VANGUARD HEALTH SYSTEMS, INC.



EXHIBIT 10.1





ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION

DIVISION OF BUSINESS AND FINANCE

CONTRACT AMENDMENT






	
Page 1 of 1 with Attachment


	


 1. AMENDMENT NUMBER:

     06

		
2.  CONTRACT NO.:

      YH04-0001-06

		
3.  EFFECTIVE DATE OF MODIFICATION:

      October 1, 2003

		
4.  PROGRAM:

      DHCM-Acute


	


 5. CONTRACTOR/PROVIDER NAME AND ADDRESS:





Phoenix Health Plan/Community Connection

 1209 South 7th Avenue

 Phoenix, Arizona  85007


	


 6. PURPOSE:  To revise capitation rates contained in Section B.


	


 7.  THE CONTRACT REFERENCED ABOVE IS AMENDED AS FOLLOWS:



      A.   The rates contained in the existing Section B are deleted and replaced with the attached revised capitation rates.  The purpose of this

              amendment is to adjust for premium tax that had not been included in previous rate schedules.



      NOTE:  Please sign, date and return one original to:          Gary L. Callahan, Contract Management Supervisor

                                                                                                
AHCCCS Contracts and Purchasing

                                                                                                
701 E Jefferson Street, MD5700

                                                                                                
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:

     Phoenix Health Plan/Community Connection

	
 

	
10. ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM


	


 SIGNATURE OF AUTHORIZED INDIVIDUAL:

 /s/ Nancy Novick                                   

 NANCY NOVICK

 CHIEF EXECUTIVE OFFICER

	
       

	


 SIGNATURE:

 /s/ Michael Veit                                       

 MICHAEL VEIT

 CONTRACTS & PURCHASING ADMINISTRATOR


	


 DATE:  11/10/03

	
    

	
DATE:  OCTOBER 31, 2003

















	
Final Awarded Rate – CYE04

 Phoenix Health Plan: GSA 8

 (Effective 10/01/03)


	
PERCENT CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS


	
PMPMs & PROGRAMMATIC ADJUSTMENTS

	
TANF & KC

 <1 M&F

	
TANF &

 KC

 1-13 M&F

	
TANF & KC

 14 - 44 F 1

	
TANF & KC

 14 - 44 M 1

	
TANF 45+

 M&F

	
SSI

 w/ Medicare

	
SSI

 w/o

 Medicare

	
Extended

 Family

 Planning

 Services

	
Maternity

 Delivery

 Payment

	
AIDS / HIV

 Supplemental

 Payment

	
Non-MED

 Prior Period

 Coverage

	
Non-MED

 Prospective

	
MED

 Prior Period

 Coverage

	
MED

 Prospective

	
MED

 Hospitalized

 Supplemental


	
Originally Awarded PMPM

	
$362.11

	
$89.55

	
$156.04

	
$107.93

	
$307.78

	
$230.10

	
$463.50

	
$14.38

	
$5,617.75

	
$740.35

	
$531.41

	
$387.36

	
$1,521.38

	
$738.34

	
$9,108.27


	
Outpatient & Emergency Room Adjustment

	
1.46%

	
2.79%

	
3.22%

	
3.71%

	
3.14%

	
2.00%

	
2.94%

	
0.00%

	
-0.73%

	
0.00%

	
2.77%

	
2.77%

	
2.65%

	
2.65%

	
1.39%


	
Cost Sharing Proposal Adjustment

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
-4.41%

	
0.00%

	
-5.09%

	
0.00%


	
Reinsurance Incorporating Catastrophic

 and Transplant Data Adjustment

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%


	
Hospital Inpatient DRI Trend Update Adjustment -

 (4.0% estimate changed to 3.8% actual)

	
-0.10%

	
-0.02%

	
-0.05%

	
-0.03%

	
-0.05%

	
-0.02%

	
-0.04%

	
-0.02%

	
-0.09%

	
0.00%

	
-0.06%

	
-0.06%

	
-0.06%

	
-0.06%

	
-0.23%


	
Fee-for-Service Schedule Change

 (Referral Physician and Lab & X-Ray COS)

