Document:

exv10w22w2

 

Exhibit 10.22.2

	 	 	 	 	 	 	 	 	 	 	 
	 	 	1. Contract Number	 	Page of Pages
	AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

	 	POHC-2002-D-0003
	 	 	1	 	 	 	3	 

	 	 	 	 	 	 	 	 	 	 	 	 	 
	2.

	 	Amendment/Modification Number
	 	3. Effective Date
	 	4. Requisition/Purchase Request No.
	 	 	5.	 	Project No. (If applicable)
	

	 	M0013
	 	See Block 16C Below
	 	* SEE BLOCK 12 BELOW	 	 	 	 	 	 

	 	 	 	 	 	 	 	 	 	 	 
	6.

	 	Issued By
	Code
                
	 	7.  	Administered By (If other than line 6)
	

	 	Office of Contracting and Procurement
	 	 	 	 	 	 	 	Department of Health, Office of Managed Care
	

	 	Department of Health Bureau
	 	 	 	 	 	 	 	Medical Assistance Administration
	

	 	441 4th Street, NW., Suite 700 South	 	 	 	 	 	 	 	 
	

	 	Washington, DC 20001
	 	 	 	 	 	 	 	825 North Capitol Street, N.E.
	

	 	 	 	 	 	 	 	 	 	Attention: Ms. Maude Holt
	

	 	 	 	 	 	 	 	 	 	Telephone: (202) 442-9074

	 	 	 	 	 	 	 
	8.

	 	Name and Address of Contractor
(No. Street, city, country, state and

ZIP Code)

	 	 	(X)  
	9A. Amendment of Solicitation No.
	 
	 	 	 	 	 	 
	

	 	AMERIGROUP DISTRICT OF COLUMBIA	 	 	 	 
	

	 	750 1 ST STREET, N.E, SUITE 1120
	 	 	 	9B. Dated (See Item 11)
	

	 	WASHINGTON, DC 20004	 	 	 	 
	

	 	ATTN: MS. JANE THOMPSON	 	 	 	 
	

	 	TELEPHONE NO.: (202) 218-4900
	 	 	 	10A. Modification of Contract/Order No.
	

	 	 	 	 	 	POHC-2002-D-0003
	 
	

	 	 	 	 	 	10B. Dated (See Item 13)
	

	 	          Code
	Facility’
	 	x
	AUGUST 1, 2002

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

	 	 	The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers o is
extended. o is not
extended.

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by
one of the
following methods: (a) By completing items 8 and 15, and returning                                        copies of the amendment:
(b) By acknowledging receipt of this
amendment on each copy of the offer submitted; or (c) By separate letter or telegram which includes a reference to the
solicitation and
amendment number. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS
PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change
an offer already submitted, such change may be made by letter or telegram, provided each letter or telegram makes reference to
the
solicitation and this amendment, and is received prior to the opening hour and date specified.
	 
	12.	 	Accounting and Appropriation Data (If Required)
	 
		 	*   CFO CERTIFICATION LETTER DATED JUNE 26, 2003

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14

	 	 	 	 	 
	

	 	(X)
	 	A. This change order is issued pursuant to: (Specify Authority)

The changes set forth in Item 14 are made in the contract/order no. in item 10A.
	 
	 	 	 	 
	

	 	X
	 	B. The above numbered contract/order is modified to reflect the administrative changes (such as changes in paying office,
appropriation
date, etc.) set forth in item 14, pursuant to the authority of 27 dCMR, Chapter 36, Section 3601.2.
	 
	 	 	 	 
	

	 	 	 	C- This supplemental agreement is entered into pursuant to authority of:
	

	 	 	 	DISTRICT OF COLUMBIA MUNICIPAL REGULATIONS 3601.2 (c) Bilateral Contract Modification and agreement between the parties
	 
	 	 	 	 
	

	 	 	 	D. Other (Specify type of modification and authority)

E. IMPORTANT: Contractor x is not, o is required to sign this document and return                                  copies to the issuing office.

	14.	 	Description of amendment/modification (Organized by USC Section headings, including solicitation/contract subject matter where
feasible.)
	 
