(AHCCS LOGO)
    
    ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATIONDIVISION OF BUSINESS AND FINANCESECTION A: CONTRACT
 1.
        
    AMENDMENT
    2.
    CONTRACT
    
    
    3.
    
    
    EFFECTIVE DATE OF
    4.
    PROGRAMNUMBER:
    
    NO.:
    
    
    
    
    
    AMENDMENT:11
    
    
    YH09-0001-07
    
    
    
    
    
    October 1, 2009
    
    DHCM  ACUTE
  VHS Phoenix Health Plan, LLC
7878 N. 16 th St., Suite 105
Phoenix, AZ 85020
   ADDto Section B, CAPITATION RATES after first subparagraph add the following
language:
    NOTE: Please sign, date, and return executed file by E-Mail to:
    
    Mark Held at
Mark.Held@azahcccs.govSr. Procurement Specialist
AHCCCS Contracts and Purchasing and Stewart McKenzie atStewart.McKenzie@azahcccs.gov
 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 AHCCCSA CONTRACTING
OFFICER:
/s/ Michael VeitTYPED NAME: NANCY NOVICK
    
    TYPED NAME: MICHAEL VEITTITLE: CHIEF EXECUTIVE OFFICER
    
    TITLE: CONTRACTS & PURCHASING
ADMINISTRATORDATE: 10/25/10
    
    DATE: OCT 8 2010




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ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
ACUTE SUPPLEMENTAL PAYMENT SUMMARY  Rural
Phoenix Health Plan
CYE 2010
 Supplemental Payment Related To:
 TANF
    
    
    TANF
    
    
    SSI
    
    
    SSI
    
    
    
    
    
    
    TotalSupplemental Payment:
    
    <1, M/F
    
    
    14-44, F
    
    
    w/ Med
    
    
    w/o Med
    
    
    Non-MED
    
    
    Payment4 Apache/Coconino/Mohave/Navajo
    
    $
    267,525.62
    
    
    $
    472,205.45
    
    
    $
    172,081.51
    
    
    $
    245,114.28
    
    
    $
    425,972.26
    
    
    $
    1,582,899.126 Yavapai
    
    $
    186,186.55
    
    
    $
    346,670.58
    
    
    $
    216,277.31
    
    
    $
    201,388.65
    
    
    $
    524,237.38
    
    
    $
    1,474,760.478 Gila/Pinal
    
    $
    154,685.29
    
    
    $
    363,596.63
    
    
    $
    88,861.76
    
    
    $
    180,701.26
    
    
    $
    282,100.83
    
    
    $
    1,069,945.77$
    4,127,605.36
   Phoenix Health Plan
    
    PaymentBenson Hospital
    
    $
    Carondelet Holy Cross
    
    $
    Cobre Valley Community Hospital
    
    $
    350,517.10Copper Queen Community Hospital
    
    $
    La Paz Regional Hospital
    
    $
    35,698.91Little Colorado Medical Center
    
    $
    292,963.73Mount Graham Regional Medical Center
    
    $
    Summit Healthcare Regional Medical Center
    
    $
    368,712.22Northern Cochise Community Hospital
    
    $
    Page Hospital
    
    $
    106,490.49Payson Regional Medical Center
    
    $
    929,435.40Sage Memorial Hospital
    
    $
    Sierra Vista Regional Health
    
    $
    Southeastern Az Medical Center
    
    $
    Valley View Medical Center
    
    $
    431,388.66Verde Valley Medical Center
    
    $
    1,256,708.34White Mountain Regional Medical Center
    
    $
    25,037.78Wickenburg Regional Health Center
    
    $
    9,066.14YRMC East
    
    $
    239,034.48Total Payments
    
    $
    4,045,053.25Premium Tax
    
    $
    82,552.11Total with Premium Tax
    
    $
    4,127,605.36