	
-0.17%

	
-0.06%

	
-0.16%

	
-0.30%

	
-0.41%

	
-0.09%

	
-0.38%

	
0.00%

	
0.04%

	
0.00%

	
-0.38%

	
-0.38%

	
-0.49%

	
-0.49%

	
-0.49%


	
Premium Tax Implementation Adjustment

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%


	
Total Adjustment Impacting Base PMPM 2

	
3.25%

	
4.80%

	
5.11%

	
5.47%

	
4.77%

	
3.97%

	
4.60%

	
2.02%

	
1.24%

	
2.04%

	
4.41%

	
-0.20%

	
4.17%

	
-1.13%

	
2.72%


	
Adjusted Awarded PMPM for Plans Electing the

 $20k Reinsurance Deductible

	
$373.88

	
$93.85

	
$164.01

	
$113.84

	
$322.45

	
$239.24

	
$484.80

	
$14.67

	
$5,687.46

	
$755.46

	
$554.83

	
$386.59

	
$1,584.83

	
$730.00

	
$9,355.58


	
Impact of Electing the $50k Reinsurance Deductible 3

	
6.08%

	
0.55%

	
1.31%

	
1.40%

	
0.87%

	
0.20%

	
3.47%

	
0.00%

	
-0.30%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%


	
Premium Tax Adjustment of Electing the $50k

 Reinsurance Deductible 3

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
0.00%

	
2.04%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%


	
Adjusted Awarded PMPM for Plans Electing

 the $50k Reinsurance Deductible

	
$397.06

	
$94.37

	
$166.19

	
$115.46

	
$325.30

	
$239.74

	
$501.95

	
$14.67

	
$5,669.95

	
$755.46

	
$554.83

	
$386.59

	
$1,584.83

	
$730.00

	
$9,355.58









	
PERCENT CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS


	
PMPMs & PROGRAMMATIC ADJUSTMENTS

	
PPC Rural

 TANF & KC

 <1 M&F

	
PPC Rural

 TANF &

 KC 1-13

 M&F

	
PPC Rural

 TANF & KC

 14 - 44 F 1

	
PPC Rural

 TANF & KC

 14 - 44 M 1

	
PPC Rural

 TANF 45+

 M&F

	
PPC Rural

 SSI w/

 Medicare

	
PPC Rural

 SSI w/o

 Medicare

	
PPC Urban

 TANF & KC

 <1

 M&F

	
PPC Urban

 TANF &

 KC 1-13

 M&F

	
PPC Urban

 TANF & KC

 14 - 44 F 1

	
PPC Urban

 TANF & KC

 14 - 44 M 1

	
PPC

 Urban

 TANF 45+

 M&F

	
PPC

 Urban

 SSI w/

 Medicare

	
PPC

 Urban

 SSI w/o

 Medicare


	
Originally Awarded PMPM

	
$714.74

	
$37.84

	
$143.67

	
$116.05

	
$269.14

	
$37.03

	
$82.34

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Outpatient & Emergency Room Adjustment

	
1.46%

	
2.79%

	
3.22%

	
3.71%

	
3.14%

	
2.00%

	
2.94%

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Cost Sharing Proposal Adjustment

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Reinsurance Incorporating Catastrophic

 and Transplant Data Adjustment

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Hospital Inpatient DRI Trend Update Adjustment -

 (4.0% estimate changed to 3.8% actual)

	
-0.10%

	
-0.02%

	
-0.05%

	
-0.03%

	
-0.05%

	
-0.02%

	
-0.04%

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Fee-for-Service Schedule Change

 (Referral Physician and Lab & X-Ray COS)

	
-0.17%

	
-0.06%

	
-0.16%

	
-0.30%

	
-0.41%

	
-0.09%

	
-0.38%

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Premium Tax Implementation Adjustment

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Total Adjustment Impacting Base PMPM 2

	
3.25%

	
4.80%

	
5.11%

	
5.47%

	
4.77%

	
3.97%

	
4.60%

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Adjusted Awarded PMPM for Plans

