Document:

exv10w19w4

Exhibit 10.19.4

AMENDMENT #9 TO CONTRACT NO. 0652 BETWEEN

GEORGIA DEPARTMENT OF COMMUNITY HEALTH AND

AMERIGROUP GEORGIA MANAGED CARE COMPANY, INC.

     This Amendment is between the Georgia Department of Community
Health (hereinafter referred to as “DCH” or the “Department”) and
Amerigroup Georgia Managed Care Company, Inc. (hereinafter referred to
as “Contractor”) and is made effective this ___ day of
__________, 2010 (hereinafter
referred to as the “Effective Date”). Other than the changes,
modifications and additions specifically articulated in this Amendment
#9 to Contract # 0652, RFP#41900-001-0000000027, the original Contract
shall remain in effect and binding on and against DCH and Contractor.
Unless expressly modified or added in this Amendment #9 the terms and
conditions of the original Contract are expressly incorporated into this
Amendment #9 as if completely restated herein.

     WHEREAS, DCH and Contractor executed a contract for the provision
of services to members of the Georgia Families Program;

     WHEREAS, DCH pays Contractor a per member per month capitation rate
for each Georgia Families member enrolled in the Contractor’s plan;

     WHEREAS, DCH has sought permission from the Centers for Medicare
and Medicaid Services (hereinafter referred to as “CMS”) to revise the
capitation rates payable to Contractor for State Fiscal Year 2011; and

     WHEREAS, pursuant to Section 32.0, Amendments in Writing, DCH and
Contractor desire to amend the above-referenced Contract by adding
additional funding as set forth below.

     NOW THEREFORE, for and in consideration of the mutual promises of
the Parties, the terms, provisions and conditions of this Amendment and
other good and valuable consideration, the sufficiency of which is
hereby acknowledged, DCH and Contractor hereby agree as follows:

	I.	 	Upon receiving written notice from CMS indicating that
agency’s approval of the revised capitation rates, the parties
shall delete the current Attachment H, Capitation Payment, in its
entirety and replace it with the new Attachment H, Capitation
Payment contained at Exhibit 1 to this Amendment.
	 
	II.	 	DCH and Contractor agree that they have assumed an
obligation to perform the
covenants, agreements, duties and obligations of the Contract, as
modified and amended herein, and agree to abide by all the
provisions, terms and conditions contained in the Contract as
modified and amended.
	 
	III.	 	This Amendment shall be binding and inure to the benefit
of the parties hereto, their
heirs, representatives, successors and assigns. Whenever the
provisions of this Amendment and the Contract are in conflict, the
provisions of this Amendment shall take precedence and control.

 

 

	IV.	 	It is understood by the Parties hereto that, if any
part, term, or provision of this Amendment or this entire
Amendment is held to be illegal or in conflict with any law of
this State, then DCH, at its sole option, may enforce the
remaining unaffected portions or provisions of this Amendment or
of the Contract and the rights and obligations of the parties
shall be construed and enforced as if the Contract or Amendment
did not contain the particular part, term or provision held to be
invalid.
	 
	V.	 	This Amendment shall become effective as stated herein and
shall remain effective for so long as the Contract is in effect.
	 
	VI.	 	This Amendment shall be construed in accordance with the
laws of the State of Georgia.
	 
	VIII.	 	All other terms and conditions contained in the Contract
and any amendment thereto, not amended by this Amendment, shall
remain in full force and effect.

- SIGNATURES ON THE FOLLOWING PAGE-

 

 

SIGNATURE PAGE

IN WITNESS WHEREOF, DCH and Contractor, through their authorized officers and agents, have caused
this Amendment to be executed on their behalf as of the date indicated.

	 	 	 	 
	 	 	 	 
	GEORGIA DEPARTMENT OF COMMUNITY HEALTH	 
	 
	 	 	 
	/s/ Clyde L. Reese, III

	 	9/23/10
	 
	 

Clyde L. Reese, III, Esq. Commissioner

	 	 Date	 
	 
	 	 	 
	/s/ Jerry Dubberly

	 	9/23/10
	 
	 

Jerry Dubberly, Medicaid Division
Chief

	 	 Date	 

AMERIGROUP

	 	 	 	 	 

	BY:

	 	/s/ Tunde Sotunde, M.D.
	 	09/16/2010

	 

	 	 	 	 
	 

	 	*SIGNATURE
	 	Date
	 
	 
	 	Tunde Sotunde, M.D.

