EXHIBIT 10.2
FIRST AMENDMENT
TO THE
CONTRACT BETWEEN
THE OFFICE OF MEDICAID POLICY AND PLANNING,
THE OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM
AND
COORDINATED CARE CORPORATION INDIANA, INC.
This FIRST AMENDMENT to the above-referenced Contract is made and
entered into by and between the State of Indiana [hereinafter "State" of "State
of Indiana"], through the Office of Medicaid Policy and Planning and Office of
the Children's Health Insurance Program [hereinafter called "Office"], of the
Indiana Family and Social Services Administration, 000 Xxxx Xxxxxxxxxx Xxxxxx,
Xxxx X000, Xxxxxxxxxxxx, Xxxxxxx 00000, and Coordinated Care Corporation
Indiana, Inc., doing business as Managed Health Services, 000 Xxxxx Xxxxxxxx,
Xxxxx 000, Xxxxxxxxxxxx, Xxxxxxx., (hereinafter "Contractor").
WHEREAS, the State of Indiana and Contractor have previously entered
into a contract for a term beginning January 1, 2001 and ending December 31,
2002, [hereinafter "the original contract"] for services to arrange for and to
administer a risk-based managed care (RBMC) program for certain Hoosier
Healthwise enrollees in packages A, B and C as procured through Broad Agency
Announcement (BAA) 01-28;
WHEREAS, the parties desire to further extend the duties to be
performed by the Contractor due to mandatory risk-based managed care (RBMC)
enrollment in certain counties, pursuant to IC 00-00-00-00;
NOW THEREFORE, the parties enter into this FIRST AMENDMENT for the
consideration set out below, all of which is deemed to be good and sufficient
consideration in order to make this FIRST AMENDMENT a binding legal instrument.
1. The parties hereby ratify and incorporate herein each term and
condition set out in the original contract, as well as all written
matters incorporated therein except as specifically provided for by
this FIRST AMENDMENT.
2. The term of this amendment is from April 1, 2002, through December 31,
2002, subject to the termination and/or extension provisions as
provided for under the original contract.
3. The parties agree that the BAA is amended to add the following
additional Contractor Duties:
A. Section 3.6.1.3 of the BAA is amended to require the
Contractor to submit the "Mandatory RBMC Transition Report"
(Attachment A) according the schedule set out in the "2002
Hoosier Healthwise MCO Reporting Calendar for Mandatory RBMC
Transition Report" (Attachment B), unless the MCO has received
written notification from OMPP that the report, or certain
data elements in the report, is/are no longer required or may
be reported less frequently.
MCO Contract, First Amendment Coordinated Care Corp. of Indiana, Inc.
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B. The parties agree that Section 3.6.3 of the BAA is amended to
require the Contractor to obtain written approval of the State
prior to closing its provider networks, which shall not be
unreasonably withheld or delayed.
C. The parties agree that Sections 3.6.6 and 3.6.7.3 of the BAA
are amended to require the Contractor to maintain a monthly
telephone abandonment rate equal to or less than five percent
of calls received each by the member helpline and provider
helpline. The parties agree that BAA Section 3.16 is amended
to add a new section 3.16.8 to read as follows:
Section 3.16.8 The MCO will comply with the call
abandonment requirements for the member and provider
helplines described in Sections 3.6.6. and 3.6.7.3 of
this BAA. Because actual damages caused by
non-compliance are not subject to exact
determination, the State will assess the MCO, as
liquidated damages and not as a penalty, (a) two
hundred dollars ($200.00) for each business day the
MCO fails to submit required documentation to provide
evidence of compliance with this requirement, or (b)
two thousand dollars ($2000.00) for each month the
MCO fails to meet the requirement after 2 consecutive
months of non-compliance on the member helpline or
(c) two thousand dollars ($2000.00) for each month
the MCO fails to meet the requirement after 2
consecutive months of non-compliance on the provider
helpline.
D. The parties agree that Section 3.5.3 of the BAA is amended to
allow OMPP to change, at OMPP's discretion, the frequency of
the MCO Enrollment Rosters generated by OMPP's fiscal agent to
once per month, upon reasonable and adequate prior written
notice to the Contractor.
E. The parties agree that Section 3.6.3 of the BAA is amended to
require the Contractor to develop and adhere to a plan for
identifying and serving people with special needs. The plan
must satisfy any applicable federal requirements.
4. The parties agree that, in consideration of the services to be
performed by the Contractor as delineated in this First Amendment and
the original contract, the Offices' will adjust the capitation rates,
as contained in the Offices' capitation payment listing, as the
counties transition to mandatory MCO enrollment. The rate adjustment
factors shown in the following table will be applied to the base rates
for the entire region upon implementation of mandatory enrollment for
the specified county or county combinations. The base rates for the
region are the rates in effect on January 1, 2002, without any
adjustment for mandatory enrollment.
