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Exhibit 10.43 HHSC Contract No. 65M1015HPC STATE OF TEXAS COUNTY OF TRAVIS AMENDMENT 6
TO THE AGREEMENT BETWEEN THE
HEALTH & HUMAN SERVICES COMMISSION
AND
AMERIGROUP TEXAS, INC.
FOR HEALTH SERVICES
TO THE
MEDICAID STAR+PLUS PROGRAM
IN THE
HARRIS SERVICE DELIVERY AREA THIS CONTRACT AMENDMENT (the Amendment) is entered into between the
HEALTH & HUMAN SERVICES COMMISSION (HHSC), an administrative agency within
the executive department of the State of Texas, and AMERIGROUP TEXAS, INC.
(HMO), a health maintenance organization organized under the laws of the
State of Texas, possessing a certificate of authority issued by the Texas
Department of Insurance to operate as a health maintenance organization, and
having its principal office at 1200 E. Copeland Rd. Suite 200, Arlington, TX
76011HHSC and CONTRACTOR may be referred to in this Amendment individually as
a Party and collectively as the Parties. The Parties hereby agree to amend their Agreement as set forth herein. ARTICLE 1. PURPOSE. Section 1.01Authorization. This Amendment is executed by the Parties in accordance with
Article 15.2 of the Agreement. Section 1.02Effective Date. Except as otherwise provided in this Amendment, the provisions of this
Amendment are effective on May 1, 2004. ARTICLE 2. AMENDMENT TO THE OBLIGATIONS OF THE PARTIES Section 2.01Modification to Article 2, Definitions  The following provisions amend and supplement the
definitions set forth in Article 2, Definitions, as follows: Court-ordered Commitmentmeans a commitment of a
STAR +PLUS Member to a psychiatric facility for
treatment that is ordered by a court of law pursuant
to the Texas Health and Safety Code, Title VII,
Subtitle C, or a placement in a state-operated
facility as a condition of probation, as authorized by
the Texas Family Code. HHSC Contract
    
    Page 1 of 6
    
    Effective Date: May 1, 2004




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Health-related Materialsare materials that are
developed by the HMO or obtained from a third party
relating to the diagnosis or treatment of medical
conditions. Section2.02 Modification to Article 3, Plan Administrative and Human Resources
Requirements  Article 3, Plan Administrative and Human Resources Requirements,
is amended by modifying Sections 3.4.1 through 3.4.4, as
follows: 3.4.1 Prior to distribution to (1) Members, (2)
prospective Members, (3) providers within HMOs network,
or (4) potential providers whom HMO intends to recruit as
network providers, and with the exception of
Health-related Materials, HMO must receive written
approval from HHSC for all written materials produced or
authorized by HMO containing information about the
STAR+PLUS Program. Health-related Materials do not need
to be submitted for review and approval. Per HHSC

request, and on an ad-hoc basis, HMOs will be required to
submit a list of Health-related Materials currently being
used, or used previously; HHSC may request the review of
selected materials from that list. HHSC will provide HMO
a reasonable amount of time to respond to such requests,
generally no less than 10 business days. 3.4.2 Member materials must meet cultural and
linguistic requirements as stated in Article 8. Unless
otherwise required, Member materials must be written at a
4th - 6th grade reading comprehension level, and
translated into the language of any major population
group, except when HHSC requires HMO to use statutory
language (i.e., advance directives, medical necessity,
etc.). 3.4.3 With the exception of Health-related
Materials, all plan materials regarding the STAR+PLUS
Program, including Member education materials, must be
submitted to HHSC for approval prior to distribution.
HHSC has fifteen (15) working days to review the
materials and recommend any suggestions or required
changes. If HHSC has not responded to HMO by the
fifteenth (15th) day, HMO may print and distribute these
materials. HHSC reserves the right to request HMO to
modify plan materials that are deemed approved and have
been printed or distributed. These modifications can be
made at the next printing unless substantial
non-compliance exists, as determined by HHSC. An
exception to the fifteen (15) working day timeframe may
be requested in writing by HMO for written provider
materials that require a quick turn-around time (e.g.,
letters). HHSC will review such requests within a
reasonable amount of time, generally within 5 working
days. MSC reserves the right to require revisions to
materials if inaccuracies are discovered or if changes
are required by changes in policy or law. These changes
can be made at the next printing unless substantial
non-compliance exists, as determined by HHSC. 3.4.4 With the exception of Health-related
Materials, HMO must send HHSC-approved English versions
of HMOs Member Handbook, Member Provider Directory,
newsletters, individual Member letters, and any written
information that applies to Medicaid-specific services to
TDHS for TDHS to translate into Spanish. TDHS must
provide the written and approved translation into Spanish
to HMO no later than 15 HHSC Contract
    
