Document:

exv10w23w1

 

Exhibit 10.23.1

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	  AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT	 	 	 	 	1. Contract Number	Page of Pages
	 	 	 	 	 	 	 	 	 	 	 	POHC-2002-D-0003	 	1	 	 	 	2	 
	 
	  2. Amendment/Modification Number	 	3. Effective Date	4. Requisition/Purchase Request No.	 	  5. Solicitation Caption
	          POHC-2002-D-0003 M0026	 	          1/1/06	 	 	 	 	 	 	 	 	 	          D.C. Health Families Program
	 
	  6. Issued By;	 	 	Code	 	 	 	 	  7. Administered By (If other than line 6)
	    Office of Contracting and Procurement	 	  Department of Health
	    Human Care Supplies and Services Commodity Group	 	  Medical Assistance Administration
	    441 4th Street, NW, Room 700 South	 	  825 North Capitol Street, NE, 5th Floor
	    Washington, D.C., 20001	 	  Washington, D.C., 20002
	 	 	 	 	 	 	 	 	 	 	  Maude Holt 202 442-9074
	 
	8. Name and Address of Contractor (No, Street, city, country, state and ZIP Code)	 	(X)	 	9A. Amendment of Solicitation No.
	 	 	 	 
	AmeriGroup Maryland	 	 	 	9B. Dated (See Item 11)
	dba AmeriGroup District of Columbia	 	 	 	 
	750 First Street, NE Suite 1120	 	 	 	10A. Modification of Contract/Order No.
	Washington, D.C. 20001	 	X	 	POHC-2002-D-0003
	Phone 202 218-4901       Fax 202 783-8207	 	 	 	10B. Dated (See Item 13)
	Code	 	Facility	 	 	 	 	 	 	8/1/2002
	 
	11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS
	 
	o	 	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 fax 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 fax, 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)
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,
IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14
	 
	 	 	  A. This change order is issued pursuant to: (Specify Authority)	 	27 DCMR, Chapter 36, Contract Modifications
	 	 	  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 data, etc.)

  set forth in Item 14, pursuant to the authority of 27 DCMR, Chapter 36, Section 3601.2.
	 
	 X 	  C. This supplemental agreement is entered into pursuant to authority of:	 	27 DCMR, Chapter 36, Contract Modifications
	 	 	  The changes set forth In Item 14 are made In the contract/order no. in item 10A.
	 
	 	 	  D. Other (Specify type of modification and authority)
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	E. IMPORTANT:       Contractor o  is not,      x
 is required to sign this document and return      2       originals to the issuing office.
 
	 
	14. Description of amendment/modification (Organized by UCF Section headings, including solicitation/contract subject matter where feasible.)
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	In accordance
with Title V Subtitle N Designated Appropriation Allocations Section 5258 Funds for Medicaid Dental Services
of the Fiscal Year 2006 Budget Support Amendment Act of 2005
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Contract POHC-2002-D-0003 is hereby modified as described on page 2:
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	ALL OTHER TERMS AND CONDITIONS OF THE CONTRACT REMAIN UNCHANGED
	 
	Except as provided herein, all terms and conditions of the document referenced In Item (9A or 10A) remain unchanged and in full force and effect
	 
	15A. Name and Title of Signer (Type or print)	 	16A. Name of Contracting Officer
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	     Dr. Sandra Nichols	 	James H. Marshall
	 
	15B. Name of Contractor	 	15C. Date Signed	 	16B. District of Columbia	16C. Date Signed
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	     -s- Dr. Sandra Nichols	 		 	 	 	            -s-
James H. Marshall	
	(Signature of person authorized to sign)	 	12/19/05	 	(Signature of Contracting Officer)	12-30-05

 

 

Amerigroup Health Plan.

