3, 4.1.6(C)33; Section
4.1.8(E), remaining items re-lettered; and
Section 4.2.4(B)5(b) and (f), 4.2.4(B)6, 4.2.4(B)6(b) and (c);
Section 4.2.4(E) (new); Section 4.2.6(A)4; Section 4.2.7(D)1; and
Section 4.5.4(B), 4.5.4(C)1 and 4.5.4(E); Section 4.5.7(B)4 (new),
and 4.5.7(B)5 (new); and
Section 4.6.2(F); 4.6.2(P), 4.6.2(Q), 4.6.2(Q)1, 4.6.2(R)1, 4.6.2(R)1(g),
4.6.2(R)2, 4.6.2(R)3, 4.6.2(R)3(c)i, 4.6.2(S), 4.6.2(T), 4.6.2(W)-paragraph 2,
4.6.2(Z) and 4.6.2(AA); Section 4.6.4(C)5, 4.6.4(D), 4.6.4(D)4 (new), 4.6.4(D)5
(new), 4.6.4(D)6 (new), 4.6.4(D)7 (new); and Section 4.6.5(C)2; and
Section 4.7.2(A)3, and 4.7.2(A)5; Section 4.7.4(B)5(a) through (m); and
Section 4.8.2(A); Section 4.8.3, and 4.8.3(B); Section 4.8.4; Section
4.8.5; Section 4.8.6(A); Section 4.8.8(A)2(a), 4.8.8(J), 4.8.8(K)3, 4.8.8(L)3,
4.8.8(L)4, 4.8.8(L)8, 4.8.8(L)10 (new), 4.8.8(L)11 (new); and
Section 4.9.1(G), 4.9.1(L) (new); Section 4.9.2(E); Section 4.9.3(B),
4.9.3(B)2; and Section 4.10(E)
shall be amended as reflected in Article 4, Section 4.1.1(D), 4.1.1(E),
4.1.1(J); Section 4.1.5(A); Section 4.1.6(B)3, 4.1.6(C)33; Section 4.1.8(E),
remaining items re-lettered; Section 4.2.4(B)5(b) and (f), 4.2.4(B)6,
4.2.4(B)6(b) and (c); Section 4.2.4(E) (new); Section 4.2.6(A)4; Section
4.2.7(D)1; Section 4.5.4(B), 4.5.4(C)1, 4.5.4(E); Section 4.5.7(B)4 (new),
4.5.7(B)5 (new); Section 4.6.2(F), 4.6.2(P), 4.6.2(Q), 4.6.2(Q)1, 4.6.2(R)1,
4.6.2(R)1(g), 4.6.2(R)2, 4.6.2(R)3, 4.6.2(R)3(c)i, 4.6.2(S), 4.6.2(T),
4.6.2(W)-paragraph 2, 4.6.2(Z), 4.6.2(AA); Section 4.6.4(C)5, 4.6.4(D),
4.6.4(D)4 new, 4.6.4(D)5 new, 4.6.4(D)6 new, 4.6.4(D)7 new; Section 4.6.5(C)2;
Section 4.7.2(A)3, 4.7.2(A)5; Section 4.7.4(B)5(a) through (m); Section
4.8.2(A); Section 4.8.3, 4.8.3(B); Section 4.8.4; Section 4.8.5; Section
4.8.6(A); Section 4.8.8(A)2(a), 4.8.8(J), 4.8.8(K)3, 4.8.8(L)3, 4.8.8(L)4,
4.8.8(L)8, 4.8.8(L)10 (new), 4.8.8(L)11 (new); Section 4.9.1(G), 4.9.1(L) (new);
Section 4.9.2(E); Section 4.9.3(B) 4.9.3(B)2; and Section 4.10(E) attached
hereto and incorporated herein.
