Document:

missouricontractamend10.htm

    Back to Form 8-K    

    Exhibit 10.1

    
      
        

         

        NOTICE OF
AWARD

      

      
         

        State
Of Missouri

      

      
        Office
Of Administration

      

      
        Division
Of Purchasing And Materials Management

      

      
        PO
Box 809

      

      
        Jefferson
City, MO 65102

      

      
        www .oa.mo.
gov/purch

      

      

      
        	
                CONTRACT
      NUMBER

                 

                C306118005

              	
                CONTRACT
      TITLE

                 

                Medicaid
      Managed Care – Eastern Region

                 

              
	
                AMENDMENT
      NUMBER

                 

                Amendment
      #010 Revised

              	
                CONTRACT
      PERIOD

                 

                July
      1, 2008 through June 30, 2009

                 

              
	
                REQUISITION
      NUMBER

                 

                NR
      886 25759002783

              	
                VENDOR
      NUMBER

                 

                3640504950
      1

                 

              
	
                CONTRACTOR
      NAME AND ADDRESS

                 

                HARMONY
      HEALTH PLAN OF MISSOURI

                23
      PUBLIC SQUARE STE 400

                BELLEVILLE
      IL 62220

                 

              	
                STATE
      AGENCY’S NAME AND ADDRESS

                 

                Department
      of Social Services

                MO
      HealthNet Division

                PO
      Box 6500

                Jefferson
      City MO 65102-6500

                 

              
	
                ACCEPTED
      BY THE STATE OF MISSOURI AS FOLLOWS:

                 

                Contract
      C306118005 is hereby amended pursuant to the attached Amendment #010
      Revised dated 09/24/08.

                 

              
	
                BUYER

                 

                Laura
      Ortmeyer

                 

              	
                BUYER
      CONTACT INFORMATION

                 

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

                Phone:
      (573) 751-4579

                 

              
	
                SIGNATURE
      OF BUYER

                 

                /s/
      Laura Ortmeyer

              	
                DATE

                 

                September
      25, 2008

                 

              
	
                DIRECTOR
      OF PURCHASING AND MATERIALS MANAGEMENT

                 

                 

                /s/ James Miluski

                James
      Miluski

                 

              

      

      
        
           

        

        
           

          
            

          

        

        
           

        

      
STATE
OF MISSOURI

    OFFICE
OF ADMINISTRATION

    DIVISION
OF PURCHASING AND MATERIALS MANAGEMENT (DPMM)

    CONTRACT
AMENDMENT

     

    
      	
              AMENDMENT
      NO.:  010
      Revised

            	
              REQ
      NO.: NR 886
      25759002783

            
	
              CONTRACT
      NO.:  C306118005

            	
              BUYER:  Laura
    Ortmeyer

            
	
              TITLE:  Mo
      Health Net Managed Care – Eastern Region

            	
              PHONE
      NO.:  (573)
      751-4579

            
	
              ISSUE
      DATE:  09/24/08

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

            

    

    

    TO:     HARMONY
HEALTH PLAN OF MISSOURI

    23 PUBLIC SQUARE STE 400

    BELLEVILLE
IL  62220

    

    RETURN
AMENDMENT NO LATER THAN:  SEPTEMBER 25, 2008 AT 5:00 PM CENTRAL
TIME

     

    RETURN
AMENDMENT TO:

    
      	
                                                      
      (U.S.
      Mail)

              Div
      of Purchasing & Matls Mgt (DPMM)    OR

              PO
      BOX 809

              JEFFERSON
      CITY MO  65102-0809

            	
                                   
      (Courier
      Service)

              Div
      of Purchasing & Matls Mgt (DPMM)

              301
      WEST HIGH STREET, ROOM 630

              JEFFERSON
      CITY MO  65101-1517

            

    

    

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

    

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

    

    Department
of Social Services, MO HealthNet Division

    Post
Office Box 6500

    Jefferson
City MO  65102-6500

    

    SIGNATURE
REQUIRED

    

    
      	
                DOING
      BUSINESS AS (DBA) NAME

               

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

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

               

               
      Harmony Health Plan of Illinois, Inc

            
	
               
      MAILING ADDRESS

               

               
      23 Public Square, Suite 400

            	
               
      IRS FORM 1099 MAILING ADDRESS

               

               
      200 West Adams Street, Suite 800

            
	
               
      CITY, STATE, ZIP CODE

               

               
      Belleville, IL 62220

            	
               
      CITY, STATE, ZIP CODE

               

               
      Chicago, IL 60606

            

    

     

    
      	
               
      CONTACT PERSON

               

               
      Ms. Tina Gallagher

            	
               
      EMAIL ADDRESS

               

               
      Tina.Gallagher@wellcare.com

            
	
               
      PHONE NUMBER

               

               
      (800) 608-8158 Ext. 2405

            	
               
      FAX NUMBER

               

               
      (800) 608-8157

            
	
               
      TAXPAYER ID NUMBER (TIN)

               
      36-4050495

            	
                
      TAXPAYER ID (TIN) TYPE (CHECK ONE)

                          ___ FEIN       ___
      SSN

            	
               
      VENDOR NUMBER (IF KNOWN)

                3640504950
      1

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

               

               ___
      Corporation         ___
      Individual         ___ State/Local
      Government         ___ Partnership         ___
      Sole
      Proprietor         ___Other
      ________________

               

            
	
               
      AUTHORIZED SIGNATURE

               

                /s/
      Heath Schiesser

            	
               
      DATE

               

                9-24-08

            
	
                 PRINTED
      NAME

               

               
      Heath Schiesser  

            	
                TITLE

               

               
      President and CEO

            

    

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    

    
      	
              Contract
      C306118005

            	 
      	
              Page
      2

            

    

     

    AMENDMENT 010 (REVISED) TO
CONTRACT C306118005

    

    
      	
              CONTRACT
      TITLE:

            	 
      	
              Mo
      Health net Managed Care – Eastern
Region

            

    

    

    
      	
              CONTRACT
      PERIOD:

            	
              July
      1, 2008 through June 30, 2009

            

    

    

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

    

    1.           Paragraph
2.4.9 is hereby amended effective July 1, 2008 as follows:

    

    
      	
               
      

            	
              2.4.9

            	
              The
      health plan shall maintain the fee schedule for office visit services and
      dental services located in Attachment 14 at no lower than the MO HealthNet
      fee-for-service fee schedule in effect at the time of
      service.  The fee schedule for office visit services included in
      Attachment 14 is for dates of services July 1, 2006 through June 30,
      2007.  The fee schedule for dental services included in
      Attachment 14 are for dates of service July 1, 2006 through June 30,
      2008.

            

    

    

    2.           Paragraph
2.4.9 d. and e. is hereby inserted effective July 1, 2008 as
follows:

    

    
      	
               

            	 2.4.9
      d.	
              A
      physician fee increase will be implemented effective July 1, 2008.
      Physician reimbursement rates that are currently less than 62.5% of the
      Medicare reimbursement rate will increase to 62.5% and physician
      reimbursement rates currently at or above 62.5% will remain
      unchanged.  The MO HealthNet Online Fee-For-Service Fee Schedule
      is available electronically at the MO HealthNet Division's
      website:  http://www.dss.mo.gov/mhd/providers/pages/cptagree.htm.

            

    

    

    
      	
               

            	 2.4.9
      e.	
              Effective
      July 1, 2008, the MO HealthNet Managed Care health plan shall increase the
      rates for physician services provided to MO HealthNet Managed Care
      enrollees in accordance with the fee-for-service rate
      increases.  The MO HealthNet Managed Care health plan's
      capitation rates will be adjusted effective July 1, 2008 to reflect the
      increases for physician services.  The MO HealthNet Managed Care
      health plan shall request and receive proof from its health care services
      subcontractors that these increases have been passed on to providers
      beginning July 1, 2008.  Such proof shall be provided to the
      state agency upon request.

            

    

    

    
      	
              3.

            	
              Paragraph
      2.4.9 f. is hereby inserted effective July 1, 2008 as
    follows:

            

    

    

    
      	
               

            	 2.4.9
      f.	
              The
      Missouri 94th
      General Assembly approved a fee increase for the MO HealthNet Optical and
      Dental Programs.  The reimbursement rates for certain optical
      and dental services will be implemented for dates of service on or after
      July 1, 2008.  The MO HealthNet Online Fee-For-Service Fee
      Schedule is available electronically at the MO HealthNet Division's
      website:  http://www.dss.mo.gov/mhd/providers/pages/cptagree.htm.

            

    

    

    
      	
              4.

            	
              Attachment
      5 is hereby revised effective July 1,
2008.

            

    

    

    
      	
              5.

            	
              Attachment
      13 is hereby revised effective July 1,
2008.

            

    

    

    
      	
              6.

            	
              Attachment
      14 is hereby revised effective July 1,
2008.

            

    

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    

    
      	
              Contract
      C306118005

            	 
      	
              Page
      3

            

    

    

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

    

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

    

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

    
      
         

      

      
         

        
          

        

      

      
         

      

    

     

    
      5.3
East Region - Firm Fixed Net Capitation Pricing Page

       

    

    
      	
              July 1, 2008

            
	
                          

            	
                  

            	
               

            	
              Column
      1

            	 
      	
              Column
      2

            
	
              Category
      

              of
      Aid

            	 Age	 Sex	
               State's
      Maximum Net 

              Capitation
      Rate

              (Per Member, Per
      Month)

            	 	
               Firm
      Fixed Net 

              Capitation
      Rate

              (Per Member, Per Month)
      

            
	
              1

            	
              Newborn
      < 01

            	
              Male
      and Female

            	
              $

            	
              $988.79

            	 
      	
              $

            	
              $988.79

            
	
              1

            	
              01
      - 06

            	
              Male
      and Female

            	
              $

            	
              $147.77

            	 
      	
              $

            	
              $147.77

            
	
              1

            	
              07
      - 13

            	
              Male
      and Female

            	
              $

            	
              $114.64

            	 
      	
              $

            	
              $114.64

            
	
              1

            	
              14
      - 20

            	
              Female

            	
              $

            	
              $221.94

            	 
      	
              $

            	
              $221.94

            
	
              1

            	
              14
      - 20

            	
              Male

            	
              $

            	
              $138.91

            	 
      	
              $

            	
              $138.91

            
	
              1

            	
              21
      - 44

            	
              Female

            	
              $

            	
              $342.35

            	 
      	
              $

            	
              $342.35

            
	
              1

            	
              21
      - 44

            	
              Male

            	
              $

            	
              $239.74

            	 
      	
              $

            	
              $239.74

            
	
              1

            	
              45
      - 99

            	
              Male
      and Female

            	
              $

            	
              $528.33

            	 
      	
              $

            	
              $528.33

            
	
              4

            	
              00
      - 20

            	
              Male
      and Female

            	
              $

            	
              $233.48

            	 
      	
              $

            	
              $233.48

            
	
              1&4

            	
              Delivery

            	 
      	
              $

            	
              $5,059.90

            	 
      	
              $

            	
              $5,059.90

            
	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
              5

            	
              00
      - 06

            	
              Male
      and Female

            	
              $

            	
              $172.28

            	 
      	
              $

            	
              $172.28

            
	
              5

            	
              07
      - 13

            	
              Male
      and Female

            	
              $

            	
              $148.51

            	 
      	
              $

            	
              $148.51

            
	
              5

            	
              14
      - 18

            	
              Male
      and Female

            	
              $

            	
              $193.76

            	 
      	
              $

            	
              $193.76

            
	
              5

            	
              Delivery

            	 
      	
              $

            	
              $5,059.90

            	 
      	
              $

            	
              $5,059.90

            

    

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    
      	
              EAST
      REGION

            	 
      	
              Attachment
      5

            	 
      	 
      
	
              Family
      Planning and STD Treatment Providers

            	
              Jul-2008

            	 
      	 
      
	 
      	 
      	 
      	 
      	 
      
	
              Franklin
      County:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Family
      Planning Clinic

            	
              920L
      Saint Clair Plaza Dr

            	
              St
      Clair

            	
              MO

            	
              63077

            
	 
      	 
      	 
      	 
      	 
      
	
              Iron
      County:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              East
      Missouri Action Agency Family Planning

            	
              606
      W Russell

            	
              Ironton

            	
              MO

            	
              63650

            
	 
      	 
      	 
      	 
      	 
      
	
              Madison
      County:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              East
      Missouri Action Agency Family Planning

            	
              806
      W College Ave

            	
              Fredericktown

            	
              MO

            	
              63645

            
	 
      	 
      	 
      	 
      	 
      
	
              Perry
      County:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              East
      Missouri Action Agency Family Planning

            	
              519
      Old Saint Marys Road

            	
              Perryville

            	
              MO

            	
              63775

            
	 
      	 
      	 
      	 
      	 
      
	
              St.
      Francois County:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              East
      Missouri Action Agency Family Planning

            	
              107
      Industrial Drive

            	
              Park
      Hills

            	
              MO

            	
              63601

            
	 
      	 
      	 
      	 
      	 
      
	
              St.
      Louis City:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Planned
      Parenthood of the St Louis Region

            	
              4251
      Forest Park Ave

            	
              St
      Louis

            	
              MO

            	
              63108

            
	 
      	 
      	 
      	 
      	 
      
	
              Warren
      County:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              NECAC
      Health Services

            	
              120
      E Booneslick

            	
              Warrenton

            	
              MO

            	
              63383

            
	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      
	
              Other:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              East
      Missouri Action Agency Family Planning

            	
              1111
      Linden

            	
              Cape
      Girardeau

            	
              MO

            	
              63702

            
	
              NECAC
      Family Planning Center

            	
              24
      Northport Plaza

            	
              Hannibal

            	
              MO

            	
              63401

            
	 
      	 
      	 
      	 
      	 
      
	
              Some
      local Public Health Agencies may also provide Family Planning and STD
      Treatment Services.

            
	
              Contact
      your local County Health Department for more information.

            	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      

    

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    
      	
              EAST
      REGION

            	 
      	
              Attachment
      5

            
	 
      	 
      	
              Jul-2008

            
	
              Local
      Health Agencies

            
	 
      	 
      	 
      
	
              Crawford
      County Nursing Service

            	 
      	
              St
      Charles County Dept of Health

            
	
              202
      W Main Street

            	 
      	
              1650
      Boonslick Road

            
	
              Steelville,
      MO  65565

            	 
      	
              St
      Charles, MO  63301

            
	 
      	 
      	 
      
	
              Franklin
      County Health Services

            	 
      	
              St
      Francois County Health Dept

            
	
              15
      South Oak

            	 
      	
              1025
      W Main

            
	
              Union,
      MO  63084

            	 
      	
              Park
      Hills, MO  63601

            
	 
      	 
      	 
      
	
              Iron
      County Health Department

            	 
      	
              St
      Louis County Department of Health

            
	
              606
      W Russell

            	 
      	
              111
      S Meramec

            
	
              Ironton,
      MO  63650

            	 
      	
              Clayton,
      MO  63105

            
	 
      	 
      	 
      
	
              Jefferson
      County Health Department

            	 
      	
              City
      of St Louis Department of Health

            
	
              405
      Main Street

            	 
      	
              634
      N Grand

            
	
              Hillsboro,
      MO  63050

            	 
      	
              St
      Louis, MO  63103

            
	 
      	 
      	 
      
	
              Lincoln
      County Health Department

            	 
      	
              Ste
      Genevieve County Health Dept

            
	
              5
      Health Department Drive

            	 
      	
              115
      Basler Drive

            
	
              Troy,
      MO  63379

            	 
      	
              Ste
      Genevieve, MO  63670

            
	 
      	 
      	 
      
	
              Madison
      County Health Department

            	 
      	
              Warren
      County Health Department

            
	
              806
      W College Ave

            	 
      	
              104
      W Booneslick

            
	
              Fredericktown,
      MO  63645

            	 
      	
              Warrenton,
      MO  63383

            
	 
      	 
      	 
      
	
              Perry
      County Health Department

            	 
      	
              Washington
      County Health Dept

            
	
              406
      N Spring

            	 
      	
              520
      Purcell Drive

            
	
              Perryville,
      MO  63775

            	 
      	
              Potosi,
      MO  63664

            
	 
      	 
      	 
      
	
              Pike
      County Health Department

            	 
      	 
      
	
              5 E
      Church Street

            	 
      	 
      
	
              Bowling
      Green, MO  63334

            	 
      	 
      

    

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    
      	
              EAST
      REGION

            	 
      	
              Attachment
      5

            	 
      
	 
      	 
      	
               

            	
              July-2008

            	 
      

    

    Federally
Qualified Health Centers (FQHC)

    
      Franklin
County:

    

    
      	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Crider
      Center South (Behavioral)

            	
              416
      Market Street

            	
              Washington

            	
              MO

            	
              63090

            
	
              Crider
      Center South (Dental)

            	
              851
      E 5th Street Ste 132

            	
              Washington

            	
              MO

            	
              63090

            

    

     

    
      Iron
County:

    

    
      	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Annapolis
      Family Clinic

            	
              Highway
      49

            	
              Annapolis

            	
              MO

            	
              63620

            
	
              Iron
      County Medical Clinic

            	
              301
      N Highway 21

            	
              Pilot
      Knob

            	
              MO

            	
              63663

            
	
              Ironton
      Medical Clinic

            	
              128
      W Russell

            	
              Ironton

            	
              MO

            	
              63650

            
	
              Viburnum
      Medical Clinic

            	
              #9
      Viburnum Shopping Ctr

            	
              Viburnum

            	
              MO

            	
              65566

            

    

     

    
      St.
Charles County:

    

    
      	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Crider
      Health Center Central

            	
              1032
      Crosswinds Court

            	
              Wentzville

            	
              MO

            	
              63385

            
	
              Crider
      Health Center East

            	
              300
      Water Street

            	
              St
      Charles

            	
              MO

            	
              63301

            

    

     

    St.
Francois County:

    
      	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Great
      Mines Health Center of Farmington

            	
              1101
      Weber Road

            	
              Farmington

            	
              MO

            	
              63640

            

    

     

    
      St.
Louis City:

    

    
      	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Family
      Care Health Centers (Carondelet)

            	
              401
      Holly Hills Ave

            	
              St
      Louis

            	
              MO

            	
              63111

            
	
              Family
      Care Health Centers (Forest Park)

            	
              4352
      Manchester Rd

            	
              St
      Louis

            	
              MO

            	
              63110

            
	
              Florence
      Hill Health Center

            	
              5541
      Riverview Blvd

            	
              St
      Louis

            	
              MO

            	
              63120

            
	
              Grace
      Hill @ St. Patrick Health Service

            	
              800
      N Tucker

            	
              St
      Louis

            	
              MO

            	
               
      63101*

            
	
              Grace
      Hill Murphy-O'Fallon Health Center

            	
              1717
      Biddle Street

            	
              St
      Louis

            	
              MO

            	
               
      63106*

            
	
              Grace
      Hill Soulard-Benton Health Center

            	
              2220
      Lemp

            	
              St
      Louis

            	
              MO

            	
               
      63104*

            
	
              Grace
      Hill South Health Center

            	
              3400
      S Jefferson

            	
              St
      Louis

            	
              MO

            	
               
      63118*

            
	
              Grace
      Hill Water Tower Health Center

            	
              4308
      N Grand

            	
              St
      Louis

            	
              MO

            	
               
      63107*

            
	
              Homer
      G. Phillips Health Center

            	
              2425
      Whittier St

            	
              St
      Louis

            	
              MO

            	
              63113

            
	
              Myrtle
      Hilliard Davis Comprehensive Health Center

            	
              5471
      Martin Luther King Dr

            	
              St
      Louis

            	
              MO

            	
              63112

            
	
              Myrtle
      Hilliard Davis Comprehensive Health Center II

            	
              4411
      N Newstead

            	
              St
      Louis

            	
              MO

            	
              63115

            
	
              Peoples
      Health Centers

            	
              5701
      Delmar Blvd

            	
              St
      Louis

            	
              MO

            	
              63112

            

    

     

    
      St.
Louis County:

    

    
      	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Peoples
      Health Centers

            	
              11642
      W Florissant

            	
              Florissant

            	
              MO

            	
              63033

            
	
              Peoples
      Health Centers

            	
              7200
      Manchester Rd

            	
              Maplewood

            	
              MO

            	
              63143

            

    

     

    
      Warren
County:

    

    
      	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Crider
      Health Center West

            	
              1428
      N State Hwy 47

            	
              Warrenton

            	
              MO

            	
              63383

            

    

    
       

      Washington
County:

    

    
      	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Great
      Mines Health Center

            	
              600
      Purcell Drive Suite B

            	
              Potosi

            	
              MO

            	
              63664

            
	 
      	 
      	 
      	 
      	 
      

    

    Other:

    
      	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Valley
      Springs Medical Clinic

            	
              County
      Road 814

            	
              Black

            	
              MO

            	
              63625

            
	
              Cross
      Trails Medical Center

            	
              408
      S Broadview St

            	
              Cape
      Girardeau

            	
              MO

            	
              63703

            
	
              Ellington
      Family Clinic

            	
              Hwy
      106 & 2nd Street

            	
              Ellington

            	
              MO

            	
              63638

            
	
              Cross
      Trails Medical Center

            	
              109
      Highway 51 N

            	
              Marble
      Hill

            	
              MO

            	
              63764

            

    

    *St.
Louis City: Grace Hill listings per Gerald Sonnenberg (Grace Hill Director of
Communications) 07-10-2008.

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    
      	
              EAST
      REGION

            	 
      	
              Attachment
      5

            	 
      	 
      
	 
      	 
      	
              Jul-2008

            	 
      	 
      
	
              Rural
      Health Clinics (RHC)

            
	
              Crawford
      County:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Bourbon
      Medical Office

            	
              240
      College Road

            	
              Bourbon

            	
              MO

            	
              65441

            
	
              Cuba
      Medical Office

            	
              102
      Ozark Street

            	
              Cuba

            	
              MO

            	
              65453

            
	
              Healthnet
      Regional Center of Cuba

            	
              412
      N Franklin

            	
              Cuba

            	
              MO

            	
              65453

            
	
              SJC-Cuba

            	
              114
      Downy Street

            	
              Cuba

            	
              MO

            	
              65453

            
	
              SJC-Steelville

            	
              518
      Pine Street

            	
              Steelville

            	
              MO

            	
              65565

            
	
              Steelville
      Medical Office

            	
              510
      W Main Street

            	
              Steelville

            	
              MO

            	
              65565

            
	
              Riverside
      Medical Clinic

            	
              101
      Progress Drive

            	
              Sullivan

            	
              MO

            	
              63080

            
	
              Sullivan
      Medical Office

            	
              965
      Mattox

            	
              Sullivan

            	
              MO

            	
              63080

            
	 
      	 
      	 
      	 
      	 
      
	
              Franklin
      County:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              St
      Johns Mercy Hospital Clinic

            	
              851
      E 5th Street Ste 312

            	
              Washington

            	
              MO

            	
              63090

            
	 
      	 
      	 
      	 
      	 
      
	
              Iron
      County:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Arcadia
      Valley Family Clinic

            	
              305
      Maple Street

            	
              Pilot
      Knob

            	
              MO

            	
              63663

            
	 
      	 
      	 
      	 
      	 
      
	
              Jefferson
      County:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              De
      Soto Family Practice

            	
              12
      Jefferson Square

            	
              De
      Soto

            	
              MO

            	
              63020

            
	
              Byrnes
      Mill Medical Center

            	
              100
      Osage Executive Circle

            	
              House
      Springs

            	
              MO

            	
              63051

            
	 
      	 
      	 
      	 
      	 
      
	
              Lincoln
      County:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Glennon
      Care Pediatrics

            	
              1165A
      East Cherry

            	
              Troy

            	
              MO

            	
              63379

            
	
              Troy
      Family Practice

            	
              344
      S Lincoln Drive

            	
              Troy

            	
              MO

            	
              63379

            
	
              Troy
      Surgical Clinic

            	
              900
      E Cherry Street

            	
              Troy

            	
              MO

            	
              63379

            
	 
      	 
      	 
      	 
      	 
      
	
              Madison
      County:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Chands
      Medical Office

            	
              733
      W Main Street

            	
              Fredericktown

            	
              MO

            	
              63645

            
	
              Community
      Health Care Associates

            	
              735
      W Main Street

            	
              Fredericktown

            	
              MO

            	
              63645

            
	
              Fredericktown
      Primary Care

            	
              309
      Garrett Street

            	
              Fredericktown

            	
              MO

            	
              63645

            
	
              Madison
      Medical Center RHC

            	
              611
      W Main Street

            	
              Fredericktown

            	
              MO

            	
              63645

            
	 
      	 
      	 
      	 
      	 
      
	
              Perry
      County:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Convenient
      Care Clinic

            	
              624
      Old Saint Marys Road

            	
              Perryville

            	
              MO

            	
              63775

            
	
              Perry
      Kids Pediatrics

            	
              210
      Hospital Lane Ste 202

            	
              Perryville

            	
              MO

            	
              63775

            
	
              Perryville
      Family Care Clinic

            	
              212
      Hospital Lane Ste 101

            	
              Perryville

            	
              MO

            	
              63775

            
	
              Perry
      County Womens Care

            	
              212
      Hospital Lane Ste 205

            	
              Perryville

            	
              MO

            	
              63775

            
	 
      	 
      	 
      	 
      	 
      
	
              Pike
      County:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Eastern
      Missouri Health Services

            	
              214
      W Church Street

            	
              Bowling
      Green

            	
              MO

            	
              63334

            
	
              Pike
      Medical Clinic Inc.

            	
              Jct
      61 & 161

            	
              Bowling
      Green

            	
              MO

            	
              63334

            
	
              Eastern
      Missouri Health Services

            	
              2305
      W Georgia

            	
              Louisiana

            	
              MO

            	
              63353

            
	
              Pike
      Medical Clinic Inc.

            	
              211
      S Third

            	
              Louisiana

            	
              MO

            	
              63353

            
	 
      	 
      	 
      	 
      	 
      
	
              St.
      Francois County:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Bonne
      Terre Primary Care

            	
              55
      Nesbit Drive

            	
              Bonne
      Terre

            	
              MO

            	
              63628

            
	
              Chands
      Medical Office

            	
              1031
      Karsch Road

            	
              Farmington

            	
              MO

            	
              63640

            
	
              Farmington
      Primary Care

            	
              1101
      Weber Rd Ste 302

            	
              Farmington

            	
              MO

            	
              63640

            
	
              Medical
      Arts Clinic

            	
              1103
      West Liberty

            	
              Farmington

            	
              MO

            	
              63640

            

    

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    
      	
              EAST
      REGION

            	 
      	
              Attachment
      5

            	 
      	 
      
	
                                                                 

            	
              Aug-2008

            	 
      	 
      
	
               
          Rural Health
      Clinics (RHC)

            
	
              Ste.
      Genevieve County:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Family
      Health Care - Pointe Basse

            	
              753
      Pointe Basse Drive

            	
              Ste
      Genevieve

            	
              MO

            	
              63670

            
	
              Ste
      Genevieve Family Health Center

            	
              930
      Park Drive

            	
              Ste
      Genevieve

            	
              MO

            	
              63670

            
	 
      	 
      	 
      	 
      	 
      
	
              Warren
      County:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Glennon
      Care Pediatrics at Warrenton

            	
              511
      Ashland

            	
              Warrenton

            	
              MO

            	
              63383

            
	 
      	 
      	 
      	 
      	 
      
	
              Washington
      County:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Heartland
      Medical Center

            	
              10048
      Settle Mill Road

            	
              Cadet

            	
              MO

            	
              63630

            
	
              Austin
      Plaza Primary Care

            	
              108
      Frizzell Suite 5

            	
              Potosi

            	
              MO

            	
              63664

            
	
              Healthway
      Primary Care

            	
              200
      Health Way Drive

            	
              Potosi

            	
              MO

            	
              63664

            
	
              Potosi
      Medical Clinic

            	
              1
      Kwan Plaza

            	
              Potosi

            	
              MO

            	
              63664

            
	
              Quality
      Health Care, Inc.

            	
              600
      Purcell Drive Suite 1

            	
              Potosi

            	
              MO

            	
              63664

            
	
              Simpelo
      Medical Clinic

            	
              108
      Frizzell Suite 6

            	
              Potosi

            	
              MO

            	
              63664

            
	
              Byrnes
      Mill Medical Center-Richwoods

            	
              10649
      State Hwy A

            	
              Richwoods

            	
              MO

            	
              63071

            
	 
      	 
      	 
      	 
      	 
      
	
              Other:

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Barry
      Rural Health Clinic

            	
              868
      Mortimer

            	
              Barry

            	
              IL

            	
              62312

            
	
              A
      Womans Life Holistic Fam HC Ctr

            	
              36
      Doctors Park

            	
              Cape
      Girardeau

            	
              MO

            	
              63703

            
	
              Cape
      Girardeau Co Public

            	
              1121
      Linden St

            	
              Cape
      Girardeau

            	
              MO

            	
              63702

            
	
              Immediate
      Healthcare

            	
              1702
      N Kingshighway

            	
              Cape
      Girardeau

            	
              MO

            	
              63701

            
	
              Medstop
      One Inc

            	
              3065
      Williams St

            	
              Cape
      Girardeau

            	
              MO

            	
              63703

            
	
              Midtown
      Family Medical Center

            	
              24
      N Sprigg St

            	
              Cape
      Girardeau

            	
              MO

            	
              63701

            
	
              River
      City Health Clinic

            	
              224
      N Frederick

            	
              Cape
      Girardeau

            	
              MO

            	
              63701

            
	
              Advanced
      Community Care Clinic

            	
              Route
      4 Box 4629

            	
              Ellington

            	
              MO

            	
              63638

            
	
              Reynolds
      Co Mem Hosp-Rains Clinic

            	
              Route
      4 Box 4273

            	
              Ellington

            	
              MO

            	
              63638

            
	
              Hermann
      Medical Arts

            	
              134
      W 6th Street

            	
              Hermann

            	
              MO

            	
              65041

            
	