DCHFP Rates August 2005 to July 2006

POHC-2002-D-0003 M0026

Page 2

Insert:

B.6.2       Supplies/Services

CONTRACT NO:       POHC-2002-D-0003

 

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	LINE	 	 	 	Annualized	 	PMPM* Rates from	 	PMPM* Rates from
	ITEM	 	 	 	October*	 	August 2005 through	 	January 2006 through
	NUMBER	 	SUPPLIES/SERVICES	 	December 2004	 	December 2005	 	July 2006
	 
	0001	 	DC HEALTHY FAMILIES PROGRAM (DCIIFP)
	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 
	0001AA	 	Infants Under 1 year of age (months 2 through 12)
	 	 	20,272	 	 	$	283.83	 	 	$	283.83	 
	 	 	Delivery month (projected delivery)
	 	 	1,244	 	 	$	6,761.98	 	 	$	6,761.98	 
	 	 	Birth Month (actual month of birth)
	 	 	1,352	 	 	$	4,826.96	 	 	$	4,826.96	 
	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 
	0001AB	 	Children of 1 year of age through 12 years of age
	 	 	223,524	 	 	$	104.16	 	 	$	107.65	 
	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 
	0001AC	 	Females ages 13 through 18 years
	 	 	43,596	 	 	$	146.03	 	 	$	150.41	 
	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 
	0001AD	 	Males ages 13 through 18 years of age
	 	 	37,488	 	 	$	137.44	 	 	$	142.04	 
	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 
	0001AE	 	Females ages 19 through 36 years of age
	 	 	90,428	 	 	$	215.75	 	 	$	215.75	 
	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 
	0001AF	 	Males ages 19 through 36 years of age
	 	 	10,740	 	 	$	124.10	 	 	$	124.10	 
	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 
	0001AG	 	Females 37 years of age and older
	 	 	43,224	 	 	$	369.69	 	 	$	369.69	 
	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 
	0001AH	 	Males 37 years of age and older
	 	 	9,536	 	 	$	261.26	 	 	$	261.26	 
	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	Estimated Total Dollars based on Annualized MMs
	 	 	478,808	 	 	$	39,502,592	 	 	$	55,970,667	 
	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	*PMPM = per member per month
	 	 	 	 	 	$	198.00	 	 	$	200.39	 
	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	FOR DISTRICT USE ONLY
	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 
	 
	LINE	 	AGY   YR   Index   PCA  
OBJ   AOB   Grant  Proj   AG1   AG2
	 	 	AG3	 	 	 	 	 	 	 	 	 
	 	 	     J         PH  
   PH
	 	 	 	 	 	 	 	 	 	 	 	 
	 

	 	 	 	 	 
	FY06 Estimated Total Dollars based on Annualized MMs at August 2005 Rates
	 	$	94,806,220	 
	FY06 Estimated Total Dollars based on Annualized MMs and Rate Update January 2006
	 	$	95,473,258	 
	 
	 	 	 	 
	Estimated Increase in FY06 Total Dollars based on Dental Rate Adjustment
	 	$	667,036exv10w23w2

 

Exhibit 10.23.2

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	  AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT	 	 	 	 	1. Contract Number	Page of Pages
	 	 	 	 	 	 	 	 	 	 	 	POHC-2002-D-0003	 	1	 	 	 	2	 
	 
	  2. Amendment/Modification Number	 	3. Effective Date	4. Requisition/Purchase Request No.	 	  5. Solicitation Caption
	M00027	 	          January 1, 2006	 	 	 	 	 	 	 	 	 	          DC Healthy Families Program
	 
	  6. Issued By:	 	 	Code  	   5BBWJ 	 	 	 	  7. Administered by (If other than line 6)
	    Office of Contracting and Procurement	 	  Department of Health
	    Human Care Supplies and Services Commodity Group	 	  Medical Assistance Administration
	    441 4th Street, NW., Suite 700 South	 	  825 North Capitol Street, NE, 4th floor
	    Washington, DC 20001	 	  Washington, DC 20002
	 	 	 	 	 	 	 	 	 	 	 
	 
	8. Name and Address of Contractor (No, street, city, country, state and zip code)	 	 	 	9A. Amendment of Solicitation No.
	 	 	 	 
