Exhibit 10.6.2

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES

AND

AMERIGROUP NEW JERSEY, INC.

AGREEMENT TO PROVIDE HMO SERVICES

In accordance with Article 7, section 7.11.2A and 7.11.2B of the contract
between AMERIGROUP New Jersey, Inc. and the State of New Jersey, Department of
Human Services, Division of Medical Assistance and Health Services (DMAHS),
effective date October 1, 2000, all parties agree that certain sections of the
contract shall be amended to be effective October 1, 2003, as follows:

 

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NJ FamilyCare Extension - October 1, 2003

1.   Article 1, “Definitions” section - for the following definition:

            • NJ FamilyCare Plan H

shall be amended as reflected in the relevant pages of Article 1 attached hereto
and incorporated herein.

2.   Article 8, “Financial Provisions,” Sections 8.5.1 and 8.7(F)4 shall be
amended as reflected in Article 8, Sections 8.5.1 and 8.7(F)4 attached hereto
and incorporated herein.   3.   Appendix, Section C, “Capitation Rates,” shall
be revised as reflected in SFY 2004 Capitation Rates attached hereto and
incorporated herein.

 

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NJ FamilyCare Extension -October 1, 2003

All other terms and conditions of the October 1, 2000 contract and subsequent
amendments remain unchanged except as noted above.

The contracting parties indicate their agreement by their signatures.

                  AMERIGROUP   State of New Jersey     New Jersey, Inc.  
Department of Human Services                   BY: /s/ Norine Yukon   BY:      
 

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                Matthew D. D’Oria                   TITLE: President & CEO  
TITLE:   Acting Director, DMAHS                   DATE: August 27, 2003   DATE  
             

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APPROVED AS TO FORM ONLY

Attorney General State

of New Jersey

      BY:        

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    Deputy Attorney General

DATE:

 

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NJ FamilyCare Plan D—means the State-operated program which provides managed
care coverage to uninsured:

  Parents/caretakers with children below the age of 19 who do not qualify for
AFDC Medicaid with family incomes up to and including 200 percent of the federal
poverty level; and
Parents/caretakers with children below the age of 23 years and children from the
age of 19 through 22 years who are full time students who do not qualify for
AFDC Medicaid with family incomes up to and including 250 percent of the federal
poverty level; and Children below the age of 19 with family incomes between
201 percent and up to and including 350 percent of the federal poverty level.

Eligibles with =incomes above 150 percent of the federal poverty level are
required to participate in cost sharing in the form of monthly premiums and
copayments for most services with the exception of both Eskimos and Native
American Indians under the age of 19 years. These groups are identified
by-Program Status Codes (PSCs) or Race Code on the eligibility system as
indicated below. For clarity, the Program Status Codes or Race Code, in the case
of Eskimos and Native American Indians under the aj; ‘of 19 years, related to
Plan D non-cost sharing groups are also listed.

                  PSC   PSC   Race Code Cost Sharing   No Cost Sharing   No Cost
Sharing

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301     300       3   493     380           494     497           495          
      498                

In addition to covered managed care services, eligibles under these programs may
access certain services which are paid fee-for-service and not covered under
this contract.

NJ FamilyCare Plan H-means the State-operated program which provides managed
care administrative services coverage to uninsured:

  Adults and couples without dependent children under the age of 19 with family
incomes up to and including 100 percent of the federal poverty level;
Adults and couples without dependent children under the age of 23 years, who do
not qualify for AFDC Medicaid, with family incomes up to and including
250 percent of the federal poverty level.

Eligibles with incomes above 150 percent of the federal poverty level are
required to participate in cost sharing in the form of monthly premiums and
copayments for most services. These groups are identified by the program status
code (PSC) indicated below. For clarity, the program status codes related to
Plan H non-cost sharing groups are also listed.

