Contract

Exhibit 10.4

CONFIDENTIAL TREATMENT OF PORTIONS OF PAGES 10 AND 11 OF THIS CONTRACT EXHIBIT HAS BEEN REQUESTED PURSUANT TO RULE 24b-2 OF THE SECURITIES EXCHANGE ACT OF 1934. THE OMITTED CONFIDENTIAL PORTIONS OF THE CONTRACT EXHIBIT HAVE BEEN FILED SEPARATELY WITH THE COMMISSION.

STATE OF CALIFORNIA
STANDARD AGREEMENT AMENDMENT
STD 213 A (DHS Rev 7/04)

			AGREEMENT NUMBER			AMENDMENT NUMBER
þ CHECK HERE IF ADDITIONAL PAGES ARE ADDED 17 PAGES			05-45908			A-02
			REGISTRATION NUMBER:

1. This Agreement is entered into between the State Agency and Contractor named below:

STATE AGENCY’S NAME		(Also referred to as CDHS, DHS, or the State)
California Department of Health Services
CONTRACTOR’S NAME		(Also referred to as Contractor)
Xxxxxx Healthcare of California Partner Plan, Inc.

2.		The term of this Agreement is June 30, 2005 through December 31, 2007
3.		The maximum amount of this Agreement is: $73,033,000
		Seventy Three Million, Thirty-three Thousand Dollars
4.		The parties mutually agree to this amendment as follows. All actions noted below are by this reference made a part of the Agreement and incorporated herein:

	1)		Amendment effective date: December 7, 2006
	2)		Purpose of amendment: To extend the Contract through December 31, 2007; to remove some aid codes; to amend the Non-Contracting Emergency Service Providers language; to remove Medicare Part D as a Covered Service; to amend the Alcohol and Substance Abuse Treatment Services language and to add its related Attachment 10-C; to add the Erectile Dysfunction language and to add its related Attachment 10-D; to amend Attachment 10-B; to amend the Grievance language; to amend the enrollment capacity; to add the Confidential Contract Terms language; to add the Federal False Claim Act Compliance language; and to adjust rates and the encumbrances/amounts payable accordingly.
	3)		Exhibit A, Attachment 8 Provider Compensation Arrangements, Section 13 Non-Contracting Emergency Service Providers, is amended to read:

(Continued on next page)

        All other terms and conditions shall remain the same.

IN WITNESS WHEREOF, this Agreement has been executed by the parties hereto.

CONTRACTOR					CALIFORNIA
CONTRACTOR’S NAME (If other than an individual, state whether a corporation, partnership, etc.)					Department of General Services Use Only
Xxxxxx Healthcare of California Partner Plan, Inc.
BY (Authorized Signature)		DATE SIGNED (Do not type)
/s/ Xxxxxxx X. O’Dell		12/9/06
PRINTED NAME AND TITLE OF PERSON SIGNING
Xxxxxxx X. O’Dell, President
ADDRESS
Xxx Xxxxxx Xxxxx Xxxxx Xxxx Xxxxx, XX 00000
STATE OF CALIFORNIA
AGENCY NAME
California Department of Health Services
BY (Authorized Signature)		DATE SIGNED (Do not type)
/s/ Xxxx Xxxxxxxxxx		2/6/07
PRINTED NAME AND TITLE OF PERSON SIGNING					Exempt per:
Xxxx Xxxxxxxxxx, Deputy Director, Medical Care Services					o    Welfare and Institutions Code section 14087.55(c)
ADDRESS
0000 Xxxxxxx Xxxxxx, 0xx Xxxxx, XX 4000, XX Xxx 000000 Xxxxxxxxxx, XX 00000-0000					þ    Welfare and Institutions Code section 14089.8(b)

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13. Non-Contracting Emergency Service Providers

	A.		Contractor shall pay for Emergency Services received by a Member from non-contracting providers. Payments to non-contracting providers shall be for the treatment of the Emergency Medical Condition, including Medically Necessary inpatient services rendered to a Member until the Member’s condition has stabilized sufficiently to permit referral and transfer in accordance with instructions from Contractor, or the Member is stabilized sufficiently to permit discharge. The attending emergency physician, or the provider treating the Member is responsible for determining when the Member is sufficiently stabilized for transfer or discharge and that determination is binding on the Contractor. Emergency Services shall not be subject to Prior Authorization by Contractor.
	B.		At a minimum, Contractor must reimburse the non-contracting emergency department and, if applicable, its affiliated providers for Physician services at the lowest level of emergency department evaluation and management CPT (Physician’s Current Procedural Terminology) codes, unless a higher level is clearly supported by documentation, and for the facility fee and diagnostic services such as laboratory and radiology.
	C.		For all non-contracting providers, reimbursement by Contractor, or by a subcontractor who is at risk for out-of-plan Emergency Services, for properly documented claims for services rendered on or after January 1, 2007 by a non-contracting provider pursuant to this provision shall be made in accordance with provision 5. Claims Processing, above, and 42 USC Section 1396u-2(b)(2)(D).
	D.		Contractor shall not refuse to cover reimbursement for Emergency Services rendered by a non-contracting provider based on the emergency room provider, hospital, or fiscal agent not notifying the Member’s Primary Care Physician or Contractor of the Member’s screening and treatment within 10 calendar days of presentation for emergency. Contractor shall not limit what constitutes an Emergency Medical Condition solely on the basis of lists of diagnoses or symptoms.
	E.		In accordance with California Code of Regulations, Title 28, Section 1300.71.4, Contractor shall approve or disapprove a request for post-stabilization inpatient services made by a non-contracting provider on behalf of a Member within 30 minutes of the request. If Contractor fails to approve or disapprove authorization within the

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required timeframe, the authorization will be deemed approved. Contractor is financially responsible for post-stabilization service payment as provided in subprovision C above.

F. Disputed Emergency Services claims may be submitted to DHS, Office of Administrative Hearings and Appeals, 0000 X Xxxxxx, Xxxxx 000, Xxxxxxxxxx, Xxxxxxxxxx, 00000 for resolution under the provisions of Welfare and Institutions Code Section 14454 and California Code of Regulations, Title 22, Section 53620 et. seq., except Section 53698. Contractor agrees to abide by the findings of DHS in such cases, to promptly reimburse the non-contracting provider within 30 calendar days of the effective date of a decision that Contractor is liable for payment of a claim and to provide proof of reimbursement in such form as the DHS Director may require. Failure to reimburse the non-contracting provider and provide proof of reimbursement to DHS within 30 calendar days shall result in liability offsets in accordance with Welfare and Institutions Code Sections 14454(c) and 14115.5, and California Code of Regulations, Title 22, Section 53702.

4) Exhibit A, Attachment 9 Access and Availability, Section 12 Cultural and Linguistic Program, is amended to read:

	12.		Cultural and Linguistic Program
			Contractor shall have a Cultural and Linguistic Services Program that monitors, evaluates, and takes effective action to address any needed improvement in the delivery of culturally and linguistically appropriate services. Contractor shall review and update their cultural and linguistic services consistent with the group needs assessment requirements stipulated below.

	A.		Written Description
			Contractor shall implement and maintain a written description of its Cultural and Linguistic Services Program, which shall include at minimum the following:

	1)		An organizational commitment to deliver culturally and linguistically appropriate health care services.
	2)		Goals and objectives.

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	3)		A timetable for implementation and accomplishment of the goals and objectives.
	4)		An organizational chart showing the key staff persons with overall responsibility for cultural and linguistic services and activities. A narrative shall explain the chart and describe the oversight and direction to the Community Advisory Committee, provisions for support staff, and reporting relationships. Qualifications of staff, including appropriate education, experience and training shall also be described.
	5)		Standards and Performance requirements for the delivery of culturally and linguistically appropriate health care services.

	B.		Linguistic Capability of Employees
			Contractor shall assess, identify and track the linguistic capability of interpreters or bilingual employees and contracted staff (clinical and non-clinical).
	C.		Group Needs Assessment (GNA)
			Contractor shall conduct group needs assessments as specified below, to identify the health education and cultural and linguistic needs of its Members; and utilize the findings for continuous development and improvement of contractually required health education and cultural linguistic programs and services.