5. ARTICLE 5,"ENROLLEE SERVICES", Section 5.3.2 and Section 5.4(A); and
Section 5.8.2(R), 5.8.2(R)2 and Section 5.8.5(B); and
Section 5.10.2(A)2(a)ii and iii; Section 5.10.3(A)3; Section
5.10.4(A)5; and
Section 5.15 (title); Section 5.15.1(A), 5.15.1(B), 5.15.1(C),
5.15.1(D), Section 5.15.2 (title); Section 5.15.2(A), 5.15.2(B), 5.15.2(B)1
through 9; Section 5.15.3 (title); Section 5.15.3(A), 5.15.3(B), 5.15.3(C),
5.15.3(D); Section 5.15.4 (title); Section 5.15.4(A), 5.15.4(B), 5.15.4(C),
5.15.4(D), 5.15.4(E), 5.15.4(F); Section 5.15.5(A), 5.15.5(B), 5.15.5(B)2
through 8; 5.15.5(C)1 and 2; and
Section 5.16.1(A), 5.16.1(G), 5.16.1(U)2 (deleted); and Section
5-16.2(A)2 shall be amended as reflected in Article 5, Section 5.3.2; Section
5.4(A); Section 5.8.2(R), 5.8.2(R)2; Section 5.8.5(B); Section
5.10.2(A)2(a)ii and iii; Section 5.10.3(A)3; Section 5.10.4(A)5; Section
5.15 (title); Section 5.15.1(A), 5.15.1(B), 5.15.1(C), 5.15.1(D), Section
5.15.2 (title); Section 5.15.2(A), 5.15.2(B), 5.15.2(B)1 through 9; Section
5.15.3 (title); Section 5.15.3(A), 5.15.3(B), 5.15.3(C), 5.15.3(D); Section
5.15.4 (title); Section 5.15.4(A), 5.15.4(B), 5.15.4(C), 5.15.4(D),
5.15.4(E), 5.15.4(F); Section 5.15.5(A), 5.15.5(B), 5.15.5(B)2 through 8;
5.15.5(C)1 and 2; Section 5.16.1(A), 5.16.1(G), 5.16.1(U)2 (deleted), and
Section 5.16.2(A)2 attached hereto and incorporated herein.
6. ARTICLE 6, "PROVIDER INFORMATION", Section 6.2(A)6; Section 6.5 (title);
Section 6.5(B), 6.5(B)1, 6.5(B)2, 6.5(C), 6.5(D), 6.5(D)1, 6.5(D)2, and
6.5(D)3 shall be amended as reflected in Article 6, Section 6.2(A)6, Section
6.5(title); Section 6.5(B), 6.5(B)1, 6.5(B)2, 6.5(C), 6.5(D), 6.5(D)1,
6.5(D)2, 6.5(D)3, attached hereto and incorporated herein.
7. ARTICLE 7, "TERMS AND CONDITIONS", Section 7.2(A), 7.2(B)1, 7.2(B)5,
(re-number remaining items); Section 7.3(A); Section 7.9; Section 7.11.2(D)
(deleted), remaining items re-lettered; and
Section 7.14(A)4, 7.14(C), 7.14(C)1(h), 7.14(C)2(c); Section 7.16.4;
Section 7.16.8.2(D) (new); and
Section 7.22(F); Section 7.26(F), 7.26(H), 7.26(I), and 7.26(J);
Section 7.27.1; and Section 7.42 shall be amended as reflected in Article
7, Section 7.2(A), 7.2(B)1, 7.2(B)5, re-number remaining items; Section
7.3(A); Section 7.9; Section 7.11.2(D); Section 7.14(A)4, 7.14(C),
7.14(C)1(h), 7.14(C)2(c); Section 7.16.4; Section 7.16.8.2(D) (new);
Section 7.22(F); Section 7.26(F); 7.26(H), 7.26(I), 7.26(J);
Section 7.27.1; and Section 7.42 attached hereto and incorporated herein.
