Document:

exhibit10-2.htm

     

      
        

      

    

    
      Back to Form 8-K

      Exhibit
10.2

      

        NOTICE
OF AWARD

        

        State
of Missouri

        Office
of Administration

        Division
Of Purchasing and Materials Management

        PO
Box 809

        Jefferson
City, MO 65102

        http://www.oa.mo.gov/purch

        

        
          	
                  CONTRACT
      NUMBER

                  C306118005

                	
                  CONTRACT
      TITLE

                  Medicaid
      Managed Care-Eastern Region

                   

                
	
                  AMENDMENT
      NUMBER

                  Amendment
      #006

                	
                  CONTRACT
      PERIOD

                  July
      1, 2007 through June 30, 2008

                   

                
	
                  REQUISITION
      NUMBER

                  NR
      886 25758005706

                	
                  VENDOR
      NUMBER

                  3640504950
      1

                   

                
	
                  CONTRACTOR
      NAME AND ADDRESS

                  Harmony
      Health Plan Inc

                  23
      Public Square Ste 400

                  Belleville
      IL 62220

                   

                	
                  STATE
      AGENCY’S NAME AND ADDRESS

                  Dept
      of Social Services

                  MO
      HealthNet Division

                  PO
      Box 6500

                  Jefferson
      City, MO 65102-6500

                   

                
	
                  ACCEPTED
      BY THE STATE OF MISSOURI AS FOLLOWS:

                  Contract
      C306118005 is hereby amended pursuant to the attached Amendment #006 dated
      12/26/07.

                   

                
	
                  BUYER

                  Laura
      Ortmeyer

                   

                	
                  BUYER
      CONTACT INFORMATION

                  Email:
      laura.ortmeyer@oa.mo.gov

                  Phone:
      (573) 751-4579  Fax (573) 526-9817

                   

                
	
                  SIGNATURE
      OF BUYER

                    /s/  Laura
      Ortmeyer   

                   

                	
                  DATE

                  12/19/07

                
	
                  DIRECTOR
      OF PURCHASING AND MATERIALS MANAGEMENT

                   
      /s/  James Miluski    
                 James
      Miluski

                
	 
      	 
      
	 
      	 
      

        

        

        
          
             

          

          
             

            
              

            

          

          
             

          

        

      STATE
OF MISSOURI

    

    
      

       

      OFFICE
OF ADMINISTRATION

    

    
      DIVISION
OF PURCHASING AND MATERIALS MANAGEMENT (DPMM)

    

    
      CONTRACT
AMENDMENT

    

    
      

    

    
      

    

    
      	
              AMENDMENT
      NO.: 006

            	
              REQ
      NO.: NR 886 25758005706

            
	
              CONTRACT
      NO.: C306118005

            	
              BUYER:
      Laura Ortmeyer

            
	
              TITLE:
      Medicaid Managed Care -Eastern Region

            	
              PHONE
      NO.: (573) 751-4579

            
	
              ISSUE
      DATE: 12/11/07

            	
              E-MAIL:
      Iaura.ortmeyer@oa.mo.gov

            

    

    
      

    

    
      
        	
                 
      TO:   

              	
                HARMONY
      HEALTH PLAN INC 

                23
      PUBLIC SQUARE STE 400 

                BELLEVILLE,
      IL 62220

              

      

    

    
      

    

    
      RETURN
AMENDMENT NO LATER THAN: DECEMBER 26, 2007 AT 5:00 PM CENTRAL
TIME

    

    
      RETURN
AMENDMENT TO:

    

    
      

    

    
      	
              (U.S.
      Mail)

            	 	
              (Courier
      Service)

            
	
              Div
      of Purchasing & Matls Mgt (DPMM)

            	 
      	
              Div
      of Purchasing &
      Matls Mgt (DPMM)

            
	
              PO
      BOX 809

            	
              OR

            	
              301
      WEST HIGH STREET, ROOM 630

            
	
              JEFFERSON
      CITY MO 65102-0809

            	 
      	
              JEFFERSON
      CITY MO 65101-1517

            
	 
      	 
      	 
      

    

    
      

    

    
      OR FAX
TO: (573) 526-9817 (either
mail or fax, not both)

    

    
      

    

    
      DELIVER
SUPPLIES/SERVICES FOB (Free On Board) DESTINATION TO THE FOLLOWING
ADDRESS:

    

    
      

    

    
      Department
of Social Services, MO HealthNet Division

    

    
      Post
Office Box 6500

    

    
      Jefferson
City MO 65102-6500

    

    
      

    

    
      SIGNATURE
REQUIRED

    

    
      

    

    

    

    
      	
              
                DOING  BUSINESS
      AS (DBA) NAME:

              

              
                Harmony
      Health Plan of Illinois, Inc. d/b/a Harmony Health Plan of
      Missouri

              

            	
              
                LEGAL
      NAME OF ENTITY/INDIVIDUAL FILED WITH IRS FOR THIS TAX ID
      NO.:

              

              
                Harmony
      Health Plan of Illinois, Inc.

