Exhibit 10.2

 

FIRST AMENDMENT

TO

CONTRACT BETWEEN

THE OFFICE OF MEDICAID POLICY AND PLANNING,

THE OFFICE OF THE CHILDREN’S HEALTH INSURANCE PROGRAM

AND

Coordinated Care Corporation Indiana, Inc.

 

This FIRST AMENDMENT to the above-referenced Contract is made and entered into
by and between the State of Indiana [hereinafter “State” or “State of Indiana”],
through the Office of Medicaid Policy and Planning and Office of the Children’s
Health Insurance Program [hereinafter called “State” or “Offices”], of the
Indiana Family and Social Services Administration, 402 West Washington Street,
Room W382, Indianapolis, Indiana 46204, and Coordinated Care Corporation
Indiana, Inc. [hereinafter called “Contractor”], 1099 North Meridian Street,
Suite 400, Indianapolis, Indiana 46204.

 

WHEREAS, the State of Indiana and Contractor have previously entered into a
contract for a term beginning January 1, 2005, and ending December 31, 2006,
[hereinafter “the original contract”] to arrange for the provision of covered
health care services for certain Hoosier Healthwise members enrolled in Benefit
Packages A, B and C, as procured through Request for Proposal (RFP) # 4-79;

 

WHEREAS, the parties are desirous to enter into this FIRST AMENDMENT to include
coordination with the First Steps program, to revise the claims dispute process,
and, due to the expansion of Hoosier Healthwise mandatory RBMC to include all
Indiana counties, to adjust the capitation rates and add exception requirements
for designated rural RBMC counties;

 

NOW THEREFORE, the parties enter into this FIRST AMENDMENT for the consideration
set out below, all of which is deemed to be good and sufficient consideration in
order to make this FIRST AMENDMENT a binding legal instrument.

 

1. The parties hereby ratify and incorporate herein each term and condition set
out in the original Contract, as well as all written matters incorporated
therein except as specifically provided for by this FIRST AMENDMENT.

 

2. The term of this amendment is July 1, 2005 through December 31, 2006.

 

3. The parties agree that Section 2.0 of Attachment 1 to the original contract,
MCO Scope of Work, is amended to include a new subsection, 2.10, Exceptions for
Members in Rural Counties, and shall read as follows:

 

In accordance with 42 CFR 438.52(b)(2)(ii), in those counties which have been
designated as “rural counties” by the Office and approved by the Centers for
Medicare and Medicaid Services (CMS), the MCO must allow rural county members to
obtain services from out-of-network providers under any of the following
circumstances:

 

a) The service or type of provider is not available within the MCO’s network.

 

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b) The out-of-network provider is the main source of a service to the member,
provided that the provider is given the opportunity to become a participating
provider. If the provider chooses not to join the network, or does not meet the
necessary requirements to join, the enrollee will be transitioned to a
participating provider within 60 days, after being given an opportunity to
select a network provider.

 

(c) The only plan or provider available to the member does not, because of moral
or religious objections, provide the service the member seeks.

 

(d) The member’s PMP or other provider determines that the member needs related
services that would subject the member to unnecessary risk if received
separately and not all the related services are available within the network.

 

(e) The Office determines that other circumstances warrant out-of-network
treatment.

 

4. The parties agree that Attachment 1 to the original contract, MCO Scope of
Work, Section 3.3.2, Members with Special Health Care Needs, last paragraph, is
amended by adding a bullet to read as follows:

 

  •   Coordinating with Indiana’s early intervention program known as First
Steps, in accordance with the policies and procedures developed by the Office in
collaboration with the Hoosier Healthwise MCOs.

 

5. The parties agree that Section 2, Consideration, of the original Contract is
amended as follows:

 

CAPITATION RATES

 

     North

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   Central

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   South

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Packages A/B

                    

Newborns

   $ 323.69    $ 302.69    $ 295.85

Preschool

     72.99      81.89      78.00

Children

     70.30      78.87      75.12

Adolescents

     101.04      113.37      107.98

Adult Males

     234.91      290.90      279.85

Adult Females

     211.19      261.53      251.59

Package C

                    

Newborns

   $ 178.20    $ 165.06    $ 161.97

Preschool

     72.60      76.63      75.19

Children

     65.42      69.05      67.75

Adolescents

     91.07      96.13      94.32

Package A/B & C

                    

Maternity Delivery

   $ 3,331.43    $ 3,301.57    $ 3,324.80

 

The South Region rates will be effective July 1, 2005. The North Region rates
will be effective September 1, 2005. The Central Region rates will be effective
November 1, 2005.

 

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6. The parties agree that RFP Attachment N, Claims Dispute Resolution Process,
Section 3.1.3, second paragraph, is amended to be consistent with the rule at
405 IAC 1-1.6-3(h), and shall read as follows:

 

In the event the panel fails to deliver to the provider the panel’s written
determination within forty-five (45) calendar days after the commencement of the
formal claim resolution procedure, the failure on the part of the panel shall
have the effect of an approval by the panel of the provider’s claim.

 

7. The parties agree that this First Amendment to the parties’ original Contract
has been duly prepared and executed pursuant to Section 8 of the original
contract.

 

8. The undersigned attests, subject to the penalties for perjury, that he is the
contracting party, or that he is the representative, agent, member or officer of
the contracting party, that he has not, nor has any other member employee,
representative, agent or officer of the firm, company, corporation or
partnership represented by him, directly or indirectly, to the best of his
knowledge, entered into or offered to enter into any combination, collusion or
agreement to receive or pay, and that he has not received or paid, any sum of
money or other consideration for the execution of this agreement other than that
which appears upon the face of the agreement.

 

The rest of this page is left intentionally blank.

 

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WHEREOF, the parties have, through duly authorized representatives, entered into
this agreement. The parties having read and understood the foregoing terms of
the contract do by their respective signatures dated below hereby agree to the
terms thereof.

 

For the Contractor:

     

For the State of Indiana:

/s/ Rita Johnson-Mills          Rita Johnson-Mills       Jeanne M. Labrecque
President/CEO       Health Policy and Medicaid Director 1099 North Meridian
Street, Suite 400       Family and Social Services Agency Indianapolis, Indiana
46204         Date: June 28, 2005       Date: ___________________ APPROVED:    
  APPROVED:           Charles Shalliol, Director       Earl A. Goode,
Commissioner State Budget Agency       Department of Administration Date:
____________________       Date: ___________________ APPROVED AS TO FORM AND
LEGALITY:                   Stephen Carter         Attorney General of Indiana  
      Date: ____________________        

 

MCO Contract, First Amendment    Page 4 of 4    Coordinated Care Corp.