EXHIBIT 10.16.1
AMENDMENT TO
CCPN AND HMO MEDICAID AGREEMENT
THIS AMENDMENT TO CCPN AND HMO MEDICAID AGREEMENT (the "Amendment") is
entered into as of the 1st day of January, 2000 (the "Effective Date"), by and
between AMERICAID Texas, Inc., a Texas corporation ("HMO") and Xxxx Children's
Physician Network, a Texas non-profit corporation ("CCPN").
RECITALS:
WHEREAS, HMO and CCPN have entered into a CCPN and HMO Medicaid Agreement
on October 1, 1996 (the "Initial Agreement"), as amended pursuant to the
Modification Agreement (defined below) and the amendments identified on Schedule
1 attached hereto (as amended, the "Medicaid Services Agreement"); and
WHEREAS, HMO and CCPN desire to amend the Medicaid Services Agreement on
the terms set forth below; and
WHEREAS, Xxxx Children's Health Care System (f/k/a Xxxx Children's Heath
Care Network) and AMERIGROUP Corporation (f/k/a AMERICAID, Inc.) as parties to
that certain Agreement executed October 9, 1997 to be effective as of September
1, 1995 (the "Modification Agreement") are executing this Amendment solely to
acknowledge that certain of its terms modify the terms of the Modification
Agreement.
NOW, THEREFORE, in consideration of the premises and the mutual promises,
covenants and agreements set forth herein, and for other good and valuable
consideration, the receipt and sufficiency of which is hereby acknowledged, the
parties agree as follows:
1. Definitions. Capitalized terms not otherwise defined herein shall have
the meaning given such terms under the Medicaid Services Agreement.
2. Modifications to Compensation Terms.
a) The "Financial Arrangements" set forth in Attachment A of the
Initial Agreement, as amended, are amended and restated in their
entirety as set forth in Attachment A attached hereto; such attachment
shall supersede Sections 5, 6 and 7 of the Modification Agreement.
The new terms therein with respect to the administration and
settlement of the pools shall be effective retroactively to September
1, 1998 (notwithstanding the Effective Date herein for the other terms
of this Amendment) so that they shall apply for purposes of the 98/99
Year-End Settlement. The Exhibits to Attachment A of the Initial
Agreement (e.g., Exhibits 4 and 5) shall continue to apply.
b) Attachments B and C to the Initial Agreement are hereby amended and
restated by the rates set forth in revised Attachments B and C
attached hereto, and Schedule A-IV.H (which had been implemented
pursuant to the Second Amendment dated
March 1, 1998) is hereby amended and restated by the rates set forth
in Attachment D hereto.
3. Delegation of Additional Administrative Functions.
a) CCPN shall have the option to receive delegation of medical
management, provider services and/or claims processing, adjudication
and payment (the "Administrative Functions"), if each of the
conditions in this Section 3 are satisfied. CCPN shall provide HMO
with not less than ninety (90) days (the "Notice Period") prior
written notice of exercise (the "Exercise Notice") and shall, with
such Notice, provide HMO with such documentation and information as
HMO may deem reasonably necessary to demonstrate that the conditions
have been or will be satisfied. HMO shall promptly review whether all
conditions are satisfied, it being the intent of the parties to
implement the delegation not earlier than ninety (90) days nor later
than one hundred fifty (150) days after the Exercise Notice is
received (assuming all conditions are satisfied). The conditions are
as follows:
i) CCPN has received delegation of the same Administrative
Functions from all other contracted health maintenance or managed
care organizations in connection with CCPN's provision of
Medicaid services to such organizations' members under the STAR
Program (or its successor program) and at least one of such
delegated arrangements for a Medicaid product will be operational
by the end of the Notice Period;
ii) CCPN meets all of HMO's standards for performing such services,
including, without limitation, HCFA, TDI and TDH requirements,
and the standards and requirements of HEDIS and NCQA. Upon
request by CCPN, HMO agrees to provide any such standards related
to the aforementioned administrative functions to CCPN. CCPN
acknowledges that HMO shall have the ability to perform a site
visit and audit prior to the delegation of such administrative
functions to ensure compliance with HMO's standards.
