AMENDMENT #4 TO CONTRACT NO. 0653 BETWEEN GEORGIA DEPARTMENT OF COMMUNITY HEALTH AND PEACH STATE HEALTH PLAN
Exhibit
10.1d
AMENDMENT
#4 TO CONTRACT NO. 0653 BETWEEN
GEORGIA
DEPARTMENT OF COMMUNITY HEALTH AND
PEACH
STATE HEALTH PLAN
This Amendment is between the Georgia
Department of Community Health (hereinafter referred to as “DCH” or the
“Department”) and Peach State Health Plan (hereinafter referred to as
“Contractor”) and is made effective this 17th
day of September, 2008
(hereinafter referred to as the “Effective Date”). Other than the
changes, modifications and additions specifically articulated in this Amendment
#4 to Contract #0653, RFP#00000-000-0000000000, the original Contract shall
remain in effect and binding on and against DCH and Contractor.
Unless
expressly modified or added in the Amendment #4, the terms and conditions of the
original Contract are expressly incorporated into this Amendment #4 as if
completely restated herein.
WHEREAS, DCH and Contractor
executed a contract for the provision of services to Georgia Families members
enrolled in the Contractor’s plan;
WHEREAS, DCH pays Contractor a
per member per month capitation rate for each Georgia Families member enrolled
in the Contractor’s plan;
WHEREAS, DCH has sought
permission from the Centers for Medicare and Medicaid Services (hereinafter
referred to as “CMS”) to revise the capitation rates payable to Contractor for
State Fiscal Year 2009; and
WHEREAS, pursuant to Section 32.0 Amendments in
Writing, DCH and Contractor desire to amend the above-referenced Contract
by adding additional funding as set forth below.
NOW THEREFORE, for and in
consideration of the mutual promises of the Parties, the terms, provisions and
conditions of this Amendment and other good and valuable consideration, the
sufficiency of which is hereby acknowledged, DCH and Contractor hereby agree as
follows:
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I.
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Upon
receiving written notice from CMS indicating that agency’s approval of the
revised capitation rates, the parties shall delete the current Attachment H, Capitation
Payment, in its entirety and replace it with the new Attachment H, Capitation
Payment, contained at Exhibit 1 to this
Amendment.
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II.
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DCH
and Contractor aggre that they have assumed an obligation to perform the
covenants, agreements, duties and obligations of the Contract, as modified
and amended herein, and agree to abide by all the provisions, terms and
conditions contained in the Contract as modified and
amended.
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III.
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This
Amendment shall be binding and inure to the benefit of the parties hereto,
their heirs, representatives, successors and assigns. Whenever
the provisions of this Amendment and the Contract are in conflict, the
provisions of this Amendment shall take precedence and
control.
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VI.
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It
is understood by the Parties hereto that, if any part, term, or provision
of this Amendment or this entire Amendment is held to be illegal or in
conflict with any law of this State, then DCH, at its sole option, may
enforce the remaining unaffected portions or provisions of the Amendment
or of the Contract and the rights and obligations of the parties shall be
construed and enforced as if the Contract or Amendment did not contain the
particular part, term or provision held to be
invalid.
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VII.
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This
Amendment shall become effective as stated herein and shall remain
effective for so long as the Contract is in
effect.
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VIII.
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This
Amendment shall be construed in accordance with the laws of the State of
Georgia.
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IX.
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All
other terms and conditions contained in the Contract and any amendment
thereto, not amended by this Amendment, shall remain in full force and
effect.
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SIGNATURE
PAGE
IN WITNESS WHEREOF, DCH and
Contractor, through their authorized officers and agents, have caused this
Amendment to be executed on their behalf as of the date indicated.
GEORGIA
DEPARTMENT OF COMMUNITY HEALTH
/s/ Xx. Xxxxxx X. Xxxxxxx,
M.D. 9/17/08
Xx.
Xxxxxx X. Xxxxxx,
M.D. Date
Commissioner
PEACH
STATE HEALTH PLAN
BY: /s/
Xxxxxxxxxxx X.
Xxxxxx 9/12/08
*SIGNATURE Date
Xxxxxxxxxxx X.
Xxxxxx
Please Print/Type Name
Here
President & CEO
_____________________________
AFFIX CORPORATE SEAL HERE
(Corporations without a seal, attach
a
Certificate of Corporate
Resolution)
ATTEST: /s/ Xxxxxxx
Xxxxx
**SIGNATURE
Confidential
Secretary
TITLE
________________________________________________________________________
*Must be
President, Vice President, CEO or Other Authorized Officer
**Must be
Corporate Secretary
EXHIBIT
1
CONFIDENTIAL
–NOT FOR CIRCULATION
ATTACHMENT
H
Attachment
H is a table displaying the contracted rates by rate cell for each contracted
region. These rates will be the basis for calculating capitation
payments in each contracted Region.
(The
table is displayed on the following page.)
| Attachment H | |||
| FY 2009 CMO Rates | |||
|
Region
|
Aid
Category
|
Age/Gender
Group
|
PeachState
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
0 -
2 Months, Male and Female
|
$ 1,674.49
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
3 -
11 Months, Male and Female
|
$ 186.49
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
$ 118.94
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
6 -
13 Years, Male and Female
|
$ 108.56
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Female
|
$ 170.49
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Male
|
$ 128.94
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Female
|
$ 283.64
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Male
|
$ 306.63
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
$ 534.63
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
$ 564.18
|
|
Atlanta
|
PeachCare
|
0 -
2 Months, Male and Female
|
$ 148.84
|
|
Atlanta
|
PeachCare
|
3 -
11 Months, Male and Female
|
$ 155.46
|
|
Atlanta
|
PeachCare
|
1 -
5 Years, Male and Female
|
$ 107.31
|
|
Atlanta
|
PeachCare
|
6 -
13 Years, Male and Female
|
$ 116.58
|
|
Atlanta
|
PeachCare
|
14
- 20 Years, Female
|
$ 135.47
|
|
Atlanta
|
PeachCare
|
14
- 20 Years, Male
|
$ 137.43
|
|
Atlanta
|
Breast
and Cervical Cancer
|
All
Ages
|
$ 1,075.36
|
|
Atlanta
|
Maternity
Delivery/Kick Payment
|
$ 6,052.09
|
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
0 -
2 Months, Male and Female
|
$ 1,980.18
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
3 -
11 Months, Male and Female
|
$ 203.54
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
$ 124.64
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
6 -
13 Years, Male and Female
|
$ 118.12
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Female
|
$ 166.91
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Male
|
$ 117.97
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Female
|
$ 309.97
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Male
|
$ 336.17
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
$ 593.33
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
$ 642.81
|
|
Central
|
PeachCare
|
0 -
2 Months, Male and Female
|
$ 143.83
|
|
Central
|
PeachCare
|
3 -
11 Months, Male and Female
|
$ 148.43
|
|
Central
|
PeachCare
|
1 -
5 Years, Male and Female
|
$ 120.34
|
|
Central
|
PeachCare
|
6 -
13 Years, Male and Female
|
$ 127.15
|
|
Central
|
PeachCare
|
14
- 20 Years, Female
|
$ 153.25
|
|
Central
|
PeachCare
|
14
- 20 Years, Male
|
$ 135.15
|
|
Central
|
Breast
and Cervical Cancer
|
All
Ages
|
$ 1,066.68
|
|
Central
|
Maternity
Delivery/Kick Payment
|
$ 6,204.72
|
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
0 -
2 Months, Male and Female
|
$ 1,891.90
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
3 -
11 Months, Male and Female
|
$ 228.29
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
$ 149.07
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
6 -
13 Years, Male and Female
|
$ 121.68
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Female
|
$ 189.05
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Male
|
$ 123.60
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Female
|
$ 339.89
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Male
|
$ 311.27
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
$ 571.82
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
$ 680.49
|
|
Southwest
|
PeachCare
|
0 -
2 Months, Male and Female
|
$ 142.53
|
|
Southwest
|
PeachCare
|
3 -
11 Months, Male and Female
|
$ 149.98
|
|
Southwest
|
PeachCare
|
1 -
5 Years, Male and Female
|
$ 133.79
|
|
Southwest
|
PeachCare
|
6 -
13 Years, Male and Female
|
$ 131.36
|
|
Southwest
|
PeachCare
|
14
- 20 Years, Female
|
$ 149.19
|
|
Southwest
|
PeachCare
|
14
- 20 Years, Male
|
$ 123.69
|
|
Southwest
|
Breast
and Cervical Cancer
|
All
Ages
|
$ 1,104.43
|
|
Southwest
|
Maternity
Delivery/Kick Payment
|
$ 6,092.09
|
