Document:

Amendment 17 to the Kansas Healthwave Managed Healthcare Services Contract

 Exhibit 10.1 
  

			
	STATE OF KANSAS	  	Contract No. 02510
	Social and Rehabilitation Services	  	 
	Health Care Policy/Medicaid	  	 

  
 AMENDMENT SEVENTEEN

 to the 
 KANSAS
HEALTHWAVE TITLE XIX AND TITLE XXI CAPITATED MANAGED CARE 
 HEALTH SERVICES CONTRACT 
 with 
 FIRSTGUARD HEALTH PLAN KANSAS,
INC. 
 2006 RENEWAL 
  
 The above referenced agreement, as amended, entered into by and between the Secretary of Social and Rehabilitation Services (SRS) and FirstGuard Health Plan Kansas, Inc.,
(FGK), a Kansas Corporation, on July 12, 2001, hereinafter sometimes referred to as Contractor, is hereby amended by agreement of the parties: 
  
 The above-named parties entered into a contract on the date referenced above for the purpose of providing and paying for HealthWave Title XIX and Title XXI capitated
managed care health services to beneficiaries enrolled with FGK. The Kansas Legislature, in the 2005 Session, enacted House Substitute for Senate Bill No. 272. This Act establishes the Health Policy Authority (HPA) and also establishes the Division
of Health Policy and Finance (DHPF) within the Kansas Department of Administration, effective July 1, 2005. This Act further provides that the DHPF shall be the single state agency for Medicaid on an interim basis and transfers related
responsibilities, duties and contracts, including this contract, from SRS to the new DHPF on July 1, 2005 and then subsequently provides that the HPA shall be the single state agency for Medicaid effective July 1, 2006 and transfers these same
responsibilities, duties and contracts to the HPA on July 1, 2006. 
  
 SRS has
determined it is in the best interests of the State to make certain changes to the contract as originally agreed upon; and FGK is agreeable to such changes; now for and in consideration of the mutual covenants and agreements contained herein, the
parties hereby mutually covenant and agree as follows: 
  

  
 The following documents are referenced for convenience only and are NOT made a part of this 
 amendment or intended to be incorporated in this contract by this reference. 
  

  
 Related Contract Amendment Number/Name: #1; #15 
 Related Memorandum of Understanding Number/Name: N/A 
 Related Policy Number/Name: N/A 
 Related Request For Proposals Reference(s): RFP #02510 
 Total Estimated Cost: Title XIX $130,997,000 Title XXI
$61,937,000 
  

 Amendment 17, Page 1 of 3 Pages 

	1.	TERM: 

  
 In accordance with the provisions of RFP #02510, Section 3.1, the term of this contract is extended for the third and last of three, optional one-year
periods, for the period July 1, 2005 through June 30, 2006. 
  

	2.	MEDICAID TITLE XIX CAPITATION RATES: 

  
 RFP #02510, Page 114, Paragraph 5.15.1.e. as added by Amendment 1 and amended by Amendment 15: 
  
 The parties agree that for the period September 1, 2004 through June 30,
2005, the capitation rates set forth in Attachment A to this Amendment, attached to and incorporated herein shall apply to Title XIX HealthWave capitation rates. Said contract rates, to take effect the first day of the month as approved by the
Centers for Medicare and Medicaid Services (CMS). 
  
 Is,
effective with the signing of this amendment, amended to read: 
  
 The parties agree that for the period July 1, 2005 through June 30, 2006, the capitation rates set forth in Attachment A - Rates for the Period July 1, 2005 through June 30, 2006, attached to and incorporated herein shall apply to Title
XIX, subject to actuarial certification and approval by the Center for Medicare and Medicaid Services (CMS). 
  

	3.	SCHIP TITLE XXI CAPITATION RATES FOR THE PERIOD BEGINNING JULY 1, 2005: 

  
 The parties agree that for the period July 1, 2005 through June 30, 2006, the capitation rates set forth in Attachment B -
HealthWave Title XXI Rates for SFY2006, attached to and incorporated herein shall apply to Title XXI. 
  

