Document:

Exhibit 10.12

Exhibit 10.12

	 	 	 
	

	 	ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION

DIVISION OF BUSINESS AND FINANCE

SECTION A: CONTRACT

	 	 	 	 	 	 	 
	1. AMENDMENT

	 	2. CONTRACT
	 	3. EFFECTIVE DATE OF
	 	4. PROGRAM
	    NUMBER:

	 	NO.:
	 	    AMENDMENT:	 	 
	                3

	 	YH09-0001-04
	 	
          May 1,
2009
	 	 DHCM — ACUTE

5. CONTRACTOR’S NAME AND ADDRESS:

Health Choice Arizona

1600 W. Broadway, Suite 260

Tempe, AZ 85282

6. PURPOSE OF AMENDMENT: To amend Section B, Capitation Rates, effective May 1, 2009.

7. THE CONTRACT REFERENCED ABOVE FOLLOWS

To
amend Section B, Capitation Rates, effective May 1, 2009.

	 	 	 
	NOTE: Please sign and date all
copies and then return one
executed original to:

	 	Mark Held
	 

	 	Sr. Procurement Specialist
	 

	 	AHCCCS Contracts
	 

	 	701 E. Jefferson St., MD 5700
	 

	 	Phoenix, AZ 85034

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 AHCCCSA
CONTRACTING
OFFICER:

	

	 	[ILLEGIBLE]
	 
	/s/ Carolyn Rose
	 	/s/ Pat Watkinson for Michael Veit 
	TYPED
NAME: CAROLYN ROSE

	 	MICHAEL VEIT
	TITLE:
CHIEF EXECUTIVE OFFICER

	 	CONTRACTS & PURCHASING ADMINISTRATOR
	DATE:

	 	DATE: 3-30-09

 

 

 

			
	SECTION B: CAPITATION RATES
	 	Contract/RFP
No. YH09-0001
	 	 	 

SECTION B: CAPITATION RATES

The Contractor shall provide services as described in this contract. In consideration for these
services, the Contractor will be paid Contractor-specific rates per member per month for the
term May 1, 2009 through September 30, 2009. See attached revised rates.

CYE ‘09 Acute Care Contract

May 1, 2009

 

61

 

ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM

CAPITATION RATE SUMMARY — ACUTE RATES

Health Choice Arizona

05/01/2009-9/30/2009

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Maternity	 	 	 	 	 	 	 
	 	 	TANF	 	 	TANF	 	 	TANF	 	 	TANF	 	 	TANF	 	 	SSI	 	 	SSI	 	 	 	 	 	 	Delivery	 	 	 	 	 	 	 
	Title XIX and KidsCare Rates 1:	 	<1, M/F	 	 	1-13, M/F	 	 	14-44, F	 	 	14-44, M	 	 	45+, M/F	 	 	w/ Med	 	 	w/o Med	 	 	SFP	 	 	Supplement	 	 	Non-MED	 	 	MED	 
	2 Yuma/La Paz
	 	$	451.13	 	 	$	105.33	 	 	$	204.19	 	 	$	118.67	 	 	$	365.40	 	 	$	178.29	 	 	$	693.11	 	 	$	20.43	 	 	$	6,190.52	 	 	$	443.94	 	 	$	1,636.99	 
	4 Apache/Coconino/Mohave/Navajo
	 	$	474.50	 	 	$	111.49	 	 	$	270.70	 	 	$	157.82	 	 	$	409.11	 	 	$	160.98	 	 	$	775.55	 	 	$	19.00	 	 	$	6,241.93	 	 	$	578.20	 	 	$	1,433.37	 
	10 Pima/Santa Cruz
	 	$	448.76	 	 	$	100.79	 	 	$	230.46	 	 	$	127.70	 	 	$	396.08	 	 	$	145.39	 	 	$	734.80	 	 	$	20.91	 	 	$	6,519.63	 	 	$	485.35	 	 	$	1,329.96	 
	12 Maricopa
	 	$	558.77	 	 	$	114.80	 	 	$	239.88	 	 	$	150.74	 	 	$	410.20	 	 	$	157.50	 	 	$	744.97	 	 	$	18.65	 	 	$	6,646.66	 	 	$	626.59	 	 	$	1,415.16	 

