Document:

CONTRACT

    Exhibit
      10.1(b)

    Contract
      Amendment for Medicaid and BadgerCare

    HMO
      Services

    

    

    The
      Contract entered into for the period February 1, 2006 through December 31,
      2007
      between the State of Wisconsin acting by or through the Department of Health
      and
      Family Services, hereinafter referred to as “Department,” and Managed Health
      Services, hereinafter referred to as the “Contractor,” is hereby amended
      effective January 1, 2007 as follows:

    

    
      	1.  	
              Article
                XVIII, C. Add language below at the
                beginning:

            

    

    

    An
      HMO
      may be eligible for an enhanced rate increase by region if all of the following
      applies:

    

    a.
       The
      HMO
      serves a county that has at least 20,000 eligible Family  Medicaid
      and BadgerCare enrollees;

    

    b.
       As
      of
      November 1, 2006, the enrollment limits of the HMOs serving that  county
      are not sufficient for the Department to enroll all of those eligible
 enrollees;
      and,

    

    c.
       The
      HMO
      agrees to increase its enrollment limit that was in effect on November
 1,
      2006.

    

    If
      the
      HMOs that increase their enrollment limits under this paragraph 1., do not
      increase sufficient for the Department to enroll all eligible enrollees then
      the
      Department may assign a higher enrollment limit for each of those
      HMOs.

    

    An
      HMO
      that accepts this enhanced rate increase cannot decrease its enrollment limit
      for two years from the date the increase is effective without the approval
      of
      the Department.

     

    
      	2.  	
              Delete
                Addendum IIIA - Rate Chart. Replace with new Addendum IIIA - Rate
                Chart.
                (Attached)

            

    

    

         
      3. All
      other
      terms and conditions of the February 1, 2006 through December 31,
      2007
      contract and any prior amendments that are not affected by this

    Amendment
      shall remain in full force and effect through the end of the contract
      period.

    

    
      	
              HMO
                Name

            	
              Department
                of Health and Family Services

            
	
              Official
                Signature

               

              /s/
                Linda McKnew

            	
              Official
                Signature

               

              /s/
                Kevin R. Hayden

            
	
              Printed
                Name

               

              Linda
                McKnew

            	
              Printed
                Name

               

              Kevin
                R. Hayden

            
	
              Title

               

              President
                & CEO

            	
              Title

              Administrator

              Division
                of Health Care Financing

            
	
              Date

               

              12-14-06

            	
              Date

               

              1-4-07

            

    

    

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

     

    
      	
              Addendum
                III-A: 

            
	
              CY
                2007 Final AFDC/HS Children Capitation Rates by Age/Gender & Rate
                Region

            
	
              effective
                January 1st, 2007

            
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
              All
                Services Capitation Rate by Age/Gender and Rate
                Region

            
	
               

            	
              Rate
                Region >

            	
              1

            	
              2

            	
              3

            	
              4

            	
              5

            	
              6

            	
              7

            	
              8

            	
              9

            	
              40

            	
              13

            	
              18

            	
              30

            	
              67

            
	
              Age
                Range

            	
              Age
                Code

            	
              Duluth/
                Superior

            	
              Wausau/
                Rhinelander

            	
              Green
                Bay

            	
              Twin
                Cities

            	
              Marshfield/
                Stevens Point

            	
              Appleton/
                Oshkosh

            	
              La
                Crosse

            	
              Madison

            	
              Southeast
                Wisconsin

            	
              Milwaukee
                County

            	
              Dane
                County

            	
              Eau
                Claire County

            	
              Kenosha
                County

            	
              Waukesha
                County

            
	
              <1

            	
              A

            	
              $
                366.94 

            	
              $
                357.21 

            	
              $
                361.51 

            	
              $
                389.16 

            	
              $
                352.89 

            	
              $
                325.99 

            	
              $
                318.85 

            	
              $
                345.01 

            	
              $
                328.93 

            	
              $
                350.28 

            	
              $
                317.61 

            	
              $
                327.61 

            	
              $
                391.72 

            	
              $
                359.32 

            
	
              01-05

            	
              B

            	
              $
                79.37 

            	
              $
                77.04 

            	
              $
                77.69 

            	
              $
                83.30 

            	
              $
                77.43 

            	
              $
                70.68 

            	
              $
                69.21 

            	
              $
                74.66 

            	
              $
                70.59 

            	
              $
                74.75 

            	
              $
                68.42 

            	
              $
                70.54 

            	
              $
                83.65 

            	
              $
                75.88 

            
	
              06-14

            	
              C

            	
              $
                67.82 

            	
              $
                65.65 

            	
              $
                66.00 

            	
              $
                70.52 

            	
              $
                66.99 

            	
              $
                60.49 

            	
              $
                59.30 

            	
              $
                63.81 

            	
              $
                59.88 

            	
              $
                63.06 

            	
              $
                58.24 

            	
              $
                60.07 

            	
              $
                70.65 

            	
              $
                63.44 

            
	
              15-20F

            	
              E

            	
              $
                242.68 

            	
              $
                236.03 

            	
              $
                238.16 

            	
              $
                256.61 

            	
              $
                235.58 

            	
              $
                215.92 

            	
              $
                211.53 

            	
              $
                228.17 

            	
              $
                216.34 

            	
              $
                229.36 

            	
              $
                209.41 

            	
              $
                217.27 

            	
              $
                256.78 

            	
              $
                234.29 

            
	
              15-20M

            	
              D

            	
              $
                93.43 

            	
              $
                90.71 

            	
              $
                91.20 

            	
              $
                98.18 

            	
              $
                91.84 

            	
              $
                83.29 

            	
              $
                81.74 

            	
              $
                87.85 

            	
              $
                82.69 

            	
              $
                87.16 

            	
              $
                80.29 

            	
              $
                83.71 

            	
              $
                97.69 

            	
              $
                88.38 

            
	
              21-34F

            	
              G

            	
              $
                351.51 

            	
              $
                342.17 

            	
              $
                345.21 

            	
              $
                372.80 

            	
              $
                340.87 

            	
              $
                312.70 

            	
              $
                306.48 

            	
              $
                330.44 

            	
              $
                313.49 

            	
              $
                332.33 

            	
              $
                303.33 

            	
              $
                315.88 

            	
              $
                372.20 

            	
              $
                340.21 

            
	
              21-34M

            	
              F

            	
              $
                202.81 

            	
              $
                197.43 

            	
              $
                198.93 

            	
              $
                215.20 

            	
              $
                197.29 

            	
              $
                180.51 

            	
              $
                177.08 

            	
              $
                190.62 

            	
              $
                180.51 

            	
              $
                190.97 

            	
              $
                174.79 

            	
              $
                182.85 

            	
              $
                214.03 

            	
              $
                195.43 

            
	
              35+F

            	
              I

            	
              $
                428.98 

            	
              $
                417.77 

            	
              $
                421.32 

            	
              $
                455.80 

            	
              $
                416.06 

            	
              $
                381.65 

            	
              $
                374.22 

            	
              $
                403.22 

            	
              $
                382.47 

            	
              $
                405.25 

            	
              $
                370.09 

            	
              $
                386.59 

            	
              $
                454.01 

            	
              $
                415.33 

            
	
              35+M

            	
              H

            	
              $
                338.91 

            	
              $
                330.00 

            	
              $
                332.78 

            	
              $
                359.93 

            	
              $
                328.88 

            	
              $
                301.54 

            	
              $
                295.68 

            	
              $
                318.55 

            	
              $
                302.08 

            	
              $
                319.99 

            	
              $
                292.35 

            	
              $
                305.34 

            	
              $
                358.51 

            	
              $
                327.81 

            
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
              Dental_No
                Chiropractic Service Capitation Rate by Age/Gender and Rate
                Region

            
	
               

            	
              Rate
                Region >

            	
              1

            	
              2

            	
              3

            	
              4

            	
              5

            	
              6

            	
              7

            	
              8

            	
              9

            	
              40

            	
              13

            	
              18

            	
              30

            	
              67

            
	
              Age
                Range

            	
              Age
                Code

            	
              Duluth/
                Superior

            	
              Wausau/
                Rhinelander

            	
              Green
                Bay

            	
              Twin
                Cities

            	
              Marshfield/
                Stevens Point

            	
              Appleton/
                Oshkosh

            	
              La
                Crosse

            	
              Madison

            	
              Southeast
                Wisconsin

            	
              Milwaukee
                County

            	
              Dane
                County

            	
              Eau
                Claire County

            	
              Kenosha
                County

            	
              Waukesha
                County

            
	
              <1

            	
              A

            	
              $
                366.54 

            	
              $
                356.73 

            	
              $
                361.17 

            	
              $
                388.36 

            	
              $
                352.30 

            	
              $
                325.60 

            	
              $
                318.35 

            	
              $
                344.67 

            	
              $
                328.72 

            	
              $
                350.25 

            	
              $
                317.37 

            	
              $
                326.63 

            	
              $
                391.57 

            	
              $
                359.12 

            
	
              01-05

            	
              B

            	
              $
                78.96 

            	
              $
                76.55 

            	
              $
                77.34 

            	
              $
                82.48 

            	
              $
                76.82 

            	
              $
                70.28 

            	
              $
                68.70 

            	
              $
                74.31 

            	
              $
                70.38 

            	
              $
                74.71 

            	
              $
                68.17 

            	
              $
                69.54 

            	
              $
                83.51 

            	
              $
                75.66 

            
	
              06-14

            	
              C

            	
              $
                67.20 

            	
              $
                64.92 

            	
              $
                65.48 

            	
              $
                69.29 

            	
              $
                66.08 

            	
              $
                59.89 

            	
              $
                58.54 

            	
              $
                63.28 

            	
              $
                59.55 

            	
              $
                63.01 

            	
              $
                57.87 

            	
              $
                58.56 

            	
              $
                70.42 

            	
              $
                63.12 

            
	
              15-20F

            	
              E

            	
              $
                241.16 

            	
              $
                234.22 

            	
              $
                236.87 

            	
              $
                253.58 

            	
              $
                233.32 

            	
              $
                214.44 

            	
              $
                209.63 

            	
              $
                226.86 

            	
              $
                215.56 

            	
              $
                229.22 

            	
              $
                208.49 

            	
              $
                213.54 

            	
              $
                256.24 

            	
              $
                233.50 

            
	
              15-20M

            	
              D

            	
              $
                92.32 

            	
              $
                89.39 

            	
              $
                90.25 

            	
              $
                95.96 

            	
              $
                90.18 

            	
              $
                82.20 

            	
              $
                80.35 

            	
              $
                86.89 

            	
              $
                82.11 

            	
              $
                87.05 

            	
              $
                79.62 

            	
              $
                80.98 

            	
              $
                97.29 

            	
              $
                87.80 

            
	
              21-34F

            	
              G

            	
              $
                348.90 

            	
              $
                339.06 

            	
              $
                342.99 

            	
              $
                367.59 

            	
              $
                336.99 

            	
              $
                310.15 

            	
              $
                303.24 

            	
              $
                328.19 

            	
              $
                312.14 

            	
              $
                332.10 

            	
              $
                301.75 

            	
              $
                309.47 

            	
              $
                371.24 

            	
              $
                338.86 

            
	
              21-34M

            	
              F

            	
              $
                200.73 

            	
              $
                194.95 

            	
              $
                197.16 

            	
              $
                211.05 

            	
              $
                194.21 

            	
              $
                178.48 

            	
              $
                174.49 

            	
              $
                188.83 

            	
              $
                179.42 

            	
              $
                190.78 

            	
              $
                173.53 

            	
              $
                177.74 

            	
              $
                213.27 

            	
              $
                194.34 

            
	
              35+F

            	
              I

            	
              $
                425.21 

            	
              $
                413.28 

            	
              $
                418.12 

            	
              $
                448.27 

            	
              $
                410.47 

            	
              $
                377.97 

            	
              $
                369.53 

            	
              $
                399.97 

            	
              $
                380.51 

            	
              $
                404.90 

            	
              $
                367.81 

            	
              $
                377.34 

            	
              $
                452.64 

            	
              $
                413.38 

            
	
              35+M

            	
              H

            	
              $
                335.90 

            	
              $
                326.42 

            	
              $
                330.22 

            	
              $
                353.92 

            	
              $
                324.42 

            	
              $
                298.60 

            	
              $
                291.94 

            	
              $
                315.96 

            	
              $
                300.51 

            	
              $
                319.72 

            	
              $
                290.52 

            	
              $
                297.94 

            	
              $
                357.42 

            	
              $
                326.25 

            
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
              Chiropractic_No
                Dental Service Capitation Rate by Age/Gender and Rate
                Region

            
	
               

            	
              Rate
                Region >

            	
              1

            	
              2

            	
              3

            	
              4

            	
              5

            	
              6

            	
              7

            	
              8

            	
              9

            	
              40

            	
              13

            	
              18

            	
              30

            	
              67

            
	
              Age
                Range

            	
              Age
                Code

            	
              Duluth/
                Superior

            	
              Wausau/
                Rhinelander

            	
              Green
                Bay

            	
              Twin
                Cities

            	
              Marshfield/
                Stevens Point

            	
              Appleton/
                Oshkosh

            	
              La
                Crosse

            	
              Madison

            	
              Southeast
                Wisconsin

            	
              Milwaukee
                County

            	
              Dane
                County

            	
              Eau
                Claire County

            	
              Kenosha
                County

            	
              Waukesha
                County

            
	
              <1

            	
              A

            	
              $
                366.90 

            	
              $
                357.18 

            	
              $
                361.48 

            	
              $
                389.13 

            	
              $
                352.85 

            	
              $
                325.96 

            	
              $
                318.82 

            	
              $
                344.98 

            	
              $
                328.90 

            	
              $
                350.25 

            	
              $
                317.58 

            	
              $
                327.58 

            	
              $
                391.69 

            	
              $
                359.30 

            
	
              01-05

            	
              B

            	
              $
                74.35 

            	
              $
                72.46 

            	
              $
                73.21 

            	
              $
                79.17 

            	
              $
                71.68 

            	
              $
                66.09 

            	
              $
                64.73 

            	
              $
                69.89 

            	
              $
                66.53 

            	
              $
                70.70 

            	
              $
                64.28 

            	
              $
                66.89 

            	
              $
                79.14 

            	
              $
                72.66 

            
	
              06-14

            	
              C

            	
              $
                59.76 

            	
              $
                58.29 

            	
              $
                58.80 

            	
              $
                63.89 

            	
              $
                57.75 

            	
              $
                53.13 

            	
              $
                52.13 

            	
              $
                56.14 

            	
              $
                53.36 

            	
              $
                56.56 

            	
              $
                51.58 

            	
              $
                54.21 

            	
              $
                63.41 

            	
              $
                58.27 

            
	
              15-20F

            	
              E

            	
              $
                234.43 

            	
              $
                228.49 

            	
              $
                230.79 

            	
              $
                249.81 

            	
              $
                226.12 

            	
              $
                208.38 

            	
              $
                204.17 

            	
              $
                220.32 

            	
              $
                209.66 

            	
              $
                222.70 

            	
              $
                202.58 

            	
              $
                211.28 

            	
              $
                249.37 

            	
              $
                228.99 

            
	
              15-20M

            	
              D

            	
              $
                85.61 

            	
              $
                83.56 

            	
              $
                84.21 

            	
              $
                91.75 

            	
              $
                82.87 

            	
              $
                76.15 

            	
              $
                74.77 

            	
              $
                80.41 

            	
              $
                76.36 

            	
              $
                80.85 

            	
              $
                73.83 

            	
              $
                78.02 

            	
              $
                90.67 

            	
              $
                83.37 

            
	
              21-34F

            	
              G

            	
              $
                342.66 

            	
              $
                334.09 

            	
              $
                337.30 

            	
              $
                365.52 

            	
              $
                330.72 

            	
              $
                304.62 

            	
              $
                298.59 

            	
              $
                322.03 

            	
              $
                306.33 

            	
              $
                325.19 

            	
              $
                296.02 

            	
              $
                309.45 

            	
              $
                364.25 

            	
              $
                334.54 

            
	
              21-34M

            	
              F

            	
              $
                195.93 

            	
              $
                191.14 

            	
              $
                192.77 

            	
              $
                209.54 

            	
              $
                189.40 

            	
              $
                174.22 

            	
              $
                170.95 

            	
              $
                184.07 

            	
              $
                174.94 

            	
              $
                185.42 

            	
              $
                169.10 

            	
              $
                177.85 

            	
              $
                207.85 

            	
              $
                191.01 

            
	
              35+F

            	
              I

            	
              $
                419.39 

            	
              $
                408.99 

            	
              $
                412.73 

            	
              $
                447.91 

            	
              $
                405.06 

            	
              $
                372.87 

            	
              $
                365.66 

            	
              $
                394.08 

            	
              $
                374.70 

            	
              $
                397.50 

            	
              $
                362.15 

            	
              $
                379.61 

            	
              $
                445.38 

            	
              $
                409.17 

            
	
              35+M

            	
              H

            	
              $
                330.45 

            	
              $
                322.27 

            	
              $
                325.20 

            	
              $
                352.96 

            	
              $
                319.19 

            	
              $
                293.80 

            	
              $
                288.13 

            	
              $
                310.50 

            	
              $
                295.23 

            	
              $
                313.16 

            	
              $
                285.35 

            	
              $
                299.19 

            	
              $
                350.90 

            	
              $
                322.38 

            
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
              No
                Chiropractic & No Dental Service Capitation Rate by Age/Gender and
                Rate Region

            
	
               

            	
              Rate
                Region >

            	
              1

            	
              2

            	
              3

            	
              4

            	
              5

            	
              6

            	
              7

            	
              8

            	
              9

            	
              40

            	
              13

            	
              18

            	
              30

            	
              67

            
	
              Age
                Range

            	
              Age
                Code

            	
              Duluth/
                Superior

            	
              Wausau/
                Rhinelander

            	
              Green
                Bay

            	
              Twin
                Cities

            	
              Marshfield/
                Stevens Point

            	
              Appleton/
                Oshkosh

            	
              La
                Crosse

            	
              Madison

            	
              Southeast
                Wisconsin

            	
              Milwaukee
                County

            	
              Dane
                County

            	
              Eau
                Claire County

            	
              Kenosha
                County

            	
              Waukesha
                County

            
	
              <1

            	
              A

            	
              $
                366.50 

            	
              $
                356.70 

            	
              $
                361.14 

            	
              $
                388.33 

            	
              $
                352.26 

            	
              $
                325.57 

            	
              $
                318.32 

            	
              $
                344.64 

            	
              $
                328.69 

            	
              $
                350.22 

            	
              $
                317.34 

            	
              $
                326.60 

            	
              $
                391.54 

            	
              $
                359.09 

            
	
              01-05

            	
              B

            	
              $
                73.94 

            	
              $
                71.97 

            	
              $
                72.86 

            	
              $
                78.35 

            	
              $
                71.07 

            	
              $
                65.69 

            	
              $
                64.22 

            	
              $
                69.54 

            	
              $
                66.32 

            	
              $
                70.66 

            	
              $
                64.03 

            	
              $
                65.89 

            	
              $
                79.00 

            	
              $
                72.45 

            
	
              06-14

            	
              C

            	
              $
                59.14 

            	
              $
                57.55 

            	
              $
                58.28 

            	
              $
                62.66 

            	
              $
                56.84 

            	
              $
                52.53 

            	
              $
                51.36 

            	
              $
                55.61 

            	
              $
                53.03 

            	
              $
                56.51 

            	
              $
                51.21 

            	
              $
                52.70 

            	
              $
                63.18 

            	
              $
                57.95 

            
	
              15-20F

            	
              E

            	
              $
                232.91 

            	
              $
                226.68 

            	
              $
                229.50 

            	
              $
                246.78 

            	
              $
                223.86 

            	
              $
                206.90 

            	
              $
                202.28 

            	
              $
                219.01 

            	
              $
                208.88 

            	
              $
                222.56 

            	
              $
                201.66 

            	
              $
                207.55 

            	
              $
                248.83 

            	
              $
                228.21 

            
	
              15-20M

            	
              D

            	
              $
                84.50 

            	
              $
                82.24 

            	
              $
                83.26 

            	
              $
                89.53 

            	
              $
                81.22 

            	
              $
                75.06 

            	
              $
                73.39 

            	
              $
                79.45 

            	
              $
                75.78 

            	
              $
                80.74 

            	
              $
                73.16 

            	
              $
                75.29 

            	
              $
                90.27 

            	
              $
                82.79 

            
	
              21-34F

            	
              G

            	
              $
                340.05 

            	
              $
                330.97 

            	
              $
                335.08 

            	
              $
                360.31 

            	
              $
                326.84 

            	
              $
                302.07 

            	
              $
                295.35 

            	
              $
                319.78 

            	
              $
                304.98 

            	
              $
                324.96 

            	
              $
                294.44 

            	
              $
                303.04 

            	
              $
                363.29 

            	
              $
                333.18 

            
	
              21-34M

            	
              F

            	
              $
                193.85 

            	
              $
                188.66 

            	
              $
                191.00 

            	
              $
                205.39 

            	
              $
                186.32 

            	
              $
                172.19 

            	
              $
                168.36 

            	
              $
                182.28 

            	
              $
                173.85 

            	
              $
                185.23 

            	
              $
                167.84 

            	
              $
                172.74 

            	
              $
                207.09 

            	
              $
                189.93 

            
	
              35+F

            	
              I

            	
              $
                415.62 

            	
              $
                404.50 

            	
              $
                409.53 

            	
              $
                440.38 

            	
              $
                399.47 

            	
              $
                369.19 

            	
              $
                360.97 

            	
              $
                390.83 

            	
              $
                372.74 

            	
              $
                397.15 

            	
              $
                359.87 

            	
              $
                370.36 

            	
              $
                444.01 

            	
              $
                407.22 

            
	
              35+M

            	
              H

            	
              $
                327.44 

            	
              $
                318.68 

            	
              $
                322.64 

            	
              $
                346.95 

            	
              $
                314.72 

            	
              $
                290.86 

            	
              $
                284.39 

            	
              $
                307.91 

            	
              $
                293.66 

            	
              $
                312.89 

            	
              $
                283.52 

            	
              $
                291.79 

            	
              $
                349.81 

            	
              $
                320.82 

            
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
              An
                HMO may be eligible for a 2.7% increase above the rate effective
                1/1/2007
                if all of the following applies:

               

               

               

              a.
                the HMO serves a county that has at least 20,000 eligible Family
                Medicaid
                and BadgerCare enrollees;

               

              b.
                as of November 1, 2006, the enrollment limits of the HMOs serving
                that
                county are not sufficient for the Department to enroll all of those
                eligible enrollees; and,

               

              c.
                the HMO agrees to increase its enrollment limit that was in effect
                on
                November 1, 2006.

