Document:

Exhibit 10.19.8

 Exhibit 10.19.8 

 

							
		 	 Contractual Document (CD) 

 
	 	

	 	

 Responsible Office: HHSC Office of General Counsel (OGC) 

 

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

 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: 3800 Buffalo Speedway,
Suite 400, Houston, Texas 77098. 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, 2011	 	August 31, 2013	 	 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. 
 x Medicaid STAR HMO Program 

 

									
	Service Areas:	 	 ̈	    	Bexar	 	 ̈	    	Lubbock
		 	x	    	Dallas	 	x	    	Nueces
		 	 ̈	    	El Paso	 	x	    	Tarrant
		 	x	    	Harris	 	x	    	Travis
		 	x	    	Jefferson	 		    	

 See Attachment B-6, “Map of Counties with HMO Program Service Areas,” for listing of counties
included within the STAR Service Areas. 
 x Medicaid STAR+PLUS HMO Program

  

									
	Service Areas:	 	x	    	Bexar	 	 ̈	    	Nueces
		 	x	    	Harris	 	x	    	Travis
		 	x	    	Jefferson	 		    	

 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. 
 x CHIP HMO Program 

 

									
	Core Service Areas:	 	 ̈	    	Bexar	 	 ̈	    	Lubbock
		 	x	    	Dallas	 	x	    	Nueces
		 	 ̈	    	El Paso	 	x	    	Tarrant
		 	x	    	Harris	 	 ̈	    	Travis
					
	Optional Service Areas:	 	 ̈	    	Bexar	 	 ̈	    	Lubbock
		 	 ̈	    	El Paso	 	 ̈	    	Nueces
		 	 ̈	    	Harris	 	 ̈	    	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. 
 x CHIP Perinatal Program

  

									
	Core Service Areas:	 	 ̈	    	Bexar	 	 ̈	    	Lubbock
		 	 ̈	    	Dallas	 	 ̈	    	Nueces
		 	 ̈	    	El Paso	 	x	    	Tarrant
		 	 ̈	    	Harris	 	 ̈	    	Travis
					
	Optional Service Areas:	 	 ̈	    	Bexar	 	 ̈	    	Lubbock
		 	 ̈	    	El Paso	 	 ̈	    	Nueces
		 	 ̈	    	Harris	 	 ̈	    	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 6. 

 x 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 6: 
 Service Area: DALLAS 
  

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
			
	 1
	  	 TANF Child >12 months
	  	$	118.85	  
	 2
	  	 TANF child £ 12 months
	  	$	403.96	  
	 3
	  	 TANF Adult
	  	$	243.15	  
	 4
	  	 Pregnant Woman
	  	$	451.92	  
	 5
	  	 Newborn £ 12 months
	  	$	508.36	  
	 6
	  	 Expansion Child >12 months
	  	$	131.73	  
	 7
	  	 Expansion child £ 12 months
	  	$	282.45	  
	 8
	  	 Federal Mandate child
	  	$	92.12	  
	 9
	  	 Delivery Supplemental Payment
	  	$	3,537.13	  

 Service Area: HARRIS 
  

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
			
	 1
	  	 TANF Child >12 months
	  	$	117.34	  
	 2
	  	 TANF child £ 12 months
	  	$	415.21	  
	 3
	  	 TANF Adult
	  	$	442.38	  
	 4
	  	 Pregnant Woman
	  	$	495.46	  
	 5
	  	 Newborn £ 12 months
	  	$	621.30	  
	 6
	  	 Expansion Child >12 months
	  	$	112.16	  
	 7
	  	 Expansion child £ 12 months
	  	$	328.13	  
	 8
	  	 Federal Mandate child
	  	$	91.18	  
	 9
	  	 Delivery Supplemental Payment
	  	$	3,519.20	  