 Electing the $20k Reinsurance Deductible

	
$737.97

	
$39.66

	
$151.00

	
$122.40

	
$281.97

	
$38.50

	
$86.12

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Impact of Electing the $50k Reinsurance Deductible

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Adjusted Awarded PMPM for Plans

 Electing the $50k Reinsurance Deductible

	
$737.97

	
$39.66

	
$151.00

	
$122.40

	
$281.97

	
$38.50

	
$86.12

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A





	
1. The KidsCare age cohort includes individuals 14 to 18 years of age, while the TANF rate cell includes 14 - 44.

									
	
2. The adjustment is multiplicative, not additive.

														
	
3. The Maternity Delivery Payment does not have a reinsurance component built directly into the rate. However, it is indirectly affected by choosing a different deductible

     level because the TANF 14-44 female rate is applied as an 8-month offset to the Maternity Delivery Payment, and the female rate is directly affected by a new reinsurance election.

					







	
Final Awarded Rate - CYE04

 Phoenix Health Plan: GSA 8

 (Effective 10/01/03)


	
PMPM CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS


	
PMPMs & PROGRAMMATIC ADJUSTMENTS

	
TANF & KC

 <1 M&F

	
TANF & KC

 1-13 M&F

	
TANF & KC

 14 - 44 F 1

	
TANF & KC

 14 - 44 M 1

	
TANF 45+

 M&F

	
SSI w/

 Medicare

	
SSI w/o

 Medicare

	
Extended Family

 Planning Services

	
Maternity Delivery

 Payment

	
AIDS / HIV

 Supplemental

 Payment

	
Non-MED

 Prior Period

 Coverage

	
Non-MED

 Prospective

	
MED

 Prior Period

 Coverage

	
MED

 Prospective

	
MED

 Hospitalized

 Supplemental


	
Originally Awarded PMPM

	
$362.11

	
$89.55

	
$156.04

	
$107.93

	
$307.78

	
$230.10

	
$463.50

	
$14.38

	
$5,617.75

	
$740.35

	
$531.41

	
$387.36

	
$1,521.38

	
$738.34

	
$9,108.27


	
Outpatient & Emergency Room Adjustment

	
$5.29

	
$2.49

	
$5.03

	
$4.00

	
$9.68

	
$4.61

	
$13.60

	
$0.00

	
($40.74)

	
$0.00

	
$14.71

	
$10.72

	
$40.31

	
$19.56

	
$126.36


	
Cost Sharing Proposal Adjustment

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
($17.56)

	
$0.00

	
($38.56)

	
$0.00


	
Reinsurance Incorporating Catastrophic

 and Transplant Data Adjustment

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00


	
Hospital Inpatient DRI Trend Update

 Adjustment - (4.0% estimate changed

 to 3.8% actual)

	
($0.38)

	
($0.02)

	
($0.08)

	
($0.04)

	
($0.15)

	
($0.04)

	
($0.19)

	
($0.00)

	
($5.29)

	
$0.00

	
($0.31)

	
($0.21)

	
($0.91)

	
($0.42)

	
($21.01)


	
Fee-for-Service Schedule Change

   (Referral Physician and Lab & X-Ray COS)

	
($0.62)

	
($0.06)

	
($0.26)

	
($0.34)

	
($1.31)

	
($0.21)

	
($1.81)

	
$0.00

	
$1.99

	
$0.00

	
($2.07)

	
($1.45)

	
($7.65)

	
($3.52)

	
($45.15)


	
Premium Tax Implementation Adjustment

	
$7.48

	
$1.88

	
$3.28

	
$2.28

	
$6.45

	
$4.78

	
$9.70

	
$0.29

	
$113.75

	
$15.11

	
$11.10

	
$7.73

	
$31.70

	
$14.60

	
$187.11


	
Total Adjustment Impacting Base PMPM

	
$11.77

	
$4.30

	
$7.97

	
$5.91

	
$14.67

	
$9.14

	
$21.30

	
$0.29

	
$69.71

	
$15.11

	
$23.42

	
($0.77)

	
$63.45

	
($8.34)