	1)		Contractor shall conduct a GNA and submit a GNA Summary to DHS every five years. Contractor shall conduct an initial GNA within 12 months from the commencement of the Operations Period unless within the last five years, Contractor has conducted a GNA and submitted a GNA Summary to DHS for this Service Area, in which case, Contractor will have until the end of the five-year term to conduct its next GNA.
	2)		Contractor shall submit a GNA Summary Report to DHS at the completion of each GNA. The summary report must include:

a) The objectives; methodology; data sources; survey instruments; findings and conclusions; program and

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policy implications; and references contained in the GNA.

b) The findings and conclusions must include the following information for Medi-Cal plan Members: 1) demographic profile; 2) related health risks, problems and conditions; 3) related knowledge, attitudes and practices including cultural beliefs and practices; 4) perceived health education needs including learning needs, preferred methods of learning and literacy level; 5) culturally competent community resources.

	3)		Contractor shall demonstrate that GNA and summary report findings and conclusions in item 2(b) above are utilized for continuous development of its health education and cultural and linguistic services program. Contractor must maintain documentation of program priorities, target populations and program goals/objectives as they are revised to meet the identified and changing needs of the Member population.
	4)		Contractor shall annually update the GNA summary report including a current update on the information required in 2(b) above. The GNA summary report updates shall be maintain and available for DHS review.

	D.		The results of the GNA shall be considered in the development of any Marketing materials prepared by the Contractor.
	E.		Cultural Competency Training
			Contractor shall provide cultural competency, sensitivity, or diversity training for staff, providers and subcontractors at key points of contact. The training shall cover information about the identified cultural groups in the Contractor’s Service Areas, such as the groups’ beliefs about illness and health; methods of interacting with providers and the health care structure; traditional home remedies that may impact what the provider is trying to do to treat the patient; and language and literacy needs.
	F.		Program Implementation and Evaluation
			Contractor shall develop and implement policies and procedures for assessing the performance of individuals who provide linguistic

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services as well as for overall monitoring and evaluation of the Cultural and Linguistic Services Program.

5) Exhibit A, Attachment 10 Scope of Services, Section 1 Covered Services, is amended to read:

	1.		Covered Services
			Contractor shall provide or arrange for all Medically Necessary Covered Services for Members. Covered Services are those services set forth in Title 22, CCR, Chapter 3, Article 4, beginning with Section 51301, and Title 17, CCR, Division 1, Chapter 4, Subchapter 13, beginning with Section 6840, unless otherwise specifically excluded under the terms of this Contract.
			Except as set forth in Attachment 3.1.B.1 (effective 1/1/2006) of the California Medicaid State Plan or as otherwise authorized by Welfare & Institutions Code Section 14133.23, effective January 1, 2006, drug benefits for full-benefit dual eligible beneficiaries who are eligible for drug benefits under Part D of Title XVIII of the Social Security Act (42 USC Section 1395w-101 et seq) are not a Covered Service under this Contract. Consequently, effective January 1, 2006, the capitation rates shall not include reimbursement for such drug benefits and existing capitation rates shall be adjusted accordingly, even if the adjustment results in a change of less than one percent of cost to Contractor. Additionally, Contractor shall comply with all applicable provisions of the Medicare Prescription Drug Improvement and Modernization Act of 2003, 42 USC 1395(x) et seq.

6)		Exhibit A, Attachment 10-B, is amended to read:
		EXCLUDED DRUGS FOR THE TREATMENT OF HUMAN IMMUNODEFICIENCY VIRUS (HIV) AND ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)
		Generic Name
		Abacavir Sulfate (Ziagen) Abacavir /Lamivudine (Epzicom) Amprenavir (Agenerase) Oral Amprenavir (Agenerase) Tabs/Caps Atazanavir Sulfate (Reyataz)