              Southwest
      Medical Associates

            	
              1714
      Wein Street

            	
              Hermann

            	
              MO

            	
              65041

            
	
              Prompt
      Care

            	
              2130
      E Jackson Blvd

            	
              Jackson

            	
              MO

            	
              63755

            
	
              Mexico
      Family Health Care

            	
              626
      Summit Suite L

            	
              Mexico

            	
              MO

            	
              65265

            
	
              Mexico
      Health Services

            	
              809
      Medical Park Drive Suite 104

            	
              Mexico

            	
              MO

            	
              65265

            
	
              Mexico
      Pediatric Services

            	
              625
      Summit

            	
              Mexico

            	
              MO

            	
              65265

            
	
              Associated
      Medical Arts

            	
              504
      N Sturgeon

            	
              Montgomery
      City

            	
              MO

            	
              63361

            
	
              Montgomery
      City Medical Clinic

            	
              240
      N Pickering

            	
              Montgomery
      City

            	
              MO

            	
              63361

            
	
              Wilbers
      Family Care Clinic

            	
              111
      E First Street

            	
              Montgomery
      City

            	
              MO

            	
              63361

            
	
              Medical
      Clinic of Owensville

            	
              303
      N First Street

            	
              Owensville

            	
              MO

            	
              65066

            
	
              Perry
      Medical Clinic

            	
              1223
      Main Street

            	
              Perry

            	
              MO

            	
              63462

            
	
              Piedmont
      Family Clinic

            	
              1
      Hals Plaza Drive

            	
              Piedmont

            	
              MO

            	
              63957

            
	
              Wayne
      Medical Center

            	
              Route
      4 Box 4515

            	
              Piedmont

            	
              MO

            	
              63957

            
	
              Pittsfield
      Rural Hlth Affil

            	
              606
      W Adams

            	
              Pittsfield

            	
              IL

            	
              62363

            
	
              Pleasant
      Hill Rural Health

            	
              405
      E State Street

            	
              Pleasant
      Hill

            	
              IL

            	
              62366

            
	
              Rolla
      Urgent Care LLC

            	
              416
      S Bishop Ave

            	
              Rolla

            	
              MO

            	
              65401

            
	
              SJC-Rolla
      Medical Group

            	
              1601
      N Bishop

            	
              Rolla

            	
              MO

            	
              65401

            
	
              SJC-Rolla
      Internal Medicine

            	
              1100
      W 10th St Ste 270

            	
              Rolla

            	
              MO

            	
              65401

            
	
              SJC-Rolla
      Pediatrics

            	
              1100
      W 10th St Ste 175

            	
              Rolla

            	
              MO

            	
              65401

            
	
              Charles
      W Cunningham DO LLC

            	
              1010
      Hwy 32 East

            	
              Salem

            	
              MO

            	
              65560

            
	
              Salem
      Family Health Care Inc

            	
              Highway
      72 North

            	
              Salem

            	
              MO

            	
              65560

            
	
              SJC-Salem

            	
              404
      W Rolla Rd

            	
              Salem

            	
              MO

            	
              65560

            
	
              Forest
      City Family Practice

            	
              1000
      N Jefferson

            	
              St
      James

            	
              MO

            	
              65559

            
	
              SJC-St
      James

            	
              107
      W Eldon Street

            	
              St
      James

            	
              MO

            	
              65559

            
	
              Vandalia
      Medical Clinic

            	
              204
      W Washington

            	
              Vandalia

            	
              MO

            	
              63382

            
	
              Wellsville
      Medical Clinic

            	
              111
      W Bates

            	
              Wellsville

            	
              MO

            	
              63384

            

      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

    
      	 
      	
              Attachment
      5

            	 
      	 
      	 
      
	 
      	
              Jul-2008

            	 
      	 
      	 
      
	
              EAST
      REGION

            	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      
	
              SAFETY
      NET HOSPITALS

            	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      
	
              St.
      Francois County:

            	 
      	 
      	 
      	 
      
	
              Hospital

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Southeast
      Missouri Mental Health Center

            	
              1010
      W Columbia

            	
              Farmington

            	
              MO

            	
              63640

            
	 
      	 
      	 
      	 
      	 
      
	
              St.
      Louis City:

            	 
      	 
      	 
      	 
      
	
              Hospital

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Metropolitan
      St Louis Psychiatric Center

            	
              5351
      Delmar

            	
              St
      Louis

            	
              MO

            	
              63112

            
	
              St
      Louis Psychiatric Rehabilitation Center

            	
              5300
      Arsenal

            	
              St
      Louis

            	
              MO

            	
              63139

            
	 
      	 
      	 
      	 
      	 
      
	
              St.
      Louis County:

            	 
      	 
      	 
      	 
      
	
              Hospital

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Hawthorn
      Childrens Psychiatric Hospital

            	
              1901
      Pennsylvania

            	
              St
      Louis

            	
              MO

            	
              63133

            
	 
      	 
      	 
      	 
      	 
      

    

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    
      	
              EAST
      REGION

            	 
      	
              Attachment
      5

            	 
      	 
      
	 
      	 
      	
              Jul-2008

            	 
      	 
      
	
              Community
      Mental Health Centers (CMHC)

            	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      
	
              Jefferson
      County:   (CMHC and Community Psychiatric
      Rehab)

            	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              COMTREA
      Community Mental Health Center

            	
              227
      Main Street

            	
              Festus

            	
              MO

            	
              63028

            
	 
      	 
      	 
      	 
      	 
      
	
              St.
      Charles County:   (CMHC and Community Psychiatric
      Rehab)

            	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Crider
      Center for Mental Health

            	
              1032
      Crosswinds Court

            	
              Wentzville

            	
              MO

            	
              63385

            
	 
      	 
      	 
      	 
      	 
      
	
              St.
      Francois County:   (Community Psychiatric
      Rehab)

            	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Community
      Health Plus

            	
              1085
      Maple Street

            	
              Farmington

            	
              MO

            	
              63640

            
	
              Mineral
      Area CPRC Inc.

            	
              203
      S Washington

            	
              Farmington

            	
              MO

            	
              63640

            
	
              Southeast
      MO Community Treatment Ctr

            	
              512
      E Main

            	
              Park
      Hills

            	
              MO

            	
              63601

            
	 
      	 
      	 
      	 
      	 
      
	
              St.
      Louis (City):   (CMHC and Community Psychiatric
      Rehab)

            	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Hopewell
      Center

            	
              1504
      S Grand

            	
              St
      Louis

            	
              MO

            	
              63104

            
	 
      	 
      	 
      	 
      	 
      
	
              St.
      Louis (City):   (Community Psychiatric
    Rehab)

            	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Adapt

            	
              2301
      Hampton Ave

            	
              St
      Louis

            	
              MO

            	
              63139

            
	
              Community
      Health Plus

            	
              1430
      Olive Street

            	
              St
      Louis

            	
              MO

            	
              63103

            
	
              Family
      Resource Center Inc.

            	
              3309
      S Kingshighway

            	
              St
      Louis

            	
              MO

            	
              63139

            
	
              Independence
      Center

            	
              4380
      West Pine

            	
              St
      Louis

            	
              MO

            	
              63108

            
	
              Our
      Little Academy Therapeutic School

            	
              4330
      Lindell Blvd

            	
              St
      Louis

            	
              MO

            	
              63108

            
	
              Places
      For People Inc.

            	
              4130
      Lindell Blvd

            	
              St
      Louis

            	
              MO

            	
              63108

            
	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      
	
              Other:    (CMHC)

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Mark
      Twain Area Counseling Center

            	
              917
      Broadway

            	
              Hannibal

            	
              MO

            	
              63401

            
	 
      	 
      	 
      	 
      	 
      
	
              Other:   (Community
      Psychiatric Rehab)

            	 
      	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Comprehensive
      Health Systems Inc.

            	
              Highway
      61 & HH

            	
              Hannibal

            	
              MO

            	
              63401

            
	 
      	 
      	 
      	 
      	 
      
	
              Other:   (CMHC
      and Community Psychiatric Rehab)

            	 
      	 
      	 
      
	
              Name

            	
              Address

            	
              City

            	
              State

            	
              ZIP

            
	
              Community
      Counseling Center

            	
              402
      S Silver Springs Road

            	
              Cape
      Girardeau

            	
              MO

            	
              63703

            
	
              East
      Central Missouri Behavioral Health Svcs

            	
              321
      W Promenade

            	
              Mexico

            	
              MO

            	
              65265

            

      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

    
      	
              East
      Region - EPSDT Withhold Amounts

            
	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	
              July
      1, 2008

            
	 
      	 
      	 
      	 
      	
              EPSDT

            
	
              CATEGORY

            	 
      	 
      	 
      	
              WITHHOLD

            
	
              OF
      AID

            	 
      	 
      	 
      	
              AMOUNT

            
	
              NUMBER

            	
              AGE

            	
              SEX

            	
              PER
      % POINT

            
	
              1

            	
              <1
      (NEWBORNS)

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.12

            
	 
      	
              1-6
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            
	 
      	
              7-13
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.01

            
	 
      	
              14-20
      YEAR OLDS

            	
              FEMALE

            	 
      	
              $0.03

            
	 
      	
              14-20
      YEAR OLDS

            	
              MALE

            	 
      	
              $0.02

            
	 
      	 
      	 
      	 
      	 
      
	
              4

            	
              0-20
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            
	 
      	 
      	 
      	 
      	 
      
	
              5

            	
              0-6
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.03

            
	 
      	
              7-13
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            
	 
      	
              14-18
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            

    

    

      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

    
      	
              Central
      Region - EPSDT Withhold Amounts

            
	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	
              July
      1, 2008

            
	 
      	 
      	 
      	 
      	
              EPSDT

            
	
              CATEGORY

            	 
      	 
      	 
      	
              WITHHOLD

            
	
              OF
      AID

            	 
      	 
      	 
      	
              AMOUNT

            
	
              NUMBER

            	
              AGE

            	
              SEX

            	
              PER
      % POINT

            
	
              1

            	
              <1
      (NEWBORNS)

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.12

            
	 
      	
              1-6
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            
	 
      	
              7-13
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            
	 
      	
              14-20
      YEAR OLDS

            	
              FEMALE

            	 
      	
