EX - 10.110 2012.6.30-10K






EXHIBIT 10.110
	
		
	
	ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION
DIVISION OF BUSINESS AND FINANCE
SECTION A: CONTRACT






	
					
	 1. AMENDMENT 
    NUMBER:
18
	2.  CONTRACT          NO.:
YH09-0001-07
	3.    EFFECTIVE DATE OF 
       AMENDMENT:
       October 1, 2011
	4. PROGRAM      
         
DHCM - ACUTE

	5.  CONTRACTOR'S NAME AND ADDRESS:
   VHS Phoenix Health Plan, LLC
   7878 N. 16th St., Suite 105
   Phoenix, AZ 85020

	6.  PURPOSE OF AMENDMENT:  To allow for payment of rural hospital inpatient reimbursement pursuant to A.R.S. §36-2905.02.

	

7.   THE CONTRACT REFERENCED ABOVE IS AMENDED AS FOLLOWS
The Contractor will be paid the attached supplemental payment amounts to increase rural hospital inpatient reimbursement. The supplemental payment amounts are allocated to the appropriate risk groups based on historical utilization. AHCCCS requires that the Contractor make one-time payments to each rural hospital as prescribed on the attached schedule, pursuant to A.R.S. §36-2905.02, to increase inpatient reimbursement to these small rural hospitals.


The Contractor shall make the prescribed payments to the rural hospitals 15 days from receipt of the funds and submit proof of payment to the rural hospitals to the Assistant Director of the Division of Health Care Management 30 days from receipt of the funds.


The regular per member per month capitation rates for the period of October 1, 2011 through September 30, 2012 remains unchanged.










NOTE:  Please sign, date, and return executed file by E-Mail to:   Mark Held at Mark.Held@azahcccs.gov Sr. Procurement Specialist, AHCCCS Contracts and Purchasing and P.J. Schoenstene at pj.schoenstene@azahcccs.gov  Contracts and Policy Administrator, Division of Health Care Management



	8.   EXCEPT AS PROVIDED FOR HEREIN, ALL TERMS AND CONDITIONS OF THE ORIGINAL CONTRACT NOT HERETOFORE CHANGED AND/OR AMENDED REMAIN UNCHANGED AND IN FULL EFFECT.  IN WITNESS WHEREOF THE PARTIES HERETO SIGN THEIR NAMES IN AGREEMENT.

	9.   SIGNATURE OF AUTHORIZED REPRESENTATIVE: /s/ Nancy Novick


	10.   SIGNATURE OF AHCCCS CONTRACTING OFFICER: /s/ Michael Veit



	TYPED NAME:  NANCY NOVICK
	TYPED NAME:  MICHAEL VEIT



	TITLE: CHIEF EXECUTIVE OFFICER


	TITLE:  CONTRACTS & PURCHASING ADMINISTRATOR

	DATE: 05/8/2012


	DATE: 05/2/2012















	
																	
	ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM

	ACUTE SUPPPLEMENTAL PAYMENT SUMMARY - Rural Hospital

	Phoenix Health Plan

	 CYE 2012

	 
	 
	 
	 
	 
	 
	 

	 
	Supplemental  Payment  Related  To:

	 
	 
	 
	 
	 
	 
	 

	 
	 
	 TANF
	 TANF
	 SSI
	 
	 Total

	Supplemental Payment:
	 <1, M/F
	 14-44, F
	 w/o Med
	 Non-MED
	 Payment

	4
	Apache/Coconino/Mohave/Navajo
	$
	144,997.98
	

	$
	386,578.41
	

	$
	149,091.80
	

	$
	504,001.42
	

	$
	1,184,669.61
	


	6
	Yavapai
	$
	229,483.29
	

	$
	650,789.44
	

	$
	223,743.16
	

	$
	724,227.56
	

	$
	1,828,243.45
	


	8
	Gila/Pinal
	$
	58,404.09
	

	$
	363,758.46
	

	$
	293,719.92
	

	$
	673,785.43
	

	$
	1,389,667.90
	


	 
	 
	 
	 
	 
	 
	$
	4,402,580.96
	







	
						
	Two percent Premium tax is included in the Supplemental Capitation Payments.

	Payments to the hospitals stated without Premium Tax.

	 
	 
	 
	 

	 
	 
	 
	 

	 
	Phoenix Health Plan
	 
	Payment

	 
	Arizona Regional Medical Center - Apache Junction
	 
	$
	187,248.00
	


	 
	Banner Ironwood Medical Center
	 
	$
	272,177.51
	


	 
	Benson Hospital
	 
	—
	


	 
	Carondelet Holy Cross
	 
	—
	


	 
	Cobre Valley Community Hospital
	 
	$
	364,285.99
	


	 
	Copper Queen Community Hospital
	 
	—
	


	 
	Florence Community Health Care
	 
	$
	25,570.48
	


	 
	La Paz Regional Hospital
	 
	—
	


	 
	Little Colorado Medical Center
	 
	$
	223,754.46
	


	 
	Mount Graham Regional Medical Center
	 
	—
	


	 
	Northern Cochise Community Hospital
	 
	—
	


	 
	Page Hospital
	 
	$
	87,257.69
	


	 
	Payson Regional Medical Center
	 
	$
	818,750.07
	


	 
	Sierra Vista Regional Health
	 
	—
	


	 
	Southeastern Az Medical Center
	 
	—
	


	 
	Summit Healthcare Regional Medical Center
	 
	$
	346,407.93
	


	 
	Valley View Medical Center
	 
	$
	329,243.73
	


	 
	Verde Valley Medical Center
	 
	$
	1,082,292.21
	


	 
	White Mountain Regional Medical Center
	 
	$
	20,122.17
	


	 
	Wickenburg Regional Health Center
	 
	—
	


	 
	YRMC East
	 
	$
	557,419.10
	


	 
	Total Payments
	 
	$
	4,314,529.34
	


	 
	Premium Tax
	 
	$
	88,051.62
	


	 
	Total with Premium Tax
	 
	$
	4,402,580.96