iii) CCPN and HMO agree to negotiate and enter into a mutually
acceptable delegation agreement to ensure CCPN appropriately
assists HMO in meeting all then applicable legal requirements
(including, without limitation, any applicable requirements of
HCFA, TDH, TDI or Texas Senate Xxxx 890 or its successor) and the
standards and requirements of HEDIS and the NCQA, and continues
to satisfy the conditions set forth herein. The agreement shall,
among other things, (A) ensure appropriate accountabilities for
performance, service delivery, and data reporting (CCPN shall,
among other things, be required to timely report all data
elements presently used by HMO in its claims processing and
precertification functions so that there will be no disruption in
HMO's ability to accurately project medical claims), (B) ensure
CCPN's
participation in and compliance with federal, state and NCQA
reviews, (C) establish performance standards and penalties, (D)
include reciprocal indemnification provisions by which each party
agrees to defend and hold the other harmless from claims,
damages, penalties, sanctions, etc. (whether governmental,
private party or otherwise) related to, among other things, the
functions for which the indemnifying party is responsible under
the agreement, whether performed by such party or sub-delegated,
(E) prohibit sub-delegation without HMO's prior written consent,
and (F) establish the circumstances under which delegation may be
revoked;
iv) The parties shall have mutually agreed on (A) the amount HMO
shall pay CCPN for CCPN's performance of the Administrative
Functions, which amount will consider, among other things, HMO's
costs to provide oversight of the delegation and HMO's actual
average total direct costs for such services as a percentage of
total premium and applied to the premium payable with respect to
pediatric Members (as defined in Attachment A), and (B)
adjustments required to the Pool allocation and settlement
methodologies set forth on Attachment A in light of such modified
payment terms; and
v) If claims processing and precertification is to be delegated,
(A) CCPN must successfully complete a thorough review by HMO
and/or its designee (such as external auditors) regarding
appropriate internal controls over the performance of such
services (based on HMO's then applicable review tool) prior
to implementation;
(B) The delegation agreement shall further provide that on a
periodic basis, but not less than quarterly for internal
review and annually for external review, CCPN (and its
designees, if any) will be audited to ensure that the
controls and procedures reviewed prior to implementation are
in place and are being used appropriately and that any
deficiencies will be promptly cured through a corrective
action plan; and
(C) The delegation agreement shall further require CCPN to meet
on an ongoing basis HMO's then applicable financial adequacy
and reporting requirements for delegated claims
relationships.
4. Use of HMO-to-HMO Contract. To the extent permitted by law, at CCPN's
option, the obligations of CCPN under the Medicaid Services Agreement shall
be effected through Xxxx Children's Health Plan (through an HMO-to-HMO
contract), which plan shall maintain sufficient risk reserves to satisfy
all of CCPN's obligations hereunder.
5. Modifications to Administrative Processes. Within thirty (30) days of
execution of this
Amendment, CCPN and HMO agree to work collaboratively to reform in writing
the current processes regarding claims submissions, claims adjudication,
claims resubmissions, and accounts receivable. CCPN and HMO shall each
assign a high level person to guide the reformation process with HMO's
person also available on a bi-weekly basis to resolve all pending claims
problems.
6. Effect of Increases to Xxxx'x Charge Master and Adjustments to
Cost-to-Charge Ratio. The rates/charges upon which HMO is reimbursing CCMC
are not subject to increase in connection with any increase in CCMC's
charge master until October 1 each year, beginning October 1, 2000. CCPN
shall (or shall cause CCMC to) provide HMO with written notice of the
change. CCMC's current cost-to-charge ratio (percentage discount) used by
the State shall be the basis for reimbursement prospectively and shall not
change (notwithstanding the State's May, 2000 adjustments, if any) until
October 1, 2000, at which time the cost-to-charge ratio shall be adjusted
prospectively to the cost-to-charge ratio then in use by the State (i.e.,
the ratio adopted in May 2000). Then, on June 1, 2001, and annually on June
1 thereafter, the cost-to-charge ratio shall be adjusted (again to apply on
a prospective basis only) to the cost-to-charge ratio that the State is
then using. Because of system configuration requirements, any change
required by the foregoing may be delayed by HMO for up to, but not more
than, sixty (60) days.