              $0.04

            
	 
      	
              14-20
      YEAR OLDS

            	
              MALE

            	 
      	
              $0.02

            
	 
      	 
      	 
      	 
      	 
      
	
              4

            	
              0-20
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.03

            
	 
      	 
      	 
      	 
      	 
      
	
              5

            	
              0-6
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.03

            
	 
      	
              7-13
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            
	 
      	
              14-18
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            

    

    

    
      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

    

    
      	
              Western
      Region - EPSDT Withhold Amounts

            
	
              With
      I-70 Expansion

            
	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	
              July
      1, 2008

            
	 
      	 
      	 
      	 
      	
              EPSDT

            
	
              CATEGORY

            	 
      	 
      	 
      	
              WITHHOLD

            
	
              OF
      AID

            	 
      	 
      	 
      	
              AMOUNT

            
	
              NUMBER

            	
              AGE

            	
              SEX

            	
              PER
      % POINT

            
	
              1

            	
              <1
      (NEWBORNS)

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.09

            
	 
      	
              1-6
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            
	 
      	
              7-13
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            
	 
      	
              14-20
      YEAR OLDS

            	
              FEMALE

            	 
      	
              $0.03

            
	 
      	
              14-20
      YEAR OLDS

            	
              MALE

            	 
      	
              $0.02

            
	 
      	 
      	 
      	 
      	 
      
	
              4
      OSJC

            	
              0-20
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.03

            
	
              4
      JC

            	
              0-20
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.03

            
	 
      	 
      	 
      	 
      	 
      
	
              5

            	
              0-6
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.03

            
	 
      	
              7-13
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            
	 
      	
              14-18
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            

    

    

    
      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

    

    
      	
              Western
      Region - EPSDT Withhold Amounts

            
	
              With
      I-70 Expansion Without Pharmacy

            
	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	
              July
      1, 2008

            
	 
      	 
      	 
      	 
      	
              EPSDT

            
	
              CATEGORY

            	 
      	 
      	 
      	
              WITHHOLD

            
	
              OF
      AID

            	 
      	 
      	 
      	
              AMOUNT

            
	
              NUMBER

            	
              AGE

            	
              SEX

            	
              PER
      % POINT

            
	
              1

            	
              <1
      (NEWBORNS)

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.09

            
	 
      	
              1-6
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            
	 
      	
              7-13
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            
	 
      	
              14-20
      YEAR OLDS

            	
              FEMALE

            	 
      	
              $0.03

            
	 
      	
              14-20
      YEAR OLDS

            	
              MALE

            	 
      	
              $0.02

            
	 
      	 
      	 
      	 
      	 
      
	
              4
      OSJC

            	
              0-20
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.03

            
	
              4
      JC

            	
              0-20
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.03

            
	 
      	 
      	 
      	 
      	 
      
	
              5

            	
              0-6
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.03

            
	 
      	
              7-13
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            
	 
      	
              14-18
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            

    

    

    
      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

     

    
      	
              Western
      Region - EPSDT Withhold Amounts

            
	
              Without
      I-70 Expansion

            
	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	
              July
      1, 2008

            
	 
      	 
      	 
      	 
      	
              EPSDT

            
	
              CATEGORY

            	 
      	 
      	 
      	
              WITHHOLD

            
	
              OF
      AID

            	 
      	 
      	 
      	
              AMOUNT

            
	
              NUMBER

            	
              AGE

            	
              SEX

            	
              PER
      % POINT

            
	
              1

            	
              <1
      (NEWBORNS)

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.08

            
	 
      	
              1-6
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            
	 
      	
              7-13
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            
	 
      	
              14-20
      YEAR OLDS

            	
              FEMALE

            	 
      	
              $0.03

            
	 
      	
              14-20
      YEAR OLDS

            	
              MALE

            	 
      	
              $0.02

            
	 
      	 
      	 
      	 
      	 
      
	
              4
      OSJC

            	
              0-20
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            
	
              4
      JC

            	
              0-20
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.03

            
	 
      	 
      	 
      	 
      	 
      
	
              5

            	
              0-6
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.03

            
	 
      	
              7-13
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            
	 
      	
              14-18
      YEAR OLDS

            	
              MALE
      AND FEMALE COMBINED

            	
              $0.02

            

    

    

    
      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

     

    Attachment
14

    Page 1
of 5

    
      	
              OFFICE
      VISIT SERVICES

            
	
              Procedure
      Code

            	
              Program
      Type

            	
              Allowable
      Fee for Dates of Service   July 1, 2006 through June 30,
      2007

            
	
              99201

            	
              Medical
      Services

            	
              $21.52

            
	
              99201
      GE

            	
              Medical
      Services

            	
              $21.52

            
	
              99201
      GT

            	
              Medical
      Services

            	
              $21.52

            
	
              99201

            	
              Nurse
      Midwife

            	
              $21.52

            
	
              99201

            	
              Podiatry

            	
              $21.52

            
	
              99201GE

            	
              Podiatry

            	
              $21.52

            
	
              99201
      W2

            	
              Podiatry

            	
              $21.52

            
	
              99201

            	
              Other
      Medical

            	
              $21.52

            
	
              99201
      GE

            	
              Other
      Medical

            	
              $21.52

            
	
              99202

            	
              Medical
      Services

            	
              $38.23

            
	
              99202
      EP

            	
              Medical
      Services

            	
              $38.23

            
	
              99202
      GT

            	
              Medical
      Services

            	
              $38.23

            
	
              99202
      GT EP

            	
              Medical
      Services

            	
              $38.23

            
	
              99202
      GE

            	
              Medical
      Services

            	
              $38.23

            
	
              99202
      GE EP

            	
              Medical
      Services

            	
              $38.23

            
	
              99202

            	
              Nurse
      Midwife

            	
              $38.23

            
	
              99202
      EP

            	
              Nurse
      Midwife

            	
              $38.23

            
	
              99202

            	
              Podiatry

            	
              $38.23

            
	
              99202
      W2

            	
              Podiatry

            	
              $38.23

            
	
              99202
      GE

            	
              Podiatry

            	
              $38.23

            
	
              99202

            	
              Other
      Medical

            	
              $38.23

            
	
              99202
      EP

            	
              Other
      Medical

            	
              $38.23

            
	
              99202
      GE

            	
              Other
      Medical

            	
              $38.23

            
	
              99202
      GE EP

            	
              Other
      Medical

            	
              $38.23

            
	
              99203

            	
              Medical
      Services

            	
              $56.93

            
	
              99203
      EP

            	
              Medical
      Services

            	
              $56.93

            
	
              99203
      GE

            	
              Medical
      Services

            	
              $56.93

            
	
              99203
      GE EP

            	
              Medical
      Services

            	
              $56.93

            
	
              99203
      GT

            	
              Medical
      Services

            	
              $56.93

            
	
              99203
      GT EP

            	
              Medical
      Services

            	
              $56.93

            
	
              99203

            	
              Nurse
      Midwife

            	
              $56.93

            
	
              99203
      EP

            	
              Medical
      Services

            	
              $56.93

            
	
              99203

            	
              Podiatry

            	
              $56.93

            
	
              99203
      W2

            	
              Podiatry

            	
              $56.93

            
	
              99203

            	
              Other
      Medical

            	
              $56.93

            
	
              99203
      EP

            	
              Other
      Medical

            	
              $56.93

            
	
              99203
      GE

            	
              Other
      Medical

            	
              $56.93

            
	
              99203
      GE EP

            	
              Other
      Medical

            	
              $56.93

            
	
              99204

            	
              Medical
      Services

            	
              $80.62

            

    

     

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

     

    Attachment
14

    Page 2
of 5

    
      	
              OFFICE
      VISIT SERVICES

            
	
              Procedure
      Code

            	
              Program
      Type

            	
              Allowable
      Fee for Dates of Service   July 1, 2006 through June 30,
      2007

            
	
              99204
      EP

            	
              Medical
      Services

            	
              $80.62

            
	
              99204
      GT

            	
              Medical
      Services

            	
              $80.62

            
	
              99204
      GT EP

            	
              Medical
      Services

            	
              $80.62

            
	
              99204

            	
              Nurse
      Midwife

            	
              $80.62

            
	
              99204
      EP

            	
              Nurse
      Midwife

            	
              $80.62

            
	
              99204

            	
              Podiatry

            	
              $80.62

            
	
              99204
      W2

            	
              Podiatry

            	
              $80.62

            
	
              99204

            	
              Other
      Medical

            	
              $80.62

            
	
              99204
      EP

            	
              Other
      Medical

            	
              $80.62

            
	
              99205

            	
              Medical
      Services

            	
              $102.58

            
	
              99205
      EP

            	
              Medical
      Services

            	
              $102.58

            
	
              99205
      GT

            	
              Medical
      Services

            	
              $102.58

            
	
              99205
      GT EP

            	
              Medical
      Services

            	
              $102.58

            
	
              99205

            	
              Nurse
      Midwife

            	
              $102.58

            
	
              99205
      EP

            	
              Nurse
      Midwife

            	
              $102.58

            
	
              99205

            	
              Podiatry

            	
              $102.58

            
	
              99205
      W2

            	
              Podiatry

            	
              $102.58

            
	
              99205

            	
              Other
      Medical

            	
              $102.58

            
	
              99205
      EP

            	
              Other
      Medical

            	
              $102.58

            
	
              99211

            	
              Medical
      Services

            	
              $12.55

            
	
              99211
      GE

            	
              Medical
      Services

            	
              $12.55

            
	
              99211
      GT

            	
              Medical
      Services

            	
              $12.55

            
	
              99211

            	
              Nurse
      Midwife

            	
              $12.55

            
	
              99211

            	
              Podiatry

            	
              $12.55

            
	
              99211
      W2

            	
              Podiatry

            	
              $12.55

            
	
              99211
      GE

            	
              Podiatry

            	
              $12.55

            
	
              99211

            	
              Other
      Medical

            	
              $12.55

            
	
              99211
      GE

            	
              Other
      Medical

            	
              $12.55

            
	
              99212

            	
              Medical
      Services

            	
              $22.60

            
	