              

            
	
              
                MAILING
      ADDRESS:

              

              
                23
      Public Square, Suite 400

              

            	
              
                IRS
      FORM 1099 MAILING ADDRESS

              

              
                200
      West Adams Street, Suite 800

              

            
	
              
                CITY,
      STATE, ZIP CODE

              

              
                Belleville,
      IL 62220

              

            	
              
                CITY,
      STATE, ZIP CODE

              

              
                Chicago,
      IL 60606

              

            
	
              
                 

                CONTACT
      PERSON

              

              
                Ms.
      Tina Gallagher

              

            	
              
                 

                EMAIL
      ADDRESS

              

              
                Tina.Gallagher@wellcare.com

              

            
	
              
                PHONE
      NUMBER

              

              
                (800)
      608-8158 Ext. 2405

              

            	
              
                FAX
      NUMBER

              

              
                (800)
      608-8157

              

            
	
              
                TAXPAYER
      ID NUMBER (TIN)

              

              
                36-4050495

              

            	
              
                TAXPAYER ID
      (TIN) TYPE (CHECK ONE)

              

              
                FEIN              SSN

              

            	
              
                VENDOR
      NUMBER (IF KNOWN)

              

              
                3640504950
      1

              

            
	
              
                VENDOR TAX FILING TYPE WITH IRS (CHECK
      ONE)                                                                                                                                (NOTE: LLC IS NOT A VALID TAX FILING
      TYPE.)

              

              
                X    Corporation              Individual               State/Local
      Government               Partnership              Sole
      Proprietor             Other

              

            
	
              
                AUTHORIZED
      SIGNATURE

                
                   
      /s/  Thaddeus Bereday

                

              

            	
              
                DATE

              

              
                December
      26, 2007

              

            
	
              
                PRINCIPAL
      NAME

              

              
                Thaddeus
      Bereday

              

            	
              
                TITLE

              

              
                Secretary

              

            

    

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    
      Contract
C306118005

    

    
      Page
2

    

    

    
      

       

      AMENDMENT #006 TO CONTRACT
C306118005

    

    
      

       

      CONTRACT
TITLE:        Medicaid Managed
Care - Eastern Region

    

    
      

       

      CONTRACT
PERIOD:    July 1, 2007 through June 30,
2008

    

    
      

       

      The State
of Missouri hereby desires to amend the above-referenced contract, as
follows.

    

    
      

      1.  The State
of Missouri, MO HealthNet Division, will no longer utilize the term MC+. All
references to MC+ shall hereinafter be referred to as "MO HealthNet". MC+
Managed Care is hereinafter referred to as "MO HealthNet Managed
Care".

       

    

    
      2. Paragraph
1.7.1 c. 1) and all bulletpoints are hereby deleted effective September 1,
2007.

    

    
      

      3. Paragraphs
1.7.1 d., 1.7.1 d. 1), and 1.7.1 d. 2) are hereby amended effective September 1,
2007 as follows:

    

    
      

       

      
        	
                d.

              	
                State Child Health Plan:
      Missouri submitted a combination State Child Health Plan under Title XXI
      of the Social Security Act for the State Children's Health Insurance
      Program (SCHIP) May 31, 2007. The Centers for Medicare and Medicaid
      Services (CMS) approved Missouri's SCHIP State Child Health Plan on
      September 28, 2007, with an effective date of September 1, 2007. Title XXI
      provides funds to states to enable them to initiate and expand the
      provision of child health assistance to uninsured, low-income children in
      an effective and efficient manner. Missouri's SCPIIP State Child Health
      Plan uses funds provided under Title XXI to both expand benefits under
      Missouri's State Medicaid Plan, and to obtain coverage that meets the
      requirements for a separate child health
  program.

              

      

    

    
      

       

      
        	
                1)

              	
                SCHD
      - Non Premium - Missouri provides presumptive eligibility for
      children in families with
      income of 150% of the FPL or below until a decision is made on regular
      SCHIP eligibility. Uninsured
      children age birth through age 18 with family income less than 150% of the
      FPL are covered.