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    Effective Date: May 1, 2004




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working days after receipt of the English version by
HHSC. HMO must incorporate the approved translation
into their materials. If TDHS has not responded to
HMO by the fifteenth day, HMO may print and
distribute these materials. HHSC reserves the right
to require revisions to materials if inaccuracies
are discovered or if changes are required by changes
in policy or law. These changes can be made at the
next printing, unless substantial non-compliance
exists, as determined by HHSC. HMO has the option to
use the TDHS translation unit or their own
translators for health education materials not
containing Medicaid-specific information and for
other marketing materials such as billboards, radio
spots, and television and newspaper advertisements. Section 2.03Modification to Article 4, Fiscal, Financial, Claims, and
Insurance Requirements  Article 4, Fiscal, Financial, Claims, and Insurance
Requirements, is amended by modifying Sections 4.10.3 and
4.10.6, respectively, as follows: 4.10.3 HMO and claims processing subcontractors
must comply with HHSCs Texas Medicaid Managed Care
Claims Manual (Claims Manual), as amended or
modified. The Claims Manual is incorporated herein
by reference and contains HHSCs claims processing
and reporting requirements. HHSC will provide the
HMO reasonable notice of changes to the Claims
Manual. For purposes of this section only,
reasonable notice will generally mean 60 days
advance written notice of systems changes and 30
days advance written notice of other changes, unless
in HHSCs sole discretion, changes in federal or
state laws, rules, regulations, or policies warrant
a shorter time period for notice. 4.10.6 All provider clean claims must be
adjudicated (finalized as paid or denied
adjudicated) within 30 days from the date the claim
is received by HMO. HMO must pay providers interest
on a claim that is not adjudicated within 30 days
from either: (1) the date the HMO receives the clean
claim, or (2) the date the claim becomes clean. HMO
must pay providers interest at an 18% annual rate,
calculated daily for the full period in which the
clean claim remains unadjudicated beyond the 30-day
claims processing deadline. HMO must comply with the
Texas Medicaid Managed Care Claims Manual to
determine the principal amount for the interest
payment computation. HMO will be held to a minimum
performance level of 90% of all clean claims paid or
denied within 30 days of receipt and 99% of all
clean claims paid or denied within 90 days of
receipt. Failure to meet these performance levels is
a default under this contract and could lead to
damages or sanctions as outlined in Article 17. The
performance levels are subject to changes, if
required to comply with federal and state laws or
regulations. Section 2.04Modification to Article 5,Statutory, Regulatory, and Compliance
Requirements  Effective February 15, 2004, Article 5, Statutory,
Regulatory, and Compliance Requirements, is amended by
adding new Section 5.1.4, and by modifying Sections 5.6.1
and 5.6.2, respectively, as set forth below. The attached
HUB monthly reporting form replaces the quarterly reporting
form included in Attachment B to the Agreement : HHSC Contract
    
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    Effective Date: May 1, 2004




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5.1.4 In accordance with Texas Government Code
§2262.003, HMO understands that acceptance of funds
under this contract acts as acceptance of the
authority of the State Auditors Office, or any
successor agency, to conduct an audit or
investigation in connection with those funds. HMO
further agrees to cooperate fully with the State
Auditors Office or its successor in the conduct of
the audit or investigation, including providing all
records requested. HMO will ensure that this clause
concerning the authority to audit funds received
indirectly by subcontractors through HMO and the
requirement to cooperate is included in any
subcontract it awards. 5.6 HISTORICALLY UNDERUTILIZED BUSINESS 5.6.1 In accordance with Texas Government Code
Chapter 2161 and 1 TAC § 111.11 et seq. and §392.100
state agencies are required to make a good faith
effort to assist Historically Underutilized
Businesses (HUBs) in receiving contract awards issued
by the State. The goal of this program is to promote
full and equal business opportunity for all
businesses in contracting with the state. It is
HHSCs intent that all contractors make a good faith
effort to subcontract with HUBs during the
performance of their contracts. Important Note: The Health and Human Services
Commission has concluded that HUB subcontracting
opportunities may exist in connection with this
contract. See Appendix B to the Agreement for the
following instructions and form: Grant/Subcontract
Applications Client Services HUB Subcontracting Plan
Instructions (C-IGA) and Determination of Good
Faith Effort for Grant Contracts (C-DGFE). If an
approved HUB Subcontracting Plan is not already on
file with HHSC, the HMO shall submit a completed
C-DGFE with the signed contract or renewal. 5.6.2 In accordance with Article 12.11, HMO is
required to submit HUB monthly reports in the format
set forth in Appendix B to the Agreement. CONTRACTOR
must submit retroactive monthly reports for months,
beginning December 2003. If HMO decides after the award to subcontract
any part of the contracted work, the HMO shall notify
HHSC Health Plan Manager prior to entering into any
subcontract. The HMO shall comply with the good faith
effort requirements relating to developing and
submitting a modified HUB Subcontracting Plan. Section 2.05Modification of Article 6, Scope of Services  Article 6, Scope of Services, is amended by modifying Section 6.6.11, as
follows: 6.6 BEHAVIORAL HEALTH CARE SERVICES  SPECIFIC
REQUIREMENTS 6.6.11 HMO must provide inpatient psychiatric
Covered Services to Members under the age of 2I who
have been ordered to receive the services by a court
of competent jurisdiction under the provisions of
Title VII, Subtitle C of the Texas Health and Safety
Code, relating to court-ordered commitments to
psychiatric facilities, or a placement in a HHSC Contract
    