 Service Area: JEFFERSON 
  

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
			
	 1
	  	 TANF Child >12 months
	  	$	95.23	  
	 2
	  	 TANF child £ 12 months
	  	$	442.86	  
	 3
	  	 TANF Adult
	  	$	237.80	  
	 4
	  	 Pregnant Woman
	  	$	281.03	  
	 5
	  	 Newborn £ 12 months
	  	$	555.83	  
	 6
	  	 Expansion Child >12 months
	  	$	89.94	  
	 7
	  	 Expansion child £ 12 months
	  	$	224.17	  
	 8
	  	 Federal Mandate child
	  	$	78.33	  
	 9
	  	 Delivery Supplemental Payment
	  	$	3,394.58	  

 Service Area: NUECES 
  

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
			
	 1
	  	 TANF Child >12 months
	  	$	184.44	  
	 2
	  	 TANF child £ 12 months
	  	$	321.82	  
	 3
	  	 TANF Adult
	  	$	347.35	  
	 4
	  	 Pregnant Woman
	  	$	520.92	  
	 5
	  	 Newborn £ 12 months
	  	$	637.76	  
	 6
	  	 Expansion Child >12 months
	  	$	164.81	  
	 7
	  	 Expansion child £ 12 months
	  	$	380.52	  
	 8
	  	 Federal Mandate child
	  	$	101.43	  
	 9
	  	 Delivery Supplemental Payment
	  	$	3,203.82	  

 Service Area: TARRANT 

 

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
			
	 1
	  	 TANF Child >12 months
	  	$	128.71	  
	 2
	  	 TANF child £ 12 months
	  	$	300.54	  
	 3
	  	 TANF Adult
	  	$	318.80	  
	 4
	  	 Pregnant Woman
	  	$	424.17	  
	 5
	  	 Newborn £ 12 months
	  	$	542.56	  
	 6
	  	 Expansion Child >12 months
	  	$	122.33	  
	 7
	  	 Expansion child £ 12 months
	  	$	220.83	  
	 8
	  	 Federal Mandate child
	  	$	91.05	  
	 9
	  	 Delivery Supplemental Payment
	  	$	3,635.64	  

 Service Area: TRAVIS 
  

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
			
	 1
	  	 TANF Child >12 months
	  	$	107.40	  
	 2
	  	 TANF child £ 12 months
	  	$	356.49	  
	 3
	  	 TANF Adult
	  	$	253.79	  
	 4
	  	 Pregnant Woman
	  	$	517.50	  
	 5
	  	 Newborn £ 12 months
	  	$	659.73	  
	 6
	  	 Expansion Child >12 months
	  	$	118.30	  
	 7
	  	 Expansion child £ 12 months
	  	$	296.34	  
	 8
	  	 Federal Mandate child
	  	$	83.64	  
	 9
	  	 Delivery Supplemental Payment
	  	$	3,247.49	  

 STAR SSI Administrative Fee: HHSC will pay a STAR HMO a monthly Administrative Fee of $14.00 per SSI
Beneficiary who voluntarily enrolls in the HMO in accordance with Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10. 
 Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing
the Delivery Supplemental Payment for the STAR Program. 
 x 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 6: 

STAR+PLUS Service Area: BEXAR 
  

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
			
	 1
	  	 Medicaid Only Standard Rate
	  	$	525.34	  
	 2
	  	 Medicaid Only 1915(C) Nursing Facility Waiver Rate
	  	$	2,907.50	  
	 3
	  	 Dual Eligible Standard Rate
	  	$	265.80	  
	 4
	  	 Dual Eligibl 1915(C) Nursing Facility Waiver Rate
	  	$	1,673.44	  
	 5
	  	 Nursing Facility - Medicaid Only
	  	$	525.34	  
	 6
	  	 Nursing Facility - Dual Eligible
	  	$	265.80	  

 STAR+PLUS Service Area: HARRIS 

 

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
			
	1	  	 Medicaid Only Standard Rate
	  	$	613.65	  
	2	  	 Medicaid Only 1915(C) Nursing Facility Waiver Rate
	  	$	3,453.66	  
	3	  	 Dual Eligible Standard Rate
	  	$	236.95	  
	4	  	 Dual Eligible 1915(C) Nursing Facility Waiver Rate
	  	$	1,469.55	  
	5	  	 Nursing Facility - Medicaid Only
	  	$	613.65	  
	6	  	 Nursing Facility - Dual Eligible
	  	$	236.95	  