8. ARTICLE 8, "FINANCIAL PROVISIONS", Section 8.4.1(A), 8.4.1(A)1, 8.4.1(A)2,
8.4.1(A)3, 8.4.1(B); Section 8.4.2; Section 8.4.3; Section 8.5.16, Section
8.5.18; and Section 8.6 shall be amended as reflected in Article 8, Section
8.4.1(A), 8.4.1(A)1, 8.4.1(A)2, 8.4.1(A)3, 8.4.1(B); Section 8.4.2; Section
8.4.3; Section 8.5.16; Section 8.5.18; and Section 8.6 attached hereto and
incorporated herein.
9. APPENDICES, TABLE OF CONTENTS - SECTION A: "REPORTS", A.7.7 - "Table 5 -
Hospital Specific Data"; A.7.19 - "Table 17 - Number of Enrollees by
Diagnosis" (deleted Table 17 and reserved section); A.7.21 - "Table 19 -
Income Statement by Rate Cell Grouping"(added to Table of Contents); A.7.22
- Table 20 - Lag Reports" (added to Table of Contents) shall be amended as
reflected in Appendices, Table of Contents - Section A: "Reports", A.7.7 -
"Table 6 - Hospital Specific Data"; A.7.19 - "Table 17 - "Number of
Enrollees by Diagnosis" (deleted Table 17 and reserved section); A.7.21 -
"Table 19 - Income Statement by Rate Cell Grouping"
(added to Table of Contents); A.7.22 - "Table 20 - Lag Reports" (added to
Table of Contents) attached hereto and incorporated herein.
10. TABLE OF CONTENTS - SECTION B: "REFERENCE MATERIALS", B.2.1 - "ABD
Phase-in" (deleted "ABD Phase-in" and reserved section); B.4.4 - "VFC
Vaccines" (deleted "VFC Vaccines" and reserved section); B.4.17 - "DUR
Standards" (added); B.7.3 - "Financial Guide" (added) shall be amended as
reflected in Table of Contents - Section B: "Reference Materials", B.2.1
"ABD Phase-in" (deleted "ABD Phase-in" and reserved section); B.4.4 - "VFC
Vaccines" (deleted "VFC Vaccines" and reserved section); B.4.17 - "DUR
Standards" (added); B.7.3 - "Financial Guide" (added) attached hereto and
incorporated herein.
11. SECTION A, "REPORTS", A.3.1 - "Electronic Media Provider File (deleted
reference to diskette, added electronic format); A.3.1 - "Attachment A -
Non-Institutional Provider File" (modified field names); A.7.7 - Table 5 -
"Hospital Specific Data" (replaced previous report tables); A.7.8 - Table 6
- "Statement of Revenues and Expenses" (deleted language in #21 and #24);
A.7.16 - Table 14 - "EPSDT Services" (added #2(d) and (e) and clarified
language in #3 and #4(g)); A.7.19 - Table 17 - "Number of Enrollees by
Diagnosis" (deleted Table 17 and reserved section); A.7.21 - Table 19 -
"Income Statement by Rate Cell Grouping" (deleted definitions, moved to
Article 1 and changed timeframes of reports due from semi-annually to
quarterly); A.7.22 - Table 20 - "Lag Reports" (changed timeframes of
reports from semi-annually to quarterly) shall be amended as reflected in
Section A, "Reports", A.3.1 - "Electronic Media Provider File" (deleted
reference to diskette, added electronic format); A.3.1 - "Attachment A -
Non-Institutional Provider File" (modified field names); A.7.7 - Table 5 -
"Hospital Specific Data"(replaced previous report tables); A.7.8 - Table 6
"Statement of Revenues and Expenses" (deleted language in #21 and #24);
A.7.16 - Table
14 "EPSDT Services" (added #2(d) and (e) and clarified language in #3 and
#4(g)); A.7.19 - Table 17 "Number of Enrollees by Diagnosis" (deleted Table
17 and reserved section); A.7.21 - Table 19 "Income Statement by Rate Cell
Grouping" (deleted definitions, moved to Article 1 and changed timeframes of
reports due from semi-annually to quarterly); A.7.22 - Table 20 "Lag
Reports" (changed timeframes of reports from semi-annually to quarterly)
attached hereto and incorporated herein.