                 

                Children
      eligible for the Non - Premium Program receive a benefit package of
      essential medically necessary health services, including Non-Emergency
      Medical Transportation (NEMT). Prescription drugs will be subject to the
      national drug rebate program requirements. Fee-for-service will be
      utilized in regions where MO HealthNet managed care is not yet available.
      When MO HealthNet managed care begins in these areas, Title XXI eligibles
      will be enrolled in MO HealthNet managed care. No new eligible will be
      excluded because of pre­existing illness or
  condition.

              

      

    

    
      
 

    

    
      
        	
                2)

              	
                SCHIP
      - Premium - Uninsured children age birth through age 18 with family
      income between 151%
      and 300% of the FPL are covered under a Separate Child Health Program
      under a Title XXI
      SCHIP State Plan. No new eligible is excluded because of pre-existing
      illness or condition.
      Children in families with income more than 150% of FPL are not eligible if
      they have
      access to affordable insurance.

                 

                Children
      eligible for the Premium Program receive a benefit package of essential
      medically necessary health services, excluding NEMT. Prescription drugs
      are subject to the national drug rebate program requirements.
      Fee-for-service is utilized in regions where MO HealthNet managed care is
      not yet available. When MO HealthNet Managed Care begins in these areas,
      Title XXI eligibles will be enrolled in MO HealthNet Managed
      Care.

              

      

    

    
      

       

    

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    
      Contract
C306118005

    

    
      Page
3

    

    

    
      

       

      "Uninsured
children" are persons up to nineteen years of age who have not had access to
employer-subsidized health care insurance or other health care coverage for six
(6) months prior to application, are residents of the State of Missouri, and
have parents or guardians who meet the following
requirements:

    

    
      

       

      
        	
                •  

              	
                Furnish
      to the Department of Social Services the uninsured child's social security
      number or numbers, if the uninsured child has more than one such
      number;

              

      

    

    
      

       

      
        	
                •  

              	
                Furnish
      to the Department of Social Services the uninsured child's documentation
      of citizenship and alien
status;

              

      

    

    
      

       

      
        	
                •  

              	
                Cooperate
      with the Department of Social Services in identifying and providing the
      information to assist the MO HealthNet Division in pursuing any
      third-party health insurance carrier who may be liable to pay for health
      care;

              

      

    

    
      

       

      
        	
                •  

              	
                Cooperate
      with the Department of Social Services, Family Support Division in
      establishing paternity and in obtaining support payments, including
      medical support;

              

      

    

    
      

       

      
        	
                •  

              	
                Demonstrate,
      upon request, their child's participation in wellness programs including
      immunizations and a periodic physical examination. (This shall not apply
      to any child whose parent or legal guardian objects in writing to such
      wellness programs including immunizations and an annual physical
      examination because of religious beliefs or medical
      contraindications);

              

      

    

    
      

       

      
        	
                •  

              	
                Demonstrate
      annually that their total net worth does not exceed two hundred fifty
      thousand dollars in total
value;

              

      

    

    
      

       

      
        	
                •  

              	
                The
      Premium Program requires a premium, but does not impose co-payments,
      co­insurance, or deductibles;
and

              

      

    

    
      

       

      
        	
                •  

              	
                There
      will be protections for the Premium population against dropping or
      foregoing private coverage, including a six (6) month waiting period and
      insurance availability screens through the MO HealthNet's Health Insurance
      Premium Payment (HIPP)
program.

              

      

    

    

    
      

       

      
        	•   	
                Any
      child identified as having special health care needs defined as a
      condition which left untreated would result in the death or serious
      physical injury of a child, that does not have access to affordable
      employer-subsidized health care insurance will be exempt from the
      requirement to be without health care coverage for six months in order to
      be eligible for services; and

              

      

    

    
      

       

      
        	
                • 
       

              	
                A
      child shall not be subject to the 30-day waiting period as long as the
      child meets all other qualifications for
  eligibility.

              

      

    

    

    
      

       

      4. Paragraphs
1.7.1 d. 3) through 6) are hereby deleted effective September 1,
2007.

    

    
      

       

      5. Paragraph
1.7.1 e. is hereby inserted effective September 1, 2007.

    

    
      

       

      
        	
                 
      

              	
                e.
      MO Health Net managed care eligibles in the above specified eligibility
      groups may voluntarily disenroll from the Managed Care Program or choose
      not to enroll in the Managed Care Program if
  they:

              

      

    

    
      

       

      
        	
                 
      

              	
                1)     Are
      eligible for Supplemental Security Income (SSI) under Title XVI of the
      Social Security Act;

              

      

    

    
      

       

      2)     Are
described in Section 501(a)(1)(D) of the Social Security
Act;

    

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    
      Contract
C306118005

    

    
      Page
4

    

    
       

      3) Are
described in Section 1902(e)(3) of the Social Security Act;

    

    
      4) Are receiving foster care or
adoption assistance under part E of Title IV of the Social Security
Act;
5) Are in
foster care or otherwise in out-of-home placement; or

    

    
      6) Meet
the SSI disability definition as determined by the Department of Social
Services.

