Amendment 19 to Contract with FirstGuard Health Plan Kansas, Inc.



 Exhibit 10.3 
  

					
	ROBERT M. DAY, Ph.D, Director	  	

	  	KATHLEEN SEBELIUS, GOVERNOR
		  	DIVISION OF HEALTH POLICY AND FINANCE	  	

 June 8, 2006 
 Jean Rumbaugh 
 FirstGuard Health Plan Kansas, Inc. 
 3801 Blue Parkway 
 Kansas City, MO 64130 
  

	RE:	Amendment Nineteen – Contract #02510 

 Dear Ms. Rumbaugh:

 Enclosed for your files is a fully executed copy of Amendment Nineteen between the Division of Policy and Finance (DHPF) and FirstGuard Health Plan
Kansas, Inc. Thank you for your assistance in getting this contract completed in a timely manner. 
 Should you have questions, don’t hesitate to
contact me at 785-296-8623, or by e-mail at jwxd@srskansas.org. 
  

	
	Sincerely,
	
	/s/ John Dixon
	 John Dixon
 Contract Manager


 JD/ms 
 Enclosure (1) 
 pc: DHPF central file 
 Landon State Office Building, 900 SW Jackson, Room 900N, Topeka, KS 66612 
 Phone 785-296-3981    Fax 785-296-4813 








			
	STATE OF KANSAS	  	Contract No. 02510
	Social and Rehabilitation Services	  	
	Health Care Policy/Medicaid	  	

 AMENDMENT NINETEEN 
 to the 
 KANSAS HEALTHWAVE TITLE XIX AND TITLE XXI CAPITATED MANAGED CARE

 HEALTH SERVICES CONTRACT 
 with 
 FIRSTGUARD HEALTH PLAN KANSAS, INC. 
 2007 SIX MONTH EXTENSION 
 The above referenced agreement, as amended, entered into by and between the Secretary of
Social and Rehabilitation Services, hereinafter referred to as SRS, and FirstGuard Health Plan Kansas, Inc., a Kansas Corporation, hereinafter referred to as FG, on July 12, 2001, and transferred effective July 1, 2005 to the Director of
Health Policy and Finance, hereinafter referred to as DHPF, is hereby amended by agreement of the parties. 
 The Kansas Legislature, in the 2005 Session,
enacted House Substitute for Senate Bill No. 272. This Act establishes the Health Policy Authority (HPA) and also establishes the Division of Health Policy and Finance (DHPF) within the Kansas Department of Administration, effective
July 1, 2005. This Act further provides that the DHPF shall be the single state agency for Medicaid on an interim basis and transfers related responsibilities, duties and contracts, including this contract, from SRS to the new DHPF on
July 1, 2005 and then subsequently provides that the HPA shall be the single state agency for Medicaid effective July 1, 2006 and transfers these same responsibilities, duties and contracts to the HPA on July 1, 2006. 
 DHPF has determined it is in the best interests of the State to make certain changes to the contract as originally agreed upon; and FGK is agreeable to such changes; now
for and in consideration of the mutual covenants and agreements contained herein, the parties hereby mutually covenant and agree as follows: 
 The following documents are referenced for convenience only and are NOT made a part of this 
 amendment or intended to be
incorporated in this contract by this reference. 
 Related Contract Amendment Number/Name: #1; #15, #17, #18 
 Related Memorandum of Understanding Number/Name: N/A 
 Related Policy Number/Name: N/A 
 Related Request For Proposals Reference(s): RFP #02510

 Total Estimated Cost: Title XIX $72,000,000 Title XXI $32,000,000 
  

 Contract #02510, Amendment 19, Page 1 of 3 Pages 









	1.	TERM: 

 By mutual agreement of the parties, the term
of this contract is extended for an additional six months, for the period July 1, 2006 through December 31, 2006. 
  

	2.	MEDICAID TITLE XIX CAPITATION RATES: 

 RFP #02510,
Page 114, Paragraph 5.15.1.e. as amended by Amendment 1 and Amendment 18: 
 The parties agree that for the period March 1, 2006 through
June 30, 2006, the capitation rates set forth in Attachment 1 –Rates for the Period March 1, 2006 through June 30, 2006, attached to and incorporated herein shall apply to Title XIX, subject to actuarial certification and
approval by the Center for Medicare and Medicaid Services (CMS). 
 Is, effective with the signing of this amendment, amended to read:

 The parties agree that for the period July 1, 2006 through December 31, 2006, the capitation rates set forth in Attachment
A – HW XIX Rates for the Period July 1, 2006 through December 31, 2006, attached to and incorporated herein shall apply to HealthWave Title XIX, subject to actuarial certification and approval by the Center for Medicare and
Medicaid Services (CMS). 
  