12. APPENDICES, SECTION B, "REFERENCE MATERIALS", B.2.1 - "ABD Phase in"
(deleted and reserved section); B.4.1 - "Benefit Package" (clarified
definition of EPSDT/PDN, revised definition of post-acute care); B.4.3 -
"ACIP Recommended Childhood and Adolescent Immunization Schedule" (included
updated schedule); B.4.4 - "VFC Vaccines" (deleted and reserved section);
B.4.9 - "Mental Health/ Substance Abuse Screening Tool" (replaced with
revised tool); B.4.10 - "Centers of Excellence" (updated list); B.4.11 -
"County Case Management Units" (updated list); B.4.14 - "New Jersey Modified
QARI/QISMC Standards", Standard IX.F.1 (changed recredentialing cycle from
two to three years) and Standard IX.J.4 (included language regarding
reporting to Health Care Integrity and Protection Data Bank); B.4.17 - "DUR
Standards" (added new standards); B.5.2 - "Cost-Sharing Requirements for NJ
FamilyCare Plans C & D" (added language clarifying no cost-sharing for
certain groups); B.7.2 "Provider Contract/Subcontract Provisions" (corrected
citation in 2.J and added school based services language in 4.7) and B.7.3 -
"Financial Guide for Reporting Medicaid/NJ FamilyCare Rate Cell Grouping
Costs" (added guide) shall be amended as reflected in Appendices, Section B,
"Reference Materials", B.2.1 - "ABD Phase In" (deleted and reserved
section); B.4.1 - "Benefit Package" (clarified definition of EPSDT/PDN,
revised definition of post-acute care); B.4.3 - "ACIP Recommended Childhood
and Adolescent Immunization Schedule" (included updated schedule); B.4.4 -
"VFC
Vaccines" (deleted and reserved section); B.4.9 - "Mental Health/Substance
Abuse Screening Tool" (replaced with revised tool); B.4.10 - "Centers of
Excellence" (updated list); B.4.11 - "County Case Management Units"
(updated list); B.4.14 - "New Jersey Modified QARI/QISMC Standards",
Standard IX.F.1 (changed recredentialing cycle from two to three years) and
Standard IX.J.4 (included language regarding reporting to Health Care
Integrity and Protection Data Bank); B.4.17 - "DUR Standards" (added new
standards); B.5.2 - "Cost-Sharing Requirements for NJ FamilyCare Plans C &
D" (added language clarifying no cost-sharing for certain groups); B.7.2
"Provider Contract/Subcontract Provisions" (corrected citation in 2.J and
added school based services language in 4.7) and B.7.3 - "Financial Guide
for Reporting Medicaid/NJ FamilyCare Rate Cell Grouping Costs" (added
guide) attached hereto and incorporated herein.
13. APPENDICES, SECTION C, "CAPITATION RATES", shall be revised as reflected in
SFY 2003 Capitation Rates attached hereto and incorporated herein
All other terms and conditions of the October 1, 2000 contract and subsequent
amendments remain unchanged except as noted above.
The contracting parties indicate their agreement by their signatures.
UNIVERSITY HEALTH PLANS, INC. STATE OF NEW JERSEY
DEPARTMENT OF HUMAN SERVICES
BY: /s/ Xxxxxxxxx X. XxXxxx BY: /s/ Xxxxxxx X. Plant
_________________________ ________________________
XXXXXXX X. PLANT
TITLE: President & CEO TITLE: ACTING DIRECTOR, DMAHS
______________________
DATE: 5/7/02 DATE: 5/23/02
_______________________ _______________________
APPROVED AS TO FORM ONLY
ATTORNEY GENERAL
STATE OF NEW JERSEY
BY: /s/ Xxxxx Xxxxxx
_________________
DEPUTY ATTORNEY GENERAL
DATE: 5/20/02
_______________
