"ALL SECTIONS MARKED WITH TWO ASTERISKS ("**") REFLECT PORTIONS WHICH HAVE
BEEN REDACTED AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE
COMMISSION BY PROSPECT MEDICAL HOLDINGS, INC. AS PART OF A REQUEST FOR
CONFIDENTIAL TREATMENT."
1993 AMENDMENT TO
IPA MEDICARE SHARED RISK SERVICES AGREEMENT
The Undersigned parties to the PacifiCare IPA Medicare Shared Risk Services
Agreement between PacifiCare of California ("PacifiCare") and Santa
Xxx-Tustin Physician's Group, Inc. ("IPA") do hereby amend said Agreement as
follows:
1. Attachment A4 COST OF CARE - is amended in part to read as follows:
See Exhibit 1, attached hereto and incorporated herein by this reference.
THE EFFECTIVE DATE OF THIS AMENDMENT IS JANUARY 1, 1993
By signing below, both parties hereto have executed and agreed to this
Amendment.
PACIFICARE, INC IPA Santa Xxx-Tustin Physician's
Group, Inc.
By: Xxxxx Xxxxxxx By: Xxxxxx X. Xxxxx
----------------------------- ----------------------------
Xxxxx Xxxxxxx, Vice President
Date: 1/15/93 Date: 12/23/92
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EXHIBIT 1
ATTACHMENT A4
COST OF CARE
For purposes of this Agreement, the Cost of Care for Medical Services
provided or arranged by IPA to Subscribers shall equal:
a) For services provided to Subscribers by Member Physicians who
practice at IPA Facilities, [ ** ] of the Medicare Locality
Fee Schedule for Participating Providers as published by the
Part B carrier.
b) For services provided to Subscribers by Specialist Physicians or
Outside Providers, [ ** ] of the fees actually paid by IPA.
General guidelines and special situations:
1. Services provided by IPA which are not a benefit, as specified in
the Subscriber's Secure Horizons Medical and Hospital Agreement, will
not be considered a part of Cost of Care.
2. The Cost of Care of Anesthesia Professional Services rendered by IPA
shall be set at [ ** ] of usual and customary charges. The Cost of
Care for Anesthesia Professional Services rendered through an outside
referral or reciprocity referral shall be set at [ ** ] or [ ** ]
of usual and customary charges, whichever is higher.
3. Any Medical Services provided where payment is considered
collectible through the coordination of benefits, third-party
liability, Worker's Compensation, or any other source including
Copayments, shall not be included in the Cost of Care. If, at a
later date, these claims are not collectible, or only partially
collectible, then these services will be included in the relevant
programs, based on the Cost of Care calculation cited above.
