STATE OF CONNECTICUT DEPARTMENT OF SOCIAL SERVICES CONTRACT AMENDMENT
Exhibit 10.3
STATE OF CONNECTICUT
DEPARTMENT OF SOCIAL SERVICES
Amendment Number: |
9 | |||
Contract #: |
093-MED-FCHP-1 | |||
Contract Period: |
08/11/2001 – 9/30/2004 | |||
Contract Name: |
FIRST CHOICE HEALTH PLAN OF CONNECTICUT, INC. | |||
Contractor Address: |
00 Xxxxxx Xxxx, Xxxxx Xxxxx, XX 00000-0000 | |||
Contract number 093-MED-FCHP-1 by and between the Department of Social Services (the “Department”) and Firstchoice Health Plan of CT (the “Contractor”) for the provision of services under the HUSKY B program as amended by Amendments 1, 2, 3, 4, 5, 6, 7 and 8 is hereby further amended as follows:
| 1. | Paragraph 1 of Part I as amended by Amendments 1, 2, 3, 4, 5, 6, 7 and 8 is further amended to extend the contract end date from December 31, 2003 to September 30, 2004. |
| 2. | Part II ‘GENERAL CONTRACT TERMS FOR MCOs” is deleted in its entirety and replaced with Part II “GENERAL CONTRACT TERMS FOR MCOS” dated December 12, 2003 pages 1 through 113 attached hereto and incorporated herein by reference. |
| 3 | Appendix I is amended by amendment 9 is deleted in its entirety and replaced with Appendix I attached hereto and incorporated herein by reference. The effective dates for appendix I are 10/01/03 through 9/30/04. |
ACCEPTANCES AND APPROVALS
This document constitutes an amendment to the above numbered contract. All provisions of that contract and prior amendments, except those explicitly changed or described above by this amendment, shall remain in full force and effect.
CONTRACTOR
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DEPARTMENT | |
FirstChoice HealthPlans of Connecticut, Inc.
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Department of Social Services | |
Xxxx X. Xxxxx 12/29/03
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_Michael X. Xxxxxxxxxx 12/30/03_ | |
Signature (Authorized Official) Date
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Signature (Authorized Official) Date | |
Xxxx X. Xxxxx Pres & CEO
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_Michael X. Xxxxxxxxxx Deputy Commissioner | |
Signature (Authorized Official) Title
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Signature (Authorized Official) Title |
OFFICE OF THE ATTORNEY GENERAL
Attorney General (as to form) Date
( ) This contract does not require the signature of the Attorney General pursuant to an agreement between the Department and the Office of the Attorney General dated:
APPENDIX A – Amended
Plan Name
FirstChoice
Capitation Rates 10/01/03 – 09/30/04 |
Fairfield | Hartford | Litchfield | Middlesex | New Haven | New London | Tolland | Xxxxxxx | ||||||||||||||||||||||||
Under One |
$ | 557.90 | $ | 631.16 | $ | 629.32 | $ | 745.86 | $ | 627.09 | $ | 624.00 | $ | 753.77 | $ | 604.77 | ||||||||||||||||
Ages 1 to 14 |
$ | 106.42 | $ | 114.88 | $ | 114.56 | $ | 135.30 | $ | 114.18 | $ | 113.60 | $ | 136.72 | $ | 112.01 | ||||||||||||||||
Male – Ages |
$ | 132.31 | $ | 143.96 | $ | 143.55 | $ | 169.02 | $ | 143.10 | $ | 142.41 | $ | 170.74 | $ | 140.59 | ||||||||||||||||
15 to 39 Female – Ages |
$ | 216.08 | $ | 240.74 | $ | 240.04 | $ | 284.72 | $ | 239.19 | $ | 237.99 | $ | 287.77 | $ | 231.99 | ||||||||||||||||
15-39 Male – Ages 40 |
$ | 236.43 | $ | 264.41 | $ | 263.62 | $ | 313.22 | $ | 262.69 | $ | 261.37 | $ | 316.58 | $ | 254.47 | ||||||||||||||||
and over Female – Ages |
$ | 227.26 | $ | 253.91 | $ | 253.15 | $ | 300.77 | $ | 252.26 | $ | 250.97 | $ | 304.02 | $ | 244.44 | ||||||||||||||||
40 and over
