Document:

exv10w6w12

 

Exhibit 10.6.12

	 	 	 	 	 
	 
	 		 	 
	 
	 	State of New Jersey	 	 
	 
	 	DEPARTMENT OF HUMAN SERVICES	 	 
	 
	 	DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES	 	 
	JON S. CORZINE
	 	P.O. Box 712
	 	JAMES W. SMITH, JR.
	Governor
	 	Trenton, NJ 08625-0712
	 	Acting Commissioner
	 
	 	Telephone 1-800-356-1561	 	 
	 	 	 	 	 
	 
	 	ANN CLEMENCY KOHLER	 	 
	 
	 	Director	 	 
	 	 	 	 	 
	 
	 	July 18, 2006	 	 

Peter D. Haytaian President and

CEO AMERIGROUP New Jersey,

Inc. 399 Thornall Street, 9th Floor

Edison, NJ 08837

Dear Mr. Haytaian:

Enclosed, for your signature, is a contract amendment for July 1, 2006. This amendment
revises the HMO capitation rate, maternity payment and MCSA administration fees for SFY
2007. The rate certification letter and supporting documentation has also been provided to
you under separate cover.

The increase of the capitation rates are required to compensate the HMOs for the SFY 2007
Budget Appropriation Bill increasing the HMO premium tax from one percent to two percent.

Please return the signed amendment by close of business July 26, 2006.

	 	 	 
	 

	 	Sincerely,
	 
	 	 
	 

	 	Jill Simone, MD
	 

	 	Executive Director
	 

	 	Office of Managed Health Care

	 	 	 
	Enclosure
	JS:

	 	H:v
	c:

	 	John Koehn
	 

	 	Jennifer Langer

New Jersey Is An Equal Opportunity Employer

 

 

STATE OF NEW JERSEY

DEPARTMENT OF HUMAN SERVICES

DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES

AND

AMERIGROUP NEW JERSEY, INC.

AGREEMENT TO PROVIDE HMO SERVICES

In accordance with Article 7, section 7.11.2A, 7.11.2B and 7.12.1 of the contract between
AMERIGROUP New Jersey, Inc. and the State of New Jersey, Department of Human Services, Division of
Medical Assistance and Health Services (DMAHS), effective date October 1, 2000, all parties agree
that the contract shall be amended, effective July 1, 2006, as follows:

Appendix, Section C, “Capitation Rates” shall be revised as reflected in SFY 2007 Capitation Rates
attached hereto and incorporated herein.

 

 

All other terms and conditions of the October 1, 2000 contract and subsequent amendments remain
unchanged except as noted above.

The contracting parties indicate their agreement by their signatures.

	 	 	 	 	 	 	 	 	 	 	 
	 	 	AMERIGROUP	 	 	 	State of New Jersey	 	 
	 	 	New Jersey, Inc.	 	 	 	Department of Human Services	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	BY:

	 	/s/ [ILLEGIBLE]	 	 	 	BY:
	 	Ann Clemency Kohler	 	 
	 

	 	 

	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	TITLE:

	 	President and CEO
	 	 	 	TITLE:
	 	Director, DMAHS	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	DATE:

	 	7/25/06
	 	 	 	DATE:	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	APPROVED AS TO FORM ONLY	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	Attorney General State of New
Jersey	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	BY:

	 	Deputy Attorney General	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	DATE:
	 	 	 	 	 	 	 	 	 	 
	 

	 	 

	 	 	 	 	 	 	 	 

 

 

SECTION C

CAPITATION RATES

 

 

STATE OF NEW JERSEY

SFY 2007

MANAGED CARE CAPITATION RATES

AND MANAGED CARE SERVICES ADMINISTRATOR FEES

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	Contract Period: 07/01/2006 - 06/30/2007	 
	Category	 	Age/Sex	 	 	Northern	 	 	Central	 	 	Southern	 	 	Statewide	 
	AFDC/KidCare A/New Jersey Care Children
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	AFDC/KidCare A/New Jersey Care Children
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	AFDC/KidCare A/New Jersey Care Children/NJCPW
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	AFDC/ NJCPW
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	AFDC
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	AFDC/ NJCPW
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Aged with Medicare
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Blind/Disabled with Medicare and Other Dual Eligibles
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Blind/Disabled with Medicare and Other Dual Eligibles	 	*******REDACTED*******
	Maternity
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	ABD-DDD with Medicare and Other Dual Eligibles
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	ABD
(including AIDS & DDD) without Medicare — non-DDD
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	ABD
(including AIDS & DDD) without Medicare — DDD &
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Non ABD-DDD
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	DYFS
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	DYFS
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	DYFS
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	KidCare B&C
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	KidCare B&C
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	KidCare B&C
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	KidCare D
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	KidCare D
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	KidCare D
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	FamilyCare
Parents 0-133%
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	FamilyCare Parents 0-133%
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	FamilyCare Parents 0-133%
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	FamilyCare Parents 134-200%
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	FamilyCare Parents 134-200%
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	FamilyCare Parents 134-200%
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	AIDS-ABD with Medicare and Other Dual Eligibles
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	AIDS-Non-ABD
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	AIDS-ABD
with Medicare and Other Dual Eligibles DDD (including Behavioral Health Add-On)
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	AIDS-Non-ABD DDD (including Behavioral Health Add-On)exv10w25w4

 

Exhibit 10.25.4

AMENDMENT # 2

TO THE MEDICAL SERVICES CONTRACT BETWEEN

THE FLORIDA HEALTHY KIDS CORPORATION

AND AMERIGROUP FLORIDA, INC.

