Exhibit
10.130


 


AMENDMENT




CALIFORNIACARE MEDICAL SERVICES AGREEMENT


 


This Amendment to CaliforniaCare Medical
Services Agreement (“Amendment”), is entered into at Woodland Hills, Los
Angeles County, California as of January 1, 1999, by and between Blue Cross of
California and its Affiliates (“BLUE CROSS”) and Prospect Medical Group
(“PARTICIPATING MEDICAL GROUP”).


 


RECITALS


 


A.                                   BLUE CROSS and PARTICIPATING MEDICAL GROUP
have previously entered into a CaliforniaCare Medical Services Agreement,
whereby PARTICIPATING MEDICAL GROUP is designated as a Participating Medical
Group.  The foregoing agreement and any
amendments thereto shall be referred to herein as the “Agreement.” All
capitalized terms not otherwise defined herein shall have the meanings ascribed
to them in the Agreement.


 


B.                                     BLUE CROSS is responsible for the performance
of certain activities (“Compliance Activities”) related to Medical Services in
order to comply with applicable state and federal laws and accreditation and
certification requirements of managed care organization oversight agencies,
including, but not limited to, the California Department of Corporations
(“DOC”) and the National Committee for Quality Assurance (“NCQA”).


 


C.                                     BLUE CROSS may delegate responsibility for
some or all Compliance Activities (“Delegated Compliance Activities”) to
qualified PARTICIPATING MEDICAL GROUPs.


 


D.                                    The parties desire to amend the Agreement to
memorialize the delegation of certain Compliance Activities by BLUE CROSS to
PARTICIPATING MEDICAL GROUP and to set forth the terms thereof.


 


NOW,
THEREFORE, IT IS AGREED:


 


1.                                       BLUE CROSS and PARTICIPATING MEDICAL GROUP
hereby agree to add the following additional provisions to the Agreement:


 


A.                                   Delegation of Compliance Activities


 


1.                                       BLUE CROSS hereby authorizes PARTICIPATING
MEDICAL GROUP to perform, and PARTICIPATING MEDICAL GROUP agrees to perform on
BLUE CROSS’ behalf, the Delegated Compliance Activities delineated in the
Division of Responsibilities For Compliance Activities, Attachment 1
(incorporated by reference herein).


 


2.                                       BLUE CROSS retains primary responsibility for
Compliance Activities that are not specifically delegated to PARTICIPATING
MEDICAL GROUP.


 

















 


PARTICIPATING
MEDICAL GROUP shall cooperate and comply with BLUE CROSS’ performance of such
activities, as necessary.


 


3.                                       If PARTICIPATING MEDICAL GROUP attains and
maintains NCQA Physician Organization Certification (“POC”), or other
certification deemed acceptable by BLUE CROSS during the term of the Agreement,
BLUE CROSS agrees to exempt PARTICIPATING MEDICAL GROUP from predelegation,
annual, and follow-up onsite audits of Delegated Compliance Activities, except
to the extent those Delegated Compliance Activities must be monitored by BLUE
CROSS as required by any regulatory agency having jurisdiction over BLUE
CROSS.  PARTICIPATING MEDICAL GROUP
shall supply written evidence of such POC certification to BLUE CROSS no less
than once every twelve (12) months and upon renewal.  PARTICIPATING MEDICAL GROUP shall immediately notify BLUE CROSS
in the event such certification is revoked or is not renewed.


 


4.                                       Notwithstanding any delegation of
credentialing or recredentialing activities to PARTICIPATING MEDICAL GROUP,
BLUE CROSS retains the right to approve, suspend or deny any Health
Professional from providing services to Members under the Agreement.


 


B.                                     Compliance Activities Performance Measurement


 


1.                                       PARTICIPATING MEDICAL GROUP agrees to comply
with the Compliance Activity Performance Measurements indicated in Attachment 1
for each listed Compliance Activity Standard for which it is delegated
responsibility.


 


2.                                       PARTICIPATING MEDICAL GROUP shall submit all
required written documentation demonstrating compliance with the Compliance
Activity Performance Measurement, as delineated in Attachment 2 (incorporated
by reference herein).  Such materials
must be submitted to the appropriate BLUE CROSS contact person as indicated in
Attachment 2 by the deadlines set forth therein.  PARTICIPATING MEDICAL GROUP will be monitored for compliance with
meeting submission time frames.


 


3.                                       PARTICIPATING MEDICAL GROUP agrees to give
BLUE CROSS a continuing right of access to PARTICIPATING MEDICAL GROUP’s
records and information pertaining to Delegated Compliance Activities as
necessary to evaluate ongoing qualification for delegation, and to copy those
records and information as needed.


 


C.                                     Corrective Actions and Revocation of
Delegation


 


1.                                       In the event that BLUE CROSS determines that
PARTICIPATING MEDICAL GROUP is in breach of the terms of this Amendment and/or
that


 

















 


1.                                       In the event that BLUE CROSS determines that
PARTICIPATING MEDICAL GROUP is in breach of the terms of this Amendment and/or
that PARTICIPATING MEDICAL GROUP fails to satisfactorily fulfill its
responsibilities for performing any Delegated Compliance Activity, BLUE CROSS
may, in addition to any other available remedy:


 


(a)                                  Require that PARTICIPATING MEDICAL GROUP
submit, within 30 calendar days of request, a corrective plan of action
acceptable to BLUE CROSS and adhere to such plan; or


 


(b)                                 Revoke PARTICIPATING MEDICAL GROUP’s
delegation status, in whole or in part, by giving thirty (30) calendar days
prior written notice to PARTICIPATING MEDICAL GROUP.


 


2.                                       In the event BLUE CROSS determines that
continued performance by PARTICIPATING MEDICAL GROUP of any Delegated
Compliance Activity poses a risk of physical, mental, emotional, or financial
harm to a Member, BLUE CROSS may revoke the delegation of such Compliance
Activity, immediately upon written notice to PARTICIPATING MEDICAL GROUP.


 


3.                                       BLUE CROSS retains the right to modify
Attachments 1 and 2 on an annual basis or as may be reasonably necessary or
required to comply with applicable laws or regulations or the accreditation
requirements of regulatory agencies and managed care organization oversight
bodies.  In any such event, BLUE CROSS
shall provide PARTICIPATING MEDICAL GROUP with written notice.


 


Upon
acceptance by the parties, this Amendment, as of the date specified above,
shall become a part of the Agreement, and all provisions of the Agreement not
specifically inconsistent herewith shall remain in full force and effect.


 


 


	
  Blue Cross of California

  	
   

  	
  Prospect Medical Group

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  Signature:

  	
   

  	
   

  	
  Signature:

  	
   /s/ James M. Wilcox

  	
   

  
	
   

  	
   

  	
   

  
	
  Name:

  	
   

  	
  Name:

  	
  James M. Wilcox

  	
   

  
	
   

  	
   

  	
   

  
	
  Title:

  	
   

  	
   

  	
  Title:

  	
  VICE
  PRESIDENT

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  HEALTH PLAN
  RELATIONS

  
											



 


3