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(LOGO)
    
    DEPARTMENT OF HEALTH & HUMAN SERVICES
    
    Centers for Medicare & Medicaid Services7500 Security BoulevardBaltimore, Maryland 21244
 Date:
    
    October 18, 2005To:
    
    Medicare Advantage, Cost, and HCPP OrganizationsFrom:
    
    David Lewis, Deputy Director, Medicare Advantage GroupSubject:
    
    Distribution of Executed 2006 Contracts




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H5817
    .  (hereinafter referred to as the MA Organization)
    You must check off AND initial each required Addendum type to reflect the coverage offered under
the H (or R) number associated with this contract
 Addendum Type
    
    Initialsü
    
    Part D Addendum
    
    AMCEmployer-Only MA-PD Addendum (800 Series)Employer-Only MA Only Addendum (800 Series)Variances/Waivers (Provided
directly to Demonstration Organizations by CMS)Regional Preferred Provider Organization Addendum(Provided directly to RPPOs by CMS)




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[422.505]
      [422.521]
     2




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[422.133; 422.504(a)(3)]
   [422.504(a)(2)]
  [422.504(a)(7)]
  Beneficiary Financial Protections.
   [422. 504(g)(1) ]
   [422. 504(g)(2) ]
 3




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[422. 504(g)(3) ]
  [422.504(a)(6)]
 Prompt Payment.
   [422. 520(a) ]
 [422. 520(b) ]
   [422.520(c)]
      4




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Performance Measurement and Reporting: [422.152(b)(l), (e)]
 Utilization Review:
 [422. 152(b) ]
 [422. 152(e) ] .
 Information Systems:
    [422.152(f)(l)]
 External Review
   [422.503(b)(4)(vi)]
   5




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6




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[422.504(a)(10)]
 Methodology. [422.504(a)(9)]
 Attestation of payment data (Attachments A, B, and C)
 (based on best knowledge, information and belief, as of the date specified on
the attestation form)
  attest to (based
on best knowledge, information and belief, as of the date specified on the attestation form) attest to (based on best knowledge, information, and
belief, as of the date specified on the attestation form) [422.504(1)]
  7




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(based on best
knowledge, information and belief, as of the date specified on the attestation form) [422.502(1)]
   [422.504(i)(l)]
   [422.504(i)(2)]
      [422. 504(i)(3) ]
 8




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[422. 504(i)(4) ]
 [422.504(i)(5)]
   [422.208]
 9




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[422.504(d)]
 Access to facilities and records
    10




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[422.502(e)]
  [422.516(a)]
       11




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[422.516(b)]
 Requirements for combined financial statements
    [422.516(c)]
  [422.502(f)(1)(ii)]
                [422.502(f)(2)]
 12




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[422.502(f)(3)]
 Reporting and disclosure under ERISA
  [422.516(d)]
 Electronic communication [422. 504(b) ]
 Risk Adjustment data [422. 504(a)(8) ]
   Renewal of contract:
 [422.506(a)]
 [422.505(d)]
   Nonrenewal by the Organization
      13




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[422.506(a)]
 CMS decision not to renew
     [422.505(d)]
 Notice
    Notice of appeal rights [422.506(b)]
 14




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[422.508(a)(2)]
 [422.508(a)(l)]
  [422. 508(b) ]
  Termination by CMS
         
    15




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Notice
    Immediate termination of contract by CMS
    Corrective action plan
 General
 Exception
 Appeal rights [422.510]
  Cause for termination
 Notice
  16




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Effective date of termination
 CMS liability
 Effect of termination by the organization [422.512]
     [422.504(h)]
 [422. 504(i) ]
  17




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[422. 504(k) ]
       18




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/s/
Aileen McCormick
    
    CooPrinted Name
    
    Title:/s/ Aileen McCormick
    
    9/7/05Signature
    
    Date:AMERGROUP Texas, Inc.Organization
    
    6700 West Loop Sauth, Suite 200Address: Bellaire, Tx 77401FOR THE CENTERS FOR MEDICARE & MEDICAID SERVICES/s/ Patricia P. Smith
    
    10/20/05Patricia P. Smith
    
    Date:DirectorMedicare Advantage GroupCenter for Beneficiary Choices
 19