	 	 	THE CONTRACT REFERENCED IN BLOCK 10A ABOVE IS MODIFIED AS FOLLOWS:

	 	1.	 	Delete sub-section “D. The time period or service limits of a service has been met” from

Section C.14.3.4.5 as listed on page 2 of this modification.

	 	2.	 	Add new definition into Section C.1.3 as listed on page 3 of this modification.

ALL OTHER CONTRACT TERMS AND CONDITIONS REMAIN UNCHANGED

Except as provided herin, all terms and conditions of the document referenced in Item (9A or 10A as heretofore changed, remains
unchanged and in full force and effect

	 	 	 
	15A. Name and Title of Signer (Type or print)

	 	16A. Name of Contracting Officer
	

	 	          Lorenzo Brown

	 	 	 	 	 	 	 
	15B. Name of Contractor

	 	15C. Date Signed
	 	16B. District of Columbia
	 	16C. Date Signed
	 
	 	 	 	 	 	 
	

	 	 	 	 	 	5/17/04
	(Signature of person authorized in sign)
	 	 	 	(Signature of Contracting Officer)	 	 

	 	 	 	 	 
	***Government of the District of Columbia

	 	Office o Contr. ting & Procurement
	 	DC OCP 202 (7-99)

 

	 	 	 
	C.143.2.9

	 	The circumstances under which benefits shall continue pending
resolution of the grievance or issuance of a District Fair Hearing
decision, as defined in C.14.3.4.4.
	 
	 	 
	   ADD
	 	 
	C.14.3.4.5

	 	While the Enrollee’s. appeal is pending, the Enrollee’s
benefits shall continue until one of the following occurs:
	 
	 	 

	 	 	 	 	 
	

	 	A.
	 	The Enrollee withdraws the appeal;
	

	 	 	 	 
	

	 	B.
	 	Ten days pass after the MCO
or PIHP mails the notice, providing the resolution
of the appeal against the enrollee, unless the
enrollee, within the 10-day timeframe, has
requested a District Fair Hearing with continuation
of benefits until the District Fair Hearing
decision is reached.
	

	 	 	 	 
	

	 	C.
	 	The District Office of Fair
Hearing issues a hearing decision adverse to the
Enrollee; or
	 
	 	 	 	 
	

	 	D.
	 	Deleted
	 
	 	 	 	 

	 	 	 
	C.14.3.4.6

	 	The Contractor is prohibited from recovering payment for
continuation of benefits furnished during a pending appeal, if the final
resolution of the appeal is adverse to the Enrollee.
	 
	 	 
	C.14.3.4.7

	 	In accordance with 42 CFR 438.424, if the Contractor or
District Office of Fair Hearing reverses a decision to deny, limit, or delay
services that Were not furnished while the appeal was pending, the Contractor
must authorize or provide the disputed services within two (2) working days,
and as expeditiously as the Enrollee’s health condition requires. In
addition, if the MCO, PIHP or District Office of Fair Hearing reverses a
decision to deny authorization of services, and the Enrollee received the
disputed services while the appeal was pending, the MCO or PIHP must pay for
those services, in accordance with District policy and regulations.
	 
	 	 
	   ADD
	 	 

Add the following after the first paragraph in Section C.14.4.1

PAGE 2 of 3

 

 

C.1.3. Definitions High

Risk Newborn:

The term high- risk newborn can be applied to any newborn that experiences a
complicated prenatal course that is at an increased risk for perinatal
morbidity or mortality. Conditions affecting the high- risk newborn include
severe pre maturity (gestational age from 24 weeks to 32 weeks), congenital
abnormalities, genetic syndromes, malignancies, acute and chronic infections,
prolonged NICU stay and developmental delays regardless of etiology.

Maternal conditions associated with high risk newborns include but not limited
to medical or obstetrical complications, inadequate or no prenatal care,
maternal age less than 18 years, mental illness, substance abuse, poor
infant-maternal bonding, homelessness, poor parenting skills and a previous
history of involvement with
Child and Family Services.

Page 3 of 3exv10w22w3

 

Exhibit 10.22.3

	 	 	 	 	 	 	 	 	 	 	 
	 	 	1. Contract Number	 	Page of Pages
	AMENDMENT OF SOI.ICITATION/MODIFICATION OF CONTRACT

	 	POHC-2002-D-0003
	 	 	1	 	 	 	2	 

	 	 	 	 	 	 	 	 	 	 	 	 	 
	2.