    Page 4 of 6
    
    Effective Date: May 1, 2004




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state-operated facility as a condition of probation,
as authorized by the Texas Family Code. Section 2.06Modificationof Article 7,Provider Network Requirements  Article 7, Provider Network Requirements, is amended by
modifying Section 7.2.8.10, as follows: 7.2.8.10 All provider clean claims must be
adjudicated (finalized as paid or denied adjudicated)
within 30 days from the date the claim is received by
HMO. HMO must agree to pay the provider interest in
accordance with Section 4.10.6 for clean claims that
are not adjudicated within 30 days. Section2.07 Modification of Article 12, Reporting Requirements  Effective February 15, 2004, Article 12, Reporting
Requirements, is amended by modifying Sections 12.2.9, and
12.11, as follows: 12.2.9 Claims Reports. HMO must comply with
Claims Reports submission requirements specified in
HHSCs Texas Medicaid Managed Care Claims Manual. The
reports must be submitted to HHSC in a format
specified within the Texas Medicaid Managed Care
Claims Manual and/or report templates provided by
HHSC. 12.11 HMO must submit monthly reports
documenting HMOs HUB program efforts and
accomplishments in a format provided by HHSC. Section 2.08Modification ofArticle 13,Payment Provisions  Article 13, Payment Provisions, is amended by modifying
Section 13.1.2; furthermore, Section 13.2.4 is deleted in its
entirety, and new Section 13.2.6 is added, as follows: 13.1.2 The capitation amount by Member risk
group has been calculated to be less than the amount
payable for providing the same services for an
actuarially equivalent population in the regular
Medicaid fee-for-service program. The monthly
capitation payments, effective September 1, 2003, are
as follows: Monthly CapitationMember Risk Group
    
    AmountsCBA Waiver Clients- Dual Eligible
    
    $
    1503.36CBA Waiver Clients- Medicaid Only
    
    $
    3614.67Other Community Clients- Dual Eligible
    
    $
    152.54Other Community Clients- Medicaid Only
    
    $
    700.61Nursing Facility Clients- Dual Eligible
    
    $
    152.54Nursing Facility Clients- Medicaid Only
    
    $
    700.61
 13.2 EXPERIENCE REBATE TO STATE HHSC Contract
    
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    Effective Date: May 1, 2004




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13.2A [deleted] 13.2.6 Interest on any experience rebate owed to
HHSC shall be charged beginning on the date that the
first and/or second settlements are overdue to the
date of the respective payment. In addition, if any
adjusted amount is owed to HHSC at the final
settlement date, then interest is charged on the
adjusted amount owed beginning on the second
settlement date to the date of the final settlement
payment. Interest charged shall be calculated on an
annual and simple basis using the current Prime
Rate(s) established by the federal government. ARTICLE 3. REPRESENTATIONS AND AGREEMENT OF THE PARTIES The Parties contract and agree that the terms of the Agreement will remain
in effect and continue to govern except to the extent modified in this
Amendment. By signing this Amendment, the Parties expressly understand and agree that
this Amendment is hereby made a part of the Agreement as though it were set out
word for word in the Agreement. IN WITNESS HEREOF, HHSC and the CONTRACTOR have each caused this Amendment
to be signed and delivered by its duly authorized representative. AMERIGROUP TEXAS, INC.
    
    HEALTH & HUMAN SERVICES COMMISSIONBy:
    
    /s/ Eric M. Yoder
    
    By:
    
    /s/ Albert HawkinsEric M. Yoder
    
    
    
    Albert HawkinsPresident & CEO
    
    
    
    Executive CommissionerDate: April 6, 2004
    
    Date: April 26, 2004
 HHSC Contract
    
    Page 6 of 6
    
    Effective Date: May 1,
2004




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Exhibit 10.43 HHSC Contract No. 65M1015HPC STATE OF TEXAS COUNTY OF TRAVIS AMENDMENT 8
TO THE AGREEMENT BETWEEN THE
HEALTH & HUMAN SERVICES COMMISSION
AND
AMERIGROUP TEXAS, INC.
FOR HEALTH SERVICES
TO THE
MEDICAID STAR+PLUS PROGRAM
IN THE
HARRIS SERVICE DELIVERY AREA THIS CONTRACT AMENDMENT (the Amendment) is entered into between the
HEALTH & HUMAN SERVICES COMMISSION (HHSC), an administrative agency within
the executive department of the State of Texas, and AMERIGROUPTEXAS, INC.
(HMO), a health maintenance organization organized under the laws of the
State of Texas, possessing a certificate of authority issued by the Texas
Department of Insurance to operate as a health maintenance organization, and
having its principal office at 1200 E. Copeland Rd. Suite 200, Arlington, TX
76011.HHSC and CONTRACTOR may be referred to within this Amendment
individually as a Party and collectively as the Parties. The Parties hereby agree to amend their
Agreement as set forth herein. ARTICLE 1. PURPOSE. Section 1.01Purpose The purpose of this Amendment is to revise the monthly capitation rates,
as last defined by Section 2.08 of Amendment 6to the Agreement of the Parties.
The Centers for Medicare and Medicaid (CMS) did not approve the monthly
capitation rates set forth in Section 2.08 of Amendment 6,thereby making the
section invalid and unenforceable by operation of law. Section 1.02Authorization. This Amendment is executed by the Parties in accordance with Article 15.2 of
the Agreement. Section 1.03Effective Date. This Amendment is effective May 1, 2004. ARTICLE 2. AMENDMENT TO THE OBLIGATIONS OF THE PARTIES Section 2.01Modification of Article 13, Payment Provisions Section 13.1.2 is deleted in its entirety and replaced as follows: 13.1.2 The following table represents the
monthly capitation rates applicable to the dates
specified below: HHSC Contract
    
    Page 1 of 2
    
    Effective Date: May 1, 2004




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Monthly Capitation
    
    Monthly Capitation
    
    Monthly CapitationRate
    
    Rate
    
    RateEffective
    
    Effective
    
    EffectiveSDA
    
    9/1/03 to 6/30/04
    
    7/1/04 to 7/31/04
    
    8/1/04 to 8/31/04CBA Waiver Clients- Dual
Eligible
    
    
    1,503.34
    
    
    
    1,503.34
    
    
    
    1,503.34CBA Waiver Clients- Medicaid
Only
    
    
    3,556.95
    
    
    
    4,191.76
    
    
    
    3,614.66Other Community Clients- Dual
Eligible
    
    
    152.55
    
    
    
    152.55
    
    
    
    152.55Other Community Clients-
Medicaid Only
    
    
    684.88
    
    
    
    857.91
    
    
    
    700.61Nursing Facility Clients- Dual
Eligible
    
    
    152.55
    
    
    
    152.55
    
    
    
    152.55Nursing Facility Clients-
Medicaid Only
    
    
    684.88
    
    
    
    857.91
    
    
    
    700.61
 ARTICLE 3. REPRESENTATIONS AND AGREEMENT OF THE PARTIES The Parties contract and agree that the terms of the Agreement will
remain in effect and continue to govern except to the extent modified in
this Amendment. By signing this Amendment, the Parties expressly understand and agree
that this Amendment is hereby made a part of the Agreement as though it were
set out word for word in the Agreement. IN WITNESS HEREOF, HHSC and the CONTRACTOR have each caused this
Amendment to be signed and delivered by its duly authorized representative. AMERIGROUP TEXAS, INC.
    
    HEALTH & HUMAN SERVICES COMMISSIONBy:
    
    /s/ Eric M. Yoder
    
    By:Dr. Eric M. Yoder
    
    
    
    Albert HawkinsPresident and CEO
    
    
    
    Exectuive CommissionerDate:
    
    June 11, 2004
    
    Date:
 HHSC Contract
    
    Page 2 of 2
    
    Effective Date: May 1, 2004