	4.	NEW SECTION 5.9.1.gg INITIAL OFFICE VISITS: 

  
 The parties agree that effective July 1, 2005, Section 5.9.1, Medical Services is amended by adding new Section 5.9.1.gg as follows: 
  

	 	5.9.1.gg	 Office visits by the plan members with their primary care physicians resulting in a primary or secondary psychiatric diagnosis shall be the responsibility of the Contractor.

  

	5.	NEW SECTION 5.10.12 KDHE LABORATORY COSTS: 

  
 The parties agree that effective July 1, 2005, Section 5.10, Medical Services Not included is amended by adding new Section 5.10.12 as follows:

  

	 	5.10.12 	Laboratory services provided by the Kansas Department of Health and Environment. 

  

 Amendment 17, Page 2 of 3 Pages 

	6.	OTHER TERMS AND CONDITIONS: 

  
 All other terms and conditions of the contract between SRS and FGK remain unchanged. 
  
 IN WITNESS HEREOF, the Parties hereto have executed this amendment to the original contract as of the date written below. 

 

					
	 FIRSTGUARD HEALTH PLAN
 KANSAS,
INC.
	 	 	 	 SECRETARY OF SOCIAL AND
 REHABILITATION
SERVICES

			
	 /s/ Joy D. Wheeler
	 	 	 	  
	 Joy D. Wheeler
	 	 	 	 Gary J. Daniels, Ph.D.

	 President & CEO
	 	 	 	     Acting Secretary

			
	 6/23/05
	 	 	 	  
	 Date
	 	 	 	 Date

			
	 DEPARTMENT OF ADMINISTRATION
 DIVISION OF
PURCHASES
	 	 	 	 
			
	  	 	 	 	  
	 Chris Howe, Director
	 	 	 	 
	 Division of Purchases
	 	 	 	 
			
	  	 	 	 	  
	 Date
	 	 	 	 

  

 Amendment 17, Page 3 of 3 Pages 

  
 Attachment A - Rates for
the Period July 1, 2005 through June 30, 2006 
  
 SFY2006 Rates, HealthWave
19 
  

													
	 	  	 Johnson,
 Leavenworth, &
 Wyandotte
 Counties

	  	 Northeast &
 Western
 Kansas

	  	Southeast
Kansas

	  	Sedgwick
County

	 TAF & PLE < 1
	  	$	437.01	  	$	405.03	  	$	401.31	  	$	457.29
	 TAF & PLE 1-5
	  	$	78.23	  	$	81.79	  	$	86.55	  	$	66.59
	 TAF & PLE 6-14
	  	$	63.50	  	$	75.15	  	$	77.71	  	$	59.57
	 TAF & PLE 15-21 F
	  	$	123.49	  	$	129.78	  	$	151.35	  	$	132.58
	 TAF & PLE 15-21 M
	  	$	73.56	  	$	88.13	  	$	85.78	  	$	66.96
	 TAF 22-29 F
	  	$	215.67	  	$	201.19	  	$	211.18	  	$	201.76
	 TAF 22-34 M
	  	$	172.29	  	$	164.26	  	$	165.19	  	$	139.56
	 TAF 30-34 F
	  	$	243.14	  	$	249.87	  	$	260.87	  	$	243.23
	 TAF 35+
	  	$	336.42	  	$	382.29	  	$	433.70	  	$	369.54
	 Preg Wom <= 29
	  	$	264.06	  	$	234.42	  	$	276.59	  	$	259.05
	 Preg Wom 30+
	  	$	326.59	  	$	294.98	  	$	322.97	  	$	319.94
					
	 Delivery Payment
	  	$	4,343.00	  	 	 	  	 	 	  	 	 

  

  
 Attachment B - HealthWave
XXI Rates for SFY2006 
  
 Title XXI - FY 2006 Rates

 For the Period July 1, 2005 thru June 30, 2006 
  

									
	 Rate Cell

	  	Johnson,
Leavenworth,
Wyandotte

	  	Northeast/
Western

	  	Sedgwick

	  	Southeast

	 <1 Female
	  	510.03	  	493.58	  	438.91	  	419.17
	 <1 Male
	  	510.03	  	493.58	  	438.91	  	419.17
	 1 - 5 Female
	  	137.52	  	110.44	  	98.23	  	98.23
	 1 - 5 Male
	  	140.69	  	112.88	  	100.49	  	100.49
	 6 - 14 Female
	  	109.91	  	87.99	  	78.5	  	78.5
	 6 - 14 Male
	  	102.88	  	82.35	  	73.48	  	73.48
	 15 - 19 Female
	  	249.96	  	199.84	  	178.55	  	178.55
	 15 - 19 Male
	  	132.61	  	106.06	  	94.71	  	94.71
	 Preg Woman < 20
	  	939.26	  	754.76	  	670.91	  	670.91First Amendment to Contract