	
$247.32


	
Adjusted Awarded PMPM for Plans Electing

 the $20k Reinsurance Deductible

	
$373.88

	
$93.85

	
$164.01

	
$113.84

	
$322.45

	
$239.24

	
$484.80

	
$14.67

	
$5,687.46

	
$755.46

	
$554.83

	
$386.59

	
$1,584.83

	
$730.00

	
$9,355.58


	
Impact of Electing the $50k Reinsurance Deductible 2

	
$22.72

	
$0.52

	
$2.14

	
$1.59

	
$2.79

	
$0.49

	
$16.81

	
$0.00

	
($17.16)

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00


	
Premium Tax Adjustment of Electing

 the $50k Reinsurance Deductible 3

	
$0.46

	
$0.01

	
$0.04

	
$0.03

	
$0.06

	
$0.01

	
$0.34

	
$0.00

	
($0.35)

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00


	
Adjusted Awarded PMPM for Plans Electing the $50k

 Reinsurance Deductible

	
$397.06

	
$94.37

	
$166.19

	
$115.46

	
$325.30

	
$239.74

	
$501.95

	
$14.67

	
$5,669.95

	
$755.46

	
$554.83

	
$386.59

	
$1,584.83

	
$730.00

	
$9,355.58











	



PMPM CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS


	
PMPMs & PROGRAMMATIC ADJUSTMENTS

	
PPC Rural

 TANF & KC <1

 M&F

	
PPC Rural

 TANF & KC 1-13

 M&F

	
PPC Rural

 TANF & KC

 14 - 44 F 1

	
PPC Rural

 TANF & KC

 14 - 44 M 1

	
PPC Rural

 TANF 45+ M&F

	
PPC Rural

 SSI w/

 Medicare

	
PPC Rural

 SSI w/o

 Medicare

	
PPC

 Urban

 TANF & KC <1

 M&F

	
PPC

 Urban

 TANF &

 KC 1-13 M&F

	
PPC

 Urban

 TANF &

 KC 14 - 44 F 1

	
PPC

 Urban

 TANF & KC

 14 - 44 M 1

	
PPC

 Urban

 TANF 45+

 M&F

	
PPC

 Urban

 SSI w/

 Medicare

	
PPC

 Urban

 SSI w/o

 Medicare


	
Originally Awarded PMPM

	
$714.74

	
$37.84

	
$143.67

	
$116.05

	
$269.14

	
$37.03

	
$82.34

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Outpatient & Emergency Room Adjustment

	
$10.44

	
$1.05

	
$4.63

	
$4.30

	
$8.46

	
$0.74

	
$2.42

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Cost Sharing Proposal Adjustment

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Reinsurance Incorporating Catastrophic

 and Transplant Data Adjustment

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Hospital Inpatient DRI Trend

 Update Adjustment -

 (4.0% estimate changed to 3.8% actual)

	
($0.75)

	
($0.01)

	
($0.07)

	
($0.04)

	
($0.13)

	
($0.01)

	
($0.03)

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Fee-for-Service Schedule Change

 (Referral Physician and Lab & X-Ray COS)

	
($1.23)

	
($0.02)

	
($0.24)

	
($0.36)

	
($1.15)

	
($0.03)

	
($0.32)

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Premium Tax Implementation Adjustment

	
$14.76

	
$0.79

	
$3.02

	
$2.45

	
$5.64

	
$0.77

	
$1.72

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Total Adjustment Impacting Base PMPM

	
$23.23

	
$1.82

	
$7.33

	
$6.35

	
$12.83

	
$1.47

	
$3.78

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Adjusted Awarded PMPM for Plans

 Electing the $20k Reinsurance Deductible

	
$737.97

	
$39.66

	
$151.00

	
$122.40

	
$281.97

	
$38.50

	
$86.12

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Impact of Electing the $50k Reinsurance Deductible

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A


	
Adjusted Awarded PMPM for Plans

 Electing the $50k Reinsurance Deductible

	
$737.97

	
$39.66

	
$151.00

	
$122.40

	
$281.97

	
$38.50

	
$86.12

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A





	
1. The KidsCare age cohort covers individuals 14 - 18 years of age while the TANF rate cell includes 14 – 44.

				
	
2. The Maternity Delivery Payment does not have a reinsurance component built directly into the rate. However, it is indirectly affected by choosing a different deductible

     level because the TANF 14-44 female rate is applied as an 8-month offset to the Maternity Delivery Payment, and the female rate is directly affected by a new reinsurance election.