 STAR+PLUS Service Area: JEFFERSON 

 

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
			
	1	  	 Medicaid Only Standard Rate
	  	$	403.39	  
	2	  	 Medicaid Only 1915(C) Nursing Facility Waiver Rate
	  	$	2,069.42	  
	3	  	 Dual Eligible Standard Rate
	  	$	189.19	  
	4	  	 Dual Eligible 1915(C) Nursing Facility Waiver Rate
	  	$	1,250.55	  
	5	  	 Nursing Facility - Medicaid Only
	  	$	403.39	  
	6	  	 Nursing Facility - Dual Eligible
	  	$	189.19	  

 STAR+PLUS Service Area: TRAVIS 
  

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
			
	1	  	 Medicaid Only Standard Rate
	  	$	611.55	  
	2	  	 Medicaid Only 1915(C) Nursing Facility Waiver Rate
	  	$	3,395.03	  
	3	  	 Dual Eligible Standard Rate
	  	$	179.87	  
	4	  	 Dual Eligible 1915(C) Nursing Facility Waiver Rate
	  	$	1,710.22	  
	5	  	 Nursing Facility - Medicaid Only
	  	$	611.55	  
	6	  	 Nursing Facility - Dual Eligible
	  	$	179.87	  

 x 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 6: 
 Service Area: DALLAS 
  

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
	1	  	 < Age 1
	  	$	216.50	  
	2	  	 Ages 1 through 5
	  	$	110.20	  
	3	  	 Ages 6 through 14
	  	$	78.69	  
	4	  	 Ages 15 through 18
	  	$	106.54	  

 Service Area: HARRIS 

 

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
	1	  	 < Age 1
	  	$	237.92	  
	2	  	 Ages 1 through 5
	  	$	102.58	  
	3	  	 Ages 6 through 14
	  	$	74.56	  
	4	  	 Ages 15 through 18
	  	$	109.03	  

 Service Area: NUECES 
  

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
	1	  	 < Age 1
	  	$	146.81	  
	2	  	 Ages 1 through 5
	  	$	112.05	  
	3	  	 Ages 6 through 14
	  	$	65.48	  
	4	  	 Ages 15 through 18
	  	$	125.81	  

 Service Area: TARRANT 
  

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
	1	  	 < Age 1
	  	$	127.64	  
	2	  	 Ages 1 through 5
	  	$	103.89	  
	3	  	 Ages 6 through 14
	  	$	69.85	  
	4	  	 Ages 15 through 18
	  	$	89.50	  

 Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms and
Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the CHIP Program. The CHIP Delivery Supplemental Payment is $3,100.00 for all Service Areas. 

x 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. 
 Service Area: TARRANT 

 

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
	1	  	 Perinate Newborn 0% to 185%
	  	$	275.32	  
	2	  	 Perinate Newborn Above 185% to 200%
	  	$	674.81	  
	3	  	 Perinate 0% to 185%
	  	$	412.74	  
	4	  	 Perinate Above 185% to 200%
	  	$	351.53	  

 Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms and
Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the CHIP Perinatal Program. The CHIP Perinatal Delivery Supplemental Payment is $3,100.00 for Perinates between 186% and
200% of the Federal Poverty Level for all Service Areas. 
 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 1.18 is replaced with Version 1.19 

B: Scope of Work/Performance Measures – Version 1.18 is replaced with Version 1.19 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 

Part 10: Special Provision for Nueces Service Area 
 Attachment A, Section 10.04 is amended to include sub-part (b) as follows: 

(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.