    

    
      

       

      6.         Paragraph
2.7.1 v. 1) is hereby amended effective September 1, 2007 as
follows:

    

    
      

       

      
        	
                1)

              	
                The
      health plan shall conduct HCY/EPSDT well child visits on all eligible
      members under age twenty-one (21) to identify health and developmental
      problems. The state agency recognizes that the decision to not have a
      child screened is the right of the parent or guardian of the child. For
      those children that have not had well child visits in accordance with the
      periodicity schedule established by the state agency, the health plan
      shall document its outreach and educational efforts to the parent or
      guardian informing them of the importance of well child visits, that a
      well child visits is due, that appointment scheduling assistance is
      available, and that transportation (except to those children with ME Codes
      73-75) is available. (The current periodicity schedule is contained in
      Attachment 3.) The health plan shall follow the MO HealthNet
      fee-for-service policies for recognition of completion of all components
      of a full medical HCY/EPSDT well child visit service. A full HCY/EPSDT
      well child visits includes all of the components listed below. A partial
      well child visit includes the first six (6) components listed below. The
      last three (3) components are individual screens. An interperiodic screen
      is defined as any encounter with a health care professional acting within
      his or her scope of practice.

              

      

    

    
       

      
        	
                  

              	
                • A
      comprehensive health and developmental history including assessment of
      both physical and mental health developments;

                • A
      comprehensive unclothed physical exam;

                • Health
      education (including anticipatory guidance); 

                  • 
      Laboratory tests as indicated (appropriate according to age and health
      history unless medically contraindicated);

                  • Appropriate
      immunizations according to age; 

                    •
      Verbal lead assessment beginning at age six (6) months and continuing
      through age seventy-two (72) months. Blood level testing is mandatory at
      twelve (12) and twenty-four (24) months or annually if residing in a
      high-risk area of Missouri as defined by Department of Health and Senior
      Services regulation 19 CSR 20-8.030;

                    • Vision
      screening;

                    • 
      Hearing screening; 

                      •
      Dental screening (oral exam by primary care provider as part of
      comprehensive exam). Recommended
      that preventive dental services begin at age six (6) through twelve (12)
      months
      and be repeated every six (6)
      months.

                    

                  

                

              

      

    

    
       

      7.         Paragraph
2.7.1 v. 5) is hereby amended effective September 1, 2007 as
follows:

    

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    
      Contract
C306118005

       Page
5

    

    
      

       

      
        	
                5)

              	
                The
      health plan shall have an established process for reminders, follow-ups,
      and outreach to members. This process shall include, but not be limited
      to, notifying the parent(s) or guardian(s) of children of the needs and
      scheduling of periodic well child visits according to the periodicity
      schedule. The health plan shall provide assistance to new members in
      accessing HCY/EPSDT well child visit services within ninety (90) calendar
      days of health plan enrollment. The health plan shall provide assistance
      to members in accessing subsequent HCY/EPSDT well child visits in
      accordance with the periodicity schedule. At the time of notification, the
      health plan shall offer transportation and scheduling assistance if
      necessary. For members with ME Codes 73 through 75, non-emergency medical
      transportation is not a covered
benefit.

              

      

    

    
      

       

      8.        Paragraph
2.7.2 is hereby amended effective September 1, 2007 as
follows:

    

    
      

       

      
        	
                 
      

              	
                2.7.2
      The health plan shall include all the services specified in the
      comprehensive benefit package with the exception of non-emergency medical
      transportation (NEMT) for uninsured children in ME Codes 73-75 (Refer to
      Attachment 1, COA 5) and children in state custody with the following ME
      Codes 08, 52, 57, and 64 (Refer to Attachment 1, COA
  4).

              

      

    

    
      

       

      9. Attachment
1 is hereby revised effective July 1, 2007.

    

    
      

       

      10. Attachment
3 is hereby revised effective September 1, 2007.

    

    
      

       

      All other
terms, conditions and provisions of the contract, including all prices, shall
remain the same and apply hereto.