7. Clarifications with Respect to the Modification Agreement.
a) The text in the first sentence of Section 10 of the Modification
Agreement beginning with "as well as" and ending with "AMERICAID" is
hereby replaced with the following: "as well as any additional
counties into which TDH permits AMERICAID to expand such Service
Area."
b) It is understood and agreed that the automatic one year renewals
following the initial term, as described in Section 13 of the
Modification Agreement, shall not apply if either party gives 180 days
notice of termination prior to the end of the term then in effect.
8. Services Outside of Service Area. If CCPN desires to be a provider in
HMO's Dallas STAR network, HMO shall include CCPN in its network on such
terms as the parties' agree; provided, such participation shall be on
Dallas contract terms and not part of the incentive arrangement implemented
through the Risk Funds.
9. Additional Regulatory Amendments. The Medicaid Services Agreement is hereby
further amended by the terms set forth on Attachment E hereto which are
incorporated for purposes of regulatory compliance.
10. Miscellaneous. Each party represents and warrants that it has full
corporate power and has taken all required corporate and other action
necessary to permit it to execute and deliver this Amendment. Except as
modified by the provisions of this Amendment, all of the terms of the
Medicaid Services Agreement shall remain in full force and effect (the
parties hereby acknowledge that Schedule 1 accurately identifies the
applicability of the
terms of the prior amendments from and after the date hereof). This
Amendment may be executed in any number of counterparts, by each party on a
separate counterpart, each of which, when so executed and delivered, shall
be deemed to be an original and all of which taken together shall
constitute one and the same instrument.
IN WITNESS WHEREOF, the parties hereto have executed this Amendment as of
the day and year first above written.
AMERICAID TEXAS, INC.
By: /s/Xxxxx X. Xxxxxxx, Xx.
-------------------------
Name: Xxxxx X. Xxxxxxx, Xx.
Title: CEO
XXXX CHILDREN'S PHYSICIAN NETWORK
By: /s/Xxxx Xxxx Xxxxxxxx, MD
---------------------------
Name: Xxxx Xxxx Xxxxxxxx, MD
Title: President and CEO
SEEN AND ACKNOWLEDGED:
XXXX CHILDREN'S HEALTH CARE SYSTEM
By: /s/Xxxx X. Xxxxxxx
--------------------
Name: Xxxx X. Xxxxxxx
Title: E.V.P./CEO
AMERIGROUP CORPORATION
By: /s/Xxxxx X. Xxxxxxx, Xx.
------------------------
Name: Xxxxx X. Xxxxxxx, Xx.
Title:
---------------------------------------
AMENDMENT TO
CCPN AND HMO MEDICAID AGREEMENT
THIS AMENDMENT TO CCPN AND HMO MEDICAID AGREEMENT (the "Amendment") is
effective thirty (30) days from the date of complete execution (the "Effective
Date"), by and between AMERIGROUP Texas, Inc. (formerly, "AMERICAID Texas,
Inc."), a Texas corporation ("HMO") and Xxxx Children's Physician Network, a
Texas non-profit corporation ("CCPN"), and is effective as of such Effective
Date, except as otherwise expressly provided herein. Xxxx Children's Health Care
System joins in this Agreement for the purpose of the acknowledgement and
agreement set on the signature page below.
RECITALS:
A. On October 1, 1996, HMO and CCPN entered into a CCPN and HMO
Medicaid Agreement (the "Initial Agreement"). The Initial Agreement was
subsequently amended pursuant to that certain Agreement, executed October 9,
1997, effective as of September 1, 1995 (the "Modification Agreement"), an
Amendment entered into as of January 1, 2000 (the "Global Amendment") and
certain other amendments identified in the Global Amendment. The Initial
Agreement, as amended by the Modification Agreement, with all such amendments,
including the Global Amendment, is hereinafter referred to as the "Medicaid
Services Agreement."