	 	 
	 

	 	Please Print/Type Name Here
	 	 

	 	 	 

	 

	 	 
	 

	 	AFFIX CORPORATE SEAL HERE
	 

	 	(Corporations without a seal, attach a
Certificate of Corporate Resolution)

	 	 	 	 

	ATTEST:

	 	/s/ Nicholas J. Pace
	 
	 

	 	**SIGNATURE	 
	 
	 	 	 
	 

	 	Director, Vice President and Secretary
	 
	 

	 	TITLE	 

 

			
	*	 	Must be President, Vice President, CEO or Other Authorized Officer
	 
	**	 	Must be Corporate Secretary

 

 

EXHIBIT 1

CONFIDENTIAL — NOT FOR CIRCULATION

ATTACHMENT H

Attachment H is a table displaying the contracted rates by rate cell for each
contracted region. These rates will be the basis for calculating capitation
payments in each contracted Region.

(The table is displayed on the following page.)

**********REDACTED**********exv10w20w6

Exhibit 10.20.6

	 	 	 	 	 

	 

	 	Contractual Document (CD)
	 	

Responsible Office: HHSC Office of General Counsel (OGC)

			
	 	 	 
	Subject: HHSC Managed Care Contract
	 	HHSC Contract No. 529-06-0280-00002-R

Part 1: Parties to the Contract:

This Contract Amendment (the “Amendment”) is between the Texas Health and Human Services Commission
(HHSC), an administrative agency within the executive department of the State of Texas, having its
principal office at 4900 North Lamar Boulevard, Austin, Texas 78751, and Amerigroup Texas,
Inc. (HMO) a corporation organized under the laws of the State of Texas, having its principal
place of business at: 2505 N. Highway 360, Suite 300, Grand Prairie, Texas 75050. HHSC and
HMO may be referred to in this Amendment individually as a “Party” and collectively as the
“Parties.”

The Parties hereby agree to amend their original contract, HHSC contract number 529-06-0280-00002
(the “Contract”) as set forth herein. The Parties agree that the terms of the Contract will remain
in effect and continue to govern except to the extent modified in this Amendment.

This Amendment is executed by the Parties in accordance with the authority granted in Attachment A
to the HHSC Managed Care Contract document, “HHSC Uniform Managed Care Contract Terms &
Conditions,” Article 8, “Amendments and Modifications.”

	 	 	 	 	 

	Part 2: Effective Date of Amendment:

	 	Part 3: Contract Expiration Date
	 	Part 4: Operational Start Date:
	 
	 	 	 	 
	December 1, 2010

	 	August 31, 2013
	 	STAR and CHIP HMOs: September 1, 2006
	 

	 	 	 	STAR+PLUS HMOs: February 1, 2007
	 

	 	 	 	CHIP Perinatal HMOs: January 1, 2007

Part 5: Project Managers:

	 	 	 

	HHSC:

	 	HMO:
	 
	 	 
	Scott Schalchlin

	 	Aileen McCormick
	Director, Health Plan Operations

	 	Amerigroup Texas, Inc.
	11209 Metric Boulevard, Building H

	 	3800 Buffalo Speedway, Suite 400
	Austin, Texas 78758

	 	Houston, Texas 77098
	Phone: 512-491-1866

	 	Phone: 713-218-5101
	Fax: 512-491-1969

	 	Fax: 713-218-8692
	 
	 	 
	 

	 	E-mail: amccorm@amerigroupcorp.com

Part 6: Deliver Legal Notices to:

	 	 	 

	HHSC:

	 	HMO:
	 
	 	 
	General Counsel

	 	Amerigroup Texas, Inc.
	4900 North Lamar Boulevard, 4th Floor

	 	3800 Buffalo Speedway, Suite 400
	Austin, Texas 78751

	 	Houston, Texas 77098
	Fax: 512-424-6586

	 	Fax: 713-218-8692

Part 7: HMO Programs and Service Areas:

This Contract applies to the following HHSC HMO Programs and Service Areas (check all that apply).
All references in the Contract Attachments to HMO Programs or Service Areas that are not checked
are superfluous and do not apply to the HMO.

 

 

	 	 	 	 	 

	 

	 	Contractual Document (CD)
	 	

Responsible Office: HHSC Office of General Counsel (OGC)

			
	 	 	 
	Subject: HHSC Managed Care Contract
	 	HHSC Contract No. 529-06-0280-00002-R

þ Medicaid STAR HMO Program

	 	 	 	 	 	 	 

	 

	 	Service Areas:
	 	o Bexar
	 	o Lubbock
	 

	 	 	 	þ Dallas
	 	þ Nueces
	 

	 	 	 	o El Paso
	 	þ Tarrant
	 

	 	 	 	þ Harris
	 	þ Travis

See Attachment B-6, “Map of Counties with HMO Program Service Areas,” for listing of counties
included within the STAR Service Areas.