    

    
      

       

      The
contractor shall sign and return this document, on or before the date indicated,
signifying acceptance of the amendment.exhibit10-3.htm

     

      
        

      

    

    
      Back to Form 8-K

      Exhibit
10.3

      

        NOTICE
OF AWARD

        

        State
of Missouri

        Office
of Administration

        Division
Of Purchasing and Materials Management

        PO
Box 809

        Jefferson
City, MO 65102

        http://www.oa.mo.gov/purch

        

        
          	
                  CONTRACT
      NUMBER

                  C306118005

                	
                  CONTRACT
      TITLE

                  Medicaid
      Managed Care-Eastern Region

                   

                
	
                  AMENDMENT
      NUMBER

                  Amendment
      #007 Revised

                	
                  CONTRACT
      PERIOD

                  July
      1, 2007 through June 30, 2008

                   

                
	
                  REQUISITION
      NUMBER

                  NR
      886 25758008554

                	
                  VENDOR
      NUMBER

                  3640504950
      1

                   

                
	
                  CONTRACTOR
      NAME AND ADDRESS

                  Harmony
      Health Plan Inc

                  23
      Public Square Ste 400

                  Belleville
      IL 62220

                   

                	
                  STATE
      AGENCY’S NAME AND ADDRESS

                  Dept
      of Social Services

                  MO
      HealthNet Division

                  PO
      Box 6500

                  Jefferson
      City, MO 65102-6500

                   

                
	
                  ACCEPTED
      BY THE STATE OF MISSOURI AS FOLLOWS:

                  Contract
      C306118005 is hereby amended pursuant to the attached Amendment #007
      Revised dated 03/26/08.

                   

                
	
                  BUYER

                  Laura
      Ortmeyer

                   

                	
                  BUYER
      CONTACT INFORMATION

                  Email:
      laura.ortmeyer@oa.mo.gov

                  Phone:
      (573) 751-4579  Fax (573) 526-9817

                   

                
	
                  SIGNATURE
      OF BUYER

                   /s/  Laura Ortmeyer  
      

                   

                	
                  DATE

                  3/25/08

                
	
                  DIRECTOR
      OF PURCHASING AND MATERIALS MANAGEMENT

                  /s/  James
      Miluski              James
      Miluski

                
	 
      	 
      
	 
      	 
      

        

        

        
          
             

          

          
             

            
              

            

          

          
             

          

        

STATE
OF MISSOURI

    

    
      OFFICE
OF ADMINISTRATION

    

    
      DIVISION
OF PURCHASING AND MATERIALS MANAGEMENT (DPMM)

    

    
      CONTRACT
AMENDMENT

    

    
      

    

    
      

    

    
      	
              AMENDMENT
      NO.: 007 (Revised)

            	
              REQ
      NO.: NR 886 25758008554

            
	
              CONTRACT
      NO.: C306118005

            	
              BUYER:
      Laura Ortmeyer

            
	
              TITLE:
      Medicaid Managed Care -Eastern Region

            	
              PHONE
      NO.: (573) 751-4579

            
	
              ISSUE
      DATE: 3/21/08

            	
              E-MAIL:
      laura.ortmeyer@oa.mo.gov

            

    

    
      

    

    
      
        	
                 
      TO:  

              	
                HARMONY
      HEALTH PLAN INC 

                23
      PUBLIC SQUARE STE 400 

                BELLEVILLE,
      IL 62220

              

      

    

    
      

    

    
      RETURN
AMENDMENT NO LATER THAN: MARCH 26, 2008 AT 12:00 PM CENTRAL
TIME

    

    
       

      RETURN
AMENDMENT TO:

    

    
      

    

    
      	
              (U.S.
      Mail)

            	 	
              (Courier
      Service)

            
	
              Div
      of Purchasing & Matls Mgt (DPMM)

            	 
      	
              Div
      of Purchasing &
      Matls Mgt (DPMM)

            
	
              PO
      BOX 809

            	
              OR

            	
              301
      WEST HIGH STREET, ROOM 630

            
	
              JEFFERSON
      CITY MO 65102-0809

            	 
      	
              JEFFERSON
      CITY MO 65101-1517

            
	 
      	 
      	 
      

    

    
      

    

    
      OR FAX
TO: (573) 526-9817 (either
mail or fax, not both)

    

    
      

    

    
      DELIVER
SUPPLIES/SERVICES FOB (Free On Board) DESTINATION TO THE FOLLOWING
ADDRESS:

    

    
      

    

    
      Department
of Social Services, MO HealthNet Division

    

    
      Post
Office Box 6500

    

    
      Jefferson
City MO 65102-6500

    

    
      SIGNATURE
REQUIRED

    

    

    
      	
              
                DOING  BUSINESS
      AS (DBA) NAME:

              

              
                Harmony
      Health Plan of Illinois, Inc. d/b/a Harmony Health Plan of
      Missouri

              

            	
              
                LEGAL
      NAME OF ENTITY/INDIVIDUAL FILED WITH IRS FOR THIS TAX ID
      NO.:

              

              
                Harmony
      Health Plan of Illinois, Inc.