			
	

	 		 	 

	 Billy R. Millwee, Deputy Executive
 Commissioner for Health Services Operations
	 		 	  
 By:

 
 Title:
	 	  
 Aileen McCormick

 
 President and CEO

					
	Date:	 	12/9/2011	 		 	Date:	 	11/29/11Exhibit 10.19.9

 Exhibit 10.19.9 

 

							
		 	 Contractual Document (CD)

 
	 	

	 	

 Responsible Office: HHSC Office of General Counsel (OGC) 

 

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

 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: 3800 Buffalo Speedway,
Suite 400, Houston, Texas 77098. 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:
			
	January 1, 2012	 	August 31, 2013	 	 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. 
 x Medicaid STAR HMO Program 

 

									
	Service Areas:	 	 ̈	    	Bexar	 	 ̈	    	Lubbock
		 	x	    	Dallas	 	x	    	Nueces
		 	 ̈	    	El Paso	 	x	    	Tarrant
		 	x	    	Harris	 	x	    	Travis
		 	x	    	Jefferson	 		    	

 See Attachment B-6, “Map of Counties with HMO Program Service Areas,” for listing of counties
included within the STAR Service Areas. 
 x Medicaid STAR+PLUS HMO Program

  

									
	Service Areas:	 	x	    	Bexar	 	 ̈	    	Nueces
		 	x	    	Harris	 	x	    	Travis
		 	x	    	Jefferson	 		    	

 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. 
 x CHIP HMO Program 

 

									
	Core Service Areas:	 	 ̈	    	Bexar	 	 ̈	    	Lubbock
		 	x	    	Dallas	 	x	    	Nueces
		 	 ̈	    	El Paso	 	x	    	Tarrant
		 	x	    	Harris	 	 ̈	    	Travis
					
	Optional Service Areas:	 	 ̈	    	Bexar	 	 ̈	    	Lubbock
		 	 ̈	    	El Paso	 	 ̈	    	Nueces
		 	 ̈	    	Harris	 	 ̈	    	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. 
 x CHIP Perinatal Program

  

									
	Core Service Areas:	 	 ̈	    	Bexar	 	 ̈	    	Lubbock
		 	 ̈	    	Dallas	 	 ̈	    	Nueces
		 	 ̈	    	El Paso	 	x	    	Tarrant
		 	 ̈	    	Harris	 	 ̈	    	Travis
					
	Optional Service Areas:	 	 ̈	    	Bexar	 	 ̈	    	Lubbock
		 	 ̈	    	El Paso	 	 ̈	    	Nueces
		 	 ̈	    	Harris	 	 ̈	    	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 6. 
 x 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 6: 

 Service Area: DALLAS 

 

											
	 	 	Rate Cell	 	Rate Period 6 Capitation
Rates (9/1/11 -12/31/11)	 	 	Rate Period 6 Capitation
Rates (1/1/12 -2/29/12)	 
	 1
	 	TANF Child >12 months	 	$	118.85	  	 	$	119.43	  
	 2
	 	TANF child £ 12 months	 	$	403.96	  	 	$	405.76	  
	 3
	 	TANF Adult	 	$	243.15	  	 	$	247.20	  
	 4
	 	Pregnant Woman	 	$	451.92	  	 	$	469.34	  
	 5
	 	Newborn £ 12 months	 	$	508.36	  	 	$	517.30	  
	 6
	 	Expansion Child >12 months	 	$	131.73	  	 	$	132.29	  
	 7
	 	Expansion child £ 12 months	 	$	282.45	  	 	$	284.03	  
	 8
	 	Federal Mandate child	 	$	92.12	  	 	$	92.37	  
	 9
	 	 Delivery Supplemental Payment
	 	$	3,537.13	  	 	$	3,537.13	  