	3.	SCHIP TITLE XXI CAPITATION RATES FOR THE PERIOD BEGINNING JULY 1, 2006: 

 The parties agree that for the period July 1, 2006 through December 31, 2006, the capitation rates set forth in Attachment B – HealthWave Title XXI Rates for the period July 1, 2006 through
December 31, 2006, attached to and incorporated herein shall apply to HealthWave Title XXI. 
  

	4.	OTHER TERMS AND CONDITIONS: 

 All other terms and
conditions of the contract between SRS and FGK remain unchanged. 
  

 Contract #02510, Amendment 19, Page 2 of 3 Pages 








 IN WITNESS HEREOF, the Parties hereto have executed this amendment to the original contract as of the date written
below. 
  

					
	FIRSTGUARD HEALTH PLAN KANSAS, INC.	 		 	DIVISION OF HEALTH POLICY AND FINANCE
			
	/s/ Jean Rumbaugh	 		 	/s/ Robert M. Day
	Jean Rumbaugh	 		 	Robert M. Day, Ph.D.
	President & COO	 		 	Director
			
	5-4-06	 		 	5-30-2006
	Date	 		 	Date
			
	DEPARTMENT OF ADMINISTRATION DIVISION OF PURCHASES	 		 	
			
	/s/ Chris Howe	 		 	 
	 Chris Howe, Director
 Division of
Purchases
	 		 	
			
	June 05, 2006	 		 	 
	Date	 		 	

  

 Contract #02510, Amendment 19, Page 3 of 3 Pages 








 Attachment A 
 HW XIX Rates Effective July 1, 2006 - December 31, 2006 
 SFY2007 Rates, HealthWave XIX (adjusted for
provider assessment - physician rate increases) 
  

													
	 	  	Johnson,
Leavenworth, &
Wyandotte
Counties	  	Northeast &
Western
Kansas	  	Southeast
Kansas	  	Sedgwick
County
	 TAF & PLE < 1
	  	$	501.76	  	$	508.68	  	$	496.20	  	$	575.18
	 TAF & PLE 1-5
	  	$	97.77	  	$	107.68	  	$	113.72	  	$	86.68
	 TAF & PLE 6-14
	  	$	78.68	  	$	96.38	  	$	99.54	  	$	76.45
	 TAF & PLE 15-21 F
	  	$	151.49	  	$	166.56	  	$	193.03	  	$	166.99
	 TAF & PLE 15-21 M
	  	$	88.11	  	$	112.24	  	$	108.29	  	$	83.86
	 TAF 22-29 F
	  	$	252.61	  	$	246.57	  	$	256.87	  	$	246.93
	 TAF 22-34 M
	  	$	199.17	  	$	199.10	  	$	198.15	  	$	168.76
	 TAF 30-34 F
	  	$	284.11	  	$	301.21	  	$	312.35	  	$	292.20
	 TAF 35+
	  	$	389.40	  	$	459.51	  	$	514.38	  	$	442.20
	 Preg Wom < 30
	  	$	315.48	  	$	293.75	  	$	341.83	  	$	319.94
	 Preg Wom 30+
	  	$	389.19	  	$	368.33	  	$	396.85	  	$	394.71
					
	 Delivery Payment
	  	$	4,987	  			  			  		








 Attachment B 
 HealthWave XXI Rates - Effective July 1, 2006 - December 31, 2006 
  

													
	 	  	JOLVWY	  	NEWE	  	SE	  	SG
	 Up to age 1 Male
	  	$	566.27	  	$	546.27	  	$	465.39	  	$	487.32
	 Up to age 1 Female
	  	$	566.27	  	$	546.27	  	$	465.39	  	$	487.32
	 1 through 5 Male
	  	$	146.74	  	$	117.49	  	$	104.81	  	$	104.81
	 1 through 5 Female
	  	$	143.43	  	$	114.85	  	$	102.45	  	$	102.45
	 6 through 14 Male
	  	$	107.30	  	$	85.92	  	$	76.64	  	$	76.64
	 6 through 14 Female
	  	$	114.64	  	$	91.79	  	$	81.88	  	$	81.88
	 15 through 19 Male
	  	$	138.31	  	$	110.74	  	$	98.79	  	$	98.79
	 15 through 19 Female
	  	$	260.71	  	$	208.74	  	$	186.22	  	$	186.22
	 Pregnant women to age 19
	  	$	1,042.84	  	$	834.99	  	$	744.89	  	$	744.89