 Exhibit 10.2 
  
 FIRST AMENDMENT 
 TO 
 CONTRACT BETWEEN 
 THE OFFICE OF MEDICAID POLICY AND PLANNING, 
 THE OFFICE OF THE CHILDREN’S HEALTH INSURANCE PROGRAM 
 AND 
 Coordinated Care Corporation Indiana, Inc.

  
 This FIRST AMENDMENT to the above-referenced Contract is made
and entered into by and between the State of Indiana [hereinafter “State” or “State of Indiana”], through the Office of Medicaid Policy and Planning and Office of the Children’s Health Insurance Program [hereinafter called
“State” or “Offices”], of the Indiana Family and Social Services Administration, 402 West Washington Street, Room W382, Indianapolis, Indiana 46204, and Coordinated Care Corporation Indiana, Inc. [hereinafter called
“Contractor”], 1099 North Meridian Street, Suite 400, Indianapolis, Indiana 46204. 
  
 WHEREAS, the State of Indiana and Contractor have previously entered into a contract for a term beginning January 1, 2005, and ending December 31, 2006, [hereinafter “the original contract”] to arrange for
the provision of covered health care services for certain Hoosier Healthwise members enrolled in Benefit Packages A, B and C, as procured through Request for Proposal (RFP) # 4-79; 
  
 WHEREAS, the parties are desirous to enter into this FIRST AMENDMENT to include coordination with the First Steps program,
to revise the claims dispute process, and, due to the expansion of Hoosier Healthwise mandatory RBMC to include all Indiana counties, to adjust the capitation rates and add exception requirements for designated rural RBMC counties; 
  
 NOW THEREFORE, the parties enter into this FIRST AMENDMENT for the
consideration set out below, all of which is deemed to be good and sufficient consideration in order to make this FIRST AMENDMENT a binding legal instrument. 
  

	1.	The parties hereby ratify and incorporate herein each term and condition set out in the original Contract, as well as all written matters incorporated therein except as specifically
provided for by this FIRST AMENDMENT. 

  

	2.	The term of this amendment is July 1, 2005 through December 31, 2006. 

  

	3.	The parties agree that Section 2.0 of Attachment 1 to the original contract, MCO Scope of Work, is amended to include a new subsection, 2.10, Exceptions for Members in Rural
Counties, and shall read as follows: 

  
 In
accordance with 42 CFR 438.52(b)(2)(ii), in those counties which have been designated as “rural counties” by the Office and approved by the Centers for Medicare and Medicaid Services (CMS), the MCO must allow rural county members to obtain
services from out-of-network providers under any of the following circumstances: 
  
 a) The service or type of provider is not available within the MCO’s network. 
  

					
	MCO Contract, First Amendment	  	Page 1 of 4	  	Coordinated Care Corp.

 b) The out-of-network provider is the main source of a service to the member, provided that the provider
is given the opportunity to become a participating provider. If the provider chooses not to join the network, or does not meet the necessary requirements to join, the enrollee will be transitioned to a participating provider within 60 days, after
being given an opportunity to select a network provider. 
  
 (c)
The only plan or provider available to the member does not, because of moral or religious objections, provide the service the member seeks. 
  
 (d) The member’s PMP or other provider determines that the member needs related services that would subject the member to unnecessary risk if
received separately and not all the related services are available within the network. 
  
 (e) The Office determines that other circumstances warrant out-of-network treatment. 
  

	4.	The parties agree that Attachment 1 to the original contract, MCO Scope of Work, Section 3.3.2, Members with Special Health Care Needs, last paragraph, is amended by adding a bullet
to read as follows: 

  

	 	•	 	Coordinating with Indiana’s early intervention program known as First Steps, in accordance with the policies and procedures developed by the Office in collaboration with the
Hoosier Healthwise MCOs. 