 Service Area: HARRIS 
  

											
	 	 	Rate Cell	 	Rate Period 6 Capitation
Rates (9/1/11 -12/31/11)	 	 	Rate Period 6 Capitation
Rates (1/1/12 -2/29/12)	 
	 1
	 	TANF Child >12 months	 	$	117.34	  	 	$	117.91	  
	 2
	 	 TANF child £ 12 months
	 	$	415.21	  	 	$	419.83	  
	 3
	 	 TANF Adult
	 	$	442.38	  	 	$	449.67	  
	 4
	 	 Pregnant Woman
	 	$	495.46	  	 	$	513.23	  
	 5
	 	 Newborn £ 12 months
	 	$	621.30	  	 	$	630.87	  
	 6
	 	 Expansion Child >12 months
	 	$	112.16	  	 	$	112.59	  
	 7
	 	 Expansion child £ 12 months
	 	$	328.13	  	 	$	329.11	  
	 8
	 	 Federal Mandate child
	 	$	91.18	  	 	$	91.53	  
	 9
	 	 Delivery Supplemental Payment
	 	$	3,519.20	  	 	$	3,519.20	  

 Service Area: JEFFERSON 
  

											
	 	 	Rate Cell	 	Rate Period 6 Capitation
Rates (9/1/11 -12/31/11)	 	 	Rate Period 6 Capitation
Rates (1/1/12 -2/29/12)	 
	 1
	 	 TANF Child >12 months
	 	$	95.23	  	 	$	96.58	  
	 2
	 	 TANF child £ 12 months
	 	$	442.86	  	 	$	447.13	  
	 3
	 	 TANF Adult
	 	$	237.80	  	 	$	244.73	  
	 4
	 	 Pregnant Woman
	 	$	281.03	  	 	$	305.32	  
	 5
	 	 Newborn £ 12 months
	 	$	555.83	  	 	$	567.87	  
	 6
	 	 Expansion Child >12 months
	 	$	89.94	  	 	$	90.72	  
	 7
	 	 Expansion child £ 12 months
	 	$	224.17	  	 	$	237.95	  
	 8
	 	 Federal Mandate child
	 	$	78.33	  	 	$	79.11	  
	 9
	 	 Delivery Supplemental Payment
	 	$	3,394.58	  	 	$	3,394.58	  

 Service Area: NUECES 
  

											
	 	 	Rate Cell	 	Rate Period 6 Capitation
Rates (9/1/11 -12/31/11)	 	 	Rate Period 6 Capitation
Rates (1/1/12 -2/29/12)	 
	 1
	 	 TANF Child >12 months
	 	$	184.44	  	 	$	186.37	  
	 2
	 	 TANF child £ 12 months
	 	$	321.82	  	 	$	325.93	  
	 3
	 	 TANF Adult
	 	$	347.35	  	 	$	361.60	  
	 4
	 	 Pregnant Woman
	 	$	520.92	  	 	$	561.08	  
	 5
	 	 Newborn £ 12 months
	 	$	637.76	  	 	$	654.98	  
	 6
	 	 Expansion Child >12 months
	 	$	164.81	  	 	$	165.91	  
	 7
	 	 Expansion child £ 12 months
	 	$	380.52	  	 	$	386.34	  
	 8
	 	 Federal Mandate child
	 	$	101.43	  	 	$	102.01	  
	 9
	 	 Delivery Supplemental Payment
	 	$	3,203.82	  	 	$	3,203.82	  

 Service Area: TARRANT 

 

											
	 	 	Rate Cell	 	Rate Period 6 Capitation
Rates (9/1/11 -12/31/11)	 	 	Rate Period 6 Capitation
Rates (1/1/12 -2/29/12)	 
	 1
	 	 TANF Child >12 months
	 	$	128.71	  	 	$	129.77	  
	 2
	 	 TANF child £ 12 months
	 	$	300.54	  	 	$	304.83	  
	 3
	 	 TANF Adult
	 	$	318.80	  	 	$	326.99	  
	 4
	 	 Pregnant Woman
	 	$	424.17	  	 	$	463.61	  
	 5
	 	 Newborn £ 12 months
	 	$	542.56	  	 	$	560.32	  
	 6
	 	 Expansion Child >12 months
	 	$	122.33	  	 	$	122.95	  
	 7
	 	 Expansion child £ 12 months
	 	$	220.83	  	 	$	222.11	  
	 8
	 	 Federal Mandate child
	 	$	91.05	  	 	$	91.56	  
	 9
	 	 Delivery Supplemental Payment
	 	$	3,635.64	  	 	$	3,635.64	  