              99212
      GT

            	
              Medical
      Services

            	
              $22.60

            
	
              99212
      GE

            	
              Medical
      Services

            	
              $22.60

            
	
              99212

            	
              Nurse
      Midwife

            	
              $22.60

            
	
              99212

            	
              Podiatry

            	
              $22.60

            
	
              99212
      W2

            	
              Podiatry

            	
              $22.60

            
	
              99212
      GE

            	
              Podiatry

            	
              $22.60

            
	
              99212

            	
              Other
      Medical

            	
              $22.60

            
	
              99212
      GE

            	
              Other
      Medical

            	
              $22.60

            
	
              99213

            	
              Medical
      Services

            	
              $30.86

            
	
              99213
      GE

            	
              Medical
      Services

            	
              $30.86

            

    

     

    
      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

     

    Attachment
14

    Page 3
of 5

    
      	
              OFFICE
      VISIT SERVICES

            
	
              Procedure
      Code

            	
              Program
      Type

            	
              Allowable
      Fee for Dates of Service   July 1, 2006 through June 30,
      2007

            
	
              99213
      GT

            	
              Medical
      Services

            	
              $30.86

            
	
              99213

            	
              Nurse
      Midwife

            	
              $30.86

            
	
              99213

            	
              Podiatry

            	
              $30.86

            
	
              99213
      W2

            	
              Podiatry

            	
              $30.86

            
	
              99213
      GE

            	
              Podiatry

            	
              $30.86

            
	
              99213

            	
              Other
      Medical

            	
              $30.86

            
	
              99213
      GE

            	
              Other
      Medical

            	
              $30.86

            
	
              99214

            	
              Medical
      Services

            	
              $48.45

            
	
              99214
      EP

            	
              Medical
      Services

            	
              $48.45

            
	
              99214
      GT

            	
              Medical
      Services

            	
              $48.45

            
	
              99214
      GT EP

            	
              Medical
      Services

            	
              $48.45

            
	
              99214

            	
              Nurse
      Midwife

            	
              $48.45

            
	
              99214
      EP

            	
              Nurse
      Midwife

            	
              $48.45

            
	
              99214

            	
              Podiatry

            	
              $48.45

            
	
              99214
      W2

            	
              Podiatry

            	
              $48.45

            
	
              99214

            	
              Other
      Medical

            	
              $48.45

            
	
              99214
      EP

            	
              Other
      Medical

            	
              $48.45

            
	
              99215

            	
              Medical
      Services

            	
              $70.63

            
	
              99215
      EP

            	
              Medical
      Services

            	
              $70.63

            
	
              99215
      GT

            	
              Medical
      Services

            	
              $70.63

            
	
              99215
      GT EP

            	
              Medical
      Services

            	
              $70.63

            
	
              99215

            	
              Nurse
      Midwife

            	
              $70.63

            
	
              99215
      EP

            	
              Nurse
      Midwife

            	
              $70.63

            
	
              99215

            	
              Podiatry

            	
              $70.63

            
	
              99215
      W2

            	
              Podiatry

            	
              $70.63

            
	
              99215

            	
              Other
      Medical

            	
              $70.63

            
	
              99215
      EP

            	
              Other
      Medical

            	
              $70.63

            

    

    

    

    
      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

    

    Attachment
14

    Page 4
of 5

    
      	
              DENTAL
      SERVICES July 1, 2006 through June 30, 2008

            
	
              Procedure

              Code

            	
              Age

            
	
              D0210

            	
              0-125

            
	
              D0270

            	
              0-125

            
	
              D0272

            	
              0-125

            
	
              D0330

            	
              0-125

            
	
              D0340

            	
              0-20

            
	
              D0350

            	
              0-20

            
	
              D1110

            	
              13-125

            
	
              D1203

            	
              0-20

            
	
              D1204

            	
              21-125

            
	
              D1351

            	
              0-20

            
	
              D2140

            	
              0-125

            
	
              D2150

            	
              0-125

            
	
              D2160

            	
              0-125

            
	
              D2161

            	
              0-125

            
	
              D2330

            	
              0-125

            
	
              D2331

            	
              0-125

            
	
              D2332

            	
              0-125

            
	
              D2335

            	
              0-125

            
	
              D2910

            	
              0-125

            
	
              D2920

            	
              0-125

            
	
              D2930

            	
              0-125

            
	
              D2931

            	
              0-125

            
	
              D2932

            	
              0-125

            
	
              D2940

            	
              0-125

            
	
              D3220

            	
              0-125

            
	
              D3310

            	
              0-125

            
	
              D3320

            	
              0-125

            
	
              D3330

            	
              0-125

            
	
              D3346

            	
              0-125

            
	
              D3347

            	
              0-125

            
	
              D3348

            	
              0-125

            
	
              D3410

            	
              0-125

            
	
              D3421

            	
              0-125

            
	
              D3425

            	
              0-125

            
	
              D4210

            	
              0-125

            
	
              D5510

            	
              0-125

            
	
              D5520

            	
              0-125

            
	
              D5610

            	
              0-125

            
	
              D5630

            	
              0-125

            
	
              D5640

            	
              0-125

            

    

     

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

     

    Attachment
14

    Page 5
of 5

    
      	
              DENTAL
      SERVICES July 1, 2006 through June 30, 2008

            
	
              Procedure

              Code

            	
              Age

            
	
              D5650

            	
              0-125

            
	
              D5660

            	
              0-125

            
	
              D5710

            	
              0-125

            
	
              D5711

            	
              0-125

            
	
              D5721

            	
              0-125

            
	
              D5730

            	
              0-125

            
	
              D5731

            	
              0-125

            
	
              D5740

            	
              0-125

            
	
              D5741

            	
              0-125

            
	
              D5750

            	
              0-125

            
	
              D5751

            	
              0-125

            
	
              D5760

            	
              0-125

            
	
              D5761

            	
              0-125

            
	
              D5820

            	
              0-125

            
	
              D5821

            	
              0-125

            
	
              D6930

            	
              0-125

            
	
              D7220

            	
              0-125

            
	
              D7230

            	
              0-125

            
	
              D7240

            	
              0-125

            
	
              D7241

            	
              0-125

            
	
              D7960

            	
              0-125

            
	
              D7970

            	
              0-125

            
	
              D9110

            	
              0-125

            
	
              D9241

            	
              0-125

            
	
              D9910

            	
              0-125

            
	
              D9951

            	
              0-125

            

    

    

    

    NOTE:  The
health plan shall review provider bulletins posted on the DMS website for future
code changes due to HCPCS and HIPAA.wffsixthamend.htm

     

    
      

      

    

    

      SIXTH
AMENDMENT TO LOAN AND SECURITY AGREEMENT

      

      

      This
SIXTH AMENDMENT TO LOAN AND SECURITY AGREEMENT (this “Amendment”) is
entered into as of October 6, 2008, among DIAMOND JO, LLC (formerly
known as Peninsula Gaming Company, LLC), a Delaware limited liability company
(“DJL”), THE OLD EVANGELINE DOWNS,
L.L.C., a Louisiana limited liability company (“OED”, and together
with DJL, referred to hereinafter each individually as a “Borrower”, and
individually and collectively, as “Borrowers”), PENINSULA GAMING, LLC, a
Delaware limited liability company (“PGL”), PENINSULA GAMING CORP., a
Delaware corporation (“PGC”, and together
with PGL, referred to hereinafter each individually as a “Guarantor”, and
individually and collectively, as “Guarantors”), the
Lenders (as defined in the hereinafter defined Loan Agreement) signatories
hereto, and WELLS FARGO
FOOTHILL, INC., a California corporation, as the arranger and agent for
the Lenders (“Agent”).  Concurrently
with the execution of this Amendment, CIT LENDING SERVICES CORPORATION will
become a party to the Loan Agreement referred to below as an additional Lender,
and will be designated as Syndication Agent for the credit facilities
therein.

       

      W
I T N E S S E T H:

      

      WHEREAS,
Borrowers, Agent, and the Lenders are parties to that certain Loan and Security
Agreement dated as of June 16, 2004, as amended by that certain First Amendment
to Loan and Security Agreement dated as of November 10, 2004, that certain
Second Amendment to Loan and Security Agreement dated as of July 12, 2005, that
certain Third Amendment to Loan and Security Agreement and Consent dated as of
December 6, 2006, that certain Fourth Amendment to Loan and Security Agreement
and Consent, dated as of December 22, 2006, and that certain Fifth Amendment to
Loan and Security Agreement, dated as of June 30, 2008 and as supplemented by
that certain Borrower Supplement No. 1 dated as of May 13, 2005 (as amended and
supplemented and as otherwise amended, restated, supplemented or otherwise
modified from time to time, the “Loan Agreement”;
capitalized terms used herein and not otherwise defined herein shall have the
meanings ascribed to such terms in the Loan Agreement), pursuant to which the
Lender Group has agreed to make the Advances and other extensions of credit to
Borrowers from time to time pursuant to the terms and conditions thereof and the
other Loan Documents;

       

      WHEREAS,
Borrowers requested that certain terms and conditions of the Loan Agreement be
amended, and the Lender Group and, by their respective acknowledgment hereof,
Guarantors have agreed to the requested amendments on the terms and conditions
provided herein;

       

      NOW
THEREFORE, in consideration of the foregoing premises and other good and
valuable consideration, the receipt and sufficiency of which are hereby
acknowledged, the parties hereto hereby agree as follows:

       

      
        
          
            LEGAL_US_W # 59347275.6

          

           

        

        
          1

          
            

          

        

        
           

        

      

          1.  Amendments to the Loan
Agreement.

       

      (a)  Section
1.1 of the Loan Agreement, Definitions, is
hereby modified and amended by amending and restating the definitions of “Applicable Margin”
and “Required
Lenders” in their entirety as follows:

       

      ““Applicable Margin”
means, as of any date of determination, effective as of the Sixth Amendment
Effective Date, (a) in the case of Base Rate Loans, 2.50%, (b) in the case of
LIBOR Rate Loans, 4.00% and (c) in the case of Letter of Credit fees,
4.00%.