              

            
	
              
                MAILING
      ADDRESS:

              

              
                23
      Public Square, Suite 400

              

            	
              
                IRS
      FORM 1099 MAILING ADDRESS

              

              
                200
      West Adams Street, Suite 800

              

            
	
              
                CITY,
      STATE, ZIP CODE

              

              
                Belleville,
      IL 62220

              

            	
              
                CITY,
      STATE, ZIP CODE

              

              
                Chicago,
      IL 60606

              

            
	
              
                 

                CONTACT
      PERSON

              

              
                Ms.
      Tina Gallagher

              

            	
              
                 

                EMAIL
      ADDRESS

              

              
                Tina.Gallagher@wellcare.com

              

            
	
              
                PHONE
      NUMBER

              

              
                (800)
      608-8158 Ext. 2405

              

            	
              
                FAX
      NUMBER

              

              
                (800)
      608-8157

              

            
	
              
                TAXPAYER
      ID NUMBER (TIN)

              

              
                36-4050495

              

            	
              
                TAXPAYER ID
      (TIN) TYPE (CHECK ONE)

              

              
                FEIN              SSN

              

            	
              
                VENDOR
      NUMBER (IF KNOWN)

              

              
                3640504950
      1

              

            
	
              
                VENDOR TAX FILING TYPE WITH IRS (CHECK
      ONE)                                                                                                                                (NOTE:
      LLC IS NOT A VALID TAX FILING TYPE.)

              

              
                X    Corporation              Individual               State/Local
      Government               Partnership              Sole
      Proprietor             Other

              

            
	
              
                AUTHORIZED
      SIGNATURE

                
                    /s/  Heath
      Schiesser

                

              

            	
              
                DATE

                March 26,
    2008

              

            
	
              
                PRINTED
      NAME

              

              
                Heath
      Schiesser

              

            	
              
                TITLE

              

              
                President
      and CEO

              

            

    

    
       

       

      

      
        
          
             

          

          
             

            
              

            

          

          
             

            
               

            

          

        

      

      

      AMENDMENT #007 (Revised) TO
CONTRACT C306118005

      

      

      CONTRACT
TITLE:  MO HealthNet Managed Care – Eastern Region

      

      CONTRACT
PERIOD:   July 1, 2007 through June 30, 2008

      

      

      The State
of Missouri hereby amends the above-referenced contract in accordance with the
following:

      

      
        	
                1.

              	
                Subparagraphs
      a. through c. of paragraph 1.1.1 of the RFP portion of the contract is
      hereby amended effective January 1, 2008 as
  follows:

              

      

      

      
        	
                 
      

              	
                1.1.1

              	
                This
      document constitutes a request for competitive, sealed proposals from the
      health plan provider community for becoming providers in the Missouri
      managed care program, hereinafter referred to as "MC+ managed care" in the
      following regions of the State of
Missouri:

              

      

      

      
        	
                 
      

              	
                a.

              	
                Central
      Region:  Audrain, Benton, Boone, Callaway, Camden, Charition,
      Cole, Cooper, Gasconade, Howard, Laclede, Linn, Macon, Maries, Marion,
      Miller, Moniteau, Monroe, Montgomery, Morgan, Osage, Pettis, Phelps,
      Pulaski, Ralls, Randolph, Saline, and Shelby
  counties.

              

      

      

      
        	
                 
      

              	
                b.

              	
                Eastern
      Region:  Franklin, Jefferson, Lincoln, Madison, Perry , Pike,
      St. Charles, St. Francois, Ste. Genevieve, St. Louis, Warren and
      Washington counties and St. Louis,
City.

              

      

      

      
        	
                2.