B. HMO and CCPN wish to amend the Medicaid Services Agreement to
add certain terms related to the provision of urgent care services and
ambulatory surgery services by CCPN under the Medicaid Services Agreement.
AGREEMENT
NOW, THEREFORE, in consideration of the premises and the mutual promises,
covenants and agreements set forth herein, and for other good and valuable
consideration, the receipt and sufficiency of which is hereby acknowledged, the
parties agree as follows:
1. Capitalized terms not otherwise defined herein shall have the
meaning given such terms under the Medicaid Services Agreement.
2. Effective thirty (30) days from the date of complete execution,
the attached "Attachment F - Compensation for Ambulatory Surgery Center Services
and Urgent Care Center Services" is hereby added to the Agreement, it being
acknowledged and agreed by the parties hereto that the compensation set forth on
such Attachment F shall apply solely to services provided at Xxxx Children's
Pediatric Surgery Center and Xxxx Children's Pediatric Urgent Care Center, both
located at 0000 Xxxxxxxx Xxxx Xxxx, Xxxxx, Xxxxx 00000. The compensation set
forth on Attachment F shall not apply to any other services provided pursuant to
the Medicaid Services Agreement at any other locations other than the location
expressly described in this paragraph. "Attachment F - Compensation for
Ambulatory Surgery Center Services and Urgent
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Care Center Services Provided at 0000 Xxxxxxxx Xxxx Xxxx, Xxxxx, Xxxxx" is
hereby added to the Medicaid Services Agreement and incorporated therein by
reference.
3. Each party represents and warrants that it has full corporate power
and has taken all required corporate and other action necessary to permit it to
execute and deliver this Amendment. Except as modified by the provisions of this
Amendment, all of the terms of the Medicaid Services Agreement shall remain in
full force and effect. This Amendment may be executed in any number of
counterparts, by each party on a separate counterpart, each of which, when so
executed and delivered, shall be deemed to be an original and all of which taken
together shall constitute one and the same instrument.
IN WITNESS WHEREOF, the parties hereto have executed this Amendment as of the
day and year first above written.
AMERIGROUP Texas, Inc. (formerly,
AMERICAID Texas, Inc.)
By: /s/Xxxxxx Xxxxxxxx
-------------------
Name: Xxxxxx X. Xxxxxxxx, XX
Title: Vice President
Date: February 18, 2003
Xxxx Children's Physician Network
By: /s/Xxxx Xxxxx, MD
-------------------
Name: Xxxx Xxxxx, MD, MS
Title: President
Date: 02/11/03
SEEN AND ACKNOWLEDGED:
Xxxx Children's Health Care System
By: /s/Xxxxxx X. Xxxx
--------------------
Name: Xxxxxx X. Xxxx
Title: Senior Vice President Managed Care
Date: 02/11/03
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AMENDMENT TO
CCPN AND HMO MEDICAID AGREEMENT
THIS AMENDMENT TO CCPN AND HMO MEDICAID AGREEMENT (the "Amendment") is
effective July 1, 2003, (the "Effective Date"), by and between AMERIGROUP Texas,
Inc., a Texas corporation ("HMO") and Xxxx Children's Physician Network, a Texas
non-profit corporation ("CCPN"). Xxxx Children's Health Care System joins in
this Agreement for the purpose of the acknowledgement and agreement set forth on
the signature page below.
RECITALS:
A. On October 1, 1996, HMO and CCPN entered into a CCPN and HMO Medicaid
Agreement (the "Initial Agreement"). The Initial Agreement was subsequently
amended pursuant to that certain Agreement, executed October 9, 1997, effective
as of September 1, 1995 (the "Modification Agreement"), an Amendment entered
into as of January 1, 2000 (the "Global Amendment") and certain other amendments
identified in the Global Amendment. The Initial Agreement, as amended by the
Modification Agreement, with all such amendments, including the Global
Amendment, is hereinafter referred to as the "Medicaid Services Agreement."
