Document:

exv10w22w6

 

Exhibit 10.22.6

	 	 	 	 	 	 	 	 	 	 	 
	AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT	 	1. Contract Number	 	Page of Pages
	

	 	POHC-2002-D-0003
	 	 	1	 	 	 	2	 

	 	 	 	 	 	 	 
	2. Amendment/Modification Number

	 	3. Effective Date
	 	4. Requisition/Purchase Request No.
	 	5. Solicitation Caption
	   M00015

	 	1-Aug-04	 	 	 	 

	 	 	 	 	 	 	 
	6. Issued By:

	 	Code
	 	PO
	 	7. Administered By (If other than line 6)
	   Office of Conracting and Procurement

	 	 	 	 	 	    Department of Health / Office of Managed Care
	   Human Care and Services Group / DOH

	 	 	 	 	 	    Medical Assistance Administration
	   441 4th Street, N. W., Suite 700 South

	 	 	 	 	 	    825 North Capital Street, N. E., 5th Floor
	   Washington, DC 20001

	 	 	 	 	 	    Washington, D. C. 20001
	

	 	 	 	 	 	    Attn: Ms. Maude R. Holt — Telephone: (202) 442-9074

	 	 	 	 	 
	8. Name and Address of Contractor (No. Street, city, country, state and ZIP Code)

	 	 	 	9A. Amendment of Solicitation No.
	   AMERIGROUP MARYLAND, INC.
	 	 	 	 
	   A Managed Card Organization

	 	 	 	9B. Dated (See Item 11)
	     d.b.a. AMERIGROUP DISTRICT OF COLUMBIA
	 	 	 	 
	     750 1st Street, N. E., Suite 1120

	 	 	 	10A. Modification of Contract Order No.
	   Washington, D. C. 20004

	 	 	 	      POHC-2002-D-0003
	   Attn: Ms. Jane E. Thom son — Telephone No.: (202) 218-4901

	 	X
	 	10B. Dated (See Item 13)
	Code’ 51-0387398                   
           
                       Facility’

	 	 	 	      ’AUGUST 1, 2002

	 
	11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

	The
above numbered solicitation is amended as set forth in Item 14.
The hour and date specified for receipt of Offers
o is extended.
o is not extended. Offers must
acknowledge receipt of this amendment prior to the hour and date specified
in the solicitation or as amended, by one of the
following methods: (a) By completing Items 8 and 15, and
returning               copies
of the amendment: (b) By acknowledging receipt of this
amendment on each copy of the offer submitted; or
(c) By separate letter or fax which includes a reference to the solicitation and
amendment number. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT THE PLACE DESIGNATED
FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN
REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change
an offer already submitted, such change may be made by letter or fax, provided
each letter or telegram makes reference to the
solicitation and this amendment, and is received prior to the opening hour and date specified.

	 	 	 	 	 
	12. Accounting and Appropriation Data (If Required)
	 	 	 	 
	    OCFO CERTIFICATION LETTER DATED JUINE 03, 2004

	 	$	87,124,011.28	 
	13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,
	IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14

	 	 	 	 	 
	(x)	 	A. This change order is
issued pursuant to: (Specify Authority) Section F.1.1.2
“Option to Extend the Term of the Contract”
	X	 	The changes set forth in Item 14 are made in the contract/order no. in item 10A.
	 	 	B. The above numbered contract/order is modified to reflect the administrative changes (such as changes in paying office, appropriation
date, etc.) set forth in item 14, pursuant to the authority of 27 DCMR, Chapter 36, Section 3601.2.
	 	 	C. This supplemental agreement is entered into pursuant to authority of:
	 	 	D. Other (Specify type of modification and authority)
	E. IMPORTANT: Contractor o is not, o is required to sign this document and return       copies to the issuing office.
	14. Description of amendment/modification (Organized by UCF Section headings, including solicitation/contract subject matter where feasible.)
	 	THE CONTRACT REFERENCED IN BLOCK 10A ABOVE IS MODIFIED AS FOLLOWS:
	 
	 	 	 	 
	

	1.	THE DISTRICT HEREBY EXERCISES ITS OPTION TO RENEW THIS CONTRACT IN
ACCORDANCE TO SECTION F.1.2, TERM OF CONTRACT FOR THE PERIOD OF AUGUST 1, 2004
THROUGH JULY 31, 2005. THE TOTAL PRICE FOR THIS OPTION IS $87,124,011.28.	 	 
	 
