EX-10.11



 Exhibit 10.11 
  

			
	



	  	 ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM

DIVISION OF BUSINESS AND FINANCE
  

SECTION A: CONTRACT AMENDMENT


  

							
	1. AMENDMENT #	  	2. CONTRACT #:	  	3. EFFECTIVE DATE OF AMENDMENT:	  	4. PROGRAM
				
	10	  	YH14-0001-07	  	April 13, 2015	  	DHCM - ACUTE

  

	5.	CONTRACTOR NAME AND ADDRESS: 

 Health Choice Arizona 

410 N. 44th Street, Suite 900 

Phoenix, AZ 85008 
  

	6.	PURPOSE: To allow for payment of rural hospital inpatient reimbursement pursuant to A.R.S. §36-2905.02. 

  

	7.	THE ABOVE REFERENCED CONTRACT IS HEREBY AMENDED AS FOLLOWS: 

 The Contractor will be paid
the attached supplemental payment amounts to increase rural hospital inpatient reimbursement. The supplemental payment amounts are allocated to the appropriate risk groups based on historical utilization. AHCCCS requires that the Contractor make
one-time payments to each rural hospital as prescribed on the attached schedule, pursuant to A.R.S. §36-2905.02, to increase inpatient reimbursement to these small rural hospitals. 

The Contractor shall make the prescribed payments to the rural hospitals 15 days from receipt of the funds and submit proof of payment to the
rural hospitals to the Finance Manager of the Division of Health Care Management 30 days from receipt of the funds. 
 The regular per member
per month capitation rates for the period of October 1, 2014 through September 30, 2015 remain unchanged unless otherwise modified by contract amendment (Acute YH14-0001 Contract Amendment
effective April 1, 2015 was submitted to CMS on February 13, 2015). 
  

	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:	  	10. SIGNATURE OF AHCCCS CONTRACTING OFFICER:
		
	 /s/ Mike Uchrin
	  	 /s/ Michael Veit

	TYPED NAME:             MIKE UCHRIN	  	TYPED NAME:             MICHAEL VEIT
		
	TITLE:         CHIEF EXECUTIVE OFFICER	  	TITLE: CONTRACTS AND PURCHASING ADMINISTRATOR
		
	DATE:                           3/9/15	  	DATE:                           FEB 25 2015








 ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM 

ACUTE SUPPLEMENTAL PAYMENT SUMMARY 

Health Choice Arizona 

CYE 2015 

Supplemental Payment Related To: 
  

																					
	 	  	TANF	 	  	TANF	 	  	SSI	 	  	AHCCCS	 	  	Total	 
	 Supplemental Payment:
	  	<1, M/F	 	  	14-44, F	 	  	w/o Med	 	  	Care	 	  	Payment	 
	 4 Apache/Coconino/Mohave/Navajo
	  	$	461,595.72	  	  	$	1,388,924.72	  	  	$	440,058.17	  	  	$	375,778.92	  	  	$	2,666,357.53	  
	 8 Glla/Pinal
	  	$	92,442.02	  	  	$	448,024.25	  	  	$	320,927.54	  	  	$	339,168.30	  	  	$	1,200,562.11	  
		  				  				  				  				  	  
	  
	 
		  				  				  				  				  	$	3,866,919.64	  

 Two percent Premium tax is included in the Supplemental Capitation Payments Payments to the hospitals stated without Premium
Tax 
  

					
	Health Choice Arizona	  	Payment	 
	 Banner Goldfield Medical Center
	  	$	52,564.48	  
	 Banner Ironwood Medical Center
	  	$	569,319.32	  
	 Benson Hospital
	  	$	—  	  
	 Carondelet Holy Cross
	  	$	—  	  
	 Cobre Valley Community Hospital
	  	$	428,409.49	  
	 Copper Queen Community Hospital
	  	$	—  	  
	 Florence Hospital Anthem
	  	$	60,318.72	  
	 La Paz Regional Hospital
	  	$	—  	  
	 Little Colorado Medical Center
	  	$	385,486.59	  
	 Mount Graham Regional Medical Center
	  	$	—  	  
	 Northern Cochise Community Hospital
	  	$	—  	  
	 Page Hospital
	  	$	180,733.35	  
	 Payson Regional Medical Center
	  	$	436,693.31	  
	 Sierra Vista Regional Health
	  	$	—  	  
	 Southeastern Az Medical Center
	  	$	—  	  
	 Summit Healthcare Regional Medical Center
	  	$	987,096.57	  
	 Valley View Medical Center
	  	$	659,522.47	  
	 Verde Valley Medical Center
	  	$	—  	  
	 White Mountain Regional Medical Center
	  	$	29,436.95	  
	 Wickenburg Regional Health Center
	  	$	—  	  
	 YRMC East
	  	$	—  	  
		  	  
	  
	 
	 Total Payments
	  	$	3,789,581.25	  
	 Premium Tax
	  	$	77,338.39	  
		  	  
	  
	 
	 Total with Premium Tax
	  	$	3,866,919.64	  








 See Exhibit 10.XX for full current amended text of AHCCCS Contract.