B. HMO and CCPN wish to amend the Medicaid Services Agreement to add
Behavioral Health Care Services to be provided by CCPN under the Medicaid
Services Agreement.
C. AMERIGROUP and CCPN wish to amend the Agreement as set forth herein.
AGREEMENT:
NOW, THEREFORE, for good and valuable consideration, the receipt and
sufficiency of which is hereby acknowledged, the parties agree as follows.
1. The Agreement is hereby amended to add the following definition of
Behavioral Health Care Services:
Behavioral Health Care Services are services a Member is entitled to
receive which AMERIGROUP is required to provide pursuant to the Texas state
Medicaid Program ("Medicaid") referenced in the Medicaid Services Agreement and
any successor programs thereto.
2. The definition of "Covered Services" in the Medicaid Services Agreement
is hereby modified to add Behavioral Health Care Services as Covered Services.
3. Attachment A-Behavioral Health attached hereto is hereby added to the
Medicaid Services Agreement.
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4. Except as expressly modified herein, nothing contained in this Amendment
shall, or shall be construed to, modify, alter or amend the Medicaid Services
Agreement. The parties hereto hereby affirm the Medicaid Services Agreement,
except as expressly modified herein.
5. To the extent any provision contained in this Amendment conflicts with
the terms and conditions of the Medicaid Services Agreement, this Amendment
shall control.
IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be
duly executed.
HMO:
AMERIGROUP Texas, Inc., a Texas corporation
By: /s/ Xxxxxx Xxxxxxx
Xxxxxx X. Xxxxxxxx, XX [Name]
Vice President [Title]
June 11, 2003 [Date]
CCPN:
Xxxx Children's Physician Network
By: /s/ Xxxx Xxxxx, MD
Xxxx Xxxxx [Name]
President [Title]
6/10/03 [Date]
000 0xx Xxx [Xxxxxxx]
Xx. Xxxxx, XX 00000
____________________________[Phone#]
SEEN AND ACKNOWLEDGED:
Xxxx Children's Health Care System
By:/s/ Xxxx X. Xxxxxxx
Name: Xxxx X. Xxxxxxx
Title: CFO
Date: 6/10/03
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AMENDMENT TO
CCPN AND HMO MEDICAID AGREEMENT
THIS AMENDMENT TO CCPN AND HMO MEDICAID AGREEMENT (the "Amendment") is
effective the first day of the month next following the date thirty (30) days
after complete execution (the "Effective Date"), by and between AMERIGROUP
Texas, Inc. (formerly, "AMERICAID Texas, Inc."), a Texas corporation ("HMO") and
Xxxx Children's Physician Network, a Texas non-profit corporation ("CCPN"). Xxxx
Children's Health Care System joins in this Agreement for the purpose of the
acknowledgement and agreement set on the signature page below.
RECITALS:
A. On October 1, 1996, HMO and CCPN entered into a CCPN and HMO Medicaid
Agreement (the "Initial Agreement"). The Initial Agreement was subsequently
amended pursuant to that certain Agreement, executed October 9, 1997, effective
as of September 1, 1995 (the "Modification Agreement"), an Amendment entered
into as of January 1, 2000 (the "Global Amendment") and certain other amendments
identified in the Global Amendment. The Initial Agreement, as amended by the
Modification Agreement, with all such amendments, including the Global
Amendment, is hereinafter referred to as the "Medicaid Services Agreement."
B. HMO and CCPN desire to amend the Medicaid Services Agreement on the
terms set forth below to convert the reimbursement methodology under the
Medicaid Services Agreement for Primary Care Physicians and Primary Care
Providers, as such terms are defined in the Medicaid Services Agreement, on and
after the Effective Date from a capitation methodology to a fee-for-service
reimbursement methodology.
AGREEMENT
NOW, THEREFORE, in consideration of the premises and the mutual promises,
covenants and agreements set forth herein, and for other good and
valuable consideration, the receipt and sufficiency of which is hereby
acknowledged, the parties agree as follows:
1. Capitalized terms not otherwise defined herein shall have the meaning
given such terms under the Medicaid Services Agreement.
