exv10w6w10



 






Exhibit 10.6.10




STATE OF NEW JERSEY




DEPARTMENT OF HUMAN SERVICES




DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES




AND




AMERIGROUP NEW JERSEY, INC.




AGREEMENT TO PROVIDE HMO SERVICES




In accordance with Article 7, section 7.11.2A and 7.11.2B of the contract between AMERIGROUP New
Jersey, Inc. and the State of New Jersey, Department of Human Services, Division of Medical
Assistance and Health Services (DMAHS), effective date October 1, 2000, all parties agree that the
contract shall be amended, effective July 1, 2005, as follows:





	1.	 	Article 4, “Provision of Health Care Services” Section 4.1.6(A)14 (new) shall be amended as
reflected in Article 4, Section 4.1.6(A)14 attached hereto and incorporated herein.






	2.	 	Appendix, Section C, “Capitation Rates” shall be revised as reflected in SFY 2005 Capitation
Rates attached hereto and incorporated herein.





 









 





All other terms and conditions of the October 1, 2000 contract and subsequent amendments
remain unchanged except as noted above.




The contracting parties indicate their agreement by their signatures.



	 	 	 	 	 	 	 
	 	 	AMERIGROUP	 	State of New Jersey
	 
	 	 	New Jersey, Inc.	 	Department of Human Services
	 
	 	 	 	 	 	 
	By:

	/s/ Norine Yukon
	 	By:
	/s/ Ann Clemency Kohler
	 

	 
	 	 	 

	 

	 	 	 	 	Ann Clemency Kohler
	 
	 	 	 	 	 	 
	TITLE: 

	President and CEO
	 	TITLE: 
	Director, DMAHS
	 

	 	 	 	 	 	 
	 
	 	 	 	 	 	 
	DATE:

	April 28, 2005
	 	DATE:
	May 2, 2005
	 

	 	 
	 	 	 	 





APPROVED AS TO FORM ONLY



Attorney General



State of New Jersey



	 	 	 	 	 
	BY:

	 	/s/ Dianna Rosenheim	 	 
	 

	 	 

Deputy Attorney General
	 	 







 









 









	 	13.	 	Prescription drugs, excluding over-the-counter drugs Exception: See Article 8
regarding Protease Inhibitors and other antiretrovirals.
	 
	 	14.	 	Dental services — Limited to preventive dental services for children under
the age of 12 years, including oral examinations, x-rays, oral prophylaxis, topical
application of fluorides, and sealants. Exception — comprehensive
orthodontia treatment services shall be provided, through completion of required
services, for any enrollee under the age of 19 years whose orthodontia services were
initiated while enrolled with the contractor as a Medicaid, NJ FamilyCare Plan A, B,
or C enrollee. The contractor shall not be responsible for, orthodontia services to a
Plan D enrollee under the age of 19 years old that were initiated while that
individual was enrolled with another contractor. The enrollee must continue enrollment
in the HMO where services were initiated until those services were completed or until
the member loses Medicaid/NJ FamilyCare eligibility. Active treatment begins with the
placement of the orthodontic appliances (banding). Cases that were authorized but not
banded do not qualify for continuation of care.
	 
	 	15.	 	Podiatrist Services — Excludes routine hygienic care of the feet, including
the treatment of corns and calluses, the trimming of nails, and other hygienic care
such as cleaning or soaking feet, in the absence of a pathological condition
	 
	 	16.	 	Prosthetic appliances — Limited to the initial provision of .t prosthetic
device that temporarily or permanently replaces all or part of an external body part
lost or impaired as a result of disease, injury, or congenital defect. Repair and
replacement services are covered when due to congenital growth.
	 
	 	17.	 	Private duty nursing — Only when authorized by the contractor
	 
	 	18.	 	Transportation Services — Limited to ambulance for medical
emergency only
	 
	 	19.	 	Well child care including immunizations, lead screening and treatments
	 
	 	20.	 	Maternity and related newborn care
	 
	 	21.	 	Diabetic supplies and equipment






	B.	 	Services Available To NJ FamilyCare Plan D Under Fee-For-Service. The following services
are available to NJ FamilyCare Plan D enrollees under fee-for-service: