exhibit101d.htm


    Exhibit
10.1d

     

    AMENDMENT
#4 TO CONTRACT NO. 0653 BETWEEN

    GEORGIA
DEPARTMENT OF COMMUNITY HEALTH AND

    PEACH
STATE HEALTH PLAN

    


    This Amendment is between the Georgia
Department of Community Health (hereinafter referred to as “DCH” or the
“Department”) and Peach State Health Plan (hereinafter referred to as
“Contractor”) and is made effective this 17th
day of September, 2008
(hereinafter referred to as the “Effective Date”).  Other than the
changes, modifications and additions specifically articulated in this Amendment
#4 to Contract #0653, RFP#41900-001-0000000027, the original Contract shall
remain in effect and binding on and against DCH and Contractor.

    Unless
expressly modified or added in the Amendment #4, the terms and conditions of the
original Contract are expressly incorporated into this Amendment #4 as if
completely restated herein.

    


    WHEREAS, DCH and Contractor
executed a contract for the provision of services to Georgia Families members
enrolled in the Contractor’s plan;

    


    WHEREAS, DCH pays Contractor a
per member per month capitation rate for each Georgia Families member enrolled
in the Contractor’s plan;

    


    WHEREAS, DCH has sought
permission from the Centers for Medicare and Medicaid Services (hereinafter
referred to as “CMS”) to revise the capitation rates payable to Contractor for
State Fiscal Year 2009; and

    


    WHEREAS, pursuant to Section 32.0 Amendments in
Writing, DCH and Contractor desire to amend the above-referenced Contract
by adding additional funding as set forth below.

    


    NOW THEREFORE, for and in
consideration of the mutual promises of the Parties, the terms, provisions and
conditions of this Amendment and other good and valuable consideration, the
sufficiency of which is hereby acknowledged, DCH and Contractor hereby agree as
follows:

    


    
      	
              I.  

            	
              Upon
      receiving written notice from CMS indicating that agency’s approval of the
      revised capitation rates, the parties shall delete the current Attachment H, Capitation
      Payment, in its entirety and replace it with the new Attachment H, Capitation
      Payment, contained at Exhibit 1 to this
  Amendment.

            


    

    


    
      	
              II.  

            	
              DCH
      and Contractor aggre that they have assumed an obligation to perform the
      covenants, agreements, duties and obligations of the Contract, as modified
      and amended herein, and agree to abide by all the provisions, terms and
      conditions contained in the Contract as modified and
    amended.

            


    

     

    
      	
              III.  

            	
              This
      Amendment shall be binding and inure to the benefit of the parties hereto,
      their heirs, representatives, successors and assigns.  Whenever
      the provisions of this Amendment and the Contract are in conflict, the
      provisions of this Amendment shall take precedence and
      control.

            


    

    


    
      	
              VI.  

            	
              It
      is understood by the Parties hereto that, if any part, term, or provision
      of this Amendment or this entire Amendment is held to be illegal or in
      conflict with any law of this State, then DCH, at its sole option, may
      enforce the remaining unaffected portions or provisions of the Amendment
      or of the Contract and the rights and obligations of the parties shall be
      construed and enforced as if the Contract or Amendment did not contain the
      particular part, term or provision held to be
  invalid.

            


    

     

    
      	
              VII.  

            	
              This
      Amendment shall become effective as stated herein and shall remain
      effective for so long as the Contract is in
  effect.

            


    

    


    
      	
              VIII.  

            	
              This
      Amendment shall be construed in accordance with the laws of the State of
      Georgia.

            


    

     

    
      	
              IX.  

            	
              All
      other terms and conditions contained in the Contract and any amendment
      thereto, not amended by this Amendment, shall remain in full force and
      effect.

            


    

    


    


    


    


    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    


    


    SIGNATURE
PAGE

    


    IN WITNESS WHEREOF, DCH and
Contractor, through their authorized officers and agents, have caused this
Amendment to be executed on their behalf as of the date indicated.

    


    GEORGIA
DEPARTMENT OF COMMUNITY HEALTH

    


    
       

      


      


      /s/ Dr. Rhonda M. Meadows,
M.D.                   9/17/08     

      Dr.
Rhonda M. Medows,
M.D.                            Date           


      Commissioner

      


      


      


      


      


      PEACH
STATE HEALTH PLAN

      


      BY:   /s/
Christopher D.
Bowers                              9/12/08     

                     
*SIGNATURE                                                Date

      


      


      Christopher D.
Bowers                                                      

      Please Print/Type Name
Here

      President & CEO

      


      


      


         
_____________________________

      AFFIX CORPORATE SEAL HERE

      (Corporations without a seal, attach
a

      Certificate of Corporate
Resolution)

      


      


      ATTEST:               /s/ Antonia
Mills                                           

      **SIGNATURE

      


      Confidential
Secretary                                                      

      TITLE

      




    


    


    


    ________________________________________________________________________

    *Must be
President, Vice President, CEO or Other Authorized Officer

    **Must be
Corporate Secretary

    


    


    


    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    EXHIBIT
1

    


    CONFIDENTIAL
–NOT FOR CIRCULATION

    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.

    


    (The
table is displayed on the following page.)