  

	5.	The parties agree that Section 2, Consideration, of the original Contract is amended as follows: 

  
 CAPITATION RATES 
  

										
	 	  	North

	  	Central

	  	South

	 Packages A/B
	  	 	 	  	 	 	  	 	 
	 Newborns
	  	$	323.69	  	$	302.69	  	$	295.85
	 Preschool
	  	 	72.99	  	 	81.89	  	 	78.00
	 Children
	  	 	70.30	  	 	78.87	  	 	75.12
	 Adolescents
	  	 	101.04	  	 	113.37	  	 	107.98
	 Adult Males
	  	 	234.91	  	 	290.90	  	 	279.85
	 Adult Females
	  	 	211.19	  	 	261.53	  	 	251.59
	 Package C
	  	 	 	  	 	 	  	 	 
	 Newborns
	  	$	178.20	  	$	165.06	  	$	161.97
	 Preschool
	  	 	72.60	  	 	76.63	  	 	75.19
	 Children
	  	 	65.42	  	 	69.05	  	 	67.75
	 Adolescents
	  	 	91.07	  	 	96.13	  	 	94.32
	 Package A/B & C
	  	 	 	  	 	 	  	 	 
	 Maternity Delivery
	  	$	3,331.43	  	$	3,301.57	  	$	3,324.80

  
 The South Region
rates will be effective July 1, 2005. The North Region rates will be effective September 1, 2005. The Central Region rates will be effective November 1, 2005. 
  

					
	MCO Contract, First Amendment	  	Page 2 of 4	  	Coordinated Care Corp.

	6.	The parties agree that RFP Attachment N, Claims Dispute Resolution Process, Section 3.1.3, second paragraph, is amended to be consistent with the rule at 405 IAC 1-1.6-3(h), and
shall read as follows: 

  
 In the event the panel
fails to deliver to the provider the panel’s written determination within forty-five (45) calendar days after the commencement of the formal claim resolution procedure, the failure on the part of the panel shall have the effect of an approval
by the panel of the provider’s claim. 
  

	7.	The parties agree that this First Amendment to the parties’ original Contract has been duly prepared and executed pursuant to Section 8 of the original contract.

  

	8.	The undersigned attests, subject to the penalties for perjury, that he is the contracting party, or that he is the representative, agent, member or officer of the contracting party,
that he has not, nor has any other member employee, representative, agent or officer of the firm, company, corporation or partnership represented by him, directly or indirectly, to the best of his knowledge, entered into or offered to enter into any
combination, collusion or agreement to receive or pay, and that he has not received or paid, any sum of money or other consideration for the execution of this agreement other than that which appears upon the face of the agreement.

  
 The rest of this page is left intentionally
blank. 
  

					
	MCO Contract, First Amendment	  	Page 3 of 4	  	Coordinated Care Corp.

 WHEREOF, the parties have, through duly authorized representatives, entered into this agreement. The parties having read
and understood the foregoing terms of the contract do by their respective signatures dated below hereby agree to the terms thereof. 
  

					
	 For the Contractor:
	 	 	 	 For the State of Indiana:

			
	/s/ Rita Johnson-Mills	 	 	 	  
	Rita Johnson-Mills	 	 	 	Jeanne M. Labrecque
	President/CEO	 	 	 	Health Policy and Medicaid Director
	1099 North Meridian Street, Suite 400	 	 	 	Family and Social Services Agency
	Indianapolis, Indiana 46204	 	 	 	 
			
	Date: June 28, 2005	 	 	 	Date: ___________________
			
	APPROVED:	 	 	 	APPROVED:
			
	 	 	 	 	 
	Charles Shalliol, Director	 	 	 	Earl A. Goode, Commissioner
	State Budget Agency	 	 	 	Department of Administration
			
	Date: ____________________	 	 	 	Date: ___________________
			
	APPROVED AS TO FORM AND LEGALITY:	 	 	 	 
			
	 	 	 	 	 
	Stephen Carter	 	 	 	 
	Attorney General of Indiana	 	 	 	 
			
	Date: ____________________	 	 	 	 

  

					
	MCO Contract, First Amendment	  	Page 4 of 4	  	Coordinated Care Corp.

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