THIS AMENDMENT #2 is made and entered into this 12th day October, 2006 by and
between THE FLORIDA HEALTHY KIDS CORPORATION (FHKC) and AMERIGROUP Florida, Inc. (AMERIGROUP).

	 	1.	 	In accordance with Sections 3-17 and 3-18 of the current Medical Services Contract
between FHKC and AMERIGROUP dated October 1, 2005 (Contract), it is agreed by the
parties that Exhibit A, Sections I, II and II are amended to read:

I. Premium Rate

The Comprehensive Medical Care Services premium for the coverage period October 1, 2006
through September 30, 2007 shall be as follows:

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

II. Additional Requirements for Premium Rates

	 	A.	 	Minimum Medical Loss Ratio
	 
	 	 	 	The minimum medical loss ratio shall be eighty five (85%) percent.
	 
	 	B.	 	Maximum Administrative Component

	 		
	FHKC Rate Adjustment Amendment 10-06
	 	                    FHKC
	 	 	 
	Page 1 of 3
	 	AMERIGROUP

 

 

          The maximum administrative shall not exceed fifteen (15%) percent III.

Experience Adjustment

In the event that the medical loss ratio. for this Agreement is better than eighty five
percent (85%) calculated in the same manner as the premium development and allocation
methodology utilized in AMERIGROUP’s response to the Request for Proposals (RFP),
AMERIGROUP shall share equally with FHKC the dollar difference between the actual loss
ratio for said period and the predicted eighty five percent (85%).

AMERIGROUP shall provide FHKC with a written copy of its findings for each Agreement year
by February 1st (first). If any payments are due under this provision,
AMERIGROUP shall forward such payment with its written notification. AMERIGROUP may be
subject to audit or verification by FHKC or its designated agents.

FHKC shall determine the adequacy of the information supplied under this section and
whether or not the calculation has been accurately performed in the manner prescribed
below.

The Calculation shall be illustrated in the following manner:

	 	 	 	 	 	 	 
	A.
	 	Total Premiums Paid During Agreement Year:	 	$	 	 
	 
	 	 	 	 	 	 
	B.
	 	Target Incurred Claims':	 	85% of A
	 
	 	 	 	 	 	 
	C.
	 	Actual Incurred Claims for Contract Year:	 	$	 	 
	 
	 	 	 	 	 	 
	D.
	 	Difference Between Target Incurred Claims and Actual Line B) Incurred Claims:	 	$
         (Subtract Line C from

                      Line
B)	 	 
	 
	 	 	 	 	 	 
	E.
	 	Amount Due FHKC  (50% of Line D):	 	$	 	 

2. The effective date of this Amendment is October 1, 2006. All other provisions of Section 3-18
and the Contract in its entirety shall remain in full force and effect as executed by the Parties
effective October 1, 2005.

[SIGNATURE PAGE FOLLOWS]

 

			
	‘	 	The target medical loss ratio for this contract and for this calculation is 85%.
FHKC Rate Adjustment Amendment 10-06

	 		
	Page 2 of 3
	 	/s/ AMERIGROUP

 

 

IN WITNESS WHEREOF, the Parties have caused this Contract, to be executed by their undersigned
officials as duly authorized.

DONE this 12th day of October, 2006.

	 	 	 	 	 	 	 
	AMERIGROUP Community Care:

	 	 	 	Florida Healthy Kids Corporation:	 	 
	 
	 	 	 	 	 	 
	 

	 	 	 	/s/ Rose M. Naff
 

	 	 
	Don Gilmore

	 	 	 	Rose M. Naff,	 	 
	CEO

	 	 	 	Executive Director	 	 
	 
	 	 	 	 	 	 
	Subscribed and sworn to me, this
12th day of October 2006.

	 	 	 	     Subscribed and sworn to me, this	 	 
	 
	 	 	 	 	 	 
	[SEAL]

 

 

	 	 	 	/s/ Amber N.Floyd
 

Notary Public
	 	 
	Notary 

 

 

	 	 	 	 	 	 
	My Commission Expires
	 	 	 	 	 	 
	 
	 	 	 	 	 	 
	 

	 	 	 	[SEAL]	 	 
	 
	1. /s/ Dalene Cosby
 

	 	 	 	/s/ Amber N.Floyd
 

	 	 
	WITNESS

	 	 	 	WITNESS	 	 
	 
	 	 	 	 	 	 
	Dalene Cosby
 

	 	 	 	Amber N.Floyd
 

	 	 
	PRINT NAME

	 	 	 	PRINT NAME	 	 
	 
	 	 	 	 	 	 
	2. /s/ Shirley Locey
 

	 	 	 	2. /s/ Jennifer K. Lloyd
 

	 	 
	WITNESS

	 	 	 	WITNESS	 	 
	 

	 	 	 	12th day of October 2006.	 	 
	 
	 	 	 	 	 	 
	Shirley Lockey
 

	 	 	 	 	 	 
	PRINT NAME
	 	 	 	 	 	 
	 

	 	 	 	/s/ Jennifer K. Lloyd 10/18/06
 

	 	 
	 

	 	 	 	Reviewed by: Jennifer K. Lloyd,	 	 
	 

	 	 	 	Director of External Affairs	 	 
	 
	 	 	 	/s/ [ILLEGIBLE]	 	 
	 

	 	 	 	 

Reviewed by:
	 	 
	 

	 	 	 	Corporate Counsel, FL Bar # 460500	 	 

			
	FHKC Rate Adjustment Amendment 10-06
	 	                     FHKC
	 	 	 
	Page 3 of 3
	 	AMERIGROUP

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