       

      “Required Lenders”
means, Lenders whose Pro Rata Shares aggregate 51% of the Commitments, or, if
the Commitments have been terminated, 51% of the Obligations outstandings, provided, however, that at such
time as Lenders other than Wells Fargo Foothill, Inc. and its Affiliates hold
aggregate Commitments or outstanding Obligations which are less than 51% of the
total, each Lender holding 20% or more of the Commitments or Obligations must be
included in the Required Lenders.”

       

      (b)  Section
1.1 of the Loan Agreement, Definitions, is
hereby further modified and amended by adding the following definitions thereto
in the appropriate alphabetical order:

       

      ““Sixth Amendment”
means that certain Sixth Amendment to Loan and Security Agreement, dated as of
the Sixth Amendment Effective Date, among Borrowers, Guarantors, Lenders party
thereto and Agent.

       

      “Sixth Amendment Effective
Date” means October 6, 2008.”

       

      (c)  Section
2.3(e) of the Loan Agreement, Agent Advances, is
hereby modified and amended by deleting such subsection in its entirety and
inserting the following in lieu thereof:

       

      “(e)    Swing Line Loans and
Optional Overadvances.  Without the consent of the Required
Lenders, Agent shall have no authority to make any Swing Line Loans,
Overadvances or other amounts available hereunder in excess of the formula
determined by the Commitments and the Borrowing Base, and no Lender shall have
any obligation to participate in any such Advance made by Agent.”

       

      (d)  Section 2.3(i) of the Loan
Agreement, Optional
Overadvances, is hereby modified and amended by deleting such subsection
in its entirety and inserting the following in lieu thereof:

       

      “(i)           Intentionally
Omitted.”

       

      (e)  Section
2.4(b) of the Loan Agreement, Apportionment, Application
and Reversal of Payments, is hereby modified and amended by (i) deleting
clause (C) in its entirety and inserting “(C)  Intentionally
Omitted.” in lieu thereof, (ii) deleting clause (E) in its entirety and
inserting “(E)  Intentionally
Omitted.” in lieu thereof and (iii) deleting clause (G) in its entirety
and inserting “(G)  Intentionally
Omitted.” in lieu thereof.

       

      
        
          
             

            LEGAL_US_W # 59347275.6

          

           

        

        
          2

          
            

          

        

        
           

        

      

      (f)  Section
2.11(c) of the Loan Agreement, Unused Line Fee, is
hereby modified and amended by deleting such subsection in its entirety and
inserting the following in lieu thereof:

       

      “(c)    Unused Line Fee.  On
the first day of each quarter during the term of this Agreement, an unused line
fee payable quarterly in arrears (for the account of the Revolving Lenders in
accordance with their Pro Rata Shares of the Revolver Commitment) in an amount
equal to 0.625% per annum times the result of (x) the Maximum Revolver Amount,
less (y) the sum of (1) the average Daily Balance of Advances that were
outstanding during the immediately preceding quarter, plus (2) the average Daily
Balance of the Letter of Credit Usage during the immediately preceding
quarter.”

       

      (g)  Section
7.20(a) of the Loan Agreement, Minimum Combined
EBITDA, is hereby modified and amended by deleting such subsection in its
entirety and inserting the following in lieu thereof:

       

      “(a)     Minimum Combined EBITDA. For the 12 fiscal month period
ended on June 30, 2008, and on the last day of each fiscal quarter ended
thereafter, fail to maintain an aggregate amount of Combined EBITDA, measured on
a fiscal quarter-end basis, of at least $40,000,000 for fiscal year 2008,
$42,000,000 for fiscal year 2009 and $44,000,000 for fiscal year 2010 and
thereafter.”

       

      (h)  Section
14.1(a) of the Loan Agreement, Assignments and
Participations, is hereby modified and amended by deleting such
subsection in its entirety and inserting the following in lieu
thereof:

       

      “(a)     Each
Lender may, with the written consent of Agent (provided that no
written consent of Agent shall be required in connection with any assignment and
delegation by a Lender to an Eligible Transferee or an Affiliate of a Lender),
and, so long as no Event of Default then exists, Borrowers, assign and delegate
to one or more assignees (each an “Assignee”) all, or
any ratable part of all, of the Obligations, the Commitments and the other
rights and obligations of such Lender hereunder and under the other Loan
Documents, in a minimum amount of $5,000,000 (except that such minimum amount
shall not apply to an Affiliate of a Lender); provided, however, that Agent’s
and Borrowers’ consent shall not be unreasonably withheld, conditioned or
delayed; and provided further that that
Borrowers and Agent may continue to deal solely and directly with such Lender in
connection with the interest so assigned to an Assignee until (i) written notice
of such assignment,

       

      
        
          
             

            LEGAL_US_W # 59347275.6

          

           

        

        
          3

          
            

          

        

        
           

        

      

      together
with payment instructions, addresses, and related information with respect to
the Assignee, have been given to Borrowers and Agent by such Lender and the
Assignee, (ii) such Lender and its Assignee have delivered to Borrowers and
Agent an Assignment and Acceptance in form and substance reasonably satisfactory
to Agent, and (iii) the assignor Lender or Assignee has paid to Agent for
Agent’s separate account a processing fee in the amount of
$3,500.  Anything contained herein to the contrary notwithstanding,
the consent of Agent shall not be required and payments of any fees shall not be
required if (x) such assignment is in connection with any merger, consolidation,
sale, transfer, or other disposition of all or any substantial portion of the
business or loan portfolio of such Lender or (y) the assignee is an Affiliate
(other than individual(s)) of a Lender.  Anything contained herein to
the contrary notwithstanding, Wells Fargo Foothill agrees for the benefit of
Borrowers that, so long as no Event of Default has occurred and is continuing,
Wells Fargo Foothill shall retain at least fifty-one percent (51%) of the
Obligations and commitment to make Advances under Section 2.1 of this
Agreement, provided, however, that, the
minimum retention of Obligations and commitment to make Advances shall not be
applicable if such assignment is in connection with any merger, consolidation,
sale, transfer, or other disposition of all or any substantial portion of the
business or loan portfolio of Wells Fargo Foothill.”

       

      (i)  Section
16.1 of the Loan Agreement, Appointment and
Authorization of Agent, is hereby modified and amended by deleting such
section in its entirety and inserting the following in lieu
thereof:

       

      “16.1  Appointment
and Authorization of Agent; Syndication Agent.

       

      (a)           Appointment and Authorization of
Agent.  Each Lender hereby designates and appoints Wells Fargo
Foothill as its representative under this Agreement and the other Loan Documents
and each Lender hereby irrevocably authorizes Agent to take such action on its
behalf under the provisions of this Agreement and each other Loan Document and
to exercise such powers and perform such duties as are expressly delegated to
Agent by the terms of this Agreement or any other Loan Document, together with
such powers as are reasonably incidental thereto.  Agent agrees to act
as such on the express conditions contained in this Section
16.  The provisions of this Section 16 are solely
for the benefit of Agent, and the Lenders, and Borrowers shall have no rights as
a third party beneficiary of any of the provisions contained
herein.  Any provision to the contrary contained elsewhere in this
Agreement or in any other Loan Document notwithstanding, Agent shall not have
any duties or responsibilities, except those expressly set forth herein, nor
shall Agent have or be deemed to have any fiduciary relationship with any
Lender, and no implied covenants, functions, responsibilities, duties,
obligations or liabilities shall be read into this Agreement or any other Loan
Document

       

      
        
          
             

            LEGAL_US_W # 59347275.6

          

           

        

        
          4

          
            

          

        

        
           

        

      

      or
otherwise exist against Agent; it being expressly understood and agreed that the
use of the word “Agent” is for convenience only, that Wells Fargo Foothill is
merely the representative of the Lenders, and only has the contractual duties
set forth herein.  Except as expressly otherwise provided in this
Agreement and the other Loan Documents, Agent shall have and may use its sole
discretion with respect to exercising or refraining from exercising any
discretionary rights or taking or refraining from taking any actions that Agent
expressly is entitled to take or assert under or pursuant to this Agreement and
the other Loan Documents, provided that Agent
shall refrain from or take actions as directed by the Required Lenders as
provided hereunder.  Without limiting the generality of the foregoing,
or of any other provision of the Loan Documents that provides rights or powers
to Agent, the Lenders agree that Agent shall have the right to exercise the
following powers as long as this Agreement remains in effect:  (i)
maintain, in accordance with its customary business practices, ledgers and
records reflecting the status of the Obligations, the Collateral, the
Collections of Borrowers and their Subsidiaries, and related matters, (ii)
execute or file any and all financing or similar statements or notices,
amendments, renewals, supplements, documents, instruments, proofs of claim,
notices and other written agreements with respect to the Loan Documents, (iii)
make Advances, for the account of the Lenders as provided in the Loan Documents,
(iv) exclusively receive, apply, and distribute the Collections of Borrowers and
their Subsidiaries as provided in the Loan Documents, (v) open and maintain such
bank accounts and cash management accounts as Agent deems necessary and
appropriate in accordance with the Loan Documents for the foregoing purposes
with respect to the Collateral and the Collections of Borrowers and their
Subsidiaries, (vi) perform, exercise, and enforce any and all other rights and
remedies of the Lender Group with respect to Borrowers, the Obligations, the
Collateral, the Collections of Borrowers and their Subsidiaries or otherwise
related to any of same as provided in the Loan Documents, and (vii) incur and
pay such Lender Group Expenses as Agent may deem necessary or appropriate for
the performance and fulfillment of its functions and powers pursuant to the Loan
Documents.

       

      (b)           Syndication
Agent.  As of the Sixth Amendment Date, each Lender hereby
designates and appoints CIT Lending Services Corporation as Syndication Agent
under this Agreement and the other Loan Documents and the cover page of this
Agreement is amended to reflect such designation and appointment.  In
its capacity as Syndication Agent, CIT Lending Services Corporation shall have
no additional rights, powers, obligations, liabilities, responsibilities or
duties under this Agreement or any other Loan Document other than those
applicable to all Lenders as such.”