      Amended as of October 1, 2003   I-19

 

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Rates for DYFS, NJ FamilyCare Plans B, C, D, and Plan H and the non
risk-adjusted rates for AIDS and clients of DUD are statewide. Rates for all
other premium groups are regional in each of the following regions:

       • Region 1: Bergen, Hudson, Hunterdon, Morris, Passaic, Somerset, Sussex,
and Warren counties

       • Region 2: Essex, Union, Middlesex, and Mercer counties

       • Region 3: Atlantic, Burlington, Camden, Cape May, Cumberland,
Gloucester, Monmouth, Ocean, and Salem counties

    Contractors may contract for one or more regions but, except as provided in
Article 2, may not contract for part of a region.   8.5.2   MAJOR PREMIUM GROUPS
      The following is a list of the major premium groups. The individual rate
groups (e.g. children under 2 years, etc.) with their respective rates are
presented in the rate tables in % the appendix.   8.5.2.1   AFDC/TANF, NJC
PREGNANT WOMEN, AND NJ FAMILYCARE PLAN A CHILDREN       This grouping includes
capitation rates for Aid to Families with Dependent Children (AFDC)/Temporary
Assistance for Needy Families (TANF), New Jersey Care Pregnant Women and
Children, and NJ FamilyCare Plan A children (includes individuals under 21 in
PSC 380), but excludes individuals who have AIDS or are clients of DDD.  
8.5.2.2   NJ FAMILYCARE PLANS B & C       This grouping includes ~ capitation
rates for NJ FamilyCare Plans. B and C enrollees, excluding individuals with
AIDS- and/or DDD. clients.   8.5.2.3   NJ FAMILYCARE PLAN D CHILDREN       This
grouping includes capitation rates for NJ FamilyCare Plan D children, excluding
individuals with AIDS.   8.5.2.4   NJ FAMILYCARE PLAN D PARENTS/CARETAKERS      
This grouping includes capitation rates for NJ FamilyCare Plan D
parents/caretakers, excluding individuals with AIDS, and include only enrollees
19 years of age or older.

      Amended as of October 1, 2003   V111-6

 

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  b. The claim is for prenatal care for a pregnant woman or for preventive
pediatric services. (including EPSDT services) that are covered by the Medicaid
program.     c.   The claim is for labor, delivery, and post-partum care and
does not involve hospital costs associated with the inpatient. hospital stay.  
  d.   The claim is for a child who is in a DYFS supported out of home
placement.     e.   The claim involves coverage or services mentioned in La, Lb,
Lc, or Ld, above in combination with another service.

  2.   If the contractor knows that the third party will neither pay for nor
provide the covered service, and the service is medically necessary, the
contractor shall neither deny payment for the service nor require a written
denial from the third party.     3.   If the contractor does not know whether a
particular service is covered by the third party, and the service is medically
necessary, the contradtor shall contact the third party and determine whether or
not such service is covered rather than requiring the enrollee to do so.
Further, the contractor shall require the provider or subcontractor to bill the
third party if coverage is available.     4.   In certain circumstances, and
with the prior approval of the DMAHS, the contractor shall retain the ability to
initiate TPL recovery actions against health insurance, as defined in section
8.7.D.1. These circumstances include; but are not limited . to, information
system failures, claims settlements, and appeal resolutions. In these cases, all
recovered funds shall be retained by the contractor; a summary level of the
recovery experience, net of -any vendor fees directly related to the specific
recovery activity, will, be reported to the State on a quarterly basis; and the
recoveries will be reflected in claims adjustments that are submitted to the
State with the monthly claims files, referenced in section 8.7.D.l.a. The State
will take into account these net recoveries in setting capitation rates and
determining the payment amounts.

G.   Sharing of TPL Information by the State.

  1. By the fifteenth (15th) day after the close of the month during which the
State learns of such information, the State may provide the contractor with a
list of all known health insurance coverage information for the purpose of
updating the contractor’s files. This information will be in the format of the
State’s TPL Resource File.

      Amended as of October 1, 2003   V111-13

 

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      State of New Jersey   Confidential

FamilyCare Rates for Adults 0-100% (includes applicable HANJ)
Terms of Eligibility - October 2003

                                                          One Month Extension  
              SFY04 Rates             SFY03 Rates                     Contract
Period: October 1, 2003 - October 31, 2003   Contract Period: March 1, 2003 -
June 30, 2003 Category.   Age/Sex   Northern   Central   Southern Statewide  
Northern   Central   Southern Statewide

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FamilyCare Adults 0 - 100%
  19 - 44 Female                   $ 258.35                     $ 215.97  
FamilyCare Adults 0 - 100%
  19 - 44 Male     —             $ 218.16                     $ 181.07  
FamilyCare Adults 0 - 100%
  45+ M&F                   $ 414.02                     $ 354.16  

      Mercer Government Human Services Consulting   Page 1 of 1