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Delavirdine Mesylate (Rescriptor)
Efavirenz (Sustiva)
Emtricitabine (Emtriva)
Enfuvirtide (Fuzeon)
Fosamprenavir (Lexiva)
Indinavir Sulfate (Crixivan)
Lamivudine (Epivir)
Lopinavir/Ritonavir (Kaletra)
Nelfinavir Mesylate (Viracept)
Nevirapine (Viramune)
Ritonavir (Norvir)
Saquinavir (Fortovase)
Saquinavir Mesylate (Invirase)
Stavudine (Zirit)
Tenofovir Disoproxil Fumarate (Viread)
Tenofovir Disoproxil-Emtricitabine (Trudada)
Tipranavir
Zidovudine/Lamivudine (Combivir)
Zidovudine/Lamivudine/Abac Sulf (Trizivir)

7) Exhibit A, Attachment 11 Case Management and Coordination of Care, Section 6 Alcohol and Substance Abuse Treatment Services, is amended to read:

	6.		Alcohol and Substance Abuse Treatment Services
			Alcohol and substance abuse treatment services available through Drug Medi-Cal Substance Abuse Services defined in Title 22, CCR, Section 51341.1, and outpatient heroin detoxification services defined in Title 22, CCR, Section 51328 are excluded from this Contract.
			These excluded services include all drugs used for the treatment of alcohol and substance abuse covered by State of California Department of Alcohol and Drug Programs (ADP) Drug Medi-Cal Substance Abuse Services as well as the drugs listed in Exhibit A, Attachment 10-C not currently covered by ADP, but reimbursed through the Medi-Cal FFS program.
			Contractor shall identify individuals requiring alcohol and or substance abuse treatment services and arrange for their referral to the ADP, including outpatient heroin detoxification providers, for appropriate services. Contractor shall assist Members in locating available treatment service sites. To the extent that treatment slots are not available in the

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ADP within the Contractor’s Service Area, the Contractor shall pursue placement outside the area. Contractor shall continue to cover and ensure the provision of primary care and other services unrelated to the alcohol and substance abuse treatment and coordinate services between the primary care providers and the treatment programs.

8) Exhibit A, Attachment 11 Case Management and Coordination of Care, Section 19 Erectile Dysfunction (ED) Drugs and Other ED Therapies, is added to read:

	19.		Erectile Dysfunction (ED) Drugs and Other ED Therapies
			Erectile dysfunction drugs and other ED therapies are excluded from this Contract. These excluded drugs include all drugs used for the treatment of ED that are listed in Exhibit A, Attachment 10-D (consisting of one page). The drugs listed in Exhibit A, Attachment 10-D are covered by the Medi-Cal Fee-For-Service program.
			Contractor shall identify individuals requiring ED drugs or ED therapies and arrange for their referral for appropriate services. Contractor shall assist Members in locating available treatment service sites. Contractor shall continue to cover and ensure the provision of primary care and other services unrelated to the ED drugs or ED therapies and coordinate services between the primary care providers and the treatment programs.

9) Exhibit A, Attachment 14 Member Grievance System, Section 3 Grievance Log and Quarterly Grievance Report, is amended to read:

3. Grievance Log and Quarterly Grievance Report

B. Contractor shall submit the quarterly grievance report for Medi-Cal Members only in the form that is required by and submitted to the Department of Managed Health Care (DMHC) as set forth in Title 28, CCR, Section 1300.68(f).

1) In addition to the types or nature of grievances listed in Title 28, CCR, Section 1300.68(f)(2)((D), the report shall also include, but not be limited to, timely assignments to a provider, issues related to cultural and linguistic sensitivity, and difficulty with accessing specialists.

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2) For the Medi-Cal category of the report, provide the following additional information: the average time it took for the plan to respond to all Member grievances; a listing of the zip codes, ethnicity, gender and primary language of the Members that filed grievances; and the total number of grievances in which the outcome/resolution was not in the Member’s favor.

10) Exhibit A, Attachment 16 Enrollments and Disenrollments, Section 2 Enrollment, is amended to read:

2. Enrollment

	E.		Enrollment Capacity (only to specific contractors that choose limitations)
			All Eligible Beneficiaries shall be accepted by Contractor up to the limits of Contractor’s Enrollment capacity approved by DHS. Contractor’s maximum enrollment capacity under this Contract shall not exceed 168,600.

11) Exhibit B, Budget Detail and Payment Provisions, Section 2 Amounts Payable, is amended to read:

2. Amounts Payable

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12) Exhibit B, Budget Detail and Payment Provisions, Section 4 Capitation Rates, is amended to read:

4. Capitation Rates

A. Commencing July 1, 2005, DHS shall remit to Contractor a capitation payment each month for each Medi-Cal Member that appears on the approved list of Members supplied to Contractor by DHS. The capitation rate shall be the amount specified below. The payment period for health care services shall commence on the first day of the Operations Period. Capitation payments shall be made in accordance with the following schedule of capitation payment rates at the end of the month for the month of service:

From July 1, 2005 through December 31, 2005:				Sacramento
Groups		Aid Codes		Rate
Family		01, 02, 03, 04, 08, 0A, 30, 32, 33, 34, 35, 38, 39, 3A, 3C, 3E, 3G, 3H, 3L, 3M, 3N, 3P, 3R, 3U, 3W, 00, 00, 00, 00, 0X, 0X, 0X, 0X, 0X, 0X, 00, 59, 5K, 5X, 72, 7A, 7J, 7X, 82, 8P, 8R		**
Disabled		20, 24, 26, 28, 2E, 36, 60, 64, 66, 68, 6A, 6C, 6E, 6H, 6J, 6N, 6P, 6V		**
Aged		10, 14, 16, 18, 1E, 1H		**
Adult		86		**
Breast and Cervical Cancer Treatment Program (BCCTP)		0M, 0N, 0P, 0R, 0T, 0U		**

** In accordance with the requirements of California Government Code Section 6254(q), confidential treatment has been requested for the redacted rate information pursuant to Rule 24b-2 of the Securities Exchange Act of 1934. The redacted rate information has been filed separately with the Commission.

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From January 1, 2006 through December 31, 2006:				Sacramento
Groups		Aid Codes		Rate
Family		01, 02, 03, 04, 08, 0A, 30, 32, 33, 34, 35, 38, 39, 3A, 3C, 3E, 3G, 3H, 3L, 3M, 3N, 3P, 3R, 3U, 3W, 00, 00, 00, 00, 0X, 0X, 0X, 0X, 0X, 0X, 00, 59, 5K, 5X, 72, 7A, 7J, 7X, 82, 8P, 8R		**
Disabled/Medi-Cal Only		20, 24, 26, 2E, 36, 60, 64, 66, 6A, 6C, 6E, 6H, 6J, 6N, 6P, 6V		**
Aged/Medi-Cal Only		10, 14, 16, 1E, 1H		**
Adult		86		**
Breast and Cervical Cancer Treatment		0N, 0P		**
Program (BCCTP)
Disabled/Dual Eligible		20, 24, 26, 2E, 36, 60, 64, 66, 6A, 6C, 6E, 6H, 6J, 6N, 6P, 6V		**
Aged/Dual Eligible		10, 14, 16, 1E, 1H		**

From January 1, 2006 through December 31, 2006:				Sacramento
Groups		Aid Codes		Rate
Family		01, 02, 03, 04, 08, 0A, 30, 32, 33, 34, 35, 38, 39, 3A, 3C, 3E, 3G, 3H, 3L, 3M, 3N, 3P, 3R, 3U, 3W, 00, 00, 00, 00, 0X, 0X, 0X, 0X, 0X, 0X, 00, 59, 5K, 5X, 72, 7A, 7J, 7X, 82, 8P, 8R		**
Disabled/Medi-Cal Only		20, 24, 26, 2E, 36, 60, 64, 66, 6A, 6C, 6E, 6H, 6J, 6N, 6P, 6V		**
Aged/Medi-Cal Only		10, 14, 16, 1E, 1H		**
Adult		86		**
Breast and Cervical Cancer Treatment		0N, 0P		**
Program (BCCTP)
Disabled/Dual Eligible		20, 24, 26, 2E, 36, 60, 64, 66, 6A, 6C, 6E, 6H, 6J, 6N, 6P, 6V		**
Aged/Dual Eligible		10, 14, 16, 1E, 1H		**

** In accordance with the requirements of California Government Code Section 6254(q), confidential treatment has been requested for the redacted rate information pursuant to Rule 24b-2 of the Securities Exchange Act of 1934. The redacted rate information has been filed separately with the Commission.