þ Medicaid STAR+PLUS HMO Program

	 	 	 	 	 	 	 

	 

	 	Service Areas:
	 	þ Bexar
	 	o Nueces
	 

	 	 	 	þ Harris
	 	þ Travis

See Attachment B-6.1, “Map of Counties with STAR+PLUS HMO Program Service Areas,” for listing of
counties included within the STAR+PLUS Service Areas.

þ CHIP HMO Program

	 	 	 	 	 	 	 

	 

	 	Core Service Areas:
	 	o Bexar
	 	þ Nueces
	 

	 	 	 	þ Dallas
	 	þ Tarrant
	 

	 	 	 	o El Paso
	 	o Travis
	 

	 	 	 	þ Harris
	 	o Webb
	 

	 	 	 	o Lubbock	 	 
	 
	 	 	 	 	 	 
	 

	 	Optional Service Areas:
	 	o Bexar
	 	o Lubbock
	 

	 	 	 	o El Paso
	 	o Nueces
	 

	 	 	 	o Harris
	 	o Travis

See Attachment B-6, “Map of Counties with HMO Program Service Areas,” for listing of counties
included within the CHIP Core Service Areas and CHIP Optional Service Areas.

þ CHIP Perinatal Program

	 	 	 	 	 	 	 

	 

	 	Core Service Areas:
	 	o Bexar
	 	o Nueces
	 

	 	 	 	o Dallas
	 	þ Tarrant
	 

	 	 	 	o El Paso
	 	o Travis
	 

	 	 	 	o Harris	 	 
	 

	 	 	 	o Lubbock	 	 

 

 

	 	 	 	 	 

	 

	 	Contractual Document (CD)
	 	

Responsible Office: HHSC Office of General Counsel (OGC)

			
	 	 	 
	Subject: HHSC Managed Care Contract
	 	HHSC Contract No. 529-06-0280-00002-R

	 	 	 	 	 	 	 

	 

	 	Optional Service Areas:
	 	o Bexar
	 	o Lubbock
	 

	 	 	 	o El Paso
	 	o Nueces
	 

	 	 	 	o Harris
	 	o Travis

See Attachment B-6.2, “Map of Counties with CHIP Perinatal HMO Program Service Areas,” for a list
of counties included within the CHIP Perinatal Service Areas.

Part 8: Payment

Part 8 of the HHSC Managed Care Contract document, “Payment,” is modified to add the capitation
rates for Rate Period 5.

          þ Medicaid STAR HMO PROGRAM

Capitation: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,”
Article 10, for a description of the Capitation Rate-setting methodology and the Capitation Payment
requirements for the STAR Program. The following Rate Cells and Capitation Rates will apply to Rate
Period 5:

******REDACTED******

STAR SSI Administrative Fee: HHSC will pay STAR HMO a monthly Administrative fee of
******REDACTED****** per SSI Beneficiary who voluntarily enrolls in HMO in accordance with
Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10.

Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract
Terms and Conditions,” Article 10, for a description of the methodology for establishing the
Delivery Supplemental Payment for the STAR Program.

Bariatric Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms
and Conditions,” Article 10, for a description of the methodology for establishing the Bariatric
Supplemental Payment for the STAR Program.

 

 

	 	 	 	 	 

	 

	 	Contractual Document (CD)
	 	

Responsible Office: HHSC Office of General Counsel (OGC)

			
	 	 	 
	Subject: HHSC Managed Care Contract
	 	HHSC Contract No. 529-06-0280-00002-R

          þ Medicaid STAR+PLUS HMO Program

Capitation: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,”
Article 10, for a description of the Capitation Rate-setting methodology and the Capitation Payment
requirements for the STAR+PLUS Program. The following Rate Cells and Capitation Rates will apply to
Rate Period 5:

******REDACTED******

Bariatric Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms
and Conditions,” Article 10, for a description of the methodology for establishing the Bariatric
Supplemental Payment for the STAR+PLUS Program.

          þ CHIP HMO PROGRAM

Capitation: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,”
Article 10, for a description of the Capitation Rate-setting methodology and the Capitation Payment
requirements for the CHIP Program. The following Rate Cells and Capitation Rates will apply to Rate
Period 5:

******REDACTED******

Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms
and Conditions,” Article 10, for a description of the methodology for establishing the Delivery
Supplemental Payment for the CHIP Program. The CHIP Delivery Supplemental Payment is
******REDACTED****** for all Service Areas.

