EX-10.1.1






ATTACHMENT H




	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 
	 	 	Attachment H is a table displaying the contracted rates by rate cell for each contracted region.	These rates will be the basis for calculating capitation payments in each contracted Region.	 
	 	 	 	 	 	 	Contracted Rates by Region	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	CMO NAME	 	Amerigroup	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	Rate Category	 	Atlanta	 	North	 	East	 	Southeast	 	Southwest	 	 	 	 
	   LIM/RSM/Refugee
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	0 - 2 Months Male & Female	 	$	1,104.24	 	 	$	1,152.84	 	 	$	1,049.52	 	 	$	1,126.52	 	 	$	1,110.28	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	3 - 11 Months Male & Female	 	$	177.85	 	 	$	217.40	 	 	$	202.50	 	 	$	247.21	 	 	$	227.72	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	1 - 5 Years Male & Female	 	$	106.42	 	 	$	129.93	 	 	$	114.88	 	 	$	139.89	 	 	$	150.95	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	6 - 13 Years Male & Female	 	$	110.25	 	 	$	131.63	 	 	$	108.55	 	 	$	123.22	 	 	$	125.95	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	14 - 20 Years Female	 	$	166.58	 	 	$	220.61	 	 	$	191.56	 	 	$	216.47	 	 	$	186.23	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	14 - 20 Years Male	 	$	129.78	 	 	$	156.49	 	 	$	112.19	 	 	$	129.16	 	 	$	119.13	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	21 - 44 Years Female	 	$	227.50	 	 	$	295.81	 	 	$	255.36	 	 	$	291.88	 	 	$	280.71	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	21 - 44 Years Male	 	$	255.65	 	 	$	372.11	 	 	$	293.03	 	 	$	340.18	 	 	$	315.01	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	45+ Years Female	 	$	388.74	 	 	$	493.45	 	 	$	429.41	 	 	$	522.44	 	 	$	498.66	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	45+ Years Male	 	$	481.46	 	 	$	561.93	 	 	$	561.93	 	 	$	642.74	 	 	$	566.68	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	   PeachCare
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	0 - 2 Months Male & Female	 	$	202.95	 	 	$	204.30	 	 	$	205.49	 	 	$	213.07	 	 	$	203.45	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	3 - 11 Months Male & Female	 	$	181.55	 	 	$	188.84	 	 	$	188.84	 	 	$	190.06	 	 	$	190.06	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	1 - 5 Years Male & Female	 	$	109.87	 	 	$	132.55	 	 	$	121.21	 	 	$	154.62	 	 	$	165.91	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	6 - 13 Years Male & Female	 	$	131.20	 	 	$	148.90	 	 	$	132.76	 	 	$	154.48	 	 	$	152.27	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	14 - 20 Years Female	 	$	156.06	 	 	$	190.61	 	 	$	167.59	 	 	$	186.58	 	 	$	182.59	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	14 - 20 Years Male	 	$	144.31	 	 	$	166.05	 	 	$	138.84	 	 	$	158.00	 	 	$	151.26	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	   Female Services
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	      Breast and Cervical Cancer
	 	$	1,544.70	 	 	$	1,623.60	 	 	$	1,623.60	 	 	$	1,637.93	 	 	$	1,637.93	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	   Maternity and Delivery Services

	 	Unit Cost	 	Unit Cost	 	Unit Cost	 	Unit Cost	 	Unit Cost	 	 	 	 
	    
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	   Kick Payment
	 	 	 	 	 	$	5,796.63	 	 	$	5,774.93	 	 	$	5,821.47	 	 	$	5,846.21	 	 	$	5,709.09