	 	 	 	 
	

	2.	A LIST OF RATES INCREASE FOR TREND EFFECTIVE FROM CONTRACT PERIOD
AUGUST 1, 2004 THROUGH JULY 31, 2005.	 	 
	 
	 	 	 	 
	

	3.	INCORPORATE THE DEPARTMENT OF LABOR WAGE DETERMINATION NO. 1994-2103,
REVISION NO., 32, DATED 05/27/2004	 	 

	 	 	 	 	 	 	 
	Except as provided herein, all terms and conditions of the document referenced in Item 10A remain unchanged and in full force and effect.
	15A. Name and Title of Signer (Type or print)

	 	 	 	16A. Name of Contracting Officer	 	 
	  Jane E. Thompson CEO

	 	 	 	     ESTHER M. SCARBOROUGH	 	 
	15B. Name of Contractor

	 	18. Date Signed
	 	16B. District of Columbia
	 	16C. Date Signed
	AMERIGROUP District of Columbia
	 	 	 	 	 	 
	/s/ Jane E. Thompson (Signature of person on authorized to s n)

	 	 7/7/04	 	 	 	 
	

	 	 	 	(Signature of Contracting Officer)exv10w23w2

 

Exhibit 10.23.2

	 	 	 
	STATE OF TEXAS

	 	HHSC CONTRACT No. 529-00-139-L

COUNTY OF TRAVIS

AMENDMENT 12

TO THE AGREEMENT BETWEEN THE

HEALTH & HUMAN SERVICES COMMISSION

AND

AMERIGROUP TEXAS, INC.

FOR HEALTH SERVICES

TO THE

CHILDREN’S HEALTH INSURANCE PROGRAM

     THIS CONTRACT AMENDMENT (the “Amendment”) is entered into between the
HEALTH & HUMAN SERVICES COMMISSION (“HHSC”), an administrative agency within
the executive department of the State of Texas, and Amerigroup Texas, Inc.,
(“CONTRACTOR”), a health maintenance organization organized under the laws of
the State of Texas, possessing a certificate of authority issued by the Texas
Department of Insurance to operate as a health maintenance organization, and
having its principal office at 1200 E. Copeland Road, Suite 200, Arlington,
Texas. HHSC and CONTRACTOR 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
n umber 529-00-139 (the “Agreement”), as set forth in Article 2 of this
Amendment.

ARTICLE 1. PURPOSE.

Section 1.01 Authorization.

     This Amendment is executed by the Parties in accordance with
Article 8 of the Agreement.

Section 1.02 Effective Date of changes

     (a) General effective date of changes.

     This Amendment is effective September 1, 2004, and terminates on the
Expiration Date of the Agreement, unless extended or terminated sooner by HHSC
in accordance with the Agreement.

ARTICLE 2. AMENDMENT TO THE OBLIGATIONS OF THE PARTIES.

Section 2.01 Modification to Article 9, Audit and Financial
Compliance

     Article 9, Audit and Financial Compliance, is modified with the addition
of a new Section 9.04, as follows:

                         Section 9.04 State Auditor’s Office Audit

               The CONTRACTOR understands that acceptance of funds under
this Contract acts as acceptance of the authority of the State
Auditor’s Office (“SAO”), or any successor agency, to conduct an
investigation in connection with those funds. The CONTRACTOR
further agrees to cooperate fully with the SAO or its successor in
the conduct of the audit or investigation, including providing all
records requested. The CONTRACTOR will ensure that this clause
concerning the authority to audit funds received indirectly by

                

					
	

	HHSC Contract 529-00-139-L
	 	Page 1 of 4
	 	Effective September 1, 2004

 

 

Exhibit 10.23.2

     subcontractors through CONTRACTOR and the requirement to
cooperate is included in any subcontract it awards.

Section 2.02 Modification to Section 10.02, Time and manner of premium payment

     Section 10.02, Time and manner of premium payment, is modified with the
addition of a new subsection (e), as follows:

     “Section 10.02 Time and manner of Premium Payment.