          þ CHIP Perinatal Program

Capitation: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,”
Article 10, for a description of the Capitation Rate-setting methodology and the Capitation Payment
requirements for the CHIP Perinatal Program.

******REDACTED******

Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms
and Conditions,” Article 10, for a description of the methodology for establishing the Delivery
Supplemental Payment for the CHIP Perinatal Program. The CHIP Perinatal Delivery Supplemental
Payment is ******REDACTED****** for Perinates between 186% and 200% of the Federal Poverty Level
for all Service Areas.

 

 

	 	 	 	 	 

	 

	 	Contractual Document (CD)
	 	

Responsible Office: HHSC Office of General Counsel (OGC)

			
	 	 	 
	Subject: HHSC Managed Care Contract
	 	HHSC Contract No. 529-06-0280-00002-R

Part 9: Contract Attachments:

Modifications to Part 9 of the HHSC Managed Care Contract document, “Contract Attachments,” are
italicized below:

A: HHSC Uniform Managed Care Contract Terms & Conditions — Version 1.16 is replaced with Version
1.17

B: Scope of Work/Performance Measures — Version 1.16 is replaced with Version 1.17 for all
attachments, except if noted.

     B-1: HHSC RFP 529-04-272, Sections 6-9

     B-2: Covered Services

          B-2.1 STAR+PLUS Covered Services

          B-2.2 CHIP Perinatal Program Covered Services

     B-3: Value-added Services

          B-3.1 STAR+PLUS Value-added Services

          B-3.2 CHIP Perinatal Program Value-added Services

     B-4: Performance Improvement Goals

          B-4.1 SFY 2008 Performance Improvement Goals

     B-5: Deliverables/Liquidated Damages Matrix

     B-6: Map of Counties with STAR and CHIP HMO Program Service Areas

          B-6.1 STAR+PLUS Service Areas

          B-6.2 CHIP Perinatal Program Service Areas

     B-7: STAR+PLUS Attendant Care Enhanced Payment Methodology

C: HMO’s Proposal and Related Documents

     C-1: HMO’s Proposal

     C-2: HMO Supplemental Responses

     C-3: Agreed Modifications to HMO’s Proposal

Part 10: Special Provision for Nueces Service Area

Attachment A, Section 10.04 is amended to include sub-part (b) as follows:

(b) In addition to the reasons set forth in Section 10.04(a), the Parties expressly understand and
agree that HHSC may, at any time, unilaterally adjust the Rate Period 2 STAR Program Capitation
Rates for the Nueces Service Area. HHSC is entitled to unilaterally adjust such rates,
prospectively and/or retrospectively, if it determines that: (1) the cumulative Rate Period 2
Encounter Data for all HMOs in the Nueces Service Area does not support the Capitation Rates; or
(2) economic factors in the Nueces Service Area significantly and measurably impact providers or
the delivery of Covered Services to Members. For adjustments made pursuant to this Section
10.04(b), HHSC will provide written notice at least ten (10) Business Days before: (1) the
effective date of a prospective adjustment; (2) offsetting Capitation Payments to recover
retrospective adjustments. Any adjustments to the Rate Period 2 Capitation Rates must meet the
actuarial soundness requirements of Attachment A, Section 10.03, “Certification of Capitation
Rates.”

 

 

	 	 	 	 	 

	 

	 	Contractual Document (CD)
	 	

Responsible Office: HHSC Office of General Counsel (OGC)

	 	 	 

	Subject: HHSC Managed Care Contract

	 	HHSC Contract No. 529-06-0280-00002-R

Part 11: Signatures:

The Parties have executed this Contract Amendment in their capacities as stated below with
authority to bind their organizations on the dates set forth by their signatures. By signing this
Amendment, the Parties expressly understand and agree that this Amendment is hereby made part of
the Contract as though it were set out word for word in the Contract.

	 	 	 

	Texas Health and Human Services Commission

	 	Amerigroup Texas, Inc.
	 
	 	 
	/s/ Charles E. Bell, M.D.

	 	/s/ Aileen McCormick
	 

	 	 
	Charles E. Bell, M.D.

	 	By: Aileen McCormick
	Deputy Executive Commissioner for Health Services

	 	Title: President and CEO
	Date: 11/5/10

	 	Date: October 13, 2010

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