##### 



(AHCCCS LOGO)
    
    ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION
DIVISION OF BUSINESS AND FINANCECONTRACT AMENDMENT
 1. AMENDMENT NO.:
    
    2. CONTRACT NO.:
    
    3. EFFECTIVE DATE OF AMENDMENT:
    
    4. PROGRAM:16
    
    YH04-0001-03
    
    October 1, 2006
    
    DHCM
  Health Choice Arizona
1600 W. Broadway, Suite 260
Tempe, Arizona 85282-1136
    A.
    
    SECTION B, CAPITATION RATES:See rate sheet attached for the revised capitation rates effective October 1, 2006
through December 31, 2006 and the amounts to be paid to the rural hospitals.Insert the following language before See attached.:The Contractor will be paid the attached Contractor specific capitation rates
retroactively, per member per month, for the period of October 1, 2006 through December
31, 2006. Only the impacted rates are included on the attachment. All other rates
remain unchanged. The Administration requires that the Contractor then make one-time
payments to each rural hospital as prescribed on the attached schedule, pursuant to ARS
§ 36-2905.02, to increase inpatient reimbursement to these small rural hospitals.The retroactive capitation rate payment will be paid in June 2007. The Contractor shall
make the prescribed payments to the rural hospitals by June 30, 2007 and submit proof
of payment to the rural hospitals to the Finance Unit of the Division of Health Care
Management by July 20, 2007.The capitation rates for the period January 1, 2007 through September 30, 2007 are
not impacted by this amendment.B.
    
    SECTION D, Paragraph 2, ELIGIBILITY CATEGORIES:To include the coverage of behavioral health services under the SSDI-TMC
program, replace the last subparagraph, which begins In order to participate
in SSDI-TMC..., with:In order to participate in SSDI-TMC, eligible persons must pay a premium. Participants
become ineligible for SSDI-TMC once they become eligible for Medicare. SSDI-TMC is
funded entirely by the State. Contractors will be capitated for these members under
unique rate codes and AHCCCS may provide a reconciliation to limit the profit or loss
of this population. If a reconciliation is to be implemented, an SSDI-TMC
reconciliation policy will be developed which will discuss the details of the
reconciliation calculations and timelines. SSDI-TMC members will not be eligible for
prior period coverage, any supplemental payments or reinsurance. Members will be
entitled to all AHCCCS Acute Care benefits.C.
    
    SECTION D, Paragraph 3, ENROLLMENT AND DISENROLLMENT:To clarify the Contractors responsibility for coverage of behavioral health
services in the Prior Period, replace the subparagraph titled Prior Period Coverage
with:Prior PeriodCoverage:AHCCCS provides prior period coverage for the period of time, prior to the
Title XIX members enrollment, during which a member is eligible for covered services. The time
frame is from the effective date of eligibility to the day a member is enrolled with
the Contractor. The Contractor receives




---



##### 



NOTE: Please sign and date both and return one original to:
    
    Phil BaldwinAHCCCS Contracts
and Purchasing 701
E. Jefferson, MD
5700 Phoenix, AZ
85034
 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.  NAME OF CONTRACTOR:
HEALTH CHOICE ARIZONA
    
    10.    ARIZONA HEALTH CARE COST CONTAINMENT 
          SYSTEMSIGNATURE OF AUTHORIZED INDIVIDUAL: /s/ Carolyn Rose
    
    SIGNATURE: /s/ Michael VeitTYPED NAME: CAROLYN ROSE
    
    TYPED NAME: MICHAEL VEITTITLE: CHIEF EXECUTIVE OFFICER
    
    TITLE: CONTRACTS AND PURCHASING 
                ADMINISTRATORDATE 4/30/07
    
    DATE: APR 19 2007