       

         

      
        
          
             

            LEGAL_US_W # 59347275.6

          

           

        

        
          5

          
            

          

        

        
           

        

      

          2. No Other Amendments or
Waivers.  Except in connection with the amendments set forth
above, the execution, delivery and effectiveness of this Amendment shall not
operate asan amendment of any right, power or remedy of Agent or the
Lenders under the Loan Agreement or any of the other Loan Documents, nor
constitute a waiver of any provision of the Loan Agreement or any of the other
Loan Documents.  Except for the amendments set forth above, the text
of the Loan Agreement (including, without limitation, the schedules thereto) and
all other Loan Documents shall remain unchanged and in full force and effect and
Borrowers and Guarantors hereby ratify and confirm their respective obligations
thereunder.  This Amendment shall not constitute a modification of the
Loan Agreement or any of the other Loan Documents or a course of dealing with
Agent or the Lenders at variance with the Loan Agreement or the other Loan
Documents such as to require further notice by Agent or the Lenders to require
strict compliance with the terms of the Loan Agreement and the other Loan
Documents in the future, except as expressly set forth
herein.  Borrowers and Guarantors acknowledge and expressly agree that
Agent and the Lenders reserve the right to, and do in fact, require strict
compliance with all terms and provisions of the Loan Agreement and the other
Loan Documents, as amended herein.  Neither Borrowers nor Guarantors
have any knowledge of any challenge to Agent’s or any Lender’s claims arising
under the Loan Documents, or to the effectiveness of the Loan
Documents.

       

          3. Conditions Precedent to
Effectiveness.  This Amendment shall become effective as of the
date hereof when, and only when, Agent shall have received, in form and
substance satisfactory to Agent:

       

      (a) counterparts
of this Amendment duly executed and delivered by Borrowers, Agent and the
Lenders;

       

      (b) an
Assignment and Acceptance, duly executed and delivered by CIT Lending Services
Corporation (“CIT”) and the
assignor party thereto, providing for the sale and assignment by such assignor
to CIT of such assignor’s rights and obligations under the Loan Documents with
respect to not less than $20,000,000 of such assignor’s portion of the Revolver
Commitment; and

       

      (c) such
other information, documents, instruments or approvals as Agent or Agent’s
counsel may reasonably require.

       

          4. Representations and
Warranties of Borrowers.  In consideration of the execution and
delivery of this Amendment by Agent and the Lenders, each Borrower and each
Guarantor (Borrowers and Guarantors are referred to hereinafter collectively as
the “Loan
Parties” and each as a “Loan Party”) hereby
represents and warrants in favor of Agent and the Lenders as
follows:

       

      (a) as to
each Loan Party, the execution, delivery, and performance by such Loan Party of
this Amendment have been duly authorized by all necessary action on the part of
such Loan Party;

       

      (b) as to
each Loan Party, the execution, delivery, and performance by such Loan Party of
this Amendment do not and will not (i) violate any provision of federal, state,
or local law or regulation applicable to such Loan Party, the Governing
Documents of any Loan Party, or any order, judgment, or decree of any court or
other Governmental Authority binding on such Loan Party, (ii) conflict with,
result in a breach of, or constitute (with due notice or lapse of time
or both) a default under any material contractual obligation of such Loan Party
(including any of the Senior Note Documents), (iii) result in or require the
creation or imposition of any Lien of any nature whatsoever upon any properties
or assets of such Loan Party, other than Permitted Liens, or (iv) require any
approval of such Loan Party’s members or shareholders or any approval or consent
of any Person under any material contractual obligation of such Loan
Party;

       

      
        
          
             

            LEGAL_US_W # 59347275.6

          

           

        

        
          6

          
            

          

        

        
           

        

      

       

      (c) the
execution, delivery, and performance by such Loan Party of this Amendment do not
and will not require any registration with, consent or approval of, notice to,
or other action with or by, any Governmental Authority or other Person, other
than any consent or approval that has been obtained and remains in full force
and effect;

       

      (d) as to
each Loan Party, the Loan Documents to which such Loan Party is a party
(including, without limitation, the Loan Agreement, this Amendment and all other
documents contemplated hereby), when executed and delivered by such Loan Party,
will be the legally valid and binding obligations of such Loan Party,
enforceable against such Loan Party in accordance with their respective terms,
except as enforcement may be limited by equitable principles or by bankruptcy,
insolvency, reorganization, moratorium, or similar laws relating to or limiting
creditors’ rights generally;

       

      (e) no
Default or Event of Default exists under the Loan Agreement or the other Loan
Documents;

       

      (f) as of the
date hereof, all representations and warranties of each Loan Party set forth in
the Loan Agreement and the other Loan Documents are true, correct and complete
in all material respects, except to the extent such representation or warranty
expressly relates to an earlier date (in which case such statement was true and
correct on and as of such earlier date); and

       

      (g) the land
described in the Mortgages issued by Borrowers to Agent to secure the
Obligations of Borrowers under the Loan Agreement includes all of the land owned
or leased by Borrowers and their Subsidiaries (other than Excluded Assets) under
(i) the DJL casino in Dubuque, Iowa, (ii) OED in St. Landry Parish, Louisiana,
and (iii) without limitation on the foregoing, the proposed new land-based
location for the DJL casino in Dubuque, Iowa.

       

          5. Counterparts.  This
Amendment may be executed in multiple counterparts, each of which shall be
deemed to be an original and all of which, taken together, shall constitute one
and the same agreement.  In proving this Amendment in any judicial
proceedings, it shall not be necessary to produce or account for more than one
such counterpart signed by the party against whom such enforcement is
sought.  Any signatures delivered by a party by facsimile transmission
or by other electronic transmission shall be deemed an original signature
hereto.

       

          6. Reference to and Effect on
the Loan Documents.  Upon the effectiveness of this Amendment,
on and after the date hereof, each reference in the Loan Agreement to “this
Agreement,” “hereunder,” “hereof” or words of like import referring to the Loan
Agreement, and each reference in the other Loan Documents to “the Loan
Agreement” “thereunder,” “thereof” or words of
like import referring to the Loan Agreement, shall mean and be a reference to
the Loan Agreement as amended hereby.

       

      
        
          
             

            LEGAL_US_W # 59347275.6

          

           

        

        
          7

          
            

          

        

        
           

        

      

       

          7. Affirmation of
Guaranty.  By executing this Amendment, each Guarantor hereby
acknowledges, consents and agrees that all of its obligations and liability
under the Guaranty to which it is a party and the other Loan Documents to which
it is a party remain in full force and effect, and that the execution and
delivery of this Amendment and any and all documents executed in connection
herewith shall not alter, amend, reduce or modify its obligations and liability
under such Guaranty or any of the other Loan Documents to which it is a
party.

       

          8. Costs, Expenses and
Taxes.  Borrowers agree, jointly and severally, to pay on
demand all costs and expenses in connection with the preparation, execution, and
delivery of this Amendment and the other instruments and documents to be
delivered hereunder, including, without limitation, the reasonable fees and
out-of-pocket expenses of counsel for Agent with respect thereto and with
respect to advising Agent as to its rights and responsibilities hereunder and
thereunder.  In addition, Borrowers agree, jointly and severally, to
pay any and all stamp and other taxes payable or determined to be payable in
connection with the execution and delivery of this Amendment and the other
instruments and documents to be delivered hereunder, and agree to save Agent and
the Lenders harmless from and against any and all liabilities with respect to or
resulting from any delay in paying or omission to pay such
taxes.  Borrowers hereby acknowledge and agree that Agent may, without
prior notice to Borrowers, charge such costs and fees to Borrowers’ Loan Account
pursuant to Section 2.6(d) of the Loan Agreement.

       

          9. Section
Titles.  The section titles contained in this Amendment are
included for the sake of convenience only, shall be without substantive meaning
or content of any kind whatsoever, and are not a part of the agreement between
the parties.

       

         10. Entire
Agreement.  This Amendment and the other Loan Documents
constitute the entire agreement and understanding between the parties hereto
with respect to the transactions contemplated hereby and thereby and supersede
all prior negotiations, understandings and agreements between such parties with
respect to such transactions.

       

         11. GOVERNING
LAW.  THE VALIDITY, INTERPRETATION AND ENFORCEMENT OF THIS
AMENDMENT SHALL BE GOVERNED BY THE LAWS OF THE STATE OF NEW YORK.

       

         12. Loan
Document.  This Amendment shall be deemed to be a Loan Document
for all purposes.

       

      

      [Remainder
of page intentionally left blank]

      
        
          
             

            LEGAL_US_W # 59347275.6

          

           

        

        
          8

          
            

          

        

        
           

        

      

      IN WITNESS WHEREOF, the parties hereto
have executed and delivered this Amendment as of the day and year first written
above.

      

      

      
        	
                BORROWERS:

              	
                DIAMOND JO, LLC, a
      Delaware limited liability company

              

      

      

       

      By:   s/Natalie
Schramm                                                         

            Name:
Natalie Schramm

            Title:  
CFO

      

      

      THE OLD EVANGELINE DOWNS,
L.L.C.,

      a
Louisiana limited liability company

      

       

      By:  s/Natalie
Schramm                                                                 

            Name: 
Natalie Schramm

            Title:   
CFO

      
        
          
            Sixth Amendment to Loan and Security
Agreement 

          

           

        

        
          9

          
            

          

        

        
           

        

      

      AGENT AND
LENDERS:                                                   WELLS FARGO FOOTHILL,
INC.,

      a
California corporation, as Agent and as a Lender

      

       

      By:   s/Patrick
McCormack                                                                 

            Name:
Patrick McCormack

            Title:  
V.P.

      

      

       

      
        
          
            Sixth Amendment to Loan and Security
Agreement 

          

           

        

        
          10

          
            

          

        

        
           

        

      

      ACKNOWLEDGED
AND AGREED:

      

       

      GUARANTORS:                                                                PENINSULA GAMING, LLC, a
Delaware limited liability company

       

      

      

      By:   s/Natalie
Schramm                                                             

            Name: 
Natalie Schramm

            Title:   
CFO

       

      

       

      PENINSULA GAMING CORP.
(formerly known

                                      as The Old Evangeline
Downs Capital Corp.), a Delaware corporation

      

      

      By:  s/Natalie
Schramm                                                               

            Name: 
Natalie Schramm

            Title:   
CFO

      

       

      
        
          
            Sixth Amendment to Loan and Security
Agreement 

          

           

        

        
          11

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