               (e) For the period beginning September 1, 2004
and ending August 31, 2005, CONTRACTOR will be
entitled to a payment in accordance with this
subsection (e). CONTRACTOR will be paid based on per
member/per month premiums and new and current
enrollment figures (including disenrollment
adjustments to previous monthly enrollment totals).
The Administrative Services Contractor will convey
premiums payable information to CONTRACTOR for data
reconciliation and to the Management Services
Contractor. CONTRACTOR must reconcile the data and
report any errors to the Management Services
Contractor by the cut-off date of the next month.
The Management Services Contractor will pay
CONTRACTOR by the first business day following the
14th day of each month. CONTRACTOR must accept
payment for premiums by direct deposit into
CONTRACTOR’s account. For the period beginning
September 1, 2004 and ending August 31, 2005, the
premium rates are:

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	CSA #

	 	Under Age 1
	 	Ages 1-5
	 	Ages 6-14
	 	Ages 15-18

	CSA 2

	 	$	358.07	 	 	$	74.35	 	 	$	49.34	 	 	$	96.31	 
	CSA 6

	 	$	299.29	 	 	$	62.13	 	 	$	41.24	 	 	$	81.15	 

               CONTRACTOR does not bill HHSC, the
Administrative Services Contractor, other state
agencies, or institutions for the monthly premium
payment.”

Section 2.03 Modifications to Article 17, Reporting
Requirements, of the Agreement

     Section 17.08 is replaced
with the following language: “Section 17.08

     Special Investigative Unit.

               (a) A CONTRACTOR that provides or arranges for
the provision of health care services to an
individual under the Children’s Health Insurance
Program must arrange for a special investigative
unit to investigate fraudulent claims and other
types of program abuse by recipients and providers.
A CONTRACTOR may choose to:

               (1) Establish and maintain the special
investigative unit within the managed care
organization; or

               (2) Contract with another entity for the investigation.

					
	

	HHSC Contract 529-00-139-L
	 	Page 2 of 4
	 	Effective September 1, 2004

 

 

Exhibit 10.23.2

               (b) A CONTRACTOR must develop a plan to prevent and reduce waste,
abuse, and fraud. The plan must meet the requirements of the rules
established by HHSC and be submitted annually to the HHSC Office of
Inspector General (HHSC-OIG) for approval each year the CONTRACTOR
is enrolled with the State of Texas. The plan must be
submitted 60 days prior to the start of the State fiscal year.

               (c) If the initial plan to prevent and reduce waste, abuse,
and fraud is not approved, the CONTRACTOR must resubmit the plan to
HHSCOIG within 15 working days of receiving the denial letter,
which will explain the deficiencies. If the plan is not resubmitted
within
the time allotted, the CONTRACTOR will be in default and
sanctions may be imposed.

               (d) If the CONTRACTOR elects to contract with another entity
for the investigation of fraudulent claims and other types of
program abuse the CONTRACTOR must adhere to all requirements of
Chapter 42, § 438.230 of the Code of Federal Regulations.

					
	

	HHSC Contract 529-00-139-L
	 	Page 3 of 4
	 	Effective September 1, 2004

 

 

ARTICLE 3. REPRESENTATIONS AND AGREEMENT OF THE PARTIES

     The Parties contract and agree that the terms of the Agreement will remain
in effect and continue to govern except to the extent modified in this
Amendment.

     By signing this Amendment, the Parties expressly understand and agree that
this Amendment is hereby made a part of the Agreement as though it were set out
word for word in the Agreement.

     IN WITNESS HEREOF, HHSC and the CONTRACTOR have each caused this Amendment
to be signed and delivered by its duly authorized representative.

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	AMERIGROUP TEXAS, INC.	 	 	 	HEALTH AND HUMAN SERVICES COMMISSION
	By:

	 	/s/ Eric M. Yoder
	 	 	 	By:	 	 	 	 	 	 	 	 
	

	 	
 
	 	
 
	 	 	 	
 	 	 	 	 	 	 
	 	 	Eric Yoder, M.D.	 	 	 	 	 	Albert Hawkins	 	 	 	 	 	 
	 	 	President and CEO	 	 	 	 	 	Executive Commissioner	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Date:

	 	7/23/04
	 	 	 	Date:	 	 	 	 	 	 	 	 
	

	 	
 
	 	 	 	 	 	
 	 	 	 	 	 	 

					
	

	HHSC Contract 529-00-139-L	 	Page 4 of 4	 	Effective September 1, 2004

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