EX-10.1B 2 exhibit101b.htm CONTRACT exhibit101b.htm
Exhibit 10.1b
 
AMENDMETN #2 TO CONTRACT NO. 0653 BETWEEN
GEORGIA DEPARTMENT OF COMMUNITY HEALTH AND
PEACH STATE HEALTH PLAN

This Amendment is between the Georgia Department of Community Health (hereinafter referred to as “DCH” or the “Department”) and Peach State Health Plan (hereinafter referred to as “Contractor”) and is made effective this 28th day of January, 2008 (hereinafter referred to as the “Effective Date”).  Other than the changes, modifications and additions specifically articulated in this Amendment #2 to Contract # 0653, RFP#41900-001-0000000027, the original Contract shall remain in effect and binding on and against DCH and Contractor.  Unless expressly modified or added in this Amendment #2 as if completely restated herein.

WHEREAS, DCH and Contractor executed a contract for the provision of services to Georgia Healthy Families; and,

WHEREAS, pursuant to Section 4.8.17.1, Network Changes, DCH and Contractor have agreed that Contractor shall notify DCH within seven (7) Business Days of any significant changes to the Provider network or, if applicable, to any Subcontractor’s Provider Network; and,

WHEREAS, pursuant to Section 32.0, Amendments in Writing, DCH and Contractor desire to amend the above-referenced Contract by adding additional funding as set forth below.

NOW THEREFORE, for and in consideration of the mutual promises of the Parties, the terms, provisions and conditions of this Amendment and other good and valuable consideration, the sufficiency of which is hereby acknowledged, DCH and Contractor hereby agree as follows:

    I.  
To delete the current Attachment H, Capitation Payment, in its entirety and replace with the new Attachment H, Capitation Payment, contained at Exhibit 1 to this Amendment.

    II.  
To amend the Contract by adding Section 4.8.17.6, which reads as follows:

4.8.17.6
If the Contractor fails to comply with the provisions of Section 4.8.17.1, the per member per month capitation rate, used by DCH to compensate the Contractor, will be reduced by 3.1% for the remaining term of the Contract, including any renewals.

    III.  
To amend the Contract by adding Section 4.8.17.7, which reads as follows:

4.8.17.7
DCH and Contractor acknowledge that any failure by Contractor to comply with the terms of Section 4.8.17.1 would constitute a material failure to implement the terms of the Contract and RFP.  If liquidated damages are assessed against the Contractor due to its failure to comply with Section 4.8.17.1, the damages will be assessed in accordance with Section 23.2.1 (Category 1).

    IV.  
DCH and Contractor agree that they have assumed an obligation to perform the covenants, agreements, duties and obligations of the Contract, as modified and amended herein, and agree to abide by all the provisions, terms and conditions contained in the Contract as modified and amended.

    V.  
This Amendment shall be binding and inure to the benefit of the parties hereto, their heirs, representatives, successors and assigns.  Whenever the provisions of this Amendment and the Contract are in conflict, the provisions of this Amendment shall take precedence and control.
 
    VI.  
It is understood by the Parties hereto that, if any part, term, or provision of this Amendment or this entire Amendment is held to be illegal or in conflict with any law of this State, then DCH, at its sole option, may enforce the remaining unaffected portions or provisions of this amendment or of the Contract and the rights and obligations of the parties shall be construed and enforced as if the Contract or Amendment did not contain the particular part, term or provision held to be invalid.

    VII.  
This Amendment shall become effective as stated herein and shall remain effective for so long as the Contract is in effect.

    VIII.  
This Amendment shall be construed in accordance with the laws of the State of Georgia.


    IX.  
All other terms and conditions contained in the Contract and any amendment thereto, not amended by this Amendment, shall remain in full force and effect.

- SIGNATURES ON THE FOLLOWING PAGE -
 

 
 
IN WITNESS WHEREOF, DCH and Contractor, through their authorized officers and agents, have caused this Amendment to be executed on their behalf as of the date indicated.

GEORGIA DEPARTMENT OF COMMUNITY HEALTH



 /s/ Dr. Rhonda M. Medows, M.D.    1/28/08
Dr. Rhonda M. Medows, M.D.
Commissioner
  
Date


PEACH STATE HELATH PLAN


BY:
  Michael Cadger    Nov. 16, 2007
 
* SIGNATURE
  
Date
       
 
Michael Cadger
    



     
   
AFFIX CORPORATE SEAL HERE
(Corporations without a seal, attach a Certificate of Corporate Resolution)


ATTEST:
  /s/ Dawn Rock    
 
** SIGNATURE
    
       
 
VP, Compliance & Regulatory Affairs
    
 
_____________________________________________________________________________
* Must be President, Vice President, CEO or Other Authorized Officer
** Must be Corporate Secretary
 
 
CONFIDENTIAL – NOT FOR CIRCULATION
ATTACHMENT H

Attachment H is a table displaying the contracted rates by rate cell for each contracted region.  These rates will be the basis for calculating capitation payments in each contracted Region.

(The table is displayed on the following page.)
 

Georgia Department of Community Health
Fiscal Year 2008 CMO Rates

     
PeachState
PeachState
   
QA