 Service Area: TRAVIS 
  

											
	 	 	Rate Cell	 	Rate Period 6 Capitation
Rates (9/1/11 -12/31/11)	 	 	Rate Period 6 Capitation
Rates (1/1/12 -2/29/12)	 
	 1
	 	 TANF Child >12 months
	 	$	107.40	  	 	$	123.69	  
	 2
	 	 TANF child £ 12 months
	 	$	356.49	  	 	$	333.70	  
	 3
	 	 TANF Adult
	 	$	253.79	  	 	$	315.08	  
	 4
	 	 Pregnant Woman
	 	$	517.50	  	 	$	540.80	  
	 5
	 	 Newborn £ 12 months
	 	$	659.73	  	 	$	681.39	  
	 6
	 	 Expansion Child >12 months
	 	$	118.30	  	 	$	133.48	  
	 7
	 	 Expansion child £ 12 months
	 	$	296.34	  	 	$	279.69	  
	 8
	 	 Federal Mandate child
	 	$	83.64	  	 	$	90.23	  
	 9
	 	 Delivery Supplemental Payment
	 	$	3,247.49	  	 	$	3,247.49	  

 STAR SSI Administrative Fee: HHSC will pay a STAR HMO a monthly Administrative Fee of $14.00 per SSI
Beneficiary who voluntarily enrolls in the HMO in accordance with Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10. 
 Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing
the Delivery Supplemental Payment for the STAR Program. 
 x 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 6: 

STAR+PLUS Service Area: BEXAR 
  

											
	 	 	Rate Cell	 	 Rate Period 6 Capitation

Rates (9/1/11 -12/31/11)
	 	 	 Rate Period 6 Capitation

Rates (1/1/12 -2/29/12)
	 
				
	 1
	 	 Medicard only Standard Rate
	 	$	525.34	  	 	$	531.27	  
	 2
	 	 Medicard only 1915(C) Nursing Facility Waiver Rate
	 	$	2,907.50	  	 	$	2,984.13	  
	 3
	 	 Dual Eligible Standard Rate
	 	$	265.80	  	 	$	265.80	  
	 4
	 	 Dual Eligible 1915(C) Nursing Facility Waiver Rate
	 	$	1,673.44	  	 	$	1,685.10	  
	 5
	 	 Nursing Facility - Medicaid Only
	 	$	525.34	  	 	$	531.27	  
	 6
	 	 Nursing Facility - Dual Eligible
	 	$	265.80	  	 	$	265.80	  

 STAR+PLUS Service Area: HARRIS 

 

											
	 	  	Rate Cell	  	 Rate Period 6 Capitation

Rates (9/1/11 - 12/31/11)
	 	  	 Rate Period 6 Capitation

Rates (1/1/12 - 2/29/12)
	 
	1	  	 Medicaid Only Standard Rate
	  	$	613.65	  	  	$	618.02	  
	2	  	 Medicaid Only 1915(C) Nursing Facility Waiver Rate
	  	$	3,453.66	  	  	$	3,536.34	  
	3	  	 Dual Eligible Standard Rate
	  	$	236.95	  	  	$	236.95	  
	4	  	 Dual Eligible 1915(C) Nursing Facility Waiver Rate
	  	$	1,469.55	  	  	$	1,480.61	  
	5	  	 Nursing Facility - Medicaid Only
	  	$	613.65	  	  	$	618.02	  
	6	  	 Nursing Facility - Dual Eligible
	  	$	236.95	  	  	$	236.95	  

 STAR+PLUS Service Area: JEFFERSON 

 

											
	 	  	Rate Cell	  	 Rate Period 6 Capitation

Rates (9/1/11 - 12/31/11)
	 	  	 Rate Period 6 Capitation

Rates (1/1/12 - 2/29/12)
	 