REGION COUNTY PACKAGE A/B PACKAGE C
------ ------ ----------- ---------
North Xxxxx 0.9% 1.7%
North Elkhart 0.7% 0.9%
North St. Xxxxxx 1.4% 1.6%
North Lake 2.1% 2.1%
MCO Contract, First Amendment Coordinated Care Corp. of Indiana, Inc.
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REGION COUNTY PACKAGE A/B PACKAGE C
------ ------ ----------- ---------
North Xxxxx/Elkhart 1.4% 2.2%
North Xxxxx/St. Xxxxxx 1.9% 2.5%
North Xxxxx/Lake 2.4% 2.8%
North Elkhart/St. Xxxxxx 1.8% 2.1%
North Elkhart/Lake 2.6% 2.8%
North Lake/St. Xxxxxx 2.6% 2.8%
North Xxxxx/Elkhart/ St. Xxxxxx 2.2% 2.8%
North Xxxxx/Elkhart/ Lake 2.7% 3.1%
North Elkhart/St. Xxxxxx/Lake 2.8% 3.0%
North Xxxxx/Elkhart/St. Xxxxxx/Lake 3.0% 3.4%
Central Xxxxxx 1.8% 2.1%
Central Xxxxxxxx 0.3% 0.6%
Central Xxxxxx/Hamilton 1.9% 2.3%
South Vanderburgh 4.1% 3.7%
5. The Contractor agrees to provide OMPP with prior written notice at
least ninety (90) days in advance of their inability to maintain a
sufficient Primary Medical Provider (PMP) network in any of the
counties where mandatory RBMC has been or will be implemented,
including Marion, Allen, Elkhart, St. Xxxxxx, Lake, Hamilton, and
Vanderburgh Counties, such that the program would not be able to
maintain the appropriate member choice of two (2) MCOs, pursuant to
federal requirements.
6. The Contractor agrees that agreements with PMPs in mandatory RBMC
counties shall comply with the following requirements:
A. Any PMP agreements entered into on or after April 1, 2002,
shall include a provision allowing the PMP to terminate the
agreement for any reason upon written notice to the
Contractor. The Contractor may require that the physician
provide said notice to the Contractor up to ninety (90) days
prior to termination.
B. Any PMP agreements entered into before April 1, 2002, in which
the initial term, as defined in the agreement, will expire on
or after June 30, 2002, will be amended by July 1, 2002, to
allow the PMP to terminate the agreement for any reason upon
written notice to the Contractor. The Contractor may require
that the physician provide said notice to the Contractor up to
ninety (90) days prior to termination. The Contractor agrees
to notify these PMPs, by April 30, 2002, that their agreements
will be amended and that they may terminate the agreement upon
ninety (90) days written notice.
C. The Contractor agrees that PMP agreements in which the initial
term has expired, or will expire before July 1, 2002, may be
terminated by the PMP for any reason upon one hundred twenty
(120) days written notice to the Contractor. The Contractor
agrees to notify the PMPs whose initial agreement term has
expired that they may terminate the agreement upon one hundred
twenty (120) days written notice. If an agreement described in
this paragraph is amended for any reason, the agreement shall
include a provision allowing the PMP to terminate the
agreement for any reason upon written
MCO Contract, First Amendment Coordinated Care Corp. of Indiana, Inc.
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notice to the Contractor. The Contractor may require that the
physician provide said notice to the Contractor up to ninety
(90) days prior to termination.
7. The parties agree that this First Amendment has been duly prepared and
executed pursuant to Section VII.B. of the original contract.
8. The undersigned attests, subject to the penalties for perjury, that he
is the contracting party, or that he is the representative, agent,
member or officer of the contracting party, that he has not, nor has
any other member employee, representative, agent or officer of the
firm, company, corporation or partnership represented by him, directly
or indirectly, to the best of his knowledge, entered into or offered to
enter into any combination, collusion or agreement to receive or pay,
and that he has not received or paid, any sum of money or other
consideration for the execution of this agreement other than that which
appears upon the face of the agreement.
MCO Contract, First Amendment Coordinated Care Corp. of Indiana, Inc.
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WHEREOF, the parties have executed this Contract.
For the Contractor: For the State of Indiana:
/s/ Xxxx Xxxxxxx-Xxxxx /s/ Xxxxxxx X. Bella
------------------------------ --------------------------------
Xxxx Xxxxxxx-Xxxxx Xxxxxxx M. Bella
Plan President and CEO Assistant Secretary
Coordinated Care Corporation Indiana, Inc. Office of Medicaid Policy and
Planning
Date: 4-5-02 Date: 4-8-02
----------- -----------
Xxxxxxx X. Xxxxx, Director
APPROVED: Office of Children's Health
Insurance Program
Xxxxx Xxxxxxx, Director Date:
State Budget Agency -----------
Date:
-----------
APPROVED AS TO FORM AND APPROVED:
LEGALITY:
------------------------------ --------------------------------
Xxxxxxx Xxxxxx Xxxxx X. Xxxxxxxx Commissioner
Attorney General of Indiana Department of Administration
Date: Date:
----------- -----------
MCO Contract, First Amendment Coordinated Care Corp. of Indiana, Inc.
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