2. Section IV.A. of Attachment A to the Medicaid Services Agreement is
hereby amended to add the following to the end of the section:
Notwithstanding the foregoing, the parties hereto acknowledge and
agree that effective as of the effective date of this Amendment, no
Primary Care Physicians and Primary Care Providers employed by CCPN
shall be paid under the capitation methodology set forth in Section
I.A. of Attachment B to this Agreement, it being acknowledged and
agreed that as of the effective date of this Amendment, all Primary
Care Physicians and Primary Care Providers employed by CCPN shall be
paid under the fee-for-service methodology set forth under Section
I.B. of Attachment B to this Agreement.
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The parties further acknowledge and agree that, although certain
Primary Care Physicians and Primary Care Providers who or which are
party to a contract with CCPN for the provision of services hereunder
(individually, a "Contracted Provider") shall continue to be paid
under the capitation methodology set forth in Section I.A of
Attachment B of this Agreement, following the effective date of this
Amendment, CCPN shall use its best efforts commencing as of such date
to execute and deliver an amendment to the agreement between CCPN and
each such Contracted Provider (a "Contracted Provider Agreement")
converting the reimbursement methodology thereunder from capitation to
fee-for-service paid in accordance with Section I.B of Attachment B to
this Agreement.
Fee-for-service reimbursement under such amended Contracted Provider
Agreements shall be effective as of the first (1st) day of the month
following the date HMO receives notice from CCPN that a Contracted
Provider and CCPN have executed and delivered an amendment to the
Contracted Provider Agreement converting the reimbursement methodology
thereunder from capitation to fee-for-service; provided such notice is
received by HMO prior to the fifteenth (15th) day of the month. Any
such notices received after the fifteenth (15th) day of the month
shall be processed by HMO for an effective date as of the first (1st)
day of the second month following HMO's receipt of such notice.
AMERIGROUP shall comply with all applicable requirements under
Amendment No. 9 to the 1999 Contract for Services between Health and
Human Services Commission and AMERIGROUP related to provider pass
through requirements.
3. The fifth sentence of Section IV.A. of Attachment A is hereby deleted
in its entirety and replaced as follows:
Primary Care Physicians or Providers shall submit itemized statements
on current HCFA 1500 claim forms with current HCPCS coding, current
ICD9 coding and current CPT4 coding for all capitated services and
non-capitated Covered Health Services provided by Primary Care
Physicians or Providers to HMO at the address set forth below within
ninety-five (95) days of the date the Covered Health Service was
provided.
4. Section I.A of Attachment B to the Medicaid Services Agreement is
amended to add the following to the end of Section I.A:
Notwithstanding the foregoing, the parties hereto acknowledge and
agree that as of the effective date of this Amendment, no Primary Care
Physicians and Primary Care Providers employed by CCPN shall be paid
under the capitation methodology set forth in this Section I.A., it
being acknowledged and agreed that as of the effective date of this
Amendment, all Primary Care Physicians and Primary Care Providers
employed by CCPN shall be paid under the fee-for-service methodology
set forth under Section I.B. of this Attachment B.
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The parties further acknowledge and agree that, although certain
Contracted Providers shall continue to be paid under the capitation
methodology set forth in this Section I.A. following the effective
date of this Amendment, CCPN shall use its best efforts commencing as
of such date to execute and deliver an amendment to all Contracted
Provider Agreements converting the reimbursement methodology
thereunder from capitation to fee-for-service paid in accordance with
Section I.B. of this Attachment B.
5. Section I.B of Attachment B to the Medicaid Services Agreement is
hereby deleted in its entirety and replaced as follows:
B. Primary Care Fee-For-Service Payment - Primary Care Physicians
-----------------------------------------------------------------
or Primary Care Providers.