	1	  	 Medicaid Only Standard Rate
	  	$	403.39	  	  	$	408.44	  
	2	  	 Medicaid Only 1915(C) Nursing Facility Waiver Rate
	  	$	2,069.42	  	  	$	2,095.29	  
	3	  	 Dual Eligible Standard Rate
	  	$	189.19	  	  	$	189.77	  
	4	  	 Dual Eligible 1915(C) Nursing Facility Waiver Rate
	  	$	1,250.55	  	  	$	1,254.36	  
	5	  	 Nursing Facility - Medicaid Only
	  	$	403.39	  	  	$	408.44	  
	6	  	 Nursing Facility - Dual Eligible
	  	$	189.19	  	  	$	189.77	  

 STAR+PLUS Service Area: TRAVIS 
  

											
	 	  	Rate Cell	  	 Rate Period 6 Capitation

Rates (9/1/11 - 12/31/11)
	 	  	 Rate Period 6 Capitation

Rates (1/1/12 - 2/29/12)
	 
	1	  	 Medicaid Only Standard Rate
	  	$	611.55	  	  	$	615.67	  
	2	  	 Medicaid Only 1915(C) Nursing Facility Waiver Rate
	  	$	3,395.03	  	  	$	3,485.14	  
	3	  	 Dual Eligible Standard Rate
	  	$	179.87	  	  	$	179.87	  
	4	  	 Dual Eligible 1915(C) Nursing Facility Waiver Rate
	  	$	1,710.22	  	  	$	1,724.30	  
	5	  	 Nursing Facility - Medicaid Only
	  	$	611.55	  	  	$	615.67	  
	6	  	 Nursing Facility - Dual Eligible
	  	$	179.87	  	  	$	179.87	  

 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 6: 
 Service Area: DALLAS 
  

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
	1	  	 < Age 1
	  	$	216.50	  
	2	  	 Ages 1 through 5
	  	$	110.20	  
	3	  	 Ages 6 through 14
	  	$	78.69	  
	4	  	 Ages 15 through 18
	  	$	106.54	  

 Service Area: HARRIS 

 

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
	1	  	< Age 1	  	$	237.92	  
	2	  	Ages 1 through 5	  	$	102.58	  
	3	  	Ages 6 through 14	  	$	74.56	  
	4	  	Ages 15 through 18	  	$	109.03	  

 Service Area: NUECES 
  

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
	1	  	< Age 1	  	$	146.81	  
	2	  	Ages 1 through 5	  	$	112.05	  
	3	  	Ages 6 through 14	  	$	65.48	  
	4	  	Ages 15 through 18	  	$	125.81	  

 Service Area: TARRANT 
  

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
	1	  	< Age 1	  	$	127.64	  
	2	  	Ages 1 through 5	  	$	103.89	  
	3	  	Ages 6 through 14	  	$	69.85	  
	4	  	Ages 15 through 18	  	$	89.50	  

 Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms and
Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the CHIP Program. The CHIP Delivery Supplemental Payment is $3,100.00 for all Service Areas. 

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. 
 Service Area: TARRANT 

 

							
	 	  	Rate Cell	  	Rate Period 6 Capitation Rates	 
	1	  	Perinate Newborn 0% to 185%	  	$	275.32	  
	2	  	Perinate Newborn Above 185% to 200%	  	$	674.81	  
	3	  	Perinate 0% to 185%	  	$	412.74	  
	4	  	Perinate Above 185% to 200%	  	$	351.53	  

 Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms and
Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the CHIP Perinatal Program. The CHIP Perinatal Delivery Supplemental Payment is $3,100.00 for Perinates between 186% and
200% of the Federal Poverty Level for all Service Areas. 
 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 1.19 is replaced with Version 1.20 

B: Scope of Work/Performance Measures – Version 1.19 is replaced with Version 1.20 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

 Part 10: Special Provision for Nueces Service Area 
 Attachment A, Section 10.04 is amended to include sub-part (b) as follows: 

(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.

			
	 

	 		 	 

	 Billy Millwee, Deputy Executive Commissioner
 for Health Services Operations
	 		 	 By:
  
 Title:
	 	 Aileen McCormick
  

President and CEO

					
	Date:	 	12/21/11	 		 	Date:	 	11/30/11

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