	 	Amendment/Modification Number
	 	3. Effective Date
	 	4. Requisition/Purchase Request No.
	 	 	5.	 	 	Project No. (If applicable)
	

	 	M0014
	 	AUGUST 1, 2004
	 	* SEE BLOCK 12 BELOW	 	 	 	 	 	 

	 	 	 	 	 
	6. issued By

	 	Code
	 	7. Administered By (if other than line 6)
	 
	 	 	 	 
	  Office of Contracting and Procurement

	 	 	 	Department of Health, Office of Managed Care
	  Department of Health Bureau

	 	 	 	Medical Assistance Administration
	441 4th Street, NW., Suite 700 South

	 	 	 	825 North Capitol Street, N.E.
	Washington, DC 20001

	 	 	 	Attention: Ms. Maude Holt
	

	 	 	 	Telephone: (202) 442-9074

	 	 	 	 	 
	8. Name and Address of Contractor (No, Street, city, country, state and ZIP Code)

	 	(X)
	 	9A. Amendment of Solicitation No.
	 
	 	 	 	 
	AMERIGROUP DISTRICT OF COLUMBIA

	 	 	 	9B. Dated (See Item 11)
	750’1 ST STREET, N.E, SUITE 1120
	 	 	 	 
	WASHINGTON, DC 20004

	 	x
	 	10A. Modification of Contract/Order No.
	ATTN: MS. JANE THOMPSON

	 	 	 	POHC-2002-D-0003
	TELEPHONE NO: (202) 216-4900

	 	 	 	10B. Dated (See Item 13)
	Code

	Facility
	 	 	AUGUST 1, 2002

11. THS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

	 	 	The above numbered solicitation is amended as set forth in Item 14.
        The hour and date specified for receipt of Offers o
        is extended. o is not extended. Offers
        must acknowledge receipt of this amendment prior to the hour and date
        specified in the solicitation or as amended, by one of the following methods:
        (a) By completing Items 8 and 15, and returning    
                          
                        copies of
        the amendment: (b) By acknowledging receipt of this amendment on
        each copy of the offer submitted; or (c) By separate letter or telegram
        which includes a reference to the solicitation and amendment number. FAILURE
        OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE
        RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION
        OF YOUR OFFER. If by virtue of this amendment you desire to change an
        offer already submitted, such Change maybe made by letter or telegram,
        provided each letter or telegram makes reference to the solicitation and
        this amendment, and is received prior to the opening hour and date specified.
	 
	12.	 	Accounting and Appropriation Data (If Required)
	 
	*	 	CFO CERTIFICATION LETTER DATED JUNE 03, 2004

  
13. THIS ITEM APPLIES ONLY TO MODIFICATIONS
    OF CONTRACTS / ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14

	 	 	 
	(X)

	 	A. This change order Is issued pursuant to: (Specify Authority)
	

	 	The changes set forth In Item 14 are made in the contract/order no. in item 10A.
	
	 	B. The above numbered contract/order is modified to reflect the administrative changes (such as changes in paying office,
appropriation
date, etc.) set forth In item 14, pursuant to the authority of 27 DCMR, Chapter 36, Section 3601.2.
	

	 	C. This supplemental agreement is entered into pursuant to authority of:
	

	 	DISTRICT OF COLUMBIA MUNICIPAL REGULATIONS 3601.2 (c) Bilateral Contract Modification and agreement between the parties
	
            x 

          
	 	D. Other (Specify type of modification and authority)
	

	 	IN ACCORDANCE TO DCMN CHAPTER 36, SECTION 3601.2 (C) OPTION

E. IMPORTANT: Contractor o is not, x is required to sign this document and return 2 copies to the issuing office.

	14.	 	Description of amendment/modification (Organized by USC Section headings, including solicitation/contract subject matter where
feasible.)
	 