              	
                Paragraph
      1.5.1 of the RFP portion of the contract is hereby amended effective
      January 1, 2008 as follows:

              

      

      

      
        	
                 
      

              	
                1.5.1

              	
                Effective
      July 1, 2006, the State of Missouri will continue a health care delivery
      program in Audrain, Boone, Callaway, Camden, Cass, Chariton, Clay, Cole,
      Cooper, Franklin, Gasconade, Henry, Howard, Jackson, Jefferson, Johnson,
      Lafayette, Lincoln, Miller, Moniteau, Monroe, Montgomery, Morgan, Osage,
      Pettis, Platte, Randolph, Ray, Saline, St. Charles, St. Clair, St.
      Francois, Ste, Genevieve, St. Louis, Warren and Washington counties and
      St. Louis City to serve MO HealthNet Managed Care eligibles meeting
      specified eligibility criteria.  Effective January 1, 2008, the
      State of Missouri will introduce the MO HealthNet Managed Care Program in
      seventeen (17) counties contiguous to the existing MO HealthNet Managed
      Care regions.  The new counties are:  Bates, Benton,
      Cedar, Laclede, Linn, Macon, Madison, Maries, Marion, Perry, Phelps, Pike,
      Polk, Pulaski, Ralls, Shelby, and Vernon.  The goal is to
      improve the accessibility and quality of health care services for MO
      HealthNet Managed Care and State aid eligible populations, while
      controlling the program's rate of cost
increase.

              

      

      

      
        	
                3.

              	
                Paragraph
      2.1.3 and subitems a. through m. of the RFP portion of the contract are
      hereby amended and subitems n. and o. are hereby deleted effective January
      1, 2008 as follows:

              

      

      

      
        	
                 
      

              	
                2.1.3

              	
                The
      health plan awarded a contract for the Eastern region shall provide
      services to individuals determined eligible by the state agency for the
      Missouri MC+ Managed Care Program in all of the following thirteen areas
      in the State of Missouri:

              

      

      

      
        	
                 
      

              	
                a.

              	
                Franklin
      County

              

      

      
        	
                 
      

              	
                b.

              	
                Jefferson
      County

              

      

      
        	
                 
      

              	
                c.

              	
                Lincoln
      County

              

      

      
        	
                 
      

              	
                d.

              	
                Madison
      County

              

      

      
        	
                 
      

              	
                e.

              	
                Perry
      County

              

      

      
        	
                 
      

              	
                f.

              	
                Pike  County

              

      

      
        	
                 
      

              	
                g.

              	
                St.
      Charles County

              

      

      
        	
                 
      

              	
                h.

              	
                St.
      Francois County

              

      

      
        	
                 
      

              	
                i.

              	
                Ste.
      Genevieve County

              

      

      
        	
                 
      

              	
                j.

              	
                St.
      Louis County

              

      

      
        	
                 
      

              	
                k.

              	
                Warren
      County

              

      

      
        	
                 
      

              	
                l.

              	
                Washington
      County

              

      

      
        	
                 
      

              	
                m.

              	
                St.
      Louis City

              

      

       

       

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
 

      
        	
                4.

              	
                Paragraph
      2.1.4 and subitems a. through bb. of the RFP portion of the contract are
      hereby amended and subitems cc. and dd. are hereby deleted effective
      January 1, 2008 as follows:

              

      

      

      
        	
                 
      

              	
                2.1.4

              	
                The
      health plan awarded a contract for the Central region shall provide
      services to individuals determined eligible by the state agency for the MO
      HealthNet Managed Care Program in all of the following twenty-eight areas
      in the State of Missouri:

              

      

      

      
        	
                 
      

              	
                 a.

              	
                Audrain
      County

              

      

      
        	
                 
      

              	
                 b.

              	
                Benton
      County

              

      

      
        	
                 
      

              	
                 c.

              	
                Boone
      County

              

      

      
        	
                 
      

              	
                 d.

              	
                Callaway
      County

              

      

      
        	
                 
      

              	
                 e.

              	
                Camden
      County

              

      

      
        	
                 
      

              	
                 f.

              	
                Chariton
      County

              

      

      
        	
                 
      

              	
                 g.

              	
                Cole
      County

              

      

      
        	
                 
      

              	
                 h.

              	
                Cooper
      County

              

      

      
        	
                 
      

              	
                 i.

              	
                Gasconade
      County

              

      

      
        	
                 
      

              	
                 j.

              	
                Howard
      County

              

      

      
        	
                 
      

              	
                 k.

              	
                Laclede
      County

              

      

      
        	
                 
      

              	
                 l.

              	
                Linn
      County

              

      

      
        	
                 
      

              	
                 m.

              	
                Macon
      County

              

      

      
        	
                 
      

              	
                 n.

              	
                Maries
      County

              

      

      
        	
                 
      

              	
                 o.

              	
                Marion
      County

              

      

      
        	
                 
      

              	
                 p.