               

            	 

    

    

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    
      	
              effective
                January 1st, 2007

            
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
              All
                Services

            
	
               

            	
               

            	
              Duluth/

            	
              Wausau/

            	
               

            	
               

            	
              Marshfield/

            	
              Appleton/

            	
               

            	
               

            	
              Southeast

            	
               

            	
               

            	
               

            	
               

            	
               

            
	
               

            	
               

            	
              Superior

            	
              Rhinelander

            	
              Green
                Bay

            	
              Twin
                Cities

            	
              Stevens
                Point

            	
              Oshkosh

            	
              La
                Crosse

            	
              Madison

            	
              Wisconsin

            	
              Milwaukee

            	
              Dane

            	
              Eau
                Claire

            	
              Kenosha

            	
              Waukesha

            
	
              Age
                Range

            	
              Gender

            	
              1

            	
              2

            	
              3

            	
              4

            	
              5

            	
              6

            	
              7

            	
              8

            	
              9

            	
              10

            	
              11

            	
              12

            	
              13

            	
              14

            
	
              Age
                0

            	
              All

            	
              $366.94
                

            	
              $357.21
                

            	
              $361.51
                

            	
              $389.16
                

            	
              $352.89
                

            	
              $325.99
                

            	
              $318.85
                

            	
              $345.01
                

            	
              $328.93
                

            	
              $350.28
                

            	
              $317.61
                

            	
              $327.61
                

            	
              $391.72
                

            	
              $359.32
                

            
	
              Age
                1-14

            	
              All

            	
              $69.01
                

            	
              $65.90
                

            	
              $66.76
                

            	
              $68.74
                

            	
              $64.27
                

            	
              $64.47
                

            	
              $53.19
                

            	
              $70.74
                

            	
              $66.02
                

            	
              $64.07
                

            	
              $60.65
                

            	
              $59.53
                

            	
              $73.52
                

            	
              $67.36
                

            
	
              Age
                15-20

            	
              F

            	
              $143.47
                

            	
              $139.50
                

            	
              $140.36
                

            	
              $145.31
                

            	
              $132.66
                

            	
              $133.28
                

            	
              $110.58
                

            	
              $147.64
                

            	
              $138.64
                

            	
              $132.11
                

            	
              $128.70
                

            	
              $125.87
                

            	
              $151.90
                

            	
              $142.44
                

            
	
              Age
                15-20

            	
              M

            	
              $104.07
                

            	
              $100.57
                

            	
              $101.43
                

            	
              $104.79
                

            	
              $96.44
                

            	
              $96.85
                

            	
              $80.19
                

            	
              $106.96
                

            	
              $100.24
                

            	
              $96.12
                

            	
              $92.74
                

            	
              $90.77
                

            	
              $110.43
                

            	
              $102.76
                

            
	
              Age
                21-34

            	
              F

            	
              $218.97
                

            	
              $214.49
                

            	
              $215.45
                

            	
              $223.10
                

            	
              $201.06
                

            	
              $202.74
                

            	
              $168.40
                

            	
              $225.65
                

            	
              $212.88
                

            	
              $201.32
                

            	
              $198.58
                

            	
              $193.38
                

            	
              $231.37
                

            	
              $219.56
                

            
	
              Age
                21-34

            	
              M

            	
              $127.22
                

            	
              $124.53
                

            	
              $124.90
                

            	
              $129.72
                

            	
              $117.69
                

            	
              $118.06
                

            	
              $98.22
                

            	
              $131.15
                

            	
              $123.25
                

            	
              $116.66
                

            	
              $114.79
                

            	
              $112.33
                

            	
              $134.34
                

            	
              $126.84
                

            
	
              Age
                35-44

            	
              F

            	
              $283.84
                

            	
              $278.69
                

            	
              $279.74
                

            	
              $289.79
                

            	
              $260.27
                

            	
              $262.58
                

            	
              $218.25
                

            	
              $292.64
                

            	
              $276.37
                

            	
              $260.75
                

            	
              $258.18
                

            	
              $251.21
                

            	
              $299.69
                

            	
              $285.34
                

            
	
              Age
                35-44

            	
              M

            	
              $198.86
                

            	
              $195.19
                

            	
              $195.86
                

            	
              $203.04
                

            	
              $182.70
                

            	
              $184.08
                

            	
              $153.05
                

            	
              $205.04
                

            	
              $193.44
                

            	
              $182.58
                

            	
              $180.62
                

            	
              $175.96
                

            	
              $209.94
                

            	
              $199.59
                

            
	
              Age
                45+

            	
              F

            	
              $367.82
                

            	
              $361.13
                

            	
              $362.63
                

            	
              $375.42
                

            	
              $336.78
                

            	
              $340.12
                

            	
              $282.60
                

            	
              $379.19
                

            	
              $358.35
                

            	
              $338.13
                

            	
              $334.84
                

            	
              $325.50
                

            	
              $388.42
                

            	
              $370.14
                

            
	
              Age
                45+

            	
              M

            	
              $323.51
                

            	
              $317.14
                

            	
              $318.88
                

            	
              $329.51
                

            	
              $295.50
                

            	
              $299.04
                

            	
              $248.13
                

            	
              $333.34
                

            	
              $315.33
                

            	
              $298.01
                

            	
              $294.55
                

            	
              $285.83
                

            	
              $341.95
                

            	
              $325.80
                

            
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
              Dental
                Services - No Chiropractic

            
	
               

            	
               

            	
              Duluth/

            	
              Wausau/

            	
               

            	
               

            	
              Marshfield/

            	
              Appleton/

            	
               

            	
               

            	
              Southeast

            	
               

            	
               

            	
               

            	
               

            	
               

            
	
               

            	
               

            	
              Superior

            	
              Rhinelander

            	
              Green
                Bay

            	
              Twin
                Cities

            	
              Stevens
                Point

            	
              Oshkosh

            	
              La
                Crosse

            	
              Madison

            	
              Wisconsin

            	
              Milwaukee

            	
              Dane

            	
              Eau
                Claire

            	
              Kenosha

            	
              Waukesha

            
	
              Age
                Range

            	
              Gender

            	
              1

            	
              2

            	
              3

            	
              4

            	
              5

            	
              6

            	
              7

            	
              8

            	
              9

            	
              10

            	
              11

            	
              12

            	
              13

            	
              14

            
	
              Age
                0

            	
              All

            	
              $366.54
                

            	
              $356.73
                

            	
              $361.17
                

            	
              $388.36
                

            	
              $352.30
                

            	
              $325.60
                

            	
              $318.35
                

            	
              $344.67
                

            	
              $328.72
                

            	
              $350.25
                

            	
              $317.37
                

            	
              $326.63
                

            	
              $391.57
                

            	
              $359.12
                

            
	
              Age
                1-14

            	
              All

            	
              $68.31
                

            	
              $64.76
                

            	
              $66.00
                

            	
              $67.41
                

            	
              $62.99
                

            	
              $63.69
                

            	
              $52.28
                

            	
              $69.86
                

            	
              $65.45
                

            	
              $63.95
                

            	
              $60.03
                

            	
              $58.49
                

            	
              $73.05
                

            	
              $66.85
                

            
	
              Age
                15-20

            	
              F

            	
              $141.57
                

            	
              $136.44
                

            	
              $138.33
                

            	
              $141.75
                

            	
              $129.21
                

            	
              $131.23
                

            	
              $108.13
                

            	
              $145.27
                

            	
              $137.12
                

            	
              $131.80
                

            	
              $127.04
                

            	
              $123.08
                

            	
              $150.64
                

            	
              $141.09
                

            
	
              Age
                15-20

            	
              M

            	
              $102.83
                

            	
              $98.56
                

            	
              $100.10
                

            	
              $102.46
                

            	
              $94.18
                

            	
              $95.50
                

            	
              $78.59
                

            	
              $105.41
                

            	
              $99.24
                

            	
              $95.91
                

            	
              $91.65
                

            	
              $88.95
                

            	
              $109.60
                

            	
              $101.87
                

            
	
              Age
                21-34

            	
              F

            	
              $216.43
                

            	
              $210.40
                

            	
              $212.73
                

            	
              $218.34
                

            	
              $196.44
                

            	
              $199.98
                

            	
              $165.12
                

            	
              $222.47
                

            	
              $210.84
                

            	
              $200.91
                

            	
              $196.37
                

            	
              $189.65
                

            	
              $229.68
                

            	
              $217.75
                

            
	
              Age
                21-34

            	
              M

            	
              $125.12
                

            	
              $121.15
                

            	
              $122.65
                

            	
              $125.79
                

            	
              $113.86
                

            	
              $115.78
                

            	
              $95.51
                

            	
              $128.52
                

            	
              $121.58
                

            	
              $116.32
                

            	
              $112.96
                

            	
              $109.25
                

            	
              $132.95
                

            	
              $125.34
                

            
	
              Age
                35-44

            	
              F

            	
              $280.54
                

            	
              $273.37
                

            	
              $276.20
                

            	
              $283.61
                

            	
              $254.25
                

            	
              $258.99
                

            	
              $213.98
                

            	
              $288.51
                

            	
              $273.72
                

            	
              $260.22
                

            	
              $255.30
                

            	
              $246.36
                

            	
              $297.50
                

            	
              $282.98
                

            
	
              Age
                35-44

            	
              M

            	
              $196.31
                

            	
              $191.08
                

            	
              $193.13
                

            	
              $198.27
                

            	
              $178.05
                

            	
              $181.31
                

            	
              $149.76
                

            	
              $201.86
                

            	
              $191.41
                

            	
              $182.17
                

            	
              $178.40
                

            	
              $172.22
                

            	
              $208.26
                

            	
              $197.78
                

            
	
              Age
                45+

            	
              F

            	
              $363.91
                

            	
              $354.85
                

            	
              $358.45
                

            	
              $368.12
                

            	
              $329.67
                

            	
              $335.88
                

            	
              $277.56
                

            	
              $374.31
                

            	
              $355.23
                

            	
              $337.49
                

            	
              $331.44
                

            	
              $319.78
                

            	
              $385.84
                

            	
              $367.36
                

            
	
              Age
                45+

            	
              M

            	
              $320.88
                

            	
              $312.89
                

            	
              $316.06
                

            	
              $324.58
                

            	
              $290.69
                

            	
              $296.17
                

            	
              $244.73
                

            	
              $330.04
                

            	
              $313.22
                

            	
              $297.57
                

            	
              $292.25
                

            	
              $281.96
                

            	
              $340.21
                

            	
              $323.92
                

            
	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
              Chiropractic
                Services - No Dental

            
	
               

            	
               

            	
              Duluth/

            	
              Wausau/

            	
               

            	
               

            	
              Marshfield/

            	
              Appleton/

            	
               

            	
               

            	
              Southeast

            	
               

            	
               

            	
               

            	
               

            	
               

            
	
               

            	
               

            	
              Superior

            	
              Rhinelander

            	
              Green
                Bay

            	
              Twin
                Cities

            	
              Stevens
                Point

            	
              Oshkosh

            	
              La
                Crosse

            	
              Madison

            	
              Wisconsin

            	
              Milwaukee

            	
              Dane

            	
              Eau
                Claire

            	
              Kenosha

            	
              Waukesha

            
	
              Age
                Range

            	
              Gender

            	
              1

            	
              2

            	
              3

            	
              4

            	
              5

            	
              6

            	
              7

            	
              8

            	
              9

            	
              10

            	
              11

            	
              12

            	
              13

            	
              14

            
	
              Age
                0

            	
              All

            	
              $366.90
                

            	
              $357.18
                

            	
              $361.48
                

            	
              $389.13
                

            	
              $352.85
                

            	
              $325.96
                

            	
              $318.82
                

            	
              $344.98
                

            	
              $328.90
                

            	
              $350.25
                

            	
              $317.58
                

            	
              $327.58
                

            	
              $391.69
                

            	
              $359.30
                

            
	
              Age
                1-14

            	
              All

            	
              $59.36
                

            	
              $58.74
                

            	
              $58.82
                

            	
              $61.02
                

            	
              $54.18
                

            	
              $54.78
                

            	
              $45.62
                

            	
              $61.30
                

            	
              $58.10
                

            	
              $54.39
                

            	
              $54.52
                

            	
              $52.92
                

            	
              $62.53
                

            	
              $60.18
                

            
	
              Age
                15-20

            	
              F

            	
              $132.75
                

            	
              $131.54
                

            	
              $131.54
                

            	
              $136.74
                

            	
              $121.45
                

            	
              $122.51
                

            	
              $102.16
                

            	
              $137.15
                

            	
              $129.84
                

            	
              $121.36
                

            	
              $121.88
                

            	
              $118.52
                

            	
              $139.69
                

            	
              $134.46
                

            
	
              Age
                15-20

            	
              M

            	
              $94.05
                

            	
              $93.14
                

            	
              $93.19
                

            	
              $96.79
                

            	
              $85.97
                

            	
              $86.79
                

            	
              $72.34
                

            	
              $97.15
                

            	
              $92.02
                

            	
              $86.07
                

            	
              $86.37
                

            	
              $83.91
                

            	
              $99.02
                

            	
              $95.31
                

            
	
              Age
                21-34

            	
              F

            	
              $210.15
                

            	
              $207.96
                

            	
              $208.20
                

            	
              $216.06
                

            	
              $191.85
                

            	
              $193.89
                

            	
              $161.48
                

            	
              $217.02
                

            	
              $205.64
                

            	
              $192.48
                

            	
              $192.98
                

            	
              $187.34
                

            	
              $221.33
                

            	
              $213.00
                

            
	
              Age
                21-34

            	
              M

            	
              $120.10
                

            	
              $119.25
                

            	
              $119.04
                

            	
              $124.03
                

            	
              $110.25
                

            	
              $110.91
                

            	
              $92.64
                

            	
              $124.18
                

            	
              $117.40
                

            	
              $109.52
                

            	
              $110.26
                

            	
              $107.45
                

            	
              $126.23
                

            	
              $121.54
                

            
	
              Age
                35-44

            	
              F

            	
              $275.09
                

            	
              $272.21
                

            	
              $272.54
                

            	
              $282.80
                

            	
              $251.12
                

            	
              $253.79
                

            	
              $211.38
                

            	
              $284.07
                

            	
              $269.18
                

            	
              $251.97
                

            	
              $252.62
                

            	
              $245.21
                

            	
              $289.72
                

            	
              $278.83
                

            
	
              Age
                35-44

            	
              M

            	
              $191.81
                

            	
              $189.96
                

            	
              $190.06
                

            	
              $197.40
                

            	
              $175.33
                

            	
              $177.00
                

            	
              $147.52
                

            	
              $198.14
                

            	
              $187.65
                

            	
              $175.51
                

            	
              $176.14
                

            	
              $171.13
                

            	
              $201.91
                

            	
              $194.34
                

            
	
              Age
                45+

            	
              F

            	
              $357.42
                

            	
              $353.43
                

            	
              $354.08
                

            	
              $367.11
                

            	
              $325.91
                

            	
              $329.68
                

            	
              $274.44
                

            	
              $369.01
                

            	
              $349.81
                

            	
              $327.70
                

            	
              $328.23
                

            	
              $318.37
                

            	
              $376.58
                

            	
              $362.40
                

            
	
              Age
                45+

            	
              M

            	
              $314.35
                

            	
              $310.35
                

            	
              $311.35
                

            	
              $322.19
                

            	
              $285.92
                

            	
              $289.84
                

            	
              $240.95
                

            	
              $324.38
                

            	
              $307.81
                

            	
              $288.82
                

            	
              $288.73
                

            	
              $279.56
                

            	
              $331.52
                

            	
              $318.98
                

            
	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            
	
               

            	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
              No
                Dental or Chiropractic

            
	
               

            	
               

            	
              Duluth/

            	
              Wausau/

            	
               

            	
               

            	
              Marshfield/

            	
              Appleton/

            	
               

            	
               

            	
              Southeast

            	
               

            	
               

            	
               

            	
               

            	
               

            
	
               

            	
               

            	
              Superior

            	
              Rhinelander

            	
              Green
                Bay

            	
              Twin
                Cities

            	
              Stevens
                Point

            	
              Oshkosh

            	
              La
                Crosse

            	
              Madison

            	
              Wisconsin

            	
              Milwaukee

            	
              Dane

            	
              Eau
                Claire

            	
              Kenosha

            	
              Waukesha

            
	
              Age
                Range

            	
              Gender

            	
              1

            	
              2

            	
              3

            	
              4

            	
              5

            	
              6

            	
              7

            	
              8

            	
              9

            	
              10

            	
              11

            	
              12

            	
              13

            	
              14

            
	
              Age
                0

            	
              All

            	
              $366.50
                

            	
              $356.70
                

            	
              $361.14
                

            	
              $388.33
                

            	
              $352.26
                

            	
              $325.57
                

            	
              $318.32
                

            	
              $344.64
                

            	
              $328.69
                

            	
              $350.22
                

            	
              $317.34
                

            	
              $326.60
                

            	
              $391.54
                

            	
              $359.09
                

            
	
              Age
                1-14

            	
              All

            	
              $58.66
                

            	
              $57.61
                

            	
              $58.06
                

            	
              $59.70
                

            	
              $52.90
                

            	
              $54.00
                

            	
              $44.71
                

            	
              $60.42
                

            	
              $57.53
                

            	
              $54.27
                

            	
              $53.90
                

            	
              $51.88
                

            	
              $62.06
                

            	
              $59.67
                

            
	
