Exhibit 10.147


 


AMENDMENT

to the

PARTICIPATING PHYSICIAN GROUP

PROVIDER SERVICES AGREEMENT

between

FOUNDATION HEALTH SYSTEM AFFILIATES

and

A.V. MEDICAL GROUP


 


The
Participating Physician Group Provider Services Agreement (“Agreement”) dated
June 1, 1998 between A.V.MEDICAL GROUP (“PPG”) and Foundation Health Systems
Affiliate(s) (“FHS”), as subsequently amended by instruments dated July 1, 1999
is hereby amended effective November 1, 2000.


 


FHS
and PPG hereby agree to amend the Agreement as follows:


 


1.          Addendum B to the Agreement, Section B. STANDARD HMO. Subsection 1.1 Capitation
Rates shall be deleted in its entirety and replaced with the following:


 


1.1            Capitation Rates. PPG Capitation for Standard HMO Members shall
be determined on a monthly basis by multiplying the following normalized PMPM
rates by the age, sex and benefit plan factors set forth in Addendum B for each
assigned Member.  Normalized rates
represent the PMPM prior to the adjustment for PPG’s assigned Members’ age, sex
and benefit plan.  Actual PPG gross
Capitation shall fluctuate from month to month to the extent that PPG’s age,
sex and benefit plan mix fluctuates.


 




	
  Effective
  Date

  	
   

  	
  Standard
  HMO

  Capitation

  
	
  November
  1, 2000

  	
   

  	
  ***
  PMPM

  
	
  May 1, 2001

  	
   

  	
  ***
  PMPM

  






 


2.          Addendum B to the Agreement, Section B. STANDARD HMO, Subsection 3.1 Shared
Risk Budgets shall be deleted in its entirety and replaced with the
following:


 


3.1                                  Shared Risk Budget.  HMO
shall fund the Shared Risk Budget for Members, with normalized rates.  These normalized rates shall be adjusted for
PPG’s assigned Members by the age, sex and benefit plan factors as set forth in
Addendum B.  Actual Shared Risk Budget
shall fluctuate from month to month to the extent that PPG’s age, sex and
benefit plan mix fluctuates.


 




	
  Standard
  HMO Shared Risk

  Budget-

  Entire Calendar Year 2000

  
	
  *** PMPM

  






 


3.          Addendum
B to the Agreement, Section C, SMALL GROUP
HMO.  Subsection
[ILLEGIBLE] Capitation Rates shall be deleted in its entirety and
replaced with the following:


 


1.1                                  Capitation Rates.  PPG
Capitation for Small Group HMO Members shall be determined on a monthly basis
by multiplying the following normalized PMPM rates by the age, sex and benefit
plan factors set forth in Addendum B for each assigned Member.  Normalized PMPM rates represent the PMPM prior
to the


 












***  Confidential Information
omitted and filed separately with the Securities and Exchange Commission.


 


1

















 


adjustment for PPG’s assigned Members’ age, sex and benefit plan.  Actual PPG gross Capitation shall fluctuate
from month to month to the extent that PPG’s age, sex and benefit plan mix
fluctuates.


 




	
  Effective
  Date

  	
   

  	
  Small
  Group HMO

  Capitation

  
	
  November
  1, 2000

  	
   

  	
  ***
  PMPM

  
	
  May
  1, 2001

  	
   

  	
  ***
  PMPM

  






 


4.          Addendum
B to the Agreement, Section C.  SMALL GROUP HMO. Subsection 3.1 Shared
Risk Budget shall be deleted in its entirety and replaced with the
following:


 


3.1                                  Shared Risk Budget.  HMO
shall fund the Shared Risk Budget for Members, with normalized rates.  These normalized rates shall be adjusted for
PPG’s assigned Members by the age, sex and benefit plan factors as set forth in
Addendum B.  Actual Shared Risk Budget
shall fluctuate from month to month to the extent that PPG’s age, sex and
benefit plan mix fluctuates.


 




	
  Small
  Group HMO Shared

  Risk Budget

  Entire Calendar Year 2000

  
	
  *** PMPM

  






 


5.          Addendum
B to the Agreement, Section D, INDIVIDUAL
HMO.  Subsection 1.1 Capitation
Rates shall be deleted in its entirety and replaced with the following:


 


1.1                                  Capitation Rates.  PPG
Capitation for Individual HMO Members shall be determined on a monthly basis by
multiplying the following normalized PMPM rates by the age, sex and benefit
plan factors set forth in Addendum B for each assigned Member.  Normalized PMPM rates represent the PMPM
prior to the adjustment for PPG’s assigned Members’ age, sex and benefit
plan.  Actual PPG gross Capitation shall
fluctuate from month to month to the extent that PPG’s age, sex and benefit
plan mix fluctuates.


 




	
  Effective
  Date

  	
   

  	
  Individual
  HMO

  Capitation

  
	
  November
  1, 2000

  	
   

  	
  *** PMPM

  
	
  May
  1, 2001

  	
   

  	
  *** PMPM

  






 


6.          Addendum
B to the Agreement, Section D, INDIVIDUAL
HMO. Subsection 3.1 Shared Risk Budget shall be deleted
in its entirety and replaced with the following:


 


3.1                                  Shared Risk Budget.  HMO shall fund
the Shared Risk Budget for Members, with normalized rates.  These normalized rates shall be adjusted for
PPG’s assigned Members by the age, sex and benefit plan factors as set forth in
Addendum B.  Actual Shared Risk Budget
shall fluctuate from month to month to the extent that PPG’s age, sex and
benefit plan mix fluctuates.


 




	
  Individual
  HMO Shared

  Risk Budget-

  Entire Calendar Year 2000

  
	
  *** PMPM

  






 


7.          Addendum
B to the Agreement, Section G. COMMERCIAL
POS. Subsection 4. Professional Capitation Rate shall be
deleted in its entirety and replaced with the following:


 


2

















 


4.                                         Professional Capitation Rate.  PPG
shall be compensated for rendering professional In-Network Services to
Commercial POS Members at the PMPM amounts set forth for Commercial HMO
Members, less a *** withhold (Professional Capitation).  This Withhold shall partially fund the
Professional Out-of-Network Budget.


 


8.          Addendum
B to the Agreement.  Section G. COMMERCIAL POS. Subsection 6.1 POS
Shared Risk Budgets shall be deleted in its entirety and replaced with the
following:


 


6.1                                  POS Shared Risk Budgets.  The
budgets shall be determined for each Commercial POS population: Standard POS,
Small Group POS and, at a later date, Individual POS Members.  Each Budget shall cover In-Network.  Out-of-Network and Out-of-Area Shared Risk
Services.  Each of the normalized Shared
Risk Budgets shall be equal to the normalized HMO Shared Risk Budget, or
institutional capitation PMPM, if applicable, and multiplied by one hundred and
five percent (105%).  Actual Shared Risk
Budget shall fluctuate from month to month to the extent that PPG’s age, sex
and benefit plan mix fluctuates.


 




	
  Entire Calendar Year 2000

  
	
  Standard HMO

  Shared Risk - 5%

  	
   

  	
  Small Group
  HMO 

  Shared Risk + 5%

  	
   

  	
  Individual
  HMO

  Shared Risk + 5%

  
	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  






 


9.          Addendum
B to the Agreement, Section J  Pharmacy Shared Risk Program and
Section K.  Pharmacy Rebate Program shall be
deleted in their entirety and replaced with the following:


 


J.                   Pharmacy Shared Risk Program.  The
Pharmacy Shared Risk Program shall be applicable to the following Members:
Standard HMO, Flex Funded HMO, Small Group HMO, and Individual HMO.


 


1.                                         Pharmacy Budget.  Each
month HMO shall fund the Pharmacy Budget at $ 16.00 per eligible Member per
month (“PEMPM”) subject to the age, sex and benefit plan factors set forth in
Addendum B.  Such Pharmacy Budget shall
be effective for the entire calendar year. 
For year 2000 the Pharmacy Budget shall be adjusted according to the
aggregate PEMPM dollar change experienced by those participating physician
groups comprising the top third of lowest PEMPM normalized pharmacy costs,
based on current calendar year experience. 
Such adjustment shall occur prior to calculating the final settlement
for the Pharmacy Reconciliation, as set forth in this Addendum.  Any calculation of the normalized pharmacy
costs shall be based upon actual claims. 
The top third calculation shall be weighed by eligible Member months.


 


2.                                         Pharmacy Reconciliation for
Commercial HMO Members.  For each Reconciliation Period, HMO shall
calculate pharmacy claims subject to this Program as outlined in the Operations
Manual.  HMO shall compare such claims
to the corresponding Pharmacy Budget. 
In the event pharmacy claims are less than the Pharmacy Budget, PPG’s
share of the Pharmacy Budget surplus shall be fifty percent (50%).  In the event pharmacy claims exceed the
Pharmacy Budget, PPG’s share of the Pharmacy Budget deficit shall be fifty
percent (50%).


 


HMO shall perform an interim and final settlement for the Pharmacy Risk
Sharing Program.  The timing of these
settlements shall correspond to the interim and final settlements of other risk
sharing programs.  Subject to Section
4.3 of this Agreement, any Pharmacy Budget deficit shall be offset against any
amounts payable by HMO, or any amounts remaining in the Withhold Fund, or shall
be offset against Capitation.


 


3

















 


Except as so amended, all other provisions of the Agreement shall remain
unchanged and in effect.


 


IN WITNESS WHEREOF, the parties hereto have executed this
Amendment by their officers duly authorized to be effective on the date and
year first written above.


 


	
  A.V. MEDICAL GROUP

  	
   

  	
  FOUNDATION HEALTH SYSTEMS AFFILIATES

  HEALTH NET

  
	
   

  	
   

  	
   

  
	
  /s/
  Peter G. Goll

  	
   

  	
  /s/
  Christopher Ciano

  	
   

  
	
  Signature

  	
   

  	
  Christopher
  Ciano

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Senior
  Vice President

  	
   

  	
  Senior
  Vice President and General Manager

  	
   

  
	
  Title

  	
   

  	
  Southern
  California

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  12-10-00

  	
   

  	
  12-18-00

  	
   

  
	
  Date

  	
   

  	
  Date

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  95 3929309

  	
   

  	
   

  	
   

  
	
  Federal
  Tax Identification Number

  	
   

  	
   

  	
   

  



 


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