    


    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

     

    
      
        	Attachment
      H	 	 	 
	 FY
      2009 CMO Rates	 	 	 
	 	 	 	 
	
                Region

              	
                Aid
      Category

              	
                Age/Gender
      Group

              	
                PeachState

              
	
                Atlanta

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                0 -
      2 Months, Male and Female

              	
                 $  1,674.49

              
	
                Atlanta

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                3 -
      11 Months, Male and Female

              	
                 $     186.49

              
	
                Atlanta

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                1 -
      5 Years, Male and Female

              	
                 $     118.94

              
	
                Atlanta

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                6 -
      13 Years, Male and Female

              	
                 $     108.56

              
	
                Atlanta

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                14
      - 20 Years, Female

              	
                 $     170.49

              
	
                Atlanta

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                14
      - 20 Years, Male

              	
                 $     128.94

              
	
                Atlanta

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                21
      - 44 Years, Female

              	
                 $     283.64

              
	
                Atlanta

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                21
      - 44 Years, Male

              	
                 $     306.63

              
	
                Atlanta

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                45+
      Years, Female

              	
                 $     534.63

              
	
                Atlanta

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                45+
      Years, Male

              	
                 $     564.18

              
	
                Atlanta

              	
                PeachCare

              	
                0 -
      2 Months, Male and Female

              	
                 $     148.84

              
	
                Atlanta

              	
                PeachCare

              	
                3 -
      11 Months, Male and Female

              	
                 $     155.46

              
	
                Atlanta

              	
                PeachCare

              	
                1 -
      5 Years, Male and Female

              	
                 $     107.31

              
	
                Atlanta

              	
                PeachCare

              	
                6 -
      13 Years, Male and Female

              	
                 $     116.58

              
	
                Atlanta

              	
                PeachCare

              	
                14
      - 20 Years, Female

              	
                 $     135.47

              
	
                Atlanta

              	
                PeachCare

              	
                14
      - 20 Years, Male

              	
                 $     137.43

              
	
                Atlanta

              	
                Breast
      and Cervical Cancer

              	
                All
      Ages

              	
                 $  1,075.36

              
	
                Atlanta

              	
                Maternity
      Delivery/Kick Payment

              	 
      	
                 $  6,052.09

              
	
                Central

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                0 -
      2 Months, Male and Female

              	
                 $  1,980.18

              
	
                Central

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                3 -
      11 Months, Male and Female

              	
                 $     203.54

              
	
                Central

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                1 -
      5 Years, Male and Female

              	
                 $     124.64

              
	
                Central

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                6 -
      13 Years, Male and Female

              	
                 $     118.12

              
	
                Central

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                14
      - 20 Years, Female

              	
                 $     166.91

              
	
                Central

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                14
      - 20 Years, Male

              	
                 $     117.97

              
	
                Central

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                21
      - 44 Years, Female

              	
                 $     309.97

              
	
                Central

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                21
      - 44 Years, Male

              	
                 $     336.17

              
	
                Central

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                45+
      Years, Female

              	
                 $     593.33

              
	
                Central

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                45+
      Years, Male

              	
                 $     642.81

              
	
                Central

              	
                PeachCare

              	
                0 -
      2 Months, Male and Female

              	
                 $     143.83

              
	
                Central

              	
                PeachCare

              	
                3 -
      11 Months, Male and Female

              	
                 $     148.43

              
	
                Central

              	
                PeachCare

              	
                1 -
      5 Years, Male and Female

              	
                 $     120.34

              
	
                Central

              	
                PeachCare

              	
                6 -
      13 Years, Male and Female

              	
                 $     127.15

              
	
                Central

              	
                PeachCare

              	
                14
      - 20 Years, Female

              	
                 $     153.25

              
	
                Central

              	
                PeachCare

              	
                14
      - 20 Years, Male

              	
                 $     135.15

              
	
                Central

              	
                Breast
      and Cervical Cancer

              	
                All
      Ages

              	
                 $  1,066.68

              
	
                Central

              	
                Maternity
      Delivery/Kick Payment

              	 
      	
                 $  6,204.72

              
	
                Southwest

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                0 -
      2 Months, Male and Female

              	
                 $  1,891.90

              
	
                Southwest

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                3 -
      11 Months, Male and Female

              	
                 $     228.29

              
	
                Southwest

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                1 -
      5 Years, Male and Female

              	
                 $     149.07

              
	
                Southwest

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                6 -
      13 Years, Male and Female

              	
                 $     121.68

              
	
                Southwest

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                14
      - 20 Years, Female

              	
                 $     189.05

              
	
                Southwest

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                14
      - 20 Years, Male

              	
                 $     123.60

              
	
                Southwest

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                21
      - 44 Years, Female

              	
                 $     339.89

              
	
                Southwest

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                21
      - 44 Years, Male

              	
                 $     311.27

              
	
                Southwest

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                45+
      Years, Female

              	
                 $     571.82

              
	
                Southwest

              	
                Medicaid
      (LIM/Refugee/RSM)

              	
                45+
      Years, Male

              	
                 $     680.49

              
	
                Southwest

              	
                PeachCare

              	
                0 -
      2 Months, Male and Female

              	
                 $     142.53

              
	
                Southwest

              	
                PeachCare

              	
                3 -
      11 Months, Male and Female

              	
                 $     149.98

              
	
                Southwest

              	
                PeachCare

              	
                1 -
      5 Years, Male and Female

              	
                 $     133.79

              
	
                Southwest

              	
                PeachCare

              	
                6 -
      13 Years, Male and Female

              	
                 $     131.36

              
	
                Southwest

              	
                PeachCare

              	
                14
      - 20 Years, Female

              	
                 $     149.19

              
	
                Southwest

              	
                PeachCare

              	
                14
      - 20 Years, Male

              	
                 $     123.69

              
	
                Southwest

              	
                Breast
      and Cervical Cancer

              	
                All
      Ages

              	
                 $  1,104.43

              
	
                Southwest

              	
                Maternity
      Delivery/Kick Payment

              	 
      	
                 $  6,092.09