              Age
                15-20

            	
              F

            	
              $130.85
                

            	
              $128.48
                

            	
              $129.51
                

            	
              $133.18
                

            	
              $118.00
                

            	
              $120.46
                

            	
              $99.71
                

            	
              $134.78
                

            	
              $128.32
                

            	
              $121.05
                

            	
              $120.23
                

            	
              $115.73
                

            	
              $138.43
                

            	
              $133.11
                

            
	
              Age
                15-20

            	
              M

            	
              $92.81
                

            	
              $91.14
                

            	
              $91.86
                

            	
              $94.46
                

            	
              $83.71
                

            	
              $85.44
                

            	
              $70.73
                

            	
              $95.60
                

            	
              $91.02
                

            	
              $85.86
                

            	
              $85.28
                

            	
              $82.09
                

            	
              $98.19
                

            	
              $94.42
                

            
	
              Age
                21-34

            	
              F

            	
              $207.61
                

            	
              $203.86
                

            	
              $205.48
                

            	
              $211.30
                

            	
              $187.23
                

            	
              $191.13
                

            	
              $158.21
                

            	
              $213.84
                

            	
              $203.60
                

            	
              $192.07
                

            	
              $190.77
                

            	
              $183.61
                

            	
              $219.64
                

            	
              $211.19
                

            
	
              Age
                21-34

            	
              M

            	
              $118.00
                

            	
              $115.87
                

            	
              $116.79
                

            	
              $120.10
                

            	
              $106.42
                

            	
              $108.63
                

            	
              $89.93
                

            	
              $121.55
                

            	
              $115.73
                

            	
              $109.18
                

            	
              $108.43
                

            	
              $104.37
                

            	
              $124.84
                

            	
              $120.04
                

            
	
              Age
                35-44

            	
              F

            	
              $271.78
                

            	
              $266.89
                

            	
              $269.00
                

            	
              $276.62
                

            	
              $245.10
                

            	
              $250.20
                

            	
              $207.11
                

            	
              $279.94
                

            	
              $266.53
                

            	
              $251.44
                

            	
              $249.73
                

            	
              $240.36
                

            	
              $287.53
                

            	
              $276.47
                

            
	
              Age
                35-44

            	
              M

            	
              $189.26
                

            	
              $185.85
                

            	
              $187.33
                

            	
              $192.63
                

            	
              $170.68
                

            	
              $174.23
                

            	
              $144.23
                

            	
              $194.96
                

            	
              $185.62
                

            	
              $175.10
                

            	
              $173.91
                

            	
              $167.39
                

            	
              $200.23
                

            	
              $192.53
                

            
	
              Age
                45+

            	
              F

            	
              $353.51
                

            	
              $347.14
                

            	
              $349.90
                

            	
              $359.81
                

            	
              $318.81
                

            	
              $325.44
                

            	
              $269.40
                

            	
              $364.13
                

            	
              $346.69
                

            	
              $327.06
                

            	
              $324.83
                

            	
              $312.65
                

            	
              $374.00
                

            	
              $359.62
                

            
	
              Age
                45+

            	
              M

            	
              $311.72
                

            	
              $306.10
                

            	
              $308.53
                

            	
              $317.26
                

            	
              $281.12
                

            	
              $286.97
                

            	
              $237.55
                

            	
              $321.08
                

            	
              $305.70
                

            	
              $288.38
                

            	
              $286.43
                

            	
              $275.69
                

            	
              $329.78
                

            	
              $317.10
                

            
	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            
	
               

            	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
               

            
	
              An
                HMO may be eligible for a 2.7% increase above the rate effective
                1/1/2007
                if all of the following applies:

               

              a.
                the HMO serves a county that has at least 20,000 eligible Family
                Medicaid
                and BadgerCare enrollees;

              b.
                as of November 1, 2006, the enrollment limits of the HMOs serving
                that
                county are not sufficient for the Department to enroll all of those
                eligible enrollees; and,

              c.
                the HMO agrees to increase its enrollment limit that was in effect
                on
                November 1, 2006.

            	 

    

    

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    
      	
              CY
                2007 Healthy Start Pregnant Women Capitation Rates by Rate Region
                and
                Service

            
	
              effective
                January 1st, 2007

            
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
              2007
                HSPW RATES

            	
              1

            	
              2

            	
              3

            	
              4

            	
              5

            	
              6

            	
              7

            	
              8

            	
              9

            	
              10

            	
              11

            	
              12

            	
              13

            	
              14

            
	
               

            	
              Duluth/

            	
              Wausau/

            	
               

            	
               

            	
              Marshfield/

            	
              Appleton/

            	
               

            	
               

            	
              Southeast

            	
               

            	
               

            	
               

            	
               

            	
               

            
	
               

            	
              Superior

            	
              Rhinelander

            	
              Green
                Bay

            	
              Twin
                Cities

            	
              Stevens
                Point

            	
              Oshkosh

            	
              La
                Crosse

            	
              Madison

            	
              Wisconsin

            	
              Milwaukee

            	
              Dane

            	
              Eau
                Claire

            	
              Kenosha

            	
              Waukesha

            
	
              All
                Services 

            	
              $690.40
                

            	
              $646.80
                

            	
              $647.21
                

            	
              $745.55
                

            	
              $676.15
                

            	
              $637.81
                

            	
              $644.62
                

            	
              $713.23
                

            	
              $661.23
                

            	
              $809.72
                

            	
              $723.07
                

            	
              $778.83
                

            	
              $732.77
                

            	
              $677.14
                

            
	
              Dental,
                No Chiro 

            	
              $688.47
                

            	
              $643.91
                

            	
              $645.83
                

            	
              $742.45
                

            	
              $672.58
                

            	
              $635.65
                

            	
              $642.31
                

            	
              $711.05
                

            	
              $659.85
                

            	
              $809.43
                

            	
              $721.78
                

            	
              $775.04
                

            	
              $732.10
                

            	
              $676.26
                

            
	
              Chiro,
                No Dental 

            	
              $687.57
                

            	
              $644.74
                

            	
              $644.98
                

            	
              $742.53
                

            	
              $672.88
                

            	
              $634.18
                

            	
              $642.36
                

            	
              $710.08
                

            	
              $658.65
                

            	
              $805.17
                

            	
              $719.95
                

            	
              $776.88
                

            	
              $727.48
                

            	
              $674.81
                

            
	
              No
                Dental or Chiro 

            	
              $685.64
                

            	
              $641.85
                

            	
              $643.60
                

            	
              $739.43
                

            	
              $669.31
                

            	
              $632.02
                

            	
              $640.05
                

            	
              $707.90
                

            	
              $657.27
                

            	
              $804.88
                

            	
              $718.66
                

            	
              $773.09
                

            	
              $726.81
                

            	
              $673.93
                

            
	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
              2007
                Rates by service and Rate Region

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            	
               

            
	
              All
                Services 

            	
              $690.40
                

            	
              $646.80
                

            	
              $647.21
                

            	
              $745.55
                

            	
              $676.15
                

            	
              $637.81
                

            	
              $644.62
                

            	
              $713.23
                

            	
              $661.23
                

            	
              $809.72
                

            	
              $723.07
                

            	
              $778.83
                

            	
              $732.77
                

            	
              $677.14
                

            
	
              Medical
                

            	
              $685.64
                

            	
              $641.85
                

            	
              $643.60
                

            	
              $739.43
                

            	
              $669.31
                

            	
              $632.02
                

            	
              $640.05
                

            	
              $707.90
                

            	
              $657.27
                

            	
              $804.88
                

            	
              $718.66
                

            	
              $773.09
                

            	
              $726.81
                

            	
              $673.93
                

            
	
              Dental
                

            	
              $2.83
                

            	
              $2.06
                

            	
              $2.23
                

            	
              $3.02
                

            	
              $3.27
                

            	
              $3.63
                

            	
              $2.26
                

            	
              $3.15
                

            	
              $2.58
                

            	
              $4.55
                

            	
              $3.12
                

            	
              $1.95
                

            	
              $5.29
                

            	
              $2.33
                

            
	
              Chiro
                

            	
              $1.93
                

            	
              $2.89
                

            	
              $1.38
                

            	
              $3.10
                

            	
              $3.57
                

            	
              $2.16
                

            	
              $2.31
                

            	
              $2.18
                

            	
              $1.38
                

            	
              $0.29
                

            	
              $1.29
                

            	
              $3.79
                

            	
              $0.67
                

            	
              $0.88CONTRACT

    Exhibit
      10.2

     

    

      99-07-MT-0053

      

      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
        Contract, entered into by and between The Office
        of Medicaid Policy and Planning and the Office of Children's Health Insurance
        Program,
        (hereinafter referred to as "State" or "Office") of the Indiana
        Family and Social Services Administration,
        402
        West Washington Street, Room W382, Indianapolis, IN 46204, and Coordinated
        Care Corporation Indiana, Inc. (hereinafter
        referred to as "Contractor"), is executed pursuant to the terms and conditions
        set forth herein.

      

      WHEREAS,
        IC 12-15-30-1 authorizes the Office of Medicaid Policy and Planning to enter
        into contracts to assist in the administration of the Medicaid
        program;

      

      WHEREAS,
        IC 12-17.6 authorizes the Office of the Children's Health Insurance Program
        to
        enter into contracts as necessary to assist in the design and administration
        of
        the Indiana Children's Health Insurance Program;

      

      WHEREAS,
        the State of Indiana desires to contract for services to assist the Office's
        efforts to effectively manage a risk-based health care delivery system that
        administers and provides covered health care services for certain Hoosier
        Healthwise members enrolled in Benefit Packages A, B and C, as procured through
        Request for Services (RFS) # 6-68;

      

      WHEREAS,
        the Contractor is willing and able to perform the desired services;

      

      NOW
        THEREFORE, the parties enter into this contract for the consideration set
        out
        below, all of which is deemed to be good and sufficient consideration in
        order
        to make this contract a binding legal instrument.

      

      
        	
                1.

              	
                Duties
                  of Contractor

              

      

      

      The
        Contractor shall provide the following services relative to this
        Contract:

      

      
        	
                A.

              	
                The
                  Contractor agrees to assume financial risk for developing and managing
                  a
                  health care delivery system and for arranging or administering
                  all Hoosier
                  Healthwise covered services except
                  as
                  set out in section 2.3 and 2.5 of Attachment D of the RFS and services
                  provided as part of an individualized education plan (IEP) pursuant
                  to the
                  Individuals with Disabilities Education Act (IDEA) at 20 U.S.C.
                  1400
                  et
                  seq.,
                  in exchange for a per-enrollee, per-month fixed fee, to certain
                  enrollees
                  in Hoosier Healthwise Packages A, B and C. Wards of the State,
                  foster
                  children and children receiving adoption assistance may enroll
                  on a
                  voluntary basis and will not be subject to auto-assignment into
                  the
                  Hoosier Healthwise program. The Contractor must, at a minimum,
                  furnish
                  covered services up to the limits specified by the Medicaid and
                  CHIP
                  programs. The Contractor may exceed these limits. However, in no
                  instance
                  may any covered service's limitations be more restrictive than
                  those which
                  exist in the Indiana Medicaid fee-for-service program for Packages
                  A and
                  B, and the Children's Health Insurance Program for Package
                  C.

              

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	
                B.

              	
                The
                  Contractor agrees to perform all duties and arrange and administer
                  the
                  provision of all services as set out herein and contained in the
                  RFS as
                  attached and the Contractor's responses to the RFS as attached,
                  all of
                  which are incorporated into this Contract by reference. In addition,
                  the
                  Contractor shall comply with all policies and procedures defined
                  in any
                  bulletin, manual, or handbook yet to be distributed by the State
                  or its
                  agents insofar as those policies and procedures are adopted in
                  a manner
                  consistent with the Office's customary practice relative to the
                  establishment of Medicaid policies. The Contractor agrees to comply
                  with
                  all pertinent state and federal statutes and regulations in effect
                  throughout the duration of this Contract and as they may be amended
                  from
                  time to time.

              

      

      

      
        	
                C.

              	
                The
                  Contractor agrees that it will not discriminate against individuals
                  eligible to be covered under this Contract on the basis of health
                  status
                  or need for health services; and the Contractor may not terminate
                  an
                  enrollee's enrollment, or act to encourage an enrollee to terminate
                  his/her enrollment because of an adverse change in the enrollee's
                  health.
                  The disenrollment function will be carried out by a State contractor
                  who
                  is independent of the Contractor; therefore, any request to terminate
                  an
                  enrollee's enrollment must be approved by the Offices. Once an
                  enrollee
                  reaches $2,000,000 in medical costs within a calendar year, Contractor
                  shall notify the Office and provide documentation of the medical
                  costs and
                  reinsurance payments. For enrollees who reach the $2,000,000 annual
                  maximum, the Office will approve the member's
                  disenrollment.

              

      

      

      
        	
                D.

              	
                The
                  Contractor agrees that no services or duties owed by the Contractor
                  under
                  this Contract will be performed or provided by any person or entity
                  other
                  than the Contractor, except as contained in written subcontracts
                  or other
                  legally binding agreements. Prior to entering into any such subcontract
                  or
                  other legally binding agreement, the Contractor shall, in each
                  case,
                  submit the proposed subcontract or other legally binding agreement
                  to the
                  Offices for prior review and approval, provided, however, provider
                  subcontracts may be entered into without prior review and approval
                  if the
                  form of such provider contract has been reviewed and approved by
                  the
                  Office and complies with Section 1.E.. Prior review and approval
                  of a
                  subcontract or legally binding agreement shall not be unreasonably
                  delayed
                  by the Offices. The Offices shall, in appropriate cases and as
                  requested
                  by the Contractor, expedite the review and approval process. Under
                  no
                  circumstances shall the Contractor be deemed to have breached its
                  obligations under this Contract if such breach was a result of
                  the
                  Offices' failure to review and approve timely any proposed subcontract
                  or
                  other legally binding agreement. If the Offices disapprove any
                  proposed
                  subcontract or other legally binding agreement, the Offices shall
                  state
                  with reasonable particularity the basis for such disapproval. No
                  subcontract into which the Contractor enters with respect to performance
                  under this Contract shall in any way relieve the Contractor of
                  any
                  responsibility for the performance of duties under this Contract.
                  All
                  subcontracts and amendments thereto executed by the Contractor
                  under this
                  Contract must meet the following requirements; any existing subcontracts
                  or legally binding agreements which fail to meet the following
                  requirements shall be revised to include the requirements within
                  ninety
                  (90) days from the effective date of this
                  Contract:

              

      

      

      
        	 	
                1.

              	
                Be
                  in writing and specify the functions of the
                  subcontractor.

              

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	 	
                2.

              	
                Be
                  legally binding agreements.

              

      

      

      
        	 	
                3.

              	
                Specify
                  the amount, duration and scope of services to be provided by the
                  subcontractor.

              

      

      

      
        	 	
                4.

              	
                Provide
                  that the Offices and the Department of Health and Human Services
                  may
                  evaluate, through inspection or other means, the quality, appropriateness,
                  and timeliness of services
                  performed.

              

      

      

      
        	 	
                5.

              	
                Provide
                  for inspections of any records pertinent to the contract by the
                  Offices.

              

      

      

      
        	 	
                6.

              	
                Require
                  an adequate record system to be maintained for recording services,
                  charges, dates and all other commonly accepted information elements
                  for
                  services rendered to recipients under the
                  contract.

              

      

      

      
        	 	
                7.

              	
                Provide
                  for the participation of the Contractor and subcontractor in any
                  internal
                  and external quality assurance, utilization review, peer review,
                  and
                  grievance procedures established by the Contractor, in conjunction
                  with
                  the Offices.

              

      

      

      
        	 	
                8.

              	
                Provide
                  that the subcontractor indemnify and hold harmless the State of
                  Indiana,
                  its officers, and employees from all claims and suits, including
                  court
                  costs, attorney's fees, and other expenses, brought because of
                  injuries or
                  damage received or sustained by any person, persons, or property
                  that is
                  caused by any act or omission of the Contractor and/or the subcontractors.
                  The State shall not provide such indemnification to the
                  subcontractor.

              

      

      

      
        	 	
                9.

              	
                Identify
                  and incorporate the applicable terms of this Contract and any incorporated
                  documents. The subcontract shall provide that the subcontractor
                  agrees to
                  perform duties under the subcontract, as those duties pertain to
                  enrollees, in accordance with the applicable terms and conditions
                  set out
                  in this Contract, any incorporated documents, and all applicable
                  state and
                  federal laws, as amended.

              

      

      

      
        	 	
                10.

              	
                Shall
                  not extend beyond the term of the state contract, in accordance
                  with IC
                  12-15-30-5 (b).

              

      

      

      
        	 	
                11.

              	
                Provide
                  for revoking subcontract or the imposition of other sanctions if
                  a
                  subcontractor's performance is
                  inadequate.

              

      

      

      
        	
                E.

              	
                The
                  Contractor agrees that, during the term of this Contract, it shall
                  maintain, with any contracted provider rendering health care services
                  under the RFS, provider service agreements which meet the following
                  requirements; any existing provider service agreements which fail
                  to meet
                  the following requirements shall be revised to include the requirements
                  within ninety (90) days from the effective date of this Contract.
                  The
                  provider service agreements shall:

              

      

      

      
        	 	
                1.

              	
                Comply
                  with the requirements for all subcontracts as detailed above in
                  Section D,
                  numbers 1-11.

              

      

      

      
        	 	
                2.

              	
                Reference
                  a written provider claim resolution
                  procedure.

              

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	 	
                3.

              	
                Provide
                  that a provider give the MCO at least 60 days notice before terminating
                  the agreement unless the provider provides thirty percent or more
                  of the
                  MCO's services, in which case the provider must give at least one
                  hundred
                  twenty days notice.

              

      

      

      
        	
                F.

              	
                The
                  Contractor agrees that all laboratory testing sites providing services
                  under this Contract must have a valid Clinical Laboratory Improvement
                  Amendments (CLIA) certificate and comply with the CLIA regulations
                  at 42
                  CFR Part 493.

              

      

      

      
        	
                G.

              	
                The
                  Contractor agrees that it shall:

              

      

      

      
        	 	
                1.

              	
                Retain,
                  at all times during the period of this Contract, a valid Certificate
                  of
                  Authority under applicable State laws issued by the State of Indiana
                  Department of Insurance.

              

      

      

      
        	 	
                2.

              	
                Ensure
                  that, during the term of this Contract, each provider rendering
                  health
                  care services under the RFS is authorized to do so in accordance
                  with the
                  following:

              

      

      

      
        	 	
                a.

              	
                The
                  provider must maintain a current Indiana Health Coverage Programs
                  (IHCP)
                  provider agreement and must be duly licensed in accordance with
                  the
                  appropriate state licensing board and shall remain in good standing
                  with
                  said board.

              

      

      

      
        	 	
                b.

              	
                If
                  a provider is not authorized to provide such services under a current
                  IHCP
                  provider agreement or is no longer licensed by said board, the
                  Contractor
                  is obligated to terminate its contractual relationship authorizing
                  or
                  requiring such provider to provide services under the RFS. The
                  Contractor
                  must terminate its contractual relationship with the provider as
                  soon as
                  the Contractor has knowledge of the termination of the provider's
                  license
                  or the IHCP provider agreement.

              

      

      

      
        	 	
                3.

              	
                Comply
                  with the specific requirements for Health Maintenance Organizations
                  (HMOs)
                  eligible to receive Federal Financial Participation (FFP) under
                  Medicaid,
                  as listed in the State Organization and General Administration
                  Chapter of
                  the Centers for Medicare and Medicaid Services Medicaid Manual.
                  These
                  requirements include, but are not limited to the
                  following:

              

      

      

      
        	 	
                a.

              	
                The
                  Contractor shall meet the definition of HMO as specified in the
                  Indiana
                  State Medicaid Plan.

              

      

      

      
        	 	
                b.

              	
                Throughout
                  the duration of this Contract, the Contractor shall satisfy the
                  Chicago
                  Regional Office of the Centers for Medicare and Medicaid Services
                  (hereinafter called CMS) that the Contractor is compliant with
                  the Federal
                  requirements for protection against insolvency pursuant to 42 CFR
                  438.116,
                  the requirement that the Contractor shall continue to provide services
                  to
                  Contractor enrollees until the end of the month in which insolvency
                  has
                  occurred, and the requirement that the Contractor shall continue
                  to
                  provide inpatient services until the date of discharge for an enrollee
                  who
                  is institutionalized when insolvency occurs. The Contractor shall
                  meet
                  this requirement by posting a performance bond and satisfying the
                  statutory reserve requirements of the Indiana Department of
                  Insurance.

              

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	 	
                c.

              	
                The
                  Contractor shall comply with, and shall exclude from participation
                  as a
                  subcontractor, including providers, of the Contractor, any entity
                  or
                  person that has been excluded under the authority of Sections 1124A,
                  1128
                  or 11 28A of the Social Security Act or does not comply with the
                  requirements of Section 1128(b) of the Social Security
                  Act.

              

      

      

      
        	 	
                d.

              	
                In
                  the event that the CMS determines that the Contractor has violated
                  any of
                  the provisions of 42 CFR 434.70(a), CMS may deny payment of FFP
                  for new
                  enrollees of the HMO under 42 USC 1396b(m)(5)(B)(ii). The Offices
                  shall
                  automatically deny State payment for new enrollees whenever, and
                  for so
                  long as, Federal payment for such enrollees has been
                  denied.

              

      

      

      
        	 	
                4.

              	
                In
                  addition to the reinsurance coverage requirements in Section 1.6.3.
                  of
                  Attachment D: Scope of Work, the Contractor must obtain reinsurance
                  coverage of at least $2,000,000 per member per
                  year.

              

      

      

      
        	
                H.

              	
                The
                  Contractor shall submit proof, satisfactory to the Offices, of
                  indemnification of the Contractor by the Contractor's parent corporation,
                  if applicable, and by all of its
                  subcontractors.

              

      

      

      
        	
                I.

              	
                The
                  Contractor shall submit proof, satisfactory to the Offices, that
                  all
                  subcontractors will hold the State harmless from liability under
                  the
                  subcontract. This assurance in no way relieves the Contractor of
                  any
                  responsibilities under the RFS or this
                  Contract.

              

      

      

      
        	
                J.

              	
                The
                  Contractor agrees that, prior to initially enrolling any Hoosier
                  Healthwise Package A, B or C enrollees, it shall go through and
                  satisfactorily complete the readiness review as described in the
                  RFS. The
                  required readiness review shall begin before the contract between
                  the
                  Contractor and the State is finalized and executed. Within ninety
                  (90)
                  days from the effective date of this Contract, the Contractor shall
                  make a
                  good faith effort to resolve, to the satisfaction of the Offices,
                  any
                  outstanding issues brought to the Contractor's attention by the
                  Offices as
                  a result of the readiness review.

              

      

      

      
        	
                K.

              	
                The
                  Contractor shall establish and maintain a quality improvement program
                  that
                  meets the requirements of 42 CFR 438, subpart D, as well as other
                  specific
                  requirements set forth in the RFS. The Offices and CMS may evaluate,
                  through inspection or other means, including but not limited to,
                  the
                  review of the quality assurance reports required under this Contract,
                  and
                  the quality, appropriateness, and timeliness of services performed
                  under
                  this Contract. The Contractor agrees to participate and cooperate,
                  as
                  directed by the Offices, in the annual external quality review
                  of the
                  services furnished by the
                  Contractor.

              

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	
                L.

              	
                In
                  accordance with 42 CFR 438.6(i), the Contractor agrees that it
                  and any of
                  its subcontractors shall comply with the requirements, if applicable,
                  of
                  42 CFR 489, Subpart I, relating to maintaining and distributing
                  written
                  policies and procedures respecting advance directives. The Contractor
                  shall distribute policies and procedures to adult individuals during
                  the
                  enrollee enrollment process and whenever there are revisions to
                  these
                  policies and procedures. The Contractor shall make available for
                  inspection, upon reasonable notice and request by the Offices,
                  documentation concerning its written policies, procedures and distribution
                  of such written procedures to
                  enrollees.

              

      

      

      
        	
                M.

              	
                Pursuant
                  to 42 CFR 417.479(a), the Contractor agrees that no specific payment
                  can
                  be made directly or indirectly under a physician incentive plan
                  to a
                  physician or physician group as an inducement to reduce or limit
                  medically
                  necessary services furnished to an individual enrollee. The Contractor
                  must disclose to the State the information on provider incentive
                  plans
                  listed in 42 CFR 417.479(h)(l) and 417.479(i) at the times indicated
                  at 42
                  C.F.R. 434.70(a)(3), in order to determine whether the incentive
                  plan
                  meets the requirements of 42 CFR 417.479(d)-(g). The Contractor
                  must
                  provide to the State satisfactory capitation data as requested
                  by the
                  State for the previous calendar year by application/contract renewal
                  of
                  each year. The Contractor will provide the information on its physician
                  incentive plan(s) listed in 42 CFR 417.479(h)(3) to any enrollee
                  upon
                  request.

              

      

      

      
        	
                N.

              	
                The
                  Contractor must not prohibit or restrict a health care professional
                  from
                  advising an enrollee about his/her health status, medical care,
                  or
                  treatment, regardless of whether benefits for such care are provided
                  under
                  this Contract, if the professional is acting within the lawful
                  scope of
                  practice. However, this provision does not require the Contractor
                  to
                  provide coverage of a counseling or referral service if the Contractor
                  objects to the service on moral or religious grounds and makes
                  available
                  information on its policies to potential enrollees and enrollees
                  within
                  ninety (90) days after the date the Contractor adopts a change
                  in policy
                  regarding such counseling or referral
                  service.

              

      

      

      
        	
                O.

              	
                In
                  accordance with 42 U.S.C. § 1396u-2(b)(6), the Contractor agrees that an
                  enrollee may not be held liable for the
                  following:

              

      

      

      
        	 	
                1.

              	
                Debts
                  of the Contractor, or its subcontractors, in the event of any
                  organization's insolvency;

              

      

      

      
        	 	
                2.

              	
                Services
                  provided to the enrollee in the event the Contractor fails to receive
                  payment from the Offices for such services or in the event a provider
                  fails to receive payment from the Contractor or Offices;
                  or

              

      

      

      
        	 	
                3.

              	
                Payments
                  made to a provider in excess of the amount that would be owed by
                  the
                  enrollee if the Contractor had directly provided the
                  services.

              

      

      

      
        	
                P.

              	
                The
                  Offices may from time to time request and the Contractor, and all
                  of its
                  subcontractors, agree that the Contractor, or its subcontractors,
                  shall
                  prepare and submit additional compilations and reports as requested
                  by the
                  Offices. Such requests will be limited to situations in which the
                  desired
                  data is considered essential and cannot be obtained through existing
                  Contractor reports. The Contractor, and all of its subcontractors,
                  agree
                  that a response to the request shall be submitted within thirty
                  (30) days
                  from the date of the request, or by the Offices' requested completion
                  date, whichever is earliest. The response shall include the additional
                  compilations and reports as requested, or the status of the requested
                  information and an expected completion date. When such requests
                  pertain to
                  legislative inquiries or expedited inquiries from the Office of
                  the
                  Governor, the additional compilations and reports shall be submitted
                  by
                  the Offices' requested completion date. Failure by the Contractor,
                  or its
                  subcontractors, to comply with response time frames shall be considered
                  grounds for the Offices to pursue the provisions outlined in Section
                  8 of
                  Attachment D of the RFS. In the event that delays in submissions
                  are a
                  consequence of a delay by the Offices or the Medicaid Fiscal Agent,
                  the
                  time frame for submission shall be extended by the length of time
                  of the
                  delay.

              

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	
                Q.

              	
                Contractor
                  agrees that an abortion will be covered only in the following
                  situations:

              

      

      

      
        	 	
                1.

              	
                If
                  the pregnancy is the result of an act of rape or incest;
                  or

              

      

      

      
        	 	
                2.

              	
                If
                  the woman suffers from a physical disorder, physical injury, or
                  physical
                  illness, including a life-endangering physical condition caused
                  by or
                  arising from the pregnancy itself, which would, as certified by
                  a
                  physician, place the woman in danger of death unless an abortion
                  is
                  performed.

              

      

      

      
        	
                R.

              	
                Contractor
                  agrees that any cost sharing charges, such as copayments, imposed
                  on
                  Contractor's members are in compliance with 42 CFR 447.50 through
                  447.60.

              

      

      

      
        	
                2.

              	
                Consideration

              

      

      

      
        	
                A.

              	
                In
                  consideration of the services to be performed by the Contractor,
                  the
                  Offices agree to pay the Contractor the amounts per month per enrolled
                  member, and per maternity delivery, as contained in the Offices'
                  capitation payment listing based upon the capitation rates by category
                  as
                  listed in FINANCIAL
                  ATTACHMENT A

              

      

      

      
        	
                B.

              	
                Special
                  payments for exceeding performance requirements will be made to
                  Contractor
                  as described on ATTACHMENT
                  B.
                  ATTACHMENT
                  B
                  also sets forth provisions respecting the assessment of liquidated
                  damages
                  based on Contract compliance. Payment will be made to (from) the
                  Contractor as set out in ATTACHMENT
                  B.

              

      

      

      
        	
                C.

              	
                ATTACHMENTS
                  A
                  and B
                  are hereby incorporated into this
                  Contract.

              

      

      

      
        	
                3.

              	
                Term

              

      

      

      This
        Contract shall be effective for a period of four (4) years. It shall commence
        on
        January 1, 2007, and shall remain in effect through December 31, 2010. At
        the
        discretion of the State, the term may be extended for up to two (2) additional
        year(s). In no event shall the term exceed December 31, 2012.

      

      
        	
                4.

              	
                Access
                  to Records

              

      

      

      The
        Contractor and its subcontractors, if any, shall maintain all books, documents,
        papers, accounting records, and other evidence pertaining to all costs incurred
        under this Contract. They shall make such materials available at their
        respective offices at all reasonable times during this Contract term, and
        for
        three (3) years from the date of final payment under this Contract, for
        inspection by the State, Federal government or by any other authorized
        representative of state government. Copies thereof shall be furnished at
        no cost
        to the State if requested.

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	
                5.

              	
                Assignment

              

      

      

      The
        Contractor binds its successors and assignees to all the terms and conditions
        of
        this Contract. The Contractor shall not assign or subcontract the whole or
        any
        part of this Contract without the State's prior written consent. The Contractor
        may assign its right to receive payments to such third parties as the Contractor
        may desire without the prior written consent of the State, provided that
        Contractor gives written notice (including evidence of such assignment) to
        the
        State thirty (30) days in advance of any payment so assigned. The assignment
        shall cover all unpaid amounts under this Contract and shall not be made
        to more
        than one party.

      

      
        	
                6.

              	
                Audits

              

      

      

      Contractor
        acknowledges that it may be required to submit to an audit of funds paid
        through
        this Contract. Any such audit shall be conducted in accordance with IC 5-11-1
        and audit guidelines specified by the State.

      

      
        	
                7.

              	
                Authority
                  to Bind Contractor

              

      

      

      The
        signatory for the Contractor represents that he/she has been duly authorized
        to
        execute this Contract on behalf of the Contractor and has obtained all necessary
        or applicable approvals to make this Contract fully binding upon the Contractor
        when his/her signature is affixed, and certifies that this Contract is not
        subject to further acceptance by Contractor when accepted by the State of
        Indiana.

      

      
        	
                8.

              	
                Changes
                  in Work

              

      

      

      In
        the
        event the State requires a material change in the scope, character or complexity
        of the work after the work has begun, adjustments in compensation to the
        Contractor shall be determined by the State in the exercise of its good faith
        and prudent judgment. The Contractor shall not commence any additional work
        or
        change the scope of the work until authorized in writing by the State. No
        claim
        for additional compensation shall be made in the absence of a prior written
        approval executed by all signatories hereto.

      

      
        	
                9.

              	
                Compliance
                  with Laws

              

      

      

      
        	
                A.

              	
                The
                  Contractor shall comply with all applicable federal, state and
                  local laws,
                  rules, regulations and ordinances, and all provisions required
                  thereby to
                  be included herein are hereby incorporated by reference. The enactment
                  of
                  any state or federal statute or the promulgation of rules or regulations
                  thereunder after execution of this Contract shall be reviewed by
                  the State
                  and the Contractor to determine whether the provisions of this
                  Contract
                  require formal modification.

              

      

      

      
        	
                B.

              	
                The
                  Contractor and its agents shall abide by all ethical requirements
                  that
                  apply to persons who have a business relationship with the State,
                  as set
                  forth in Indiana Code § 4-2-6 et
                  seq.,
                  the regulations promulgated thereunder, and Executive Order 04-08,
                  dated
                  April 27, 2004. If the contractor is not familiar with these ethical
                  requirements, the contractor should refer any questions to the
                  State
                  Ethics Commission, or visit the State Ethics Commission website
                  at
                  http://www.in.gov/ethics/.
                  If the Contractor or its agents violate any applicable ethical
                  standards,
                  the State may, in its sole discretion, terminate this Contract
                  immediately
                  upon notice to the contractor. In addition, the Contractor may
                  be subject
                  to penalties under Indiana Code §
4-2-6-12.

              

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	
                C.

              	
                The
                  Contractor certifies by entering into this Contract that neither
                  it nor
                  its principal(s) is presently in arrears in payment of taxes, permit
                  fees
                  or other statutory, regulatory or judicially required payments
                  to the
                  State. The Contractor agrees that any payments currently due to
                  the State
                  of Indiana may be withheld from payments due to the Contractor.
                  Additionally, further work or payments may be withheld, delayed,
                  or denied
                  and/or this Contract suspended until the Contractor is current
                  in its
                  payments and has submitted proof of such payment to the
                  State.

              

      

      

      
        	
                D.

              	
                The
                  Contractor warrants that it has no pending or outstanding criminal,
                  civil,
                  or enforcement actions initiated by the State, and agrees that
                  it will
                  immediately notify the State of any such actions. During the term
                  of such
                  actions, Contractor agrees that the State may delay, withhold,
                  or deny
                  work under any supplement, amendment, change order or other contractual
                  device issued pursuant to this
                  Contract.

              

      

      

      
        	
                E.

              	
                If
                  a valid dispute exists as to the Contractor's liability or guilt
                  in any
                  action initiated by the State of Indiana or its agencies, and the
                  State
                  decides to delay, withhold, or deny work to the Contractor, the
                  Contractor
                  may request that it be allowed to continue, or receive work, without
                  delay. The Contractor must submit, in writing, a request for review
                  to the
                  Indiana Department of Administration (IDOA) following the procedures
                  for
                  disputes outlined herein. A determination by IDOA shall be binding
                  on the
                  parties.

              

      

      

      
        	
                F.

              	
                Any
                  payments that the State may delay, withhold, deny, or apply under
                  this
                  section shall not be subject to penalty or interest under IC
                  5-17-5.

              

      

      

      
        	
                G.

              	
                The
                  Contractor warrants that the Contractor and its subcontractors,
                  if any,
                  shall obtain and maintain all required permits, licenses, and approvals,
                  as well as comply with all health, safety, and environmental statutes,
                  rules, or regulations in the performance of work activities for
                  the State.
                  Failure to do so may be deemed a material breach of this Contract
                  and
                  grounds for immediate termination and denial of further work with
                  the
                  State.

              

      

      

      
        	
                H.

              	
                The
                  Contractor affirms that it is properly registered and owes no outstanding
                  reports with the Indiana Secretary of
                  State.

              

      

      

      
        	
                I.

              	
                As
                  required by IC 5-22-3-7:

              

      

      

      (1)
        the
        Contractor and any principals of the Contractor certify that (A) the Contractor,
        except for de minimis and nonsystematic violations, has not violated the
        terms
        of (i) IC 24-4.7 [Telephone Solicitation Of Consumers], (ii) IC 24-5-12
        [Telephone Solicitations], or (iii) IC 24-5-14 [Regulation of Automatic Dialing
        Machines] in the previous three hundred sixty-five (365) days, even if IC
        24-4.7
        is preempted by federal law; and (B) the Contractor will not violate the
        terms
        of IC 24-4.7 for the duration of the Contract, even if IC 24-4.7 is preempted
        by
        federal law.

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      (2)
        The
        Contractor and any principals of the Contractor certify that an affiliate
        or
        principal of the Contractor and any agent acting on behalf of the Contractor
        or
        on behalf of an affiliate or principal of the Contractor: (A) except for
        de
        minimis and nonsystematic violations, has not violated the terms of IC 24-4.7
        in
        the previous three hundred sixty-five (365) days, even if IC 24-4.7 is preempted
        by federal law; and (B) will not violate the terms of IC 24-4.7 for the duration
        of the Contract, even if IC 24-4.7 is preempted by federal law.

      

      
        	
                10.

              	
                Condition
                  of Payment

              

      

      

      All
        services provided by the Contractor under this Contract must be performed
        to the
        State's reasonable satisfaction, as determined at the discretion of the
        undersigned State representative and in accordance with all applicable federal,
        state, local laws, ordinances, rules, and regulations. The State shall not
        be
        required to pay for work found to be unsatisfactory, inconsistent with this
        Contract or performed in violation of any federal, state, or local statute,
        ordinance, rule or regulation.

      

      
        	
                11.

              	
                Confidentiality
                  of State Information

              

      

      

      The
        Contractor understands and agrees that data, materials, and information
        disclosed to Contractor may contain confidential and protected information.
        The
        Contractor covenants that data, material, and information gathered, based
        upon,
        or disclosed to the Contractor for the purpose of this Contract, will not
        be
        disclosed to or discussed with third parties without the prior written consent
        of the State; however, Contractor may disclose such confidential information
        to
        Contractor's legal and financial advisors, providers and other subcontractors
        to
        the extent that such disclosure is permitted by applicable law.

      

      
        	
                12.

              	
                Conflict
                  of Interest

              

      

      

      
        	
                A.

              	
                As
                  used in this section:

              

      

      

      "Immediate
        family" means the spouse and the unemancipated children of an
        individual.

      

      "Interested
        party," means:

      

      
        	 	
                1

              	
                The
                  individual executing this Contract;

              

      

      

      
        	 	
                2.

              	
                An
                  individual who has an interest of three percent (3%) or more of
                  Contractor, if Contractor is not an individual;
                  or

              

      

      

      
        	 	
                3.

              	
                Any
                  member of the immediate family of an individual specified under
                  subdivision 1 or 2.

              

      

      

      "Department"
        means the Indiana Department of Administration.

      

      "Commission"
        means the State Ethics Commission.

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	
                B.

              	
                The
                  Department may cancel this Contract without recourse by Contractor
                  if any
                  interested party is an employee of the State of
                  Indiana.

              

      

      

      
        	
                C.

              	
                The
                  Department will not exercise its right of cancellation under section
                  B,
                  above, if the Contractor gives the Department an opinion by the
                  Commission
                  indicating that the existence of this Contract and the employment
                  by the
                  State of Indiana of the interested party does not violate any statute
                  or
                  rule relating to ethical conduct of State employees. The Department
                  may
                  take action, including cancellation of this Contract, consistent
                  with an
                  opinion of the Commission obtained under this
                  section.

              

      

      

      
        	
                D.

              	
                Contractor
                  has an affirmative obligation under this Contract to disclose to
                  the
                  Department when an interested party is or becomes an employee of
                  the State
                  of Indiana. The obligation under this section extends only to those
                  facts
                  that Contractor knows or reasonably could
                  know.

              

      

      

      
        	
                13.

              	
                Continuity
                  of Services

              

      

      

      The
        Contractor recognizes that the service(s) to be performed under this Contract
        are vital to the State and must be continued without interruption and that,
        upon
        Contract expiration, a successor, either the State or another contractor,
        may
        continue them. The Contractor agrees to:

      

      
        	 	
                1.

              	
                Furnish
                  phase-in training, and

              

      

      

      
        	 	
                2.

              	
                Exercise
                  its best efforts and cooperation to effect an orderly and efficient
                  transition to a successor.

              

      

      

      In
        addition, Contractor shall fulfill its responsibilities under Section 9.3
        of RFS
        Attachment D.

      

      
        	
                14.

              	
                Debarment
                  and Suspension

              

      

      

      
        	
                A.

              	
                The
                  Contractor certifies, by entering into this Contract, that neither
                  it nor
                  its principals nor any of its subcontractors are presently debarred,
                  suspended, proposed for debarment, declared ineligible, or voluntarily
                  excluded from entering into this Contract by any federal agency
                  or by any
                  department, agency or political subdivision of the State. The term
                  "principal" for purposes of this Contract means an officer, director,
                  owner, partner, key employee, or other person with primary management
                  or
                  supervisory responsibilities, or a person who has a critical influence
                  on
                  or substantive control over the operations of the
                  Contractor.

              

      

      

      
        	
                B.

              	
                The
                  Contractor certifies that it has verified the suspension and debarment
                  status for all sub-contractors receiving funds under this Contract
                  and
                  shall be solely responsible for any recoupments or penalties that
                  might
                  arise from non-compliance. Contractor shall notify the State if
                  any
                  sub-contractor becomes debarred or suspended, and shall, at the
                  State's
                  request, take all steps required by the State to terminate its
                  contractual
                  relationship with the sub-contractor for work to be performed under
                  this
                  Contract.

              

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	
                15.

              	
                Default
                  by State

              

      

      

      If
        the
        State, sixty (60) days after receipt of written notice, fails to correct
        or cure
        any material breach of this Contract, then the Contractor may cancel and
        terminate this Contract and institute the appropriate measures to collect
        all
        monies due up to and including the date of termination.

      

      
        	
                16.

              	
                Disputes

              

      

      

      
        	
                A.

              	
                Should
                  any disputes arise with respect to this Contract, the Contractor
                  and the
                  State agree to act immediately to resolve such disputes. Time is
                  of the
                  essence in the resolution of
                  disputes.

              

      

      

      
        	
                B.

              	
                The
                  Contractor agrees that, the existence of a dispute notwithstanding,
                  it
                  will continue without delay to carry out all its responsibilities
                  under
                  this Contract that are not affected by the dispute. Should the
                  Contractor
                  fail to continue to perform its responsibilities regarding all
                  non-disputed work, without delay, any additional costs incurred
                  by the
                  State or the Contractor as a result of such failure to proceed
                  shall be
                  borne by the Contractor, and the Contractor shall make no claim
                  against
                  the State for such costs. If the State and the Contractor cannot
                  resolve a
                  dispute within ten (10) working days following notification in
                  writing by
                  either party of the existence of a dispute, then the following
                  procedure
                  shall apply:

              

      

      

      
        	 	
                1.

              	
                The
                  parties agree to resolve such matters through submission of their
                  dispute
                  to the Commissioner of the Indiana Department of Administration.
                  The
                  Commissioner shall reduce a decision to writing and mail or otherwise
                  furnish a copy thereof to the Contractor and the State within ten
                  (10)
                  working days after presentation of such dispute for action. The
                  Commissioner's decision shall be final and conclusive unless either
                  party
                  mails or otherwise furnishes to the Commissioner, within ten (10)
                  working
                  days after receipt of the Commissioner's decision, a written appeal.
                  Within ten (10) working days of receipt by the Commissioner of
                  a written
                  request for appeal, the decision may be reconsidered. If no
                  reconsideration is provided within ten (10) working days, the parties
                  may
                  mutually agree to submit the dispute to arbitration for a determination,
                  or otherwise either party may submit the dispute to an Indiana
                  court of
                  competent jurisdiction.

              

      

      

      
        	 	
                2.

              	
                The
                  State may withhold payments on disputed items pending resolution
                  of the
                  dispute. The unintentional nonpayment by the State to the Contractor
                  of
                  one or more invoices not in dispute in accordance with the terms
                  of this
                  Contract will not by itself be cause for Contractor to terminate
                  this
                  Contract, and the Contractor may bring suit to collect these amounts
                  without following the disputes procedure contained
                  herein.

              

      

      

      
        	
                17.

              	
                Drug-Free
                  Workplace Certification

              

      

      

      The
        Contractor hereby covenants and agrees to make a good faith effort to provide
        and maintain a drug-free workplace. The Contractor will give written notice
        to
        the State within ten (10) days after receiving actual notice that the Contractor
        or an employee of the Contractor in the State of Indiana has been convicted
        of a
        criminal drug violation occurring in the Contractor's
        workplace.

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      False
        certification or violation of this certification may result in sanctions
        including, but not limited to, suspension of contract payments, termination
        of
        this Contract and/or debarment of contracting opportunities with the State
        for
        up to three (3) years.

      

      In
        addition to the provisions of the above paragraphs, if the total contract
        amount
        set forth in this Contract is in excess of $25,000.00, Contractor hereby
        further
        agrees that this contract is expressly subject to the terms, conditions,
        and
        representations of the following certification:

      

      This
        certification is required by Executive Order No. 90-5, April 12, 1990, issued
        by
        the Governor of Indiana. Pursuant to its delegated authority, the Indiana
        Department of Administration is requiring the inclusion of this certification
        in
        all contracts and grants from the State of Indiana in excess of $25,000.00.
        No
        award of a contract shall be made, and no contract, purchase order or agreement,
        the total amount of which exceeds $25,000.00, shall be valid, unless and
        until
        this certification has been fully executed by the Contractor and made a part
        of
        the contract or agreement as part of the contract documents.

      

      The
        Contractor certifies and agrees that it will provide a drug-free workplace
        by:

      

      
        	
                A.

              	
                Publishing
                  and providing to all of its employees a statement notifying them
                  that the
                  unlawful manufacture, distribution, dispensing, possession or use
                  of a
                  controlled substance is prohibited in the Contractor's workplace,
                  and
                  specifying the actions that will be taken against employees for
                  violations
                  of such prohibition;

              

      

      

      
        	
                B.

              	
                Establishing
                  a drug-free awareness program to inform its employees of (1) the
                  dangers
                  of drug abuse in the workplace; (2) the Contractor's policy of
                  maintaining
                  a drug-free workplace; (3) any available drug counseling, rehabilitation,
                  and employee assistance programs; and (4) the penalties that may
                  be
                  imposed upon an employee for drug abuse violations occurring in
                  the
                  workplace;

              

      

      

      
        	
                C.

              	
                Notifying
                  all employees in the statement required by subparagraph (A) above
                  that as
                  a condition of continued employment, the employee will (1) abide
                  by the
                  terms of the statement; and (2) notify the Contractor of any criminal
                  drug
                  statute conviction for a violation occurring in the workplace no
                  later
                  than five (5) days after such
                  conviction;

              

      

      

      
        	
                D.

              	
                Notifying
                  in writing the State within ten (10) days after receiving notice
                  from an
                  employee under subdivision (C)(2) above, or otherwise receiving
                  actual
                  notice of such conviction;

              

      

      

      
        	
                E.

              	
                Within
                  thirty (30) days after receiving notice under subdivision (C)(2)
                  above of
                  a conviction, imposing the following sanctions or remedial measures
                  on any
                  employee who is convicted of drug abuse violations occurring in
                  the
                  workplace: (1) taking appropriate personnel action against the
                  employee,
                  up to and including termination; or (2) requiring such employee
                  to
                  satisfactorily participate in a drug abuse assistance or rehabilitation
                  program approved for such purposes by a federal, state or local
                  health,
                  law enforcement, or other appropriate agency;
                  and

              

      

      

      
        	
                F.

              	
                Making
                  a good faith effort to maintain a drug-free workplace through the
                  implementation of subparagraphs (A) through (E)
                  above.

              

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	
                18.

              	
                Employment
                  Option

              

      

      

      If
        the
        State determines that it would be in the State's best interest to hire an
        employee of the Contractor, the Contractor will release the selected employee
        from any non-compete agreements that may be in effect solely for the purpose
        of
        employment with the State and any non-compete will otherwise remain in effect.
        This release will be at no cost to the State or the employee.

      

      
        	
                19.

              	
                Force
                  Majeure

              

      

      

      In
        the
        event that either party is unable to perform any of its obligations under
        this
        Contract or to enjoy any of its benefits because of natural disaster or decrees
        of governmental bodies not the fault of the affected party (hereinafter referred
        to as a "Force Majeure Event"), the party who has been so affected shall
        immediately give notice to the other party and shall do everything possible
        to
        resume performance. Upon receipt of such notice, all obligations under this
        Contract shall be immediately suspended. If the period of nonperformance
        exceeds
        thirty (30) days from the receipt of notice of the Force Majeure Event, the
        party whose ability to perform has not been so affected may, by giving written
        notice, terminate this Contract.

      

      
        	
                20.

              	
                Funding
                  Cancellation

              

      

      

      When
        the
        Director of the State Budget Agency makes a written determination that funds
        are
        not appropriated or otherwise available to support continuation of performance
        of this Contract, this Contract shall be canceled. A determination by the
        Budget
        Director that funds are not appropriated or otherwise available to support
        continuation of performance shall be final and conclusive.

      

      
        	
                21.

              	
                Governing
                  Laws

              

      

      

      This
        Contract shall be construed in accordance with and governed by the laws of
        the
        State of Indiana and suit, if any, must be brought in the State of
        Indiana.

      

      
        	
                22.

              	
                Indemnification

              

      

      

      Contractor
        agrees to indemnify, defend, and hold harmless the State of Indiana and its
        agents and employees from all claims and suits including court costs, attorney's
        fees, and other expenses caused by any act or omission of the Contractor
        and/or
        its subcontractors, if any, in the performance of this contract. The State
        shall
not
        provide
        such indemnification to the Contractor.

      

      
        	
                23.

              	
                Independent
                  Contractor

              

      

      

      Both
        parties hereto, in the performance of this Contract, shall act in an individual
        capacity and not as agents, employees, partners, joint venturers or associates
        of one another. The employees or agents of one party shall not be deemed
        or
        construed to be the employees or agents of the other party for any purposes
        whatsoever. Neither party will assume liability for any injury (including
        death)
        to any persons, or damage to any property arising out of the acts or omissions
        of the agents, employees or subcontractors of the other party.

      

      The
        Contractor shall be responsible for providing all necessary unemployment
        and
        workers' compensation insurance for the Contractor's employees.

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	
                24.

              	
                Information
                  Technology Enterprise Architecture
                  Requirements

              

      

      

      If
        Contractor provides any information technology related products or services
        to
        the State, Contractor shall comply with all Indiana Office of Technology
        (IOT)
        standards, policies, and guidelines, which are online at http://iot.in.gov/architecture/.
        Contractor specifically agrees that all hardware, software, and services
        provided to or purchased by the State shall be compatible with the principles
        and goals contained in the electronic and information technology accessibility
        standards adopted under Section 508 of the Federal Rehabilitation Act of
        1973
        (29 U.S.C. 794d) and IC 4-13.1-3. Any deviation from these architecture
        requirements must be approved in writing by IOT in advance. The State may
        terminate this contract for default if Contractor fails to cure a breach
        of this
        provision within a reasonable time

      

      
        	
                25.

              	
                Insurance

              

      

      

      
        	
                A.

              	
                The
                  Contractor shall secure and keep in force during the term of this
                  Contract, the following insurance coverage, covering the Contractor
                  for
                  any and all claims of any nature which may in any manner arise
                  out of or
                  result from this Contract:

              

      

      

      
        	 	
                1.

              	
                Commercial
                  general liability, including contractual coverage, and products
                  or
                  completed operations coverage (if applicable), with minimum liability
                  limits of $5,000,000 per occurrence unless additional coverage
                  is required
                  by the State.

              

      

      

      
        	 	
                2.

              	
                Automobile
                  liability with minimum liability limits of $700,000 per person
                  and
                  $5,000,000 per occurrence.

              

      

      

      
        	 	
                3.

              	
                The
                  Contractor shall provide proof of such insurance coverage by tendering
                  to
                  the undersigned State representative, a certificate of insurance
                  prior to
                  the commencement of this Contract and proof of Workers compensation
                  coverage meeting all statutory requirements of IC 22-3-2. In addition,
                  an
                  "all states endorsement" covering claims occurring outside the
                  State if
                  any of the services provided under this Contract involve work outside
                  of
                  Indiana.

              

      

      

      
        	
                B.

              	
                The
                  Contractor's insurance coverage must meet the following additional
                  requirements:

              

      

      

      
        	 	
                1.

              	
                The
                  insurer must have a certificate of authority issued by the Indiana
                  Department of Insurance.

              

      

      

      
        	 	
                2.

              	
                Any
                  deductible or self-insured retention amount or other similar obligation
                  under the insurance policies shall be the sole obligation of the
                  Contractor.

              

      

      

      
        	 	
                3.

              	
                The
                  State will be defended, indemnified, and held harmless to the full
                  extent
                  of any coverage actually secured by the Contractor in excess of
                  the
                  minimum requirements set forth above. The duty to indemnify the
                  State
                  under this contract shall not be limited by the insurance required
                  in this
                  Contract.

              

      

      

      
        	 	
                4.

              	
                The
                  insurance required in this Contract, through a policy or endorsements,
                  shall include a provision that the policy and endorsements may
                  not be
                  canceled or modified without thirty (30) days' prior written notice
                  to the
                  undersigned State agency.

              

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      Failure
        to provide insurance as required in this Contract may be deemed a material
        breach of contract entitling the State to immediately terminate this Contract.
        The Contractor shall furnish a certificate of insurance and all endorsements
        to
        the undersigned State agency prior to the commencement of this
        Contract.

      

      
        	
                26.

              	
                Key
                  Person(s)

              

      

      

      
        	
                A.

              	
                If
                  both parties have designated that certain individual(s) are essential
                  to
                  the services offered, the parties agree that should such individual(s)
                  leave their employment during the term of this Contract for whatever
                  reason, the State shall have the right to terminate this Contract
                  upon
                  thirty (30) days prior written
                  notice.

              

      

      

      
        	
                B.

              	
                In
                  the event that the Contractor is an individual, that individual
                  shall be
                  considered a key person and, as such, essential to this Contract.
                  Substitution of another for the Contractor shall not be permitted
                  without
                  express written consent of the
                  State.

              

      

      

      
        	
                C.

              	
                Nothing
                  in sections A and B, above shall be construed to prevent the Contractor
                  from using the services of others to perform tasks ancillary to
                  those
                  tasks which directly require the expertise of the key person. Examples
                  of
                  such ancillary tasks include secretarial, clerical, and common
                  labor
                  duties. The Contractor shall, at all times, remain responsible
                  for the
                  performance of all necessary tasks, whether performed by a key
                  person or
                  others.

              

      

      

      Key
        person to this Contract is

      None.______________________________________________

      

      
        	
                27.

              	
                Licensing
                  Standards

              

      

      

      The
        parties agree that Contractor and its employees and subcontractors shall
        comply
        with all applicable licensing standards, certification standards, accrediting
        standards and any other laws, rules or regulations governing services to
        be
        provided by the Contractor pursuant to this Contract. The State shall not
        be
        required to reimburse Contractor for any services performed when Contractor
        or
        its employees or subcontractors are not in compliance with such applicable
        standards, laws, rules or regulations. If licensure, certification or
        accreditation expires or is revoked, or if disciplinary action is taken against
        the applicable licensure or accreditation, Contractor shall notify State
        immediately and the State, at its option, may immediately terminate this
        Contract.

      

      
        	
                28.

              	
                Merger
                  and Modification

              

      

      

      This
        contract constitutes the entire agreement between the parties. No
        understandings, agreements, or representations, oral or written, not specified
        within this contract will be valid provisions of this contract. This contract
        may not be modified, supplemented, or amended, in any manner, except by written
        agreement signed by all necessary parties.

      

      
        	
                29.

              	
                Minority
                  and Women Business Enterprise
                  Compliance

              

      

      

      The
        Contractor agrees to comply fully with the provisions of 25 IAC 5 and any
        participation plan that may have been submitted to the State.

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      The
        following MBE's and WBE's listed on the Minority and Women's Business
        Enterprises Division directory of certified firms will be participating in
        this
        Contract. During the course of the Contract, any change to the listed firms
        found in this section must be submitted to, and approved by, IDOA in writing.
        A
        formal amendment process is not required, but formal written approval from
        IDOA
        is required for changes in subcontractor participation.

      

      
        	
                MBE/WBE

              	
                PHONE

              	
                COMPANY NAME

              	
                SCOPE
                  OF PRODUCTS/
                  SERVICES

              	
                UTILIZATION DATE

              	
                AMOUNT

              
	 	 	 	 	 	 
	
                SEE

              	
                ATTACHED

              	
                EXHIBIT
                  1

              	
                 

              	
                 

              	
                 

              
	 	 	 	 	 	 
	 	 	 	 	 	 

      

      

      
        	
                30.

              	
                Nondiscrimination

              

      

      

      Pursuant
        to IC 22-9-1-10 and the Civil Rights Act of 1964, Contractor and its
        subcontractors shall not discriminate against any employee or applicant for
        employment in the performance of this Contract. The Contractor shall not
        discriminate with respect to the hire, tenure, terms, conditions or privileges
        of employment or any matter directly or indirectly related to employment,
        because of race, color, religion, sex, disability, national origin or ancestry.
        Breach of this covenant may be regarded as a material breach of this Contract.
        The Contractor's execution of this Contract also signifies compliance with
        applicable federal laws, regulations, and executive orders prohibiting
        discrimination in the provision of services based on race, color, national
        origin, age, sex, disability or status as a veteran.

      

      The
        Contractor understands that the State is a recipient of federal funds. Pursuant
        to that understanding, the Contractor and its subcontractor, if any, agree
        that
        if the Contractor employs fifty (50) or more employees and does at least
        $50,000.00 worth of business with the State and is not exempt, the Contractor
        will comply with the affirmative action reporting requirements of 41 CFR
        60-1.7.
        The Contractor shall comply with Section 202 of Executive Order 11246, as
        amended, 41 CFR 60-250, and 41 CFR 60-741, as amended, which are incorporated
        herein by specific reference. Breach of this covenant may be regarded as
        a
        material breach of this Contract.

      

      
        	
                31.

              	
                Notice
                  to Parties

              

      

      

      Whenever
        any notice, statement or other communication is required under this Contract,
        it
        shall be sent to the following addresses, unless otherwise specifically
        advised.

      

      
        	
                A.

              	
                Notices
                  to the State shall be sent to:

              

      

      

      Mark
        Fritz

      Managed
        Care Manager

      Office
        of
        Medicaid Policy and Planning

      402
        W.
        Washington Street, W374

      Indianapolis,
        IN 46204

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	
                B.

              	
                Notices
                  to the Contractor shall be sent to:

              

      

      

      Rita
        Johnson-Mills

      Managed
        Health Services

      1099
        N.
        Meridian Street, #400

      Indianapolis,
        IN 46204

      

      
        	
                32.

              	
                Order
                  of Precedence

              

      

      

      Any
        inconsistency or ambiguity in this Contract shall be resolved by giving
        precedence in the following order: (1) This Contract, (2) attachments to
        this
        Contract prepared by the State, (3) RFS# 6-68, (4) Contractor's response
        to RFS#
        6-68. All attachments and all documents referred to in this paragraph are
        hereby
        incorporated fully by reference.

      

      
        	
                33.

              	
                Ownership
                  of Documents and Materials

              

      

      

      All
        documents, records, programs, data, film, tape, articles, memoranda, and
        other
        materials not developed or licensed by the Contractor prior to execution
        of this
        Contract, but specifically developed under this Contract shall be considered
        "work for hire" and the Contractor transfers any ownership claim to the State
        of
        Indiana and all such materials will be the property of the State of Indiana.
        Use
        of these materials, other than related to contract performance by the
        Contractor, without the prior written consent of the State, which consent
        shall
        not be unreasonably withheld or delayed, is prohibited, except that State
        agrees
        that Contractor shall be permitted to utilize such materials to comply with
        Contractor's own reporting obligations or to otherwise comply with applicable
        law without seeking prior consent from the State. During the performance
        of this
        Contract, the Contractor shall be responsible for any loss of or damage to
        these
        materials developed for or supplied by the State and used to develop or assist
        in the services provided herein while the materials are in the possession
        of the
        Contractor. Any loss or damage thereto shall be restored at the Contractor's
        expense. Full, immediate, and unrestricted access to the work product of
        the
        Contractor during the term of this Contract shall be available to the
        State.

      

      
        	
                34.

              	
                Payments

              

      

      

      All
        payments shall be made in arrears in conformance with State fiscal policies
        and
        procedures and, as required by IC 4-13-2-14.8, by electronic funds transfer
        to
        the financial institution designated by the Contractor in writing unless
        a
        specific waiver has been obtained from the Auditor of State. No payments
        will be
        made in advance of receipt of the goods or services that are the subject
        of this
        Contract except as permitted by IC 4-13-2-20.

      

      
        	
                35.

              	
                Penalties/Interest/Attorney's
                  Fees

              

      

      

      The
        State
        will in good faith perform its required obligations hereunder and does not
        agree
        to pay any penalties, liquidated damages, interest, or attorney's fees, except
        as required by Indiana law, in part, IC 5-17-5, IC 34-54-8, and IC
        34-13-1.

      

      Notwithstanding
        the provisions contained in IC 5-17-5, the Parties stipulate and agree that
        any
        liability resulting from the State of Indiana's failure to make prompt payment
        shall be based solely on the amount of funding originating from the State
        of
        Indiana and shall not be based on funding from federal or other
        sources.

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	
                36.

              	
                Progress
                  Reports

              

      

      

      The
        Contractor shall submit progress reports to the State upon request. The report
        shall be oral, unless the State, upon receipt of the oral report, should
        deem it
        necessary to have it in written form. The progress reports shall serve the
        purpose of assuring the State that work is progressing in line with the
        schedule, and that completion can be reasonably assured on the scheduled
        date.

      

      
        	
                37.

              	
                Reserved

              

      

      

      
        	
                38.

              	
                Security
                  and Privacy of Health
                  Information

              

      

      

      The
        Contractor agrees to comply with all requirements of the Health Insurance
        Portability and Accountability Act of 1996 (HIPAA), Privacy Regulations that
        took effect April 14, 2003, and Security Regulations that took effect on
        April
        20, 2005, in all activities related to the contract, to maintain compliance
        throughout the life of the contract, to operate any systems used to fulfill
        the
        requirements of this contract in full compliance with HIPAA and to take no
        action which adversely affects the State's HIPAA compliance.

      

      The
        parties acknowledge that the Department of Health and Human Services (DHHS)
        has
        issued the Final Rules, as amended from time to time on the Standards for
        Privacy of Individually Identifiable Health Information and on the Standards
        for
        Security of Individually Identifiable Health Information, as required by
        the
        Administrative Simplification Section of HIPAA. The parties acknowledge that
        the
        Office is Covered Entity within the meaning of HIPAA. To the extent required
        by
        the provisions of HIPAA and regulations promulgated thereunder, the Contractor
        assures that it will appropriately safeguard Protected Health Information
        (PHI),
        as defined by the regulations, which is made available to or obtained by
        the
        Contractor in the course of its work under the contract. The Contractor agrees
        to comply with all applicable requirements of law relating to PHI with respect
        to any task or other activity it performs for the Office including, as required
        by the final Privacy and Security regulations:

      

      
        	
                A.

              	
                Contractor
                  may use and disclose PHI for the following purposes: (a) to perform
                  the
                  services described in this Contract; (b) the proper management
                  and
                  administration of Contractor; (c) to carry out the legal responsibilities
                  of Contractor; (d) as required by law; or (e) to report violations
                  of law
                  to appropriate Federal and State authorities, consistent with 42
                  CFR §
                  164.502(j)(l). If Contractor discloses PHI for a purpose related
                  to (b) or
                  (c) in the foregoing sentence, Contractor shall obtain reasonable
                  assurances from the person to whom the information is disclosed
                  that it
                  will remain confidential and used or further disclosed only as
                  required by
                  law or for the purpose for which it was disclosed to the person,
                  and
                  require the person to notify Contractor of any instances of which
                  it is
                  aware in which the confidentiality of the information has been
                  breached.

              

      

      

      
        	
                B.

              	
                Implementing
                  administrative, physical and technical safeguards that reasonably
                  and
                  appropriately protect the confidentiality, integrity and availability
                  of
                  the electronic PHI that the Contractor creates, receives, maintains,
                  or
                  transmits on behalf of OMPP;

              

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	
                C.

              	
                Implementing
                  a disaster recovery plan, as appropriate, which includes mechanisms
                  to
                  recover data and/or alternative data storage sites, as determined
                  by OMPP
                  to be necessary to uphold integral business functions in the event
                  of an
                  unforeseen disaster;

              

      

      

      
        	
                D.

              	
                Not
                  using or further disclosing PHI other than as permitted or required
                  by
                  this Contract or by applicable law;

              

      

      

      
        	
                E.

              	
                Using
                  appropriate safeguards to prevent use or disclosure of PHI other
                  than as
                  provided by this Contract or by applicable
                  law;

              

      

      

      
        	
                F.

              	
                Reporting
                  to OMPP any security and/or privacy incident of which the Contractor
                  becomes aware;

              

      

      

      
        	
                G.

              	
                Mitigating,
                  to the extent practicable, any harmful effect that is known to
                  the
                  Contractor and reporting to the Office any use or disclosure by
                  the
                  Contractor, its agent, employees, subcontractors or third parties,
                  of PHI
                  obtained under this Contract in a manner not provided for by this
                  Contract
                  or by applicable law of which the Contractor becomes
                  aware;

              

      

      

      
        	
                H.

              	
                Ensuring
                  that any subcontractors or agents to whom the Contractor provides
                  PHI
                  received from, or created or received by the Contractor, subcontractors
                  or
                  agents on behalf of the Office agree to the same restrictions,
                  conditions
                  and obligations applicable to such party regarding PHI and agrees
                  to
                  implement reasonable and appropriate safeguards to protect
                  it;

              

      

      

      
        	
                I.

              	
                Making
                  the Contractor's internal practices, books and records related
                  to the use
                  or disclosure of PHI received from, or created or received by the
                  Contractor on behalf of the Office available to the Office at its
                  request
                  or to the Secretary of the United States Department of Health and
                  Human
                  Services for purposes of determining the Office's compliance with
                  applicable law. The Contractor shall immediately notify the Office
                  upon
                  receipt by the Contractor of any such request from the Secretary
                  of DHHS,
                  and shall provide the Office with copies of any materials made
                  available
                  in response to such a request;

              

      

      

      
        	
                J.

              	
                In
                  accordance with procedures established by the Office, making available
                  the
                  information required to provide an accounting of disclosures pursuant
                  to
                  applicable law, if the duties of the Contractor include disclosures
                  that
                  must be accounted for;

              

      

      

      
        	
                K.

              	
                Making
                  available PHI for amendment and incorporating any amendments to
                  PHI in
                  accordance with 45 CFR 164.526, if the Contractor maintains PHI
                  subject to
                  amendment;

              

      

      

      
        	
                L.

              	
                In
                  accordance with procedures established by the Office, making PHI
                  available
                  to individuals entitled to access and requesting access in compliance
                  with
                  45 CFR 164.524 and the duties of the
                  Contractor;

              

      

      

      
        	
                M.

              	
                Authorizing
                  termination of the Contract if OMPP determines that the Contractor
                  has
                  violated a material provision; and

              

      

      

      
        	
                N.

              	
                At
                  the termination of the Contract, if feasible, return or destroy
                  all PHI
                  received or created under the Contract. If OMPP determines return
                  or
                  destruction is not feasible, the protections in this agreement
                  shall
                  continue to be extended to any PHI maintained by the Contractor
                  for as
                  long as it is maintained.

              

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	
                38.5

              	
                Electronic
                  Transaction Standards
                  Compliance

              

      

      

      In
        order
        to fulfill the terms of this Contract, Contractor will utilize and interface
        with the State's electronic systems and will use them to perform certain
        electronic transactions that contain health information, and which are subject
        to the final rules for the Standards for Electronic Transactions, dated August
        17, 2000, under the Administrative Simplification Section of HIPAA (the
        "Transaction Standards").

      

      The
        Contractor shall comply with the Transaction Standards, as may be amended
        from
        time to time, and shall provide documentation of its compliance with them,
        including a summary of project plans for remediation, status reports of
        remediation efforts, summary of text results, copies of certifications, if
        any,
        and the Contractor's statement affirming completion of all requirements.
        Such
        compliance shall be maintained at no additional cost to the State.

      

      Contractor
        will indemnify and hold the State harmless from any loss, damage, costs,
        expense, judgment, sanction or liability, including, but not limited to,
        attorneys' fees and costs, that the State incurs or is subject to as a result
        of
        Contractor's breach of this Paragraph.

      

      
        	
                39.

              	
                Severability

              

      

      

      The
        invalidity of any section, subsection, clause or provision of this Contract
        shall not affect the validity of the remaining sections, subsections, clauses
        or
        provisions of this Contract.

      

      
        	
                40.

              	
                Substantial
                  Performance

              

      

      

      This
        Contract shall be deemed to be substantially performed only when fully performed
        according to its terms and conditions and any modification thereof.

      

      
        	
                41.

              	
                Taxes

              

      

      

      The
        State
        of Indiana is exempt from state, federal, and local taxes. The State will
        not be
        responsible for any taxes levied on the Contractor as a result of this
        Contract.

      

      
        	
                42.

              	
                Termination
                  for Convenience

              

      

      

      This
        Contract may be terminated, in whole or in part, by the State whenever, for
        any
        reason, the State determines that such termination is in the best interest
        of
        the State. Termination of services shall be effected by delivery to the
        Contractor of a Termination Notice at least thirty (30) days prior to the
        termination effective date, specifying the extent to which performance of
        services under such termination becomes effective. The Contractor shall be
        compensated for services properly rendered prior to the effective date of
        termination. The State will not be liable for services performed after the
        effective date of termination. The Contractor shall be compensated for services
        herein provided but in no case shall total payment made to the Contractor
        exceed
        the original contract price or shall any price increase be allowed on individual
        line items if canceled only in part prior to the original termination
        date.

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	
                43.

              	
                Termination
                  for Default

              

      

      

      
        	
                A.

              	
                With
                  the provision of thirty (30) days notice to the Contractor, the
                  State may
                  terminate this Contract in whole or in part, if the Contractor
                  fails
                  to:

              

      

      

      
        	 	
                1.

              	
                Correct
                  or cure any breach of this
                  Contract;

              

      

      

      
        	 	
                2.

              	
                Deliver
                  the supplies or perform the services within the time specified
                  in this
                  Contract or any extension;

              

      

      

      
        	 	
                3.

              	
                Make
                  progress so as to endanger performance of this Contract;
                  or

              

      

      

      
        	 	
                4.

              	
                Perform
                  any of the other provisions of this
                  Contract.

              

      

      

      
        	
                B.

              	
                If
                  the State terminates this Contract in whole or in part, in accordance
                  with
                  Section 43(A), it may acquire, under the terms and in the manner
                  the State
                  considers appropriate, supplies or services similar to those terminated,
                  and the Contractor will be liable to the State for any excess costs
                  for
                  those supplies or services. However, the Contractor shall continue
                  the
                  work not terminated.

              

      

      

      
        	
                C.

              	
                The
                  State shall pay the contract price for completed supplies delivered
                  and
                  services accepted. The Contractor and the State shall agree on
                  the amount
                  of payment for manufacturing materials delivered and accepted and
                  for the
                  protection and preservation of the property. Failure to agree will
                  be a
                  dispute under the Disputes clause. The State may withhold from
                  these
                  amounts any sum the State determines to be necessary to protect
                  the State
                  against loss because of outstanding liens or claims of former lien
                  holders.

              

      

      

      
        	
                D.

              	
                The
                  rights and remedies of the State in this clause are in addition
                  to any
                  other rights and remedies provided by law or equity or under this
                  Contract.

              

      

      

      
        	
                44.

              	
                Reserved

              

      

      

      
        	
                45.

              	
                Waiver
                  of Rights

              

      

      

      No
        right
        conferred on either party under this Contract shall be deemed waived, and
        no
        breach of this Contract excused, unless such waiver is in writing and signed
        by
        the party claimed to have waived such right.

      

      
        	
                46.

              	
                Work
                  Standards

              

      

      

      The
        Contractor shall execute its responsibilities by following and applying at
        all
        times the highest professional and technical guidelines and standards. If
        the
        State becomes dissatisfied with the work product of or the working relationship
        with those individuals assigned to work on this Contract, the State may request
        in writing the replacement of any or all such individuals, and Contractor
        shall
        grant such request.

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	
                47.

              	
                Assurance
                  of Compliance with Civil Rights Act of 1964, Section 504 of the
                  Rehabilitation Act of 1973 and the Age Discrimination Act of 1975,
                  the
                  Americans with Disabilities Act of 1990 and Title IX of the Education
                  Amendments of 1972

              

      

      

      The
        Contractor agrees that it, and all of its subcontractors, including providers,
        will comply with the following:

      

      
        	
                A.

              	
                Title
                  VI of the Civil Rights Act of 1964 (Pub. L. 88-352), as amended,
                  and all
                  requirements imposed by or pursuant to the Regulation of the Department
                  of
                  Health and Human Services (45 CFR Part 80), to the end that, in
                  accordance
                  with Title VI of that Act and the Regulation, no person in the
                  United
                  States shall on the ground of race, color, or national origin,
                  be excluded
                  from participation in, be denied the benefits of, or be otherwise
                  subjected to discrimination under any program or activity for which
                  the
                  Contractor receives Federal financial assistance under this
                  Contract.

              

      

      

      
        	
                B.

              	
                Section
                  504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), as amended,
                  and
                  all requirements imposed by or pursuant to the Regulation of the
                  Department of Health and Human Services (45 CFR Part 84), to the
                  end that,
                  in accordance with Section 504 of that Act and the Regulation,
                  no
                  otherwise qualified handicapped individual in the United States
                  shall,
                  solely by reason of his/her handicap, be excluded from participation
                  in,
                  be denied the benefits of, or be subjected to discrimination under
                  any
                  program or activity for which the Contractor receives Federal financial
                  assistance under this Contract.

              

      

      

      
        	
                C.

              	
                The
                  Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and
                  all
                  requirements imposed by or pursuant to the Regulation of the Department
                  of
                  Health and Human Services (45 CFR Part 91), to the end that, in
                  accordance
                  with the Act and the Regulation, no person in the United States
                  shall, on
                  the basis of age, be denied the benefits of, be excluded from
                  participation in, or be subjected to discrimination under any program
                  or
                  activity for which the Contractor receives Federal financial assistance
                  under this Contract.

              

      

      

      
        	
                D.

              	
                The
                  Americans with Disabilities Act of 1990 (Pub. L. 101-336), as amended,
                  and
                  all requirements imposed by or pursuant to the Regulation of the
                  Department of Justice (28 CFR 35.101 et seq.), to the end that
                  in
                  accordance with the Act and Regulation, no person in the United
                  States
                  with a disability shall, on the basis of the disability, be excluded
                  from
                  participation in, be denied the benefits of, or otherwise be subjected
                  to
                  discrimination under any program or activity for which the Contractor
                  receives Federal financial assistance under this
                  Contract.

              

      

      

      
        	
                E.

              	
                Title
                  IX of the Education Amendments of 1972, as amended (20 U.S.C. §§ 1681,
                  1683, and 1685-1686), and all requirements imposed by or pursuant
                  to
                  regulation, to the end that, in accordance with the Amendments,
                  no person
                  in the United States shall, on the basis of sex, be excluded from
                  participation in, be denied the benefits of, or otherwise be subjected
                  to
                  discrimination under any program or activity for which the Contractor
                  receives Federal financial assistance under this
                  Contract.

              

      

      

      The
        Contractor agrees that compliance with this assurance constitutes a condition
        of
        continued receipt of Federal financial assistance, and that it is binding
        upon
        the Contractor, its successors, transferees and assignees for the period
        during
        which such assistance is provided. The Contractor further recognizes that
        the
        United States shall have the right to seek judicial enforcement of this
        assurance.

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	
                48.

              	
                Conveyance
                  of Documents and Continuation of Existing
                  Activity

              

      

      

      Should
        the Contract for whatever reason, (i.e. completion of a contract with no
        renewal, or termination of service by either party), be discontinued and
        the
        activities as provided for in the Contract for services cease, the Contractor
        and any subcontractors employed by the terminating Contractor in the performance
        of the duties of the Contract shall promptly convey to the State of Indiana,
        copies of all vendor working papers, data collection forms, reports, charts,
        programs, cost records and all other material related to work performed on
        this
        Contract. The Contractor and the Office shall convene immediately upon
        notification of termination or non-renewal of the Contract to determine what
        work shall be suspended, what work shall be completed, and the time frame
        for
        completion and conveyance. The Office will then provide the Contractor with
        a
        written schedule of the completion and conveyance activities associated with
        termination. Documents/materials associated with suspended activities shall
        be
        conveyed by the Contractor to the State of Indiana upon five (5) days notice
        from the State of Indiana or such other time as the parties shall mutually
        agree. Upon completion of those remaining activities noted on the written
        schedule, the Contractor shall also convey all documents and materials to
        the
        State of Indiana upon five (5) business days' notice from the State of
        Indiana.

      

      
        	
                49.

              	
                Environmental
                  Standards

              

      

      

      If
        the
        contract amount set forth in this Contract is in excess of $ 100,000, the
        Contractor shall comply with all applicable standards, orders, or requirements
        issued under section 306 of the Clean Air Act (42 U.S.C. § 7606), section 508 of
        the Clean Water Act (33 U.S.C. § 1368), Executive Order 11738, and Environmental
        Protection Agency regulations (40 C.F.R. Part 32), which prohibit the use
        under
        non-exempt Federal contracts of facilities included on the EPA List of Violating
        Facilities. The Contractor shall report any violations of this paragraph
        to the
        State of Indiana and to the United States Environmental Protection Agency
        Assistant Administrator for Enforcement.

      

      
        	
                50.

              	
                Lobbying
                  Activities

              

      

      

      Pursuant
        to 31 U.S.C. § 1352, and any regulations promulgated thereunder, the Contractor
        hereby assures and certifies that no federally appropriated funds have been
        paid, or will be paid, by or on behalf of the Contractor, to any person for
        influencing or attempting to influence an officer or employee of any agency,
        a
        member of Congress, an officer or employee of Congress, or an employee of
        a
        member of Congress, in connection with the awarding of any federal contract,
        the
        making of any federal grant, the making of any federal loan, the entering
        into
        of any cooperative contract, and the extension, continuation, renewal,
        amendment, or modification of any federal contract, grant, loan or cooperative
        contract. If any funds other than federally appropriated funds have been
        paid or
        will be paid to any person for influencing or attempting to influence an
        officer
        or employee of any agency, a member of Congress, an officer or employee of
        Congress, or an employee of a member of Congress in connection with this
        Contract, the Contractor shall complete and submit Standard Form-LLL,
        "Disclosure Form to Report Lobbying", in accordance with its
        instructions.

      

      The
        rest of this page is left blank intentionally

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      SIGNATURE
        PAGE

      

      99-07-MT-0053

      

      Non-Collusion
        and Acceptance

      

      The
        undersigned attests, subject to the penalties for perjury, that he/she is
        the
        Contractor, or that he/she is the properly authorized representative, agent,
        member or officer of the Contractor, that he/she has not, nor has any other
        member, employee, representative, agent or officer of the Contractor, directly
        or indirectly, to the best of the undersigned's knowledge, entered into or
        offered to enter into any combination, collusion or agreement to receive
        or pay,
        and that he/she has not received or paid, any sum of money or other
        consideration for the execution of this Contract other than that which appears
        upon the face of this Contract.

      

      In
        Witness Whereof,
        Contractor and the State have, through their duly authorized representatives,
        entered into this Contract. The parties, having read and understand the
        foregoing terms of this Contract, do by their respective signatures dated
        below
        hereby agree to the terms thereof.

      

      
        	
                Contractor:
                  Coordinated Care Corporation Indiana, Inc.

              
	 	 	 
	
                By:
                  

              	 /s/
                Rita J. Mills	 
	
                Printed
                  Name:

              	 Rita
                J. Mills	 
	
                Title:

              	 Regional
                VP & CEO	 
	
                Date:

              	 10/31/06	 
	 	 	 
	
                Office
                  of Medicaid Policy and Planning

              
	 	 	 
	
                By:

              	 /s/
                Jeanne LaBrecque	 
	
                Jeanne
                  Labrecque, Director

              
	 	 	 
	
                Date:

              	 11/2/2006	 
	 	 	 
	
                Department
                  of Administration

              
	 	 	 
	
                By:

              	 /s/
                Dawina L. Patterson FOR	 
	
                Carrie
                  Henderson, Commissioner

              
	 	 	 
	
                Date:

              	 12/8/06	 

      

      

      
        	 	 	
                APPROVED
                  as to Form and Legality:

              
	
                State
                  Budget Agency

              	 	
                Office
                  of the Attorney General

              
	 	 	 
	
                By:

              	 /s/
                Illegible	 	
                By:

              	 /s/
                Susan H. Gard FOR
	
                Charles
                  E. Schalliol, Director

              	 	
                Stephen
                  Carter, Attorney General

              
	 	 	 
	
                Date:

              	 12/15/06	 	
                Date:

              	 1/17/2007

      

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      

      
        	 	
                ATTACHMENT
                  DOCUMENT SUMMARY

              	
                ATTACHMENT: 

              	
                A 

              
	
                 

              	 	
                AGREEMENT
                  #: 

              	
                99-07-MT-0053 

              
	
                 

              	 	
                AGREEMENT
                  TERM: 

              	
                01/01/2007-12/31/2010 

              

      

      

       

      
        	
                VENDOR
                  INFORMATION: 

              	 
	
                LEGAL
                  NAME: 

              	
                COORDINATED
                  CARE CORPORATION INDIANA, INC. 

              
	 	 
	
                MAILING
                  ADDRESS: 

              	
                1099
                  N. MERIDIAN ST., 

              
	 	
                SUITE
                  400 

              
	 	
                INDIANAPOLIS,
                  IN 46204-1041 

              
	 	 
	
                FSSA
                  CONTRACT CONTACT: 

              	
                Cook,
                  Mel E (317) 234-4200 

              
	
                EMAIL
                  ADDRESS: 

              	
                Melvin.Cook@dcs.IN.gov 

              
	 	 
	
                FID/SSN: 

              	
                39-1864073 

              
	 	 
	
                CHANGE
                  NUMBER: 

              	
                ORIG 

              

      

      

       

      
        	
                STATUTORY
                  INFORMATION: 

              
	
                I.C.
                  12-15-30-1 

              
	
                I.C.
                  12-17.6 

              

      

      

       

      
        	
                FINANCIAL
                  SUMMARY:

              	
                SERVICE

              	 	 	
                AWARD

              
	
                CLAIM
                  PROG ID

              	
                CODE

              	
                PROGRAM

              	
                EFFECTIVE
                  DATES

              	
                AMOUNT

              
	
                49-07-MT-0053-01 

              	
                4005 

              	
                MEDICAID
                  ASSIST 

              	
                01/01/2007-06/30/2007

              	
                ZERO-BASED 

              
	 	 	 	 	 
	
                49-07-MT-0053-02 

              	
                4005 

              	
                MEDICAID
                  ASSIST 

              	
                07/01/2007-06/30/2008

              	
                ZERO-BASED 

              
	 	 	 	 	 
	
                49-07-MT-0053-03 

              	
                4005 

              	
                MEDICAID
                  ASSIST 

              	
                07/01/2008-06/30/2009

              	
                ZERO-BASED 

              
	 	 	 	 	 
	
                49-07-MT-0053-04 

              	
                4005 

              	
                MEDICAID
                  ASSIST 

              	
                07/01/2009-06/30/2010

              	
                ZERO-BASED 

              
	 	 	 	 	 
	
                49-07-MT-0053-05 

              	
                4005 

              	
                MEDICAID
                  ASSIST 

              	
                07/01/2010-12/31/2010

              	
                ZERO-BASED 

              
	
                TOTAL
                  DOLLAR AMOUNT: 

              	 	 	 	
                ZERO-BASED 

              

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      

      
        	 	
                ATTACHMENT
                  DOCUMENT SUMMARY

              	
                ATTACHMENT: 

              	
                A 

              
	
                [Graphic

              	 	
                AGREEMENT
                  #: 

              	
                99-07-MT-0053 

              
	
                Omitted]

              	 	
                AGREEMENT
                  TERM: 

              	
                01/01/2007-12/31/2010 

              

      

      

       

      
        	
                CLAIM
                  PROGRAM ID: 

              	
                49-07-MT-0053-01 

              	 	 
	
                PROGRAM
                  TOTAL: 

              	
                ZERO-BASED 

              	
                REGION: 

              	
                Statewide 

              
	
                FUND
                  DESCRIPTION: 

              	
                MEDICAID
                  ASSISTANCE 

              	
                CFDA
                  NUMBER: 

              	
                n/a 

              
	
                ACCOUNT
                  NUMBER: 

              	
                3530-185600 

              	
                FEDERAL
                  YEAR: 

              	
                2007 

              
	
                EFFECTIVE
                  DATES: 

              	
                01/01/2007-06/30/2007 

              	
                STATE
                  YEAR: 

              	
                2007 

              
	
                ADVANCE
                  DUE DAYS: 

              	
                0

              	
                ADMINISTRATIVE
                  CAP: 

              	
                0.00 

              
	
                ADVANCE
                  PERCENT: 

              	
                0.0000% 

              	
                CLOSE
                  OUT DATE: 

              	
                08/29/2007 

              
	 	 	 	 
	
                NMT
                  PERCENT: 

              	
                0.0000% 

              	
                NMT
                  DOLLARS: 

              	
                0.00 

              
	
                MATCH
                  PERCENT: 

              	
                0.0000% 

              	
                MATCH
                  AMOUNT: 

              	
                0.00 

              
	 	 	 	 
	
                FEDERAL
                  PERCENT: 

              	
                0.0000% 

              	
                STATE
                  PERCENT: 

              	
                0.0000% 

              
	
                PRIVATE
                  PERCENT: 

              	
                0.0000% 

              	
                OTHER
                  PERCENT: 

              	
                0.0000% 

              

      

      

       

      
        	
                SERVICE
                  INFORMATION: 

              	
                4005
                  MANAGED CARE 

              	 	 
	
                SERVICE
                  EFF DATES: 

              	
                1/1/2007-6/30/2007 

              	 	 
	
                COMPONENT
                  DESCRIPTION 

              	
                COMPONENT
                  DATES 

              	
                UNITS

              	
                RATE

              
	
                .1
                  PROFESSIONAL SERVICES 

              	
                1/01/07-6/30/07 

              	
                ACTUAL
                  COST

              	
                1.0000

              
	
                SERVICE
                  TOTAL: 

              	 	 	
                ZERO-BASED 

              

      

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      

      
        	 	
                ATTACHMENT
                  DOCUMENT SUMMARY

              	
                ATTACHMENT: 

              	
                A 

              
	
                [Graphic

              	 	
                AGREEMENT
                  #: 

              	
                99-07-MT-0053 

              
	
                Omitted]

              	 	
                AGREEMENT
                  TERM: 

              	
                01/01/2007-12/31/2010 

              

      

      

       

      
        	
                CLAIM
                  PROGRAM ID: 

              	
                49-07-MT-0053-02 

              	 	 
	
                PROGRAM
                  TOTAL: 

              	
                ZERO-BASED 

              	
                REGION: 

              	
                Statewide 

              
	
                FUND
                  DESCRIPTION: 

              	
                MEDICAID
                  ASSISTANCE 

              	
                CFDA
                  NUMBER: 

              	
                n/a 

              
	
                ACCOUNT
                  NUMBER: 

              	
                3530-185600 

              	
                FEDERAL
                  YEAR: 

              	
                2007 

              
	
                EFFECTIVE
                  DATES: 

              	
                07/01/2007-06/30/2008 

              	
                STATE
                  YEAR: 

              	
                2008 

              
	
                ADVANCE
                  DUE DAYS: 

              	
                0 

              	
                ADMINISTRATIVE
                  CAP: 

              	
                0.00 

              
	
                ADVANCE
                  PERCENT: 

              	
                0.0000% 

              	
                CLOSE
                  OUT DATE: 

              	
                08/29/2008 

              
	 	 	 	 
	
                NMT
                  PERCENT: 

              	
                0.0000% 

              	
                NMT
                  DOLLARS: 

              	
                0.00 

              
	
                MATCH
                  PERCENT: 

              	
                0.0000% 

              	
                MATCH
                  AMOUNT: 

              	
                0.00 

              
	 	 	 	 
	
                FEDERAL
                  PERCENT: 

              	
                0.0000% 

              	
                STATE
                  PERCENT: 

              	
                0.0000% 

              
	
                PRIVATE
                  PERCENT: 

              	
                0.0000% 

              	
                OTHER
                  PERCENT: 

              	
                0.0000% 

              

      

      

       

      
        	
                SERVICE
                  INFORMATION: 

              	
                4005
                  MANAGED CARE 

              	 	 
	
                SERVICE
                  EFF DATES: 

              	
                7/1/2007-6/30/2008 

              	 	 
	
                COMPONENT
                  DESCRIPTION 

              	
                COMPONENT
                  DATES 

              	
                UNITS

              	
                RATE

              
	
                .1
                  PROFESSIONAL SERVICES 

              	
                7/01/07-6/30/08 

              	
                ACTUAL
                  COST

              	
                1.0000

              
	
                SERVICE
                  TOTAL: 

              	 	 	
                ZERO-BASED

              

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      

      
        	 	
                ATTACHMENT
                  DOCUMENT SUMMARY

              	
                ATTACHMENT: 

              	
                A 

              
	
                [Graphic

              	 	
                AGREEMENT
                  #: 

              	
                99-07-MT-0053 

              
	
                Omitted]

              	 	
                AGREEMENT
                  TERM: 

              	
                01/01/2007-12/31/2010 

              

      

      

      
        	
                CLAIM
                  PROGRAM ID:

              	
                49-07-MT-0053-03 

              	 	 
	
                PROGRAM
                  TOTAL: 

              	
                ZERO-BASED 

              	
                REGION: 

              	
                Statewide 

              
	
                FUND
                  DESCRIPTION: 

              	
                MEDICAID
                  ASSISTANCE 

              	
                CFDA
                  NUMBER: 

              	
                n/a 

              
	
                ACCOUNT
                  NUMBER: 

              	
                3530-185600 

              	
                FEDERAL
                  YEAR: 

              	
                2008 

              
	
                EFFECTIVE
                  DATES: 

              	
                07/01/2008-06/30/2009 

              	
                STATE
                  YEAR: 

              	
                2009 

              
	
                ADVANCE
                  DUE DAYS: 

              	
                0 

              	
                ADMINISTRATIVE
                  CAP: 

              	
                0.00 

              
	
                ADVANCE
                  PERCENT: 

              	
                0.0000% 

              	
                CLOSE
                  OUT DATE: 

              	
                08/29/2009 

              
	 	 	 	 
	
                NMT
                  PERCENT: 

              	
                0.0000% 

              	
                NMT
                  DOLLARS: 

              	
                0.00 

              
	
                MATCH
                  PERCENT: 

              	
                0.0000% 

              	
                MATCH
                  AMOUNT: 

              	
                0.00 

              
	 	 	 	 
	
                FEDERAL
                  PERCENT: 

              	
                0.0000% 

              	
                STATE
                  PERCENT: 

              	
                0.0000% 

              
	
                PRIVATE
                  PERCENT: 

              	
                0.0000% 

              	
                OTHER
                  PERCENT: 

              	
                0.0000% 

              

      

      

       

      
        	
                SERVICE
                  INFORMATION: 

              	
                4005
                  MANAGED CARE 

              	 	 
	
                SERVICE
                  EFF DATES: 

              	
                7/1/2008-6/30/2009 

              	 	 
	
                COMPONENT
                  DESCRIPTION 

              	
                COMPONENT
                  DATES 

              	
                UNITS

              	
                RATE

              
	
                .1
                  PROFESSIONAL SERVICES 

              	
                7/01/08-6/30/09

              	
                ACTUAL
                  COST

              	
                1.0000

              
	
                SERVICE
                  TOTAL: 

              	 	 	
                ZERO-BASED 

              

      

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      

      
        	 	
                ATTACHMENT
                  DOCUMENT SUMMARY

              	
                ATTACHMENT: 

              	
                A 

              
	
                [Graphic

              	 	
                AGREEMENT
                  #: 

              	
                99-07-MT-0053 

              
	
                Omitted]

              	 	
                AGREEMENT
                  TERM: 

              	
                01/01/2007-12/31/2010 

              

      

      

      
        	
                CLAIM
                  PROGRAM ID: 

              	
                49-07-MT-0053-04 

              	 	 
	
                PROGRAM
                  TOTAL: 

              	
                ZERO-BASED 

              	
                REGION: 

              	
                Statewide 

              
	
                FUND
                  DESCRIPTION: 

              	
                MEDICAID
                  ASSISTANCE 

              	
                CFDA
                  NUMBER: 

              	
                n/a 

              
	
                ACCOUNT
                  NUMBER: 

              	
                3530-185600 

              	
                FEDERAL
                  YEAR: 

              	
                2009 

              
	
                EFFECTIVE
                  DATES: 

              	
                07/01/2009-06/30/2010 

              	
                STATE
                  YEAR: 

              	
                2010 

              
	
                ADVANCE
                  DUE DAYS: 

              	
                0 

              	
                ADMINISTRATIVE
                  CAP: 

              	
                0.00 

              
	
                ADVANCE
                  PERCENT: 

              	
                0.0000% 

              	
                CLOSE
                  OUT DATE: 

              	
                08/29/2010 

              
	 	 	 	 
	
                NMT
                  PERCENT: 

              	
                0.0000% 

              	
                NMT
                  DOLLARS: 

              	
                0.00 

              
	
                MATCH
                  PERCENT: 

              	
                0.0000% 

              	
                MATCH
                  AMOUNT: 

              	
                0.00 

              
	 	 	 	 
	
                FEDERAL
                  PERCENT: 

              	
                0.0000% 

              	
                STATE
                  PERCENT: 

              	
                0.0000% 

              
	
                PRIVATE
                  PERCENT: 

              	
                0.0000% 

              	
                OTHER
                  PERCENT: 

              	
                0.0000% 

              

      

      

       

      
        	
                SERVICE
                  INFORMATION: 

              	
                4005
                  MANAGED CARE 

              	 	 
	
                SERVICE
                  EFF DATES: 

              	
                7/1/2009-6/30/2010 

              	 	 
	
                COMPONENT
                  DESCRIPTION 

              	
                COMPONENT
                  DATES 

              	
                UNITS

              	
                RATE

              
	
                .1
                  PROFESSIONAL SERVICES 

              	
                7/01/09-6/30/10 

              	
                ACTUAL
                  COST

              	
                1.0000

              
	
                SERVICE
                  TOTAL: 

              	 	 	
                ZERO-BASED 

              

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      

      
        	 	
                ATTACHMENT
                  DOCUMENT SUMMARY

              	
                ATTACHMENT: 

              	
                A 

              
	
                [Graphic

              	 	
                AGREEMENT
                  #: 

              	
                99-07-MT-0053 

              
	
                Omitted]

              	 	
                AGREEMENT
                  TERM: 

              	
                01/01/2007-12/31/2010 

              

      

      

      
        	
                CLAIM
                  PROGRAM ID: 

              	
                49-07-MT-0053-05 

              	 	 
	
                PROGRAM
                  TOTAL: 

              	
                ZERO-BASED 

              	
                REGION: 

              	
                Statewide 

              
	
                FUND
                  DESCRIPTION: 

              	
                MEDICAID
                  ASSISTANCE 

              	
                CFDA
                  NUMBER: 

              	
                n/a 

              
	
                ACCOUNT
                  NUMBER: 

              	
                3530-185600 

              	
                FEDERAL
                  YEAR: 

              	
                2010 

              
	
                EFFECTIVE
                  DATES: 

              	
                07/01/2010-12/31/2010 

              	
                STATE
                  YEAR: 

              	
                2011 

              
	
                ADVANCE
                  DUE DAYS: 

              	
                0 

              	
                ADMINISTRATIVE
                  CAP: 

              	
                0.00 

              
	
                ADVANCE
                  PERCENT: 

              	
                0.0000% 

              	
                CLOSE
                  OUT DATE: 

              	
                03/01/2011 

              
	 	 	 	 
	
                NMT
                  PERCENT: 

              	
                0.0000% 

              	
                NMT
                  DOLLARS: 

              	
                0.00 

              
	
                MATCH
                  PERCENT: 

              	
                0.0000% 

              	
                MATCH
                  AMOUNT: 

              	
                0.00 

              
	 	 	 	 
	
                FEDERAL
                  PERCENT: 

              	
                0.0000% 

              	
                STATE
                  PERCENT: 

              	
                0.0000% 

              
	
                PRIVATE
                  PERCENT: 

              	
                0.0000% 

              	
                OTHER
                  PERCENT: 

              	
                0.0000% 

              

      

      

       

      
        	
                SERVICE
                  INFORMATION: 

              	
                4005
                  MANAGED CARE 

              	 	 
	
                SERVICE
                  EFF DATES: 

              	
                7/1/2010-12/31/2010 

              	 	 
	
                COMPONENT
                  DESCRIPTION 

              	
                COMPONENT
                  DATES 

              	
                UNITS

              	
                RATE

              
	
                .1
                  PROFESSIONAL SERVICES 

              	
                7/01/10-12/31/10

              	
                ACTUAL
                  COST

              	
                1.0000

              
	
                SERVICE
                  TOTAL: 

              	 	 	
                ZERO-BASED 

              

      

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      Contract
        Attachment A

      

      Capitation
        Rates

      Effective
        rates as of January 1, 2007

      

      
        	
                Regions

              	
                Northwest

              	
                Northcentral

              	
                Northeast

              	
                Westcentral

              
	
                Package
                  A-B

              	 	 	 	 
	
                Newborn 

              	
                $
                  334.20 

              	
                $
                  328.46 

              	
                $
                  353.86 

              	
                $
                  370.16 

              
	
                Preschool 

              	
                68.11 

              	
                74.91 

              	
                75.40 

              	
                78.92 

              
	
                Children 

              	
                77.13 

              	
                84.83 

              	
                85.39 

              	
                89.38 

              
	
                Teenager 

              	
                112.83 

              	
                124.10 

              	
                124.92 

              	
                130.75 

              
	
                Adult
                  Male 

              	
                270.00 

              	
                249.42 

              	
                262.95 

              	
                296.61
                  

              
	
                Adult
                  Female 

              	
                257.11 

              	
                237.51 

              	
                250.40 

              	
                282.46 

              
	
                Maternity
                  Delivery 

              	
                3,429.99 

              	
                3,421.86 

              	
                3,366.24 

              	
                3,302.18 

              
	
                Package
                  C

              	 	 	 	 
	
                Newborn 

              	
                193.70 

              	
                193.70 

              	
                193.70 

              	
                193.70 

              
	
                Preschool 

              	
                80.14 

              	
                87.15 

              	
                86.92 

              	
                90.51 

              
	
                Children 

              	
                87.08 

              	
                94.69 

              	
                94.44 

              	
                98.34 

              
	
                Teenager 

              	
                118.67 

              	
                129.04 

              	
                128.70 

              	
                134.01 

              
	
                Maternity
                  Delivery 

              	
                3,429.99 

              	
                3,421.86 

              	
                3,366.24 

              	
                3,302.18 

              

      

      

       

      
        	
                Regions

              	
                Central

              	
                Eastcentral

              	
                Southwest

              	
                Southeast

              
	
                Package
                  A-B

              	 	 	 	 
	
                Newborn 

              	
                $
                  341.58 

              	
                $
                  377.13 

              	
                $
                  379.10 

              	
                $
                  386.76 

              
	
                Preschool 

              	
                70.95 

              	
                81.22 

              	
                85.54 

              	
                81.42 

              
	
                Children 

              	
                80.35 

              	
                91.98 

              	
                96.88 

              	
                92.21 

              
	
                Teenager 

              	
                117.54 

              	
                134.55 

              	
                141.72 

              	
                134.88 

              
	
                Adult
                  Male 

              	
                244.00 

              	
                291.44 

              	
                319.16 

              	
                302.12 

              
	
                Adult
                  Female 

              	
                232.36 

              	
                277.53 

              	
                303.92 

              	
                287.70 

              
	
                Maternity Delivery 

              	
                3,431.83 

              	
                3,431.51 

              	
                3,466.88 

              	
                3,481.37 

              
	
                Package
                  C

              	 	 	 	 
	
                Newborn 

              	
                193.70 

              	
                193.70 

              	
                193.70 

              	
                193.70 

              
	
                Preschool 

              	
                84.01 

              	
                92.35 

              	
                97.74 

              	
                93.63 

              
	
                Children 

              	
                91.28 

              	
                100.34 

              	
                106.20 

              	
                101.73 

              
	
                Teenager 

              	
                124.40 

              	
                136.74 

              	
                144.72 

              	
                138.64 

              
	
                Maternity Delivery 

              	
                3,431.83 

              	
                3,431.51 

              	
                3,466.88 

              	
                3,481.37 

              

      

      

       

      
        	
                Statewide-MAU

              	 
	
                Newborn 

              	
                $
                  1,306.69 

              
	
                Preschool 

              	
                627.56 

              
	
                Children 

              	
                370.56 

              
	
                Teenager 

              	
                342.84 

              
	
                Adult
                  Male 

              	
                451.08 

              
	
                Adult
                  Female 

              	
                567.64 

              
	
                Maternity
                  Delivery 

              	
                3,850.54 

              

      

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      CONTRACT
        ATTACHMENT B

      

      PAY
        FOR PERFORMANCE AND CONTRACT COMPLIANCE

      

      Except
        as
        defined below or the context requires otherwise, all capitalized terms shall
        have the meanings ascribed to them in the Contract.

      

      
        	
                A.

              	
                Pay
                  for Performance
                  Program

              

      

      

      1. Program
        Establishment and Eligibility.
        The
        Office has established a pay for performance program under which Contractor
        may
        receive additional compensation if certain conditions are met. Participation
        in
        the pay for performance program by Contractor is subject to Contractor's
        complete and timely satisfaction of its obligations under the Contract,
        including but not limited to all data reporting obligations. In furtherance
        of
        the foregoing and not by limitation, in the event Contractor has been subject
        to
        any of the following corrective actions (administered pursuant to the Contract)
        as a result of its failure to perform or non-compliance under the Contract,
        Contractor shall lose eligibility for participation in the program:

      

      a. The
        Office has suspended, in whole or in part, capitation payments or enrollment
        to
        the Contractor;

      

      b. The
        Office has assigned, in whole or in part, the membership and responsibilities
        of
        Contractor to another participating managed care plan contractor;

      

      c. The
        Office has assumed or appointed temporary management with respect to the
        Contractor;

      

      d. The
        Contract has been terminated; or

      

      e. Pursuant
        to the Contract including without limitation this Attachment, the Office
        has
        assessed liquidated damages against Contractor, in relation to its performance
        under the Contract more than four times during the measurement
        year.

      

      The
        Office may, at its option, reinstate Contractor's eligibility for participation
        in the pay for performance program once Contractor has properly cured all
        prior
        instances of non-compliance of its obligations under the Contract, and the
        Office has satisfactory assurances of acceptable future
        performance.

      

      2. Bonus
        Potential.
        Contractor may be eligible to receive a bonus based on performance in an
        amount
        not to exceed one-half of one percent (0.5%) of the capitation revenue paid
        to
        Contractor during the measurement year.

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      3. Priority
        Areas and Data Submission.
        The
        Office has identified the following priority areas for performance improvement,
        and the items denoted by an asterisk will be measured during calendar year
        2007
        for purposes of determining any performance bonus:

      

      
        	 	
                a.

              	
                Appropriate
                  emergency room utilization

              

      

      
        	 	
                b.

              	
                Frequency
                  of Ongoing Prenatal Care*

              

      

      
        	 	
                c.

              	
                Well
                  Child Visits*

              

      

      
        	 	
                d.

              	
                Blood
                  lead screening*

              

      

      
        	 	
                e.

              	
                Behavioral
                  health and physical health
                  coordination.

              

      

      

      Contractor
        shall submit information to the Office, in the format and detail specified
        by
        the Office, with respect to each of these priority areas. It is the Office's
        expectation that the Contractor's 2008 HEDIS report (where 2007 is the
        measurement year) will include the information with respect to items (a)
        through
        (c) above. The Office will identify to Contractor the reporting requirements
        as
        respects items (d) and (e) above as part of its normal process for communicating
        quality improvement program initiatives and reporting requirements.

      

      4. Performance
        Measures.
        The
        performance measures for calendar year 2007 and the amount of the bonus
        allocable to each measure are set out below:

      

      
        	
                PERFORMANCE
                  MEASURE

              	
                ALLOCABLE
                  BONUS

              
	 	 	 
	
                a.

              	
                Frequency
                  of Ongoing Prenatal Care (>=81%)

              	
                one-third

              
	
                b.

              	
                Well
                  Child Visits (3-6 yrs)

              	
                one-third

              
	
                c.

              	
                Blood
                  lead screening

              	
                one-third

              

      

      

      The
        performance measures applicable during subsequent years of the Contract will
        be
        established annually by the Office and reflected in an amendment to the
        Contract.

      

      5. Performance
        Targets.
        The
        performance targets for calendar year 2007 are the following:

      

      
        	 	
                a.

              	
                Frequency
                  of Ongoing Prenatal Care
                  (>=81%):

              

      

      

      If
        Contractor's 2007 measurement year rate is at or above the base line of 50th
        percentile and below the 75th
        percentile of NCQA Medicaid (2006), twenty percent (20%) of allocable
        bonus.

      

      If
        Contractor's 2007 measurement year rate is at or above the 75th
        percentile of NCQA Medicaid (2006) and below the 90th
        percentile of NCQA Medicaid (2006), seventy percent (70%) of allocable
        bonus.

      

      If
        Contractor's 2007 measurement year rate is at or above the 90th
        percentile of NCQA Medicaid (2006), one hundred percent (100%) of allocable
        bonus.

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	 	
                b.

              	
                Well
                  Child Visits (3-6 yrs):

              

      

      

      If
        Contractor's 2007 measurement year rate is at or above the base line of
        50th
        percentile and below the 75th
        percentile of NCQA Medicaid (2006), twenty percent (20%) of allocable
        bonus.

      

      If
        Contractor's 2007 measurement year rate is at or above the 75th
        percentile of NCQA Medicaid (2006) and below the 90th
        percentile of NCQA Medicaid (2006), seventy percent (70%) of allocable
        bonus.

      

      If
        Contractor's 2007 measurement year rate is at or above the 90th
        percentile of NCQA Medicaid (2006), one hundred percent (100%) of allocable
        bonus.

      

      
        	 	
                c.

              	
                Blood
                  Lead Screening:

              

      

      

      If
        Contractor's 2007 measurement year rate is at or above 30% and below 35%,
        eighty-five percent (85%) of allocable bonus.

      

      If
        Contractor's 2007 measurement year rate is at or above 35%, one hundred percent
        (100%) of allocable bonus.

      

      The
        performance targets and bonus opportunities applicable during subsequent
        years
        of the Contract will be established annually by the Office and reflected
        in an
        amendment to the Contract.

      

      6. Timing
        of Bonus Payment.
        The
        Office will distribute a report identifying Contractor's performance during
        calendar year 2007 and the amount of bonus earned as respects each performance
        measure for such year by October 1, 2008. Payment will be distributed to
        Contractor, subject to Section 7 below, by October 31, 2008.

      

      7. Conditions
        to Bonus Payment.
        The
        Office will not have any obligation to distribute bonus payments to Contractor
        if the Office has made a determination that Contractor is not eligible to
        participate in the pay for performance program, as described in Section 1
        above.
        In addition to the foregoing and not by limitation, the Office will not have
        any
        obligation to distribute bonus payments to Contractor unless Contractor has
        furnished to the Office an acceptable plan for distributing fifty percent
        (50%)
        of the bonus to the Contractor's health care providers and Contractor's Hoosier
        Healthwise members. The plan for distribution of the bonus must specifically
        include a performance-based incentive system for high volume PMPs. As used
        herein, high volume PMPs are the top ten percent (10%) of the Contractor's
        PMPs
        based on member enrollment. All plans for distributing payment to providers
        and
        members must be consistent with state and federal law and approved by the
        Office
        prior to payment being made hereunder.

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      8. Disposition
        of Undistributed Bonus Funds.
        In the
        event the maximum amount of the bonus available to all managed care plan
        contractors is not earned and distributed based on the performance of Contractor
        and/or other managed care plan contractors, the Office will retain the
        difference (hereinafter referred to as the "undistributed bonus funds").
        The
        Office will provide quality service award payments to Contractor and other
        managed care plan contractors from the undistributed bonus funds subject
        to the
        conditions set forth in Section 7 above. Any such quality service award payments
        will be based on performance in other areas, including without limitation,
        those
        priority areas described in Section 3 above for which performance targets
        were
        not established (e.g., appropriate emergency room utilization; behavioral
        health
        and physical health coordination); number of provider and member complaints
        handled; overall HEDIS scores; PMP access; timeliness of claim payment; and
        clinical initiatives. In addition to the foregoing and not by limitation,
        the
        Office may distribute a portion of the undistributed bonus funds to Contractor
        and other managed care plan contractors, subject to the conditions set forth
        in
        Section 7 above, to fund all or a portion of quality improvement initiatives
        deemed meritorious by the Office. Contractor acknowledges that it does not
        have
        any right to quality service award payments or funds for quality improvement
        initiatives, and that the Office has full discretion to determine whether
        and
        the extent to which any such distributions will be made.

      

      9. Non-financial
        Incentives.
        In
        addition to the potential to earn bonuses based on performance in the identified
        areas, the Office may establish other means to incent performance improvement.
        The Office intends to distribute information on key performance indicators
        to
        participating managed care plan contractors on a regular basis, identifying
        Contractor's performance, and comparing that performance to other participating
        managed care plan contractors, and standards set by the Office and/or external
        benchmarks. The Office will recognize contractors that attain superior
        performance and/or improvement by publicizing their achievements. For example,
        The Office may post information concerning exceptional performance on its
        website, where it will be available to both stakeholders and members of the
        public. The Office may also revise its auto-assignment methodology during
        the
        Contract period for new members who do not select a participating managed
        care
        plan contractor. The new assignment methodology would reward those contractors
        that demonstrate superior performance and/or improvement on one or more
        performance measures.

      

      
        	 	
                B.

              	
                Contract
                  Compliance

              

      

      

      1. Scope.
        The
        ability of the Office to assess liquidated damages, as set forth in this
        Attachment, is in addition to any other remedies set forth in the Contract
        and
        the Scope of Work. In the event of any inconsistency between the terms of
        this
        Attachment and the Contract and/or Scope of Work, the terms of this Attachment
        shall control.

      

      2. Performance
        and Reporting Requirements.
        The
        Contract and Scope of Work specify the performance requirements of the
        Contractor. The MCO Reporting Manual details the required formats, templates
        and
        submission instructions for the reports required to be submitted pursuant
        to
        this Contract. The Office may change the frequency of required reports, or
        may
        require additional reports, at the Office's discretion.

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      3. Liquidated
        Damages.
        In the
        event that the Contractor fails to meet performance requirements or reporting
        standards set forth in this Contract or the MCO Reporting Manual, it is agreed
        that damages shall be sustained by the State, and the Contractor shall pay
        to
        the Office the liquidated damages as set forth in this Attachment. It is
        further
        agreed that in the failure to meet specified performance or reporting
        requirements subject to liquidated damages, it is and will be extremely
        impractical and extremely difficult to ascertain and determine the actual
        damages which the State will sustain in the event of, and by reason of, such
        failure; and it is therefore agreed that the Contractor will pay the Office
        for
        such failures as set forth below. No punitive intention is inherent in the
        following liquidated damages provisions.

      

      4. Priority
        Performance and Reporting Requirements.
        The
        Office has assigned high priority to the following reports (collectively
        referred to herein as "Priority Reports"):

      

      
        	
                No
                  

              	
                Title

              
	
                A.
                  

              	
                Systems
                  and Claims Reports 

              
	
                1.
                  

              	
                Claims
                  Processing Summary 

              
	
                2.
                  

              	
                Adjudicated
                  Claims Inventory Summary 

              
	
                3.
                  

              	
                Claims
                  Denial Reasons 

              
	
                4.
                  

              	
                Shadow
                  Claims/Encounter Data 

              
	 	 
	
                B.
                  

              	
                Member
                  Services Reports 

              
	
                1.
                  

              	
                Member
                  Helpline Performance 

              
	
                2.
                  

              	
                Member
                  Grievances and Appeals 

              
	
                3.
                  

              	
                Consumer
                  Assessment of Healthcare Providers and Systems (CAHPS®)
                  Summary 

              
	 	 
	
                C.
                  

              	
                Network
                  Development and Access Reports 

              
	
                1.
                  

              	
                Network
                  Geographic Access Assessment 

              
	
                2.
                  

              	
                Provider
                  Directory 

              
	
                3.
                  

              	
                24-Hour
                  Availability Audit 

              
	 	 
	
                D.
                  

              	
                Provider
                  Services Reports 

              
	
                1.
                  

              	
                Provider
                  Claims Disputes 

              
	
                2.
                  

              	
                Provider
                  Helpline Performance 

              
	 	 
	
                E.
                  

              	
                Quality
                  Management and Improvement Reports 

              
	
                1.
                  

              	
                Quality
                  Management and Improvement Work Plan 

              
	
                2.
                  

              	
                HEDIS®
                  Data Submission Tool Report 

              
	 	 
	
                F.
                  

              	
                Utilization
                  Reports 

              
	 	 
	
                G.
                  

              	
                Financial
                  Reports 

              
	
                1.
                  

              	
                Indiana
                  Department of Insurance (IDOI) Filing 

              
	 	 
	
                H.
                  

              	
                Pharmacy
                  Reports 

              
	 	 

      

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      5. Non-compliance
        with Reporting Requirements.
        If
        Contractor fails to submit any Priority Report in a timely, complete and
        accurate manner as required under the Contract or MCO Reporting Manual,
        Contractor will pay liquidated damages of five thousand dollars ($5,000.00)
        for
        each Priority Report that is not submitted in a timely, complete and accurate
        manner. If Contractor fails to submit any other required report (other than
        a
        Priority Report) in a timely, complete and accurate manner, Contractor will
        pay
        liquidated damages as set forth in the Scope of Work.

      

      6. Non-compliance
        with Performance Requirements.

      

      a. Network
        Access.
        If the
        Office determines that the Contractor has not met the network access standards
        established in Scope of Work, the Office shall impose sanctions on the
        Contractor and require submission of a Corrective Action Plan to the Office
        within ten (10) business days following imposition of sanctions. Determination
        of failure to meet network access standards shall be made following a review
        of
        the Contractor's Network Geographic Access Assessment Report. Upon the effective
        date of this Contract, the above-referenced report shall be submitted on
        a
        monthly basis until such time as the Office directs Contractor to submit
        the
        above-referenced report on a quarterly basis. Contractor will pay liquidated
        damages as follows: (i) five thousand dollars ($5,000.00) for each reporting
        period (month or quarter, as the case may be) that the Contractor fails to
        meet
        the Network Access Standards for Primary Medical Practitioners (PMPs), and
        (ii)
        five thousand dollars ($5,000.00) for each reporting period (month or quarter,
        as the case may be) that the Contractor fails to meet the network access
        standards for Behavioral Health Providers. Further, should Contractor be
        liable
        for liquidated damages for two consecutive reporting periods as a result
        of
        failure to meet network access standards, the Office shall immediately suspend
        auto-enrollment of Hoosier Healthwise members with the Contractor, until
        such
        time as Contractor successfully demonstrates compliance with the network
        access
        standards.

      

      b. Marketing
        Violations.
        If the
        Office determines that Contractor has violated the requirements of Contractor's
        obligations with respect to marketing and marketing materials as set forth
        in
        Section 3.2 of the Scope of Work and 42 CFR 438.104, Contractor will pay
        liquidated damages of one thousand dollars ($1,000.00) for each instance
        that
        such determination of a violation is made. For illustration purposes only,
        a
        violation will be determined to exist if Contractor distributed, directly,
        or
        indirectly through any agent or independent contractor, marketing materials
        that
        have not been approved by the Office or that contain inaccurate, false or
        misleading information.

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      c. Claims
        Payment.
        If
        Contractor fails to pay or deny at least ninety-eight percent (98%) of
        electronically filed clean claims in a given month within 21 calendar days
        of
        receipt, and/or at least of ninety-eight percent (98%) clean paper claims
        in a
        given month within thirty (30) calendar days of receipt, the Office shall
        deem
        this to be an instance of unsatisfactory claims performance and Contractor
        will
        pay liquidated damages of five thousand dollars ($5,000.00) for each month
        that
        such determination is made. Should Contractor be liable for liquidated damages
        under this provision for two consecutive months for unsatisfactory claims
        performance, the Office shall immediately suspend auto-enrollment of Hoosier
        Healthwise members with the Contractor, until such time as Contractor
        successfully demonstrates that all past due clean claims have been
        paid.

      

      d. Complaints.
        As used
        herein, the term "Office Investigated Complaint" refers to a written member
        or
        provider complaint to the Office (or to another State agency or official
        and
        which is directed to the Office) where (i) Office staff are assigned to
        investigate and address the issues raised by the complaint, and (ii) the
        Office
        concludes that the complaint is valid even if the disposition of the complaint
        is not resolved in favor of the complaining party. If Contractor is subject
        to
        more than three (3) Office Investigated Complaints in any one month, Contractor
        will pay liquidated damages of one thousand dollars ($1,000.00) for each
        such
        Office Investigated Complaint above three (3) per month. For illustration
        purposes only, if Contractor is the subject of two Office Investigated
        Complaints initiated by providers and two Office Investigated Complaints
        initiated by members in a particular month, Contractor will pay one thousand
        dollars ($1,000.00) as liquidated damages for that month.

      

      e. Other
        Non-Performance.
        If
        Contractor fails to meet the other performance standards set forth in the
        Contract or Scope of Work, Contractor will pay liquidated damages as set
        forth
        in the Scope of Work.

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      EXHIBIT
        1

      Coordinated
        Care

      

      MHS
        Vendor List

      (Response
        to Section 1, Question 1 and Section 5, Question 2)

      

      (Note
        that none of these vendors will bear 5% or more of the risk of Hoosier
        Healthwise revenues. However, they are important subcontractors for
        MHS)

      

      LCP
        Tranportation Company(MBE)

      4308
        Guion Road, Suite D

      Indianapolis,
        IN 46254

      Approximate
        Spend: $4,320,000

      8%

      Scope
        of
        Work: Transportation services

      

      HR
        Solutions(MBE)

      16650
        Lakeville Crossing

      Westfield,
        IN 46074

      Approximate
        Spend: 36,000

      .07%

      Scope
        of
        Work: Executive Searches, Temporary contract employees

      

      Engaging
        Solutions(WBE)

      3145
        N.
        Meridian Suite 240

      Indianapolis,
        IN 46208

      Approximate
        Spend: $800,000

      1.5%

      Scope
        of
        Work: Member Retention, Behavioral health integration and program
        integrity

      

      Briljent(WBE)

      7615
        W.
        Jefferson Blvd.

      Fort
        Wayne, IN 46804

      Approximate
        Spend: $50,000

      .09%

      Scope
        of
        Work: Staff augmentation, assisting providers with certification

      

      Bright
        Ideas in Broad Ripple, Inc(WBE)

      7425
        Westfield Blvd.

      Indianapolis,
        IN 46260

      .09%

      Approximate
        Spend: $50,000

      Scope
        of
        Work: promotional merchandise

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      Universal
        Behaviroal Services(MBE)

      3590
        N.
        Meridian

      Indianapolis,
        IN 46208

      Approximate
        Spend: $7,000

      .01%

      .Scope
        of
        Work: Comprehensive assessments, diagnosis, treatment of major psychiatric
        illnesses for persons with chronic and persistent mental illness or acute
        episodes

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