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	TANF	 	 	TANF	 	 	TANF	 	 	TANF	 	 	TANF	 	 	SSI	 	 	SSI	 	 	 	 	 	 	 
	PPC Rates:	 	<1, MF	 	 	1-13, M/F	 	 	14-44, F	 	 	14-44, M	 	 	45+, M/F	 	 	w/ Med	 	 	w/o Med	 	 	Non-MED	 	 	MED	 
	2 Yuma/La Paz
	 	$	1,204.81	 	 	$	61.66	 	 	$	238.16	 	 	$	212.19	 	 	$	436.74	 	 	$	134.22	 	 	$	410.31	 	 	$	1,075.65	 	 	$	7,443.55	 
	4 Apache/Coconino/Mohave/Navajo
	 	$	1,190.43	 	 	$	62.09	 	 	$	264.19	 	 	$	215.00	 	 	$	439.32	 	 	$	135.74	 	 	$	405.56	 	 	$	1,127.34	 	 	$	7,404.72	 
	10 Pima/Santa Cruz
	 	$	1,192.26	 	 	$	56.23	 	 	$	247.42	 	 	$	196.93	 	 	$	439.38	 	 	$	132.24	 	 	$	408.04	 	 	$	887.69	 	 	$	7,387.84	 
	12 Maricopa
	 	$	1,217.54	 	 	$	66.04	 	 	$	255.60	 	 	$	224.64	 	 	$	446.27	 	 	$	132.38	 	 	$	425.30	 	 	$	1,319.34	 	 	$	7,668.50	 

	 	 	 	 	 	 	 	 	 
	 	 	Option 1	 	 	Option 2	 
	Other Rates:	 	Transplant	 	 	Transplant	 
	2 Yuma/La Paz
	 	$	40.00	 	 	$	40.00	 
	4 Apache/Coconino/Mohave/Navajo
	 	$	40.00	 	 	$	40.00	 
	10 Pima/Santa Cruz
	 	$	40.00	 	 	$	40.00	 
	12 Maricopa
	 	$	40.00	 	 	$	40.00	 

	 	 	 
	1.	 	Rates have been adjusted for $50,000 Reinsurance DeductibleExhibit 10.13

Exhibit 10.13

	 	 	 
	

	 	ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION

DIVISION OF BUSINESS AND FINANCE

SECTION A: CONTRACT

	 	 	 	 	 	 	 
	1.  AMENDMENT
NUMBER:

	 	2.  CONTRACT
NO.:

	 	3.  EFFECTIVE DATE OF
AMENDMENT:

	 	4.  PROGRAM
	                4

	 	YH09-0001-04
	 	          August 1, 2009
	 	DHCM — ACUTE

5. CONTRACTOR’S NAME AND ADDRESS:

Health Choice Arizona

410 N. 44th Street, Suite 900

Phoenix, AZ 85008

6. PURPOSE OF AMENDMENT: To amend Section B, Capitation Rates, effective October 1, 2008 and May 1,
2009.

7. THE CONTRACT REFERENCED ABOVE FOLLOWS

To amend Section B, Capitation Rates, effective October 1, 2008 and May 1, 2009.

	 	 	 
	NOTE: Please sign and date all copies and then return one executed original to:
	 	Mark Held
	 
	 	Sr. Procurement Specialist
	 
	 	AHCCCS Contracts
	 
	 	701 E. Jefferson St., MD 5700
	 
	 	Phoenix, AZ 85034

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 AHCCCSA
CONTRACTING

OFFICER:
	 
	/s/ Carolyn Rose	 	/s/ Michael Veit
	TYPED NAME: CAROLYN ROSE

	 	MICHAEL VEIT
	TITLE: CHIEF EXECUTIVE OFFICER

	 	CONTRACTS & PURCHASING ADMINISTRATOR
	DATE: 7/8/2009

	 	DATE:

 

 

 

Contract Rates 27 — HCA

ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM

REVISED CAPITATION RATE SUMMARY — ACUTE RATES

Health Choice Arizona

10/01/2008-9/30/2009

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	Effective 10/01/08-4/30/09	 
	 	 	TANF	 	 	TANF	 	 	TANF	 	 	TANF	 	 	TANF	 	 	SSI	 	 	SSI	 	 	 	 
	Title XIX and KidsCare Rates:	 	<1, M/F	 	 	1-13, M/F	 	 	14-44, F	 	 	14-44, M	 	 	45+, M/F	 	 	w/ Med	 	 	w/o Med	 	 	Non-MED	 
	2 Yuma/La Paz
	 	$	453.20	 	 	$	103.35	 	 	$	199.61	 	 	$	119.61	 	 	$	341.83	 	 	$	165.83	 	 	$	658.72	 	 	$	431.08	 
	4 Apache/Coconino/Mohave/Navajo
	 	$	475.32	 	 	$	113.25	 	 	$	278.74	 	 	$	161.12	 	 	$	425.28	 	 	$	167.82	 	 	$	801.67	 	 	$	598.27	 
	10 Pima/Santa Cruz
	 	$	439.11	 	 	$	102.38	 	 	$	234.44	 	 	$	129.37	 	 	$	403.87	 	 	$	144.10	 	 	$	714.67	 	 	$	489.61	 
	12 Maricopa
	 	$	560.63	 	 	$	112.55	 	 	$	234.65	 	 	$	141.03	 	 	$	399.17	 	 	$	143.29	 	 	$	725.26	 	 	$	608.77	 

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	Effective 5/01/09-9/30/09	 
	 	 	TANF	 	 	TANF	 	 	TANF	 	 	TANF	 	 	TANF	 	 	SSI	 	 	SSI	 	 	 	 
	PPC Rates:	 	<1, M/F	 	 	1-13, M/F	 	 	14-44, F	 	 	14-44, M	 	 	45+, M/F	 	 	w/ Med	 	 	w/o Med	 	 	Non-MED	 
	2 Yuma/La Paz
	 	$	448.09	 	 	$	101.83	 	 	$	196.55	 	 	$	118.05	 	 	$	336.42	 	 	$	163.00	 	 	$	651.89	 	 	$	425.51	 
	4 Apache/Coconino/Mohave/Navajo
	 	$	470.51	 	 	$	112.00	 	 	$	275.06	 	 	$	159.38	 	 	$	419.72	 	 	$	165.04	 	 	$	795.45	 	 	$	592.00	 
	10 Pima/Santa Cruz
	 	$	434.20	 	 	$	101.19	 	 	$	231.05	 	 	$	127.92	 	 	$	398.31	 	 	$	141.90	 	 	$	708.50	 	 	$	484.03	 
	12 Maricopa
	 	$	555.13	 	 	$	111.15	 	 	$	231.43	 	 	$	139.53	 	 	$	393.96	 	 	$	141.40	 	 	$	719.08	 	 	$	602.64Exhibit 10.14

Exhibit 10.14

	 	 	 
	

	 	ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION

DIVISION OF BUSINESS AND FINANCE

SECTION A: CONTRACT

	 	 	 	 	 	 	 
	1. AMENDMENT

	 	2. CONTRACT
	 	3. EFFECTIVE DATE OF
	 	4. PROGRAM
	    NUMBER:

	 	NO.:
	 	    AMENDMENT:	 	 
	                5

	 	YH09-0001-04
	 	           August 1, 2009
	 	DHCM — ACUTE

5. CONTRACTOR’S NAME AND ADDRESS:

Health Choice Arizona

410 N. 44th Street, Suite 900

Phoenix, AZ 85008

6. PURPOSE OF AMENDMENT: To amend Section B, Capitation Rates, effective October 1, 2008.

7. THE CONTRACT REFERENCED ABOVE FOLLOWS

ADD
to Section B, CAPITATION RATES after first subparagraph add the following language:

“The Contractor will be paid the attached Contractor specific capitation rates
retroactively, per member per month, for the period of October 1, 2008 through December
31, 2008, to increase rural hospital inpatient reimbursement. The retroactive rate
adjustment is applied to the risk adjusted capitation rates. Only the impacted rates are
included on the attachment; all other rates remain unchanged. The Administration requires
that the Contractor then make one-time payments to each rural hospital as prescribed on
the attached schedule, pursuant to ARS § 36-2905.02, to increase inpatient reimbursement
to these small rural hospitals.

The retroactive capitation rate payment for rural hospital reimbursement will be paid
after the retroactive risk adjustment capitation is paid. 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 Assistant Director of the Division of
Health Care Management 30 days from receipt of the funds.

The capitation rates for the period of January 1, 2009 through September 30, 2009,
are not impacted by this amendment.”

	 	 	 
	NOTE: Please sign and date all copies and return one executed original to:

	 	Mark Held
	 

	 	Sr. Procurement Specialist
	 

	 	AHCCCS Contracts
	 

	 	701 E. Jefferson St., MD 5700
	 

	 	Phoenix, AZ 85034

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

	 	10. SIGNATURE OF AHCCCSA CONTRACTING
	REPRESENTATIVE:

	 	OFFICER:
	 
	 	 
	
/s/ Carolyn Rose
	 	/s/ Michael Veit
	TYPED NAME: CAROLYN ROSE

	 	MICHAEL VEIT
	TITLE: CHIEF EXECUTIVE OFFICER

	 	CONTRACTS & PURCHASING ADMINISTRATOR
	DATE: 7/8/2009

	 	DATE:

 

 

 

Contract Rates 27 — HCA

ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM

REVISED CAPITATION RATE SUMMARY — ACUTE RATES

Health Choice Arizona

10/1/08-12/31/08

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	TANF	 	 	TANF	 	 	TANF	 	 	SSI	 	 	SSI	 	 	 	 
	Title XIX and KidsCare Rates:	 	<1, M/F	 	 	1-13, M/F	 	 	14-44, F	 	 	w/ Med	 	 	w/o Med	 	 	Non-MED	 
	4 Apache/Coconino/Mohave/Navajo
	 	$	548.07	 	 	$	120.39	 	 	$	305.79	 	 	$	194.72	 	 	$	829.54	 	 	$	621.64	 
	10 Prima/Santa Cruz
	 	$	451.00	 	 	$	103.70	 	 	$	239.79	 	 	$	146.21	 	 	$	723.04	 	 	$	492.11	 

Two percent Premium tax is included in the Capitation Rates.

Payments stated without Premium Tax.

	 	 	 	 	 
	Health Choice Arizona	 	Payment	 
	Benson Hospital
	 	$	—	 
	Carondelet Holy Cross
	 	$	270,760.88	 
	Cobre Valley Community Hospital
	 	$	—	 
	Copper Queen Community Hospital
	 	$	7,317.94	 
	La Paz Regional Hospital
	 	$	60,575.13	 
	Little Colorado Medical Center
	 	$	350,785.77	 
	Mount Graham Regional Medical Center
	 	$	—	 
	Navapache Regional Medical Center
	 	$	1,298,323.31	 
	Northern Cochise Community Hospital
	 	$	—	 
	Page Hospital
	 	$	130,195.80	 
	Payson Regional Medical Center
	 	$	—	 
	Sage Memorial Hospital
	 	$	158,128.18	 
	Sierra Vista Regional Health
	 	$	—	 
	Southeastern Az Medical Center
	 	$	—	 
	Valley View Medical Center
	 	$	645,706.65	 
	Verde Valley Medical Center
	 	$	—	 
	White Mountain Regional Medical Center
	 	$	63,693.11	 
	Wickenburg Regional Health Center
	 	$	—	 
	YRMC East
	 	$	—	 
	 
	 	 	 
	Total
	 	$	2,985,486.77

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