--------------------------
HMO shall compensate Primary Care Physicians/Primary Care
Providers for Primary Care Services on a fee-for service basis for
services provided to Members at the lesser of the Primary Care
Provider's/Primary Care Physician's billed charges or the current
AMERIGROUP fee schedule ("HMO's fee schedule") which is based on the
Texas Medicaid Fee Schedule. A representative sample of the current
HMO's fee schedule for Primary Care Services is attached as "Schedule
1 to Attachment B". HMO shall provide written notice to CCPN at least
thirty (30) days prior to any material changes to the HMO's fee
schedule. Following receipt of such notice, CCPN shall have thirty
(30) days to provide written acceptance or objections to such changes.
If CCPN fails to provide the required written acceptance or objections
to such changes in thirty (30) days, HMO shall be entitled to
implement the material change. If CCPN timely objects, the parties
shall negotiate in good faith regarding such changes and shall use
best efforts to agree within sixty (60) days. In the event HMO and
CCPN do not reach mutual agreement within the sixty (60) day period,
then no fee schedule changes shall be implemented until the parties
agree. The parties will jointly perform financial reviews of any fee
schedule changes. HMO shall have a minimum of sixty (60) days notice
to implement any fee schedule changes, or as may be reasonably
required.
HMO shall also provide timely written notice to CCPN of any
changes to the HMO's fee schedule that may be required by the
applicable Texas Medicaid agency; in that event CCPN shall not have
the opportunity to object and must accept such fee schedule changes.
6. Effective as of September 1, 2001, Compensation under Section II of
Attachment B of the Medicaid Services Agreement is increased from $21.00 per
visit to $34.00 per visit for the Reporting of Texas Health Steps screenings on
a HCFA-1500 based on the Texas Health Steps codes and periodicity schedule in
the TDN/NHIC manual.
7. Section IV of Attachment B to the Agreement is hereby deleted in its
entirety and replaced as follows:
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IV. NO PRIMARY CARE CAPITATION OPTION. The parties hereto acknowledge
and agree that all Primary Care Physicians and all Primary Care
Providers shall be reimbursed on a fee-for-service basis pursuant to
the terms of this Agreement, except as otherwise expressly provided
herein, and that, notwithstanding any provision contained herein, or
in any other agreement between the parties hereto, and no Primary Care
Physicians or Primary Care Providers be reimbursed under a capitation
methodology, except as expressly provided herein or as otherwise
agreed by the parties in a writing signed by the parties hereto
evidencing such agreement.
8. Schedule 1 to Attachment B to the Medicaid Services Agreement is hereby
deleted in its entirety and replaced with Schedule 1 to Attachment B attached
hereto.
9. The parties acknowledge and agree that the compensation for CPT Code
99213 set forth on Schedule 1 to Attachment B attached hereto was the then
current compensation for such services as of the effective date of this
Amendment. The parties further acknowledge and agree that the compensation set
forth on Schedule 1 to Attachment B attached hereto for the Texas Health Steps
Well Child Visits was the then current compensation for such services as of
January 18, 2002.
10. Each party represents and warrants that it has full corporate power and
has taken all required corporate and other action necessary to permit it to
execute and deliver this Amendment. Except as modified by the provisions of this
Amendment, all of the terms of the Medicaid Services Agreement shall remain in
full force and effect. This Amendment may be executed in any number of
counterparts, by each party on a separate counterpart, each of which, when so
executed and delivered, shall be deemed to be an original and all of which taken
together shall constitute one and the same instrument.
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IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed
by their duly authorized officers or agents.
AMERIGROUP Texas, Inc. (formerly,
AMERICAID Texas, Inc.)
By: /s/ Xxxxxx X. Xxxxxxxx
-----------------------
Name: Xxxxxx X. Xxxxxxxx, XX
Title: Vice President
Date: June 11, 2003
Xxxx Children's Physician Network
By:/s/ Xxxx Xxxxx, MD
Name: Xxxx Xxxxx, MD, MS
Title: President
Date: 6/23/03
SEEN AND ACKNOWLEDGED:
Xxxx Children's Health Care System
By:/s/ Xxxx X. Xxxxxxx
Name: Xxxx X. Xxxxxxx
Title: EVP/CFO
Date: 6/20/03