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B. If DHS creates a new aid code that is split or derived from an existing aid code covered under this Contract, and the aid code has a neutral revenue effect for the Contractor, then the split aid code will automatically be included in the same aid code rate group as the original aid code covered under this Contract. Contractor agrees to continue providing Covered Services to the Members at the monthly capitation rate specified for the original aid code. DHS shall confirm all aid code splits, and the rates of payment for such new aid codes, in writing to Contractor as soon as practicable after such aid code splits occur.

13) Exhibit E, Additional Provisions, Section 1 Additional Incorporated Exhibits, is amended to read:

	1.		Additional Incorporated Exhibits
			The following additional exhibits are attached, incorporated herein, and made a part hereof by this reference:

1) Exhibit A		Scope of Work		2 pages
		Attachment 1 — Organization and Administration of the Plan		4 pages
		Attachment 2 — Financial Information		4 pages
		Attachment 3 — Management Information System		2 pages
		Attachment 4 — Quality Improvement System		12 pages
		Attachment 5 — Utilization Management		4 pages
		Attachment 6 — Provider Network		8 pages
		Attachment 7 — Provider Relations		2 pages
		Attachment 8 — Provider Compensation Arrangements		6 pages
		Attachment 9 — Access and Availability		11 pages
		Attachment 10 — Scope of Services		19 pages
		Attachment 11 — Case Management and Coordination of Care		13 pages
		Attachment 12 — Local Health Department Coordination		3 pages
		Attachment 13 — Member Services		11 pages
		Attachment 14 — Member Grievance System		3 pages
		Attachment 15 — Marketing		5 pages

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		Xxxxxxxxxx 00 — Enrollments and Disenrollments		5 pages
		Attachment 17 — Reporting Requirements		2 pages
		Attachment 18 — Implementation Plan and Deliverables		15 pages
2) Exhibit B		Budget Detail and Payment Provisions		8 pages
3) Exhibit C*		General Terms and Conditions: Notwithstanding provisions 15 and 18, which do not apply to this Contract.		GTC 306*
		Attachment 1 — Certifications: Notwithstanding provisions 4, 5, and 7, which do not apply to this Contract.		CCC-1005*
		Attachment 2 — Doing Business with the State of California: Notwithstanding provisions 4 and 6, which do not apply to this Contract.		CCC-1005*
4) Exhibit D(F)		Special Terms and Conditions: Notwithstanding provisions 2, 3, 4, 5, 6, 7, 10, 11, 12, 14, 15, 16, 18, 22, 25, 27, 29, 30, and 31, which do not apply to this Contract.		10 pages
5) Exhibit E		Additional Provisions		3 pages
		Attachment 1 — Definitions		17 pages
		Attachment 2 — Program Terms and Conditions		24 pages
		Attachment 3 — Duties of the State		5 pages
6) Exhibit F		Contractor’s Release		1 page
7) Exhibit G		Health insurance Portability and Accountability Act		5 pages

Items shown above with an Asterisk (*), are hereby incorporated by reference and made part of this agreement as if attached hereto. These documents can be viewed at xxxx://xxx.xxx.xx.xxx/xxxxxxxxx.

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00) Xxxxxxx X, Xxxxxxxxxx 1 Definitions, Section 34 Eligible Beneficiary, is amended to read:

	34.		Eligible Beneficiary means any Medi-Cal beneficiary who is residing in the Contractor’s Service Area with one of the following aid codes:
			Mandatory Aid Codes:
			Family — 01, 02, 08, 0A, 30, 32, 33, 34, 35, 38, 39, 3A, 3C, 3E, 3G, 3H, 3L, 3M, 3N, 3P, 3R, 3U, 3W, 47, 54, 59, 5X, 72, 7A, 7X, 82, 8P, 8R
			Non-Mandatory Aid Codes:
			Family — 03, 04, 40, 42, 45, 4A, 4C, 4F, 4G, 4K, 4M, 5K, 7J
			Aged — 10, 14, 16, 1E, 1H
			Disabled — 20, 24, 26, 2E, 36, 60, 64, 66, 6A, 6C, 6E, 6H, 6J, 6N, 6P, 6V
			Adult- 86
			Breast and Cervical Cancer Treatment Program (BCCTP) — ON, OP
			An Eligible Beneficiary may continue to be a Member following any redetermination of Medi-Cal eligibility that determines that the individual is eligible for, and the individual thereafter enrolls in, the BCCTP.
			The following exclusions apply to all the above:

	A.		Individuals who have been approved by the Medi-Cal Field Office or the California Children Services Program for any major organ transplant that is a Medi-Cal FFS benefit except kidney transplants.
	B.		Individuals who elect and are accepted to participate in the following Medi-Cal waiver programs: In-Home Medical Care Waiver, the Nursing Facility Subacute Waiver, and the Nursing Facility A/B Waiver.
	C.		Individuals determined by the Medi-Cal Field Office to be in need of long term care and residing in a Skilled Nursing Facility for 30 calendar days past the month of admission.
	D.		Individuals who have commercial or Medicare HMO coverage, unless the Medicare HMO is a provider under this Contract and DHS has agreed, as a term of the HMO’s contract, that these

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individuals may be enrolled. Individuals with Medicare fee-for-service coverage are not excluded from enrolling under this Contract.

15) Exhibit E, Attachment 2 Program Terms and Conditions, Section 13 Term, is amended to read:

	13.		Term
			The Contract will become effective June 30, 2005, and will continue in full force and effect through December 31, 2007, subject to the provisions of Exhibit B, provision 1. Budget Contingency Clause and Exhibit D(F), provision 9. Federal Contract Funds, because the State has currently appropriated and available for encumbrance only funds to cover costs through June 30, 2005.
			The term of the Contract consists of the following three periods: 1) The Implementation Period, which ended as of the effective date of this Contract; 2) The Operations Period shall commence at the conclusion of the Implementation Period, subject to DHS acceptance of the Contractor’s readiness to begin the Operations Period. The term of the Operations Period is subject to the termination provisions of provision 16. Termination, and provision 18. Sanctions, and subject to the limitation provisions of Exhibit B, provision 1. Budget Contingency Clause; and 3) The Phaseout Period shall extend for six (6) months from the end of the Operations Period, subject to provision 15. Contract Extension, in which case the Phaseout Period shall apply to the six (6) month period beginning with the first day after the end of the Operations Period, as extended.

16) Exhibit E, Attachment 2 Program Terms and Conditions, Section 34 Confidential Contract Terms, is added to read:

	34.		Confidential Contract Terms
			The terms of this Contract are confidential and may be disclosed by the Contractor or its providers and subcontractors only in accordance with the disclosure time limits set forth in Government Code section 6254(q).

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17) Exhibit E, Attachment 2 Program Terms and Conditions, Section 35 Federal False Claim Act Compliance, is added to read:

	35.		Federal False Claim Act Compliance
			Effective January 1, 2007, Contractor shall comply with 42 USC Section 1396a(a)(68) as a condition of receiving payments under this contract. Upon request by DHS, Contractor shall demonstrate compliance with this provision, which may include providing DHS with copies of Contractor’s applicable written policies and procedures and any relevant employee handbook excerpts.

18) All rights, duties, obligations and liabilities of the parties hereto otherwise remain unchanged.

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XXXXXXXXXX 00-X

EXCLUDED DRUGS FOR ALCOHOL AND HEROIN (OPIOID) DEPENDENCE
TREATMENT

Generic Name

Buprenorphine HCL
Buprenorphine HCL and Naloxone HCL dihydrate

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ATTACHMENT 10-D

EXCLUDED DRUGS FOR THE TREATMENT OF ERECTILE
DYSFUNCTION (ED)

Generic Name

Alprostadil
Papaverine
Phentolamine Mesylate
Sildenafil Citrate
Tadalafil
Vardenafil HCL
Yohimbine HCL
Yohimbine HCL/Strychnine
Yohimbine HCL/Zinc Sulfate

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