	 	 	THE CONTRACT REFERENCED IN BLOCK 10A ABOVE IS MODIFIED AS FOLLOWS:

	 	1.	 	THE DISTRICT HEREBY EXERCISES ITS OPTION TO RENEW THIS CONTRACT IN ACCORDANCE TO SECTION F 1.2, TERM OF CONTRACT
FOR THE PERIOD OF AUGUST 1, 2004 THROUGH JULY 31, 2005. THE TOTAL PRICE FOR THIS OPTION IS $ 87,124,011.28
	 
	 	2.	 	A LIST OF RATES INCREASE FOR TREND EFFECTIVE FROM CONTRACT PERIOD AUGUST 1, 2004 THROUGH JULY 31, 2005
IS LISTED ON PAGE 2 OF THIS MODIFICATION.
	 
	 	3.	 	INCORPORATE THE DEPARTMENT OF LABOR WAGE DETERMINATION NO. 1994-2103, REVISION NO. 32, DATED 05/27/2004.

ALL OTHER CONTRACT TERMS AND CONDITIONS REMAIN UNCHANGED

Except as provided herin, all terms and conditions of the document referenced in Item (9A or 10A as heretofore changed. remains
unchanged and in full force and effect

	 	 	 
	15A. Name and Title of Signer (Type or print)

	 	16A. Name of Contracting Officer
	Jane E. Thompson CEO

	 	          ESTHER M. SCARBOROUGH

	 	 	 	 	 	 	 
	15B. Name of Contractor

	 	15C. Date Signed
	 	16B. District of Columbia
	 	‘16C. Date Signed
	 
	 	 	 	 	 	 
	AMERIGROUP District of Columbia
	 	 	 	 	 	 
	/s/ Jane E. Thompson

	 	6/22/04/O	 	 	 	 
	(Signature of person authorized to sign)
	 	 	 	(Signature of Contracting Officer)	 	 

	 	 	 	 	 
	* Government of the District of Columbia

	 	‘`r’j’’ Office of Contracting & Procurement
	 	DC OCP 202 (7-99)

 

Amerigroup Health Plan.

DCHFP Rates August 2004 to July 2006

B.6.2 Supplies/Services

CONTRACT NO: POHC-2002•D-00033

	 	 	 	 	 	 	 	 	 	 	 	 	 
	LINE	 	 	 	Annualized	 	 
	ITEM	 	 	 	January-March	 	 
	NUMBER
	 	SQPPTTRC/SERVICES
	 	2004 MMs
	 	TOTAL PMPM*

	 	0001	 	 	DC HEALTHY FAMILIES PROGRAM (DCHFP)
	 	 	 	 	 	 	 	 
	 	0001AA	 	 	Infants Under 1 year of ago (months 2 through 12)
	 	 	18,324	 	 	 	310.33	 
	 	 	 	 	Delivery month (projected delivery)
	 	 	1,140	 	 	$	6,257.93	 
	 	 	 	 	Birth Month (actual month of birth)
	 	 	1,160	 	 	$	5,192.71	 
	 	0001AB	 	 	Children of 1 year of age through 12 years of age
	 	 	216,632	 	 	$	108.85	 
	000]AC	 	Females ages 13 through 18 years
	 	 	39,000	 	 	$	158.49	 
	 	0001AD	 	 	Males ages 13 through 18 years of age
	 	 	33,920	 	 	 	144.57	 
	 	0001AE	 	 	Females ages 19 through 36 years of age
	 	 	83,316	 	 	$	201.08	 
	 	000IAF	 	 	Males ages 19 through 36 years of age
	 	 	9,832	 	 	$	142.49	 
	 	0001AG	 	 	Females 37 years of ages and older
	 	 	38,584	 	 	$	346.34	 
	 	0001AM	 	 	Males 37 years of age and older
	 	 	8,560	 	 	 	244.94	 
	 	 	 	 	 
	 	 	
 	 	 	 	
 	 
	 	 	 	 	Estimated Total Dollars based on Annualized MMs
	 	 	448,168	 	 	$	87,124,011.28	 
	 	 	 	 	*PMPM = per member per month
	 	 	 	 	 	$	194.40	 
	 	 	 	 	OR DISTRCT USE ONLY
	 	 	 	 	 	 	 	 

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	LINE

	 	AGY	 	YR  	 	Index 	 	PCA	 	OBJ 	 	AOB
	 	Grant
	 	Proj
	 	AG1
	 	AG2
	 	AG3
	 	 	 	 	 	 
	
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	.1
	 	PH
	 	PH

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00069-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00069-of-00352.parquet"}]]