              	
                Miller
      County

              

      

      
        	
                 
      

              	
                 q.

              	
                Moniteau
      County

              

      

      
        	
                 
      

              	
                 r.

              	
                Monroe
      County

              

      

      
        	
                 
      

              	
                 s.

              	
                Montgomery
      County

              

      

      
        	
                 
      

              	
                 t.

              	
                Morgan
      County

              

      

      
        	
                 
      

              	
                 u.

              	
                Osage
      County

              

      

      
        	
                 
      

              	
                 v.

              	
                Pettis
      County

              

      

      
        	
                 
      

              	
                 w.

              	
                Phelps
      County

              

      

      
        	
                 
      

              	
                 x.

              	
                Pulaski
      County

              

      

      
        	
                 
      

              	
                 y.

              	
                Ralls
      County

              

      

      
        	
                 
      

              	
                 z.

              	
                Randolph
      County

              

      

      
        	
                 
      

              	
                 aa.

              	
                Saline
      County

              

      

      
        	
                 
      

              	
                 bb.

              	
                Shelby
      County

              

      

      

      
        	
                5.

              	
                Attachment
      1 is hereby revised effective January 1,
2008.

              

      

      

      
        	
                6.

              	
                Attachment
      6, Exhibit 1 is hereby revised effective January 1,
  2008.

              

      

      

      
        	
                7.

              	
                Attachment
      9 is hereby revised effective January 1,
2008.

              

      

      

      
        	
                8.

              	
                Attachment
      10 is hereby revised effective January 1,
2008.

              

      

      

      The
contractor shall indicate in Column 2 on the attached Pricing page, any changes
to the firm, fixed prices of the contract for performing the required services
in accordance with the terms, conditions, and provisions of the contract,
including the above stated changes.  The contractor's firm, fixed PMPM
Net Capitation Rate for Each Category of Aid (COA) Rate subgroup must not exceed
the State's Maximum Net Capitation Rate listed in Column 1.

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

       

      All other
terms, conditions and provisions of the contract shall remain the same and apply
hereto.

      

      The
contractor shall sign and return this document, on or before the date indicated,
signifying acceptance of the amendment.

      

      

      
        
          
             

          

          
             

            
              

            

          

          
             

          

        

      

       

      

      
        	
                January
      1, 2008

              
	
                Category
      of Aid

              	
                Age

              	
                Sex

              	
                Column
      1

              	 
      	
                Column
      2

              
	 
      	 
      	 
      	
                State's
      Maximum Net Capitation Rate

                (Per
      Member, Per Month)

              	
                Firm
      Fixed Net Capitation Rate

                (Per
      Member, Per Month)

              
	
                1

              	
                Newborn
      < 01

              	
                Male
      and Female

              	
                $

              	
                $902.13

              	 
      	
                $

              	
                902.13

              
	
                1

              	
                01
      - 06

              	
                Male
      and Female

              	
                $

              	
                $131.02

              	 
      	
                $

              	
                131.02

              
	
                1

              	
                07
      - 13

              	
                Male
      and Female

              	
                $

              	
                $102.52

              	 
      	
                $

              	
                102.52

              
	
                1

              	
                14
      - 20

              	
                Female

              	
                $

              	
                $320.94

              	 
      	
                $

              	
                320.94

              
	
                1

              	
                14
      - 20

              	
                Male

              	
                $

              	
                $131.64

              	 
      	
                $

              	
                131.64

              
	
                1

              	
                21
      - 44

              	
                Female

              	
                $

              	
                $437.92

              	 
      	
                $

              	
                437.92

              
	
                1

              	
                21
      - 44

              	
                Male

              	
                $

              	
                $199.77

              	 
      	
                $

              	
                199.77

              
	
                1

              	
                45
      - 99

              	
                Male
      and Female

              	
                $

              	
                $459.29

              	 
      	
                $

              	
                459.29

              
	
                4

              	
                00
      - 20

              	
                Male
      and Female

              	
                $

              	
                $244.16

              	 
      	
                $

              	
                244.16

              
	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                5

              	
                00
      - 06

              	
                Male
      and Female

              	
                $

              	
                $161.15

              	 
      	
                $

              	
                161.15

              
	
                5

              	
                07
      - 13

              	
                Male
      and Female

              	
                $

              	
                $124.74

              	 
      	
                $

              	
                124.74

              
	
                5

              	
                14
      - 18

              	
                Male
      and Female

              	
                $

              	
                $183.18

              	 
      	
                $

              	
                183.18

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00141-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00141-of-00352.parquet"}]]