Document:

exv10w2

Exhibit 10.2

					
	 	 	 	 	 
	 
	 	Contractual Document (CD)
	 	

Responsible Office: HHSC Office of General Counsel (OGC)

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

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:
	 
	 	 	 	 
	September 1, 2009

	 	August 31, 2010
	 	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-M

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
	 	Webb
	 

	 	 	 	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-M

	 	 	 	 	 	 	 	 	 	 	 
	 

	 	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 4.

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 4:

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

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 4:

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

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
4:

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

 

 

					
	 	 	 	 	 
	 
	 	Contractual Document (CD)
	 	

Responsible Office: HHSC Office of General Counsel (OGC)

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

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******

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 1.12 is replaced with Version
1.13

B: Scope of Work/Performance Measures — Version 1.12 is replaced with Version 1.13 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

 

 

					
	 	 	 	 	 
	 
	 	Contractual Document (CD)
	 	

Responsible Office: HHSC Office of General Counsel (OGC)

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

Part 10: Special Provision for Nueces Service Area

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

Section 10.04(b) added by Version 1.8

(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.”

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.	 	 
	 
	 	 	 	 
	
 

	 	
 

	 	 
	Charles E. Bell, M.D.

	 	By: Aileen McCormick	 	 
	 
	 	 	 	 
	Deputy Executive Commissioner for Health Services

	 	Title: President and CEO	 	 
	 
	 	 	 	 
	Date: 08/21/09

	 	Date: 7/30/09exv10w3

Exhibit 10.3

AMENDMENT #7 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 23 day of September, 2009 (hereinafter
referred to as the “Effective Date”). Other than the changes, modifications and additions
specifically articulated in this Amendment #7 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 #7, the terms and conditions of the original Contract
are expressly incorporated into this Amendment #17 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 2010; 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.
	 
	 	VI.	 	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.
	 
	 	VII.	 	This Amendment shall become effective as stated herein and shall remain effective for so
long as the Contract is in effect.
	 
	 	VIII.	 	This Amendment shall be construed in accordance with the laws of the State of Georgia.
	 
	 	IX.	 	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

	 	 	 	 	 
	
 

	 	9/23/09

Date
 

	 	 
	Dr. Rhonda M. Meadows, M.D

	 	 	 	 
	Commissioner
	 	 	 	 

AMERIGROUP GEORGIA MANAGED CARE COMPANY, INC.

	 	 	 	 	 	 	 
	BY:

	 	
 

SIGNATURE
	 	09/02/09
 

Date
	 	[SEAL]
	 
	 	 	 	 	 	 
	 

	 		 	 	 	 
	 

	 	 	 	 	 	 
	 

	 	Please Print/Type Name Here	 	 	 	 
	 

	 	Chief Executive Officer	 	 	 	 

	 	 	 	 	 
	 

	 	 

AFFIX CORPORATE SEAL HERE
	 	 
	 

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

	 	 	 	 	 
	ATTEST:

	 	
 

**SIGNATURE
	 	 
	 
	 	 	 	 
	 

	 	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.

*****REDACTED*****

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