	
Final Awarded Rate – CYE04

 Phoenix Health Plan: GSA 12

 (Effective 10/01/03)


	
PERCENT CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS


	
PMPMs & PROGRAMMATIC ADJUSTMENTS

	
TANF

 & KC <1 M&F

	
TANF

 & KC 1-13 M&F

	
TANF

 & KC 14 - 44 F 1

	
TANF

 & KC 14 - 44 M 1

	
TANF

 45+ M&F

	
SSI w/

 Medicare

	
SSI w/o

 Medicare

	
Extended Family

 Planning Services

	
Maternity Delivery

 Payment

	
AIDS / HIV

 Supplemental

 Payment

	
Non-MED

 Prior Period

 Coverage

	
Non-MED

 Prospective

	
MED

 Prior Period

 Coverage

	
MED

 Prospective

	
MED

 Hospitalized

 Supplemental


	
Originally Awarded PMPM

	
$352.43

	
$88.86

	
$151.56

	
$108.07

	
$318.52

	
$222.78

	
$454.21

	
$15.46

	
$5,599.72

	
$740.35

	
$516.02

	
$405.62

	
$1,509.89

	
$742.57

	
$9,000.32


	
Outpatient & Emergency Room Adjustment

	
1.46%

	
2.79%

	
3.22%

	
3.71%

	
3.14%

	
2.00%

	
2.94%

	
0.00%

	
-0.73%

	
0.00%

	
2.77%

	
2.77%

	
2.65%

	
2.65%

	
1.39%


	
Cost Sharing Proposal Adjustment

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
-4.41%

	
0.00%

	
-5.09%

	
0.00%


	
Reinsurance Incorporating Catastrophic

 and Transplant Data Adjustment

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%


	
Hospital Inpatient DRI Trend Update Adjustment-

 (4.0% estimate changed to 3.8% actual)

	
-0.10%

	
-0.02%

	
-0.05%

	
-0.03%

	
-0.05%

	
-0.02%

	
-0.04%

	
-0.02%

	
-0.09%

	
0.00%

	
-0.06%

	
-0.06%

	
-0.06%

	
-0.06%

	
-0.23%


	
Fee-for-Service Schedule Change

 (Referral Physician and Lab & X-Ray COS)

	
-0.17%

	
-0.06%

	
-0.16%

	
-0.30%

	
-0.41%

	
-0.09%

	
-0.38%

	
0.00%

	
0.04%

	
0.00%

	
-0.38%

	
-0.38%

	
-0.49%

	
-0.49%

	
-0.49%


	
Premium Tax Implementation Adjustment

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%


	
Total Adjustment Impacting Base PMPM 2

	
3.25%

	
4.80%

	
5.11%

	
5.47%

	
4.77%

	
3.97%

	
4.60%

	
2.02%

	
1.24%

	
2.04%

	
4.41%

	
-0.20%

	
4.17%

	
-1.13%

	
2.72%


	
Adjusted Awarded PMPM for Plans Electing

 the $20k Reinsurance Deductible

	
$363.88

	
$93.13

	
$159.30

	
$113.99

	
$333.70

	
$231.63

	
$475.09

	
$15.77

	
$5,669.20

	
$755.46

	
$538.76

	
$404.81

	
$1,572.86

	
$734.18

	
$9,244.71


	
Impact of Electing the $50k Reinsurance Deductible 3

	
6.14%

	
0.54%

	
1.32%

	
1.36%

	
0.82%

	
0.21%

	
3.47%

	
0.00%

	
-0.30%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%


	
Premium Tax Adjustment of Electing the $50k Reinsurance Deductible 3

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
0.00%

	
2.04%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%


	
Adjusted Awarded PMPM for Plans Electing the $50k Reinsurance Deductible

	
$386.68

	
$93.64

	
$161.44

	
$115.57

	
$336.49

	
$232.12

	
$491.93

	
$15.77

	
$5,652.03

	
$755.46

	
$538.76

	
$404.81

	
$1,572.86

	
$734.18

	
$9,244.71









	
PERCENT CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS


	
PMPMs & PROGRAMMATIC ADJUSTMENTS

	
PPC

 Rural

 TANF & KC

 <1 M&F

	
PPC

 Rural

 TANF & KC

 1-13 M&F

	
PPC

 Rural

 TANF & KC

 14 - 44 F 1

	
PPC

 Rural

 TANF & KC

 14 - 44 M 1

	
PPC

 Rural

 TANF 45+

 M&F

	
PPC

 Rural

 SSI w/

 Medicare

	
PPC

 Rural

 SSI w/o

 Medicare

	
PPC

 Urban

 TANF & KC

 <1 M&F

	
PPC

 Urban

 TANF & KC

 1-13 M&F

	
PPC

 Urban

 TANF & KC

 14 - 44 F 1

	
PPC

 Urban

 TANF

 & KC

 14 – 44

 M 1

	
PPC

 Urban

 TANF

 45+

 M&F

	
PPC

 Urban

 SSI w/

 Medicare

	
PPC

 Urban

 SSI w/o

 Medicare


	
Originally Awarded PMPM

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
$1,158.74

	
$37.84

	
$149.42

	
$120.69

	
$279.90

	
$29.06

	
$77.68


	
Outpatient & Emergency Room Adjustment

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
1.46%

	
2.79%

	
3.22%

	
3.71%

	
3.14%

	
2.00%

	
2.94%


	
Cost Sharing Proposal Adjustment

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%


	
Reinsurance Incorporating Catastrophic

 and Transplant Data Adjustment

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%


	
Hospital Inpatient DRI Trend Update

 Adjustment - (4.0% estimate changed to 3.8% actual)

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
-0.10%

	
-0.02%

	
-0.05%

	
-0.03%

	
-0.05%

	
-0.02%

	
-0.04%


	
Fee-for-Service Schedule Change

 (Referral Physician and Lab & X-Ray COS)

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
-0.17%

	
-0.06%

	
-0.16%

	
-0.30%

	
-0.41%

	
-0.09%

	
-0.38%


	
Premium Tax Implementation Adjustment

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%

	
2.04%


	
Total Adjustment Impacting Base PMPM 2

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
3.25%

	
4.80%

	
5.11%

	
5.47%

	
4.77%

	
3.97%

	
4.60%


	
Adjusted Awarded PMPM for Plans

 Electing the $20k Reinsurance Deductible

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
$1,196.40

	
$39.66

	
$157.05

	
$127.30

	
$293.24

	
$30.21

	
$81.25


	
Impact of Electing the $50k

 Reinsurance Deductible

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%

	
0.00%


	
Adjusted Awarded PMPM for Plans

 Electing the $50k Reinsurance Deductible

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
$1,196.40

	
$39.66

	
$157.05

	
$127.30

	
$293.24

	
$30.21

	
$81.25





	
1. The KidsCare age cohort includes individuals 14 to 18 years of age, while the TANF rate cell includes 14 - 44.

				
	
2. The adjustment is multiplicative, not additive.

									
	
3. The Maternity Delivery Payment does not have a reinsurance component built directly into the rate. However, it is indirectly affected by choosing a different deductible

     level because the TANF 14-44 female rate is applied as an 8-month offset to the Maternity Delivery Payment, and the female rate is directly affected by a new reinsurance election.