	AmeriGroup Maryland	 	 	 	9B. Dated (See Item 11)
	dba AmeriGroup District of Columbia	 	 	 	 
	750 First Street, NE Suite 1120	 	 	 	10A. Modification of Contract/Order No.
	Washington. D.C. 20001	 	X	 	POHC-2002-D-0003
	Phone:  202-218-4901       Fax:   202-783-8207	 	 	 	10B. Dated (See Item 13)
	DUNSCode	 	TIN	 	 	 	 	 	 	August 1, 2002
	 
	11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS
	 
	o	 	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 fax 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 may be made by letter or fax, provided each letter or fax 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)
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,
IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14
	 
	 	 	  A. This change order is issued pursuant to (Specify Authority): 27 DCMR, Chapter 36, Section 3601.2.
	 	 	  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 data, etc.)

  set forth in item 14, pursuant to the authority of 27 DCMR Section 3601.2 Changes Clause
	 
	 	  C. This supplemental agreement is entered into pursuant to authority of:	 	 
	 
	 X 	D. Other (Specify type of modification and authority)

Title 27 DCMR Section 3601.2 (c) and Contract POHC-2002-D-0003, Exercise of Option, Offer Rates effective 8-1-05
through 7-31-06, and Rate Issues Impact, Issue #5, Medicare Part D, Coverage of Pharmacy Benefit
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	E. IMPORTANT:       Contractor x  is not,      o
 is required to sign this document and return one copy to the issuing office.
 
	 
	14. Description of Amendment/Modification (Organized by UCF Section headings, including solicitation/contract subject matter where feasible.)
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	In accordance with the Exercise of Option, Offer Rates effective 8-1-05 through 7-31-06, and Rate Issues Impact, Issue #5, Medicare
 Part D, Coverage of Pharmacy Benefit, Contract POHC-2002-D-0003 is hereby modified as described on Page 2.
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED
	 
	Except as provided herein, all terms and conditions of the document referenced In Item 9A or 10A remain unchanged and in full force and effect.
	 
	15A. Name and Title of Signer (Type or print)	 	16A. Name of Contracting Officer
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	     	 	James H. Marshall
	 
	15B. Name of Contractor	 	15C. Date Signed	 	16B. District of Columbia	16C. Date Signed
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
		 	 	 	 	             /s/	
	(Signature)	 	 	 	(Signature of Contracting Officer)	12-30-05

 

Contract # POHC-2002-C-0003

Modification 00027

	 	 	 	 	 	 	 
	Section A.2.1	 	 Attachment 7 - Minimum Covered Services for Minimum Covered Services for Medicaid Managed care Program (MMCP)
	 
	 	 	 	 	 	 
	Insert	 	Number 13:
	 
	 	 	 	 	 	 
	 	 	The prescription benefit does not apply to the Medicaid/Medicare dual eligible with the exception of the contractor paying for benzodiazepines, barbiturates and over the counter medication that Medicaid currently pays for.
	 
	 	 	 	 	 	 
	Section	 	C.1.2 Applicable Documents:
	 
	 	 	 	 	 	 
	Insert:
	 	 	 	 	 	 
	 
	 	 	 	 	 	 
	 	 	•   Section 1927 (d)(2) of the Social Security Act
	 	 	•   Section 1935 (d)(2) of the Social Security Act
	 
	 	 	 	 	 	 
	Section	 	C.8.3.3 Prescription Drug Services
	 
	 	 	 	 	 	 
	Delete In its entirety
	 
	 	 	 	 	 	 
	Insert:	 	C.8.3.3	 	Prescription Drug Services
	 
	 	 	 	 	 	 
	 	 	 	 	The Contractor shall provide pharmacy services either directly or through a subcontractor with the exception of the Medicaid/Medicare dual eligible enrollees.
	 
	 	 	 	 	 	 
	 

	 	 	 	C.8.3.3.1
	 	The contractor shall not provide pharmacy services to the
Medicaid dual eligible enrollees that are enrolled in the MCO, effective January
1, 2006. The contractor shall assist the Medicaid dual eligible with procuring of
the pharmacy benefit that is being paid for by Medicare. This exemption is for
pharmacy services only and not for the medications exempted from payment by
Medicare Prescription Drug Benefit in accordance with Section 1927 (d)(2) and
1935 (d)(2).
	 
	 	 	 	 	 	 
	 

	 	 	 	C.8.3.3.2
	 	The contractor shall pay for the benzodiazepines, barbiturates and over the
counter medication that Medicaid currently pays for. The contractor shall ensure
that the medication is available on the enrollees plan.

2

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