	
Final Awarded Rate- CYE04

 Phoenix Health Plan: GSA 12

 (EFFECTIVE 10/01/03)


	
PMPM CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS


	
PMPMs & PROGRAMMATIC ADJUSTMENTS

	
TANF & KC <1

 M&F

	
TANF & KC

 1-13 M&F

	
TANF & KC

 14 - 44 F 1

	
TANF & KC

 14 - 44 M 1

	
TANF 45+

 M&F

	
SSI w/

 Medicare

	
SSI w/o

 Medicare

	
Extended Family

 Planning Services

	
Maternity Delivery

 Payment

	
AIDS / HIV

 Supplemental

 Payment

	
Non-MED

 Prior Period

 Coverage

	
Non-MED

 Prospective

	
MED

 Prior Period

 Coverage

	
MED

 Prospective

	
MED

 Hospitalized

 Supplemental


	
Originally Awarded PMPM

	
$352.43

	
$88.86

	
$151.56

	
$108.07

	
$318.52

	
$222.78

	
$454.21

	
$15.46

	
$5,599.72

	
$740.35

	
$516.02

	
$405.62

	
$1,509.89

	
$742.57

	
$9,000.32


	
Outpatient & Emergency Room Adjustment

	
$5.15

	
$2.48

	
$4.88

	
$4.01

	
$10.01

	
$4.47

	
$13.33

	
$0.00

	
($40.61)

	
$0.00

	
$14.28

	
$11.23

	
$40.00

	
$19.67

	
$124.86


	
Cost Sharing Proposal Adjustment

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
($18.39)

	
$0.00

	
($38.78)

	
$0.00


	
Reinsurance Incorporating Catastrophic

 and Transplant Data Adjustment

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00


	
Hospital Inpatient DRI Trend Update

 Adjustment - (4.0% estimate changed to 3.8% actual)

	
($0.37)

	
($0.02)

	
($0.07)

	
($0.04)

	
($0.15)

	
($0.04)

	
($0.18)

	
($0.00)

	
($5.27)

	
$0.00

	
($0.30)

	
($0.22)

	
($0.90)

	
($0.42)

	
($20.76)


	
Fee-for-Service Schedule Change

 (Referral Physician and Lab & X-Ray COS)

	
($0.61)

	
($0.06)

	
($0.26)

	
($0.34)

	
($1.36)

	
($0.21)

	
($1.77)

	
$0.00

	
$1.98

	
$0.00

	
($2.01)

	
($1.51)

	
($7.59)

	
($3.54)

	
($44.61)


	
Premium Tax Implementation Adjustment

	
$7.28

	
$1.86

	
$3.19

	
$2.28

	
$6.67

	
$4.63

	
$9.50

	
$0.32

	
$113.38

	
$15.11

	
$10.78

	
$8.10

	
$31.46

	
$14.68

	
$184.89


	
Total Adjustment Impacting Base PMPM

	
$11.45

	
$4.27

	
$7.74

	
$5.92

	
$15.18

	
$8.85

	
$20.88

	
$0.31

	
$69.48

	
$15.11

	
$22.74

	
($0.81)

	
$62.97

	
($8.38)

	
$244.39


	
Adjusted Awarded PMPM for Plans Electing

 the $20k Reinsurance Deductible

	
$363.88

	
$93.13

	
$159.30

	
$113.99

	
$333.70

	
$231.63

	
$475.09

	
$15.77

	
$5,669.20

	
$755.46

	
$538.76

	
$404.81

	
$1,572.86

	
$734.18

	
$9,244.71


	
Impact of Electing the $50k Reinsurance Deductible 2

	
$22.34

	
$0.51

	
$2.10

	
$1.55

	
$2.74

	
$0.48

	
$16.50

	
$0.00

	
($16.83)

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00


	
Premium Tax Adjustment of Electing the

 $50k Reinsurance Deductible 3

	
$0.46

	
$0.01

	
$0.04

	
$0.03

	
$0.06

	
$0.01

	
$0.34

	
$0.00

	
($0.34)

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00


	
Adjusted Awarded PMPM for Plans

 Electing the $50k Reinsurance Deductible

	
$386.68

	
$93.64

	
$161.44

	
$115.57

	
$336.49

	
$232.12

	
$491.93

	
$15.77

	
$5,652.03

	
$755.46

	
$538.76

	
$404.81

	
$1,572.86

	
$734.18

	
$9,244.71









	
PMPM CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS


	
PMPMs & PROGRAMMATIC ADJUSTMENTS

	
PPC

 Rural

 TANF &

 KC <1

 M&F

	
PPC

 Rural

 TANF &

 KC 1-13

 M&F

	
PPC

 Rural

 TANF &

 KC 14 -

   44 F 1

	
PPC

 Rural

 TANF &

 KC 14 -

 44 M 1

	
PPC

 Rural

 TANF

 45+ M&F

	
PPC

 Rural

 SSI w/

 Medicare

	
PPC

 Rural

 SSI w/o

 Medicare

	
PPC

 Urban

 TANF &

 KC <1 M&F

	
PPC

 Urban

 TANF &

 KC 1-13

 M&F

	
PPC

 Urban

 TANF &

 KC 14 -

   44 F 1

	
PPC

 Urban

 TANF &

 KC 14 -

   44 M 1

	
PPC

 Urban

 TANF

 45+ M&F

	
PPC

 Urban

 SSI w/

 Medicare

	
PPC

 Urban

 SSI w/o

 Medicare


	
Originally Awarded PMPM

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
$1,158.74

	
$37.84

	
$149.42

	
$120.69

	
$279.90

	
$29.06

	
$77.68


	
Outpatient & Emergency Room Adjustment

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
$16.93

	
$1.05

	
$4.81

	
$4.48

	
$8.80

	
$0.58

	
$2.28


	
Cost Sharing Proposal Adjustment

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00


	
Reinsurance Incorporating Catastrophic

 and Transplant Data Adjustment

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00


	
Hospital Inpatient DRI Trend Update

 Adjustment - (4.0% estimate changed to 3.8% actual)

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
($1.21)

	
($0.01)

	
($0.07)

	
($0.04)

	
($0.13)

	
($0.01)

	
($0.03)


	
Fee-for-Service Schedule Change

 (Referral Physician and Lab & X-Ray COS)

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
($1.99)

	
($0.02)

	
($0.25)

	
($0.37)

	
($1.19)

	
($0.03)

	
($0.30)


	
Premium Tax Implementation Adjustment

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
$23.93

	
$0.79

	
$3.14

	
$2.55

	
$5.86

	
$0.60

	
$1.63


	
Total Adjustment Impacting Base PMPM

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
$37.66

	
$1.82

	
$7.63

	
$6.61

	
$13.34

	
$1.15

	
$3.57


	
Adjusted Awarded PMPM for Plans

 Electing the $20k Reinsurance Deductible

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
$1,196.40

	
$39.66

	
$157.05

	
$127.30

	
$293.24

	
$30.21

	
$81.25


	
Impact of Electing the $50k Reinsurance

 Deductible

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00

	
$0.00


	
Adjusted Awarded PMPM for Plans

 Electing the $50k Reinsurance Deductible

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
N/A

	
$1,196.40

	
$39.66

	
$157.05

	
$127.30

	
$293.24

	
$30.21

	
$81.25





	
1. The KidsCare age cohort covers individuals 14 - 18 years of age while the TANF rate cell includes 14 - 44.

				
	
2. The Maternity Delivery Payment does not have a reinsurance component built directly into the rate. However, it is indirectly affected by choosing a different deductible

     level because the TANF 14-44 female rate is applied as an 8-month offset to the Maternity Delivery Payment, and the female rate is directly affected by a new reinsurance election.









	
Arizona Health Care Cost Containment System

 HIFA Capitation Rates

 CYE ‘04

 Effective 10/1/03


	
Phoenix Health Plan

	
 

	
 

	
 

	
 


	
 

	
 

	
 

	
 

	
 


	
HIFA Parent Rates

				
	
 

	
 

	
 

	
 

	
 


	
GSA

		
14-44F

	
14-44M

	
45+


	
2

	
Yuma, La Paz

			
	
4

	
Mohave, Coconino, Apache, Navajo

			
	
6

	
Yavapai

			
	
8

	
Pinal, Gila

	
$182.60

	
$126.84

	
$357.54


	
10

	
Pima, Santa Cruz

			
	
12

	
Maricopa

	
$177.38

	
$126.98

	
$369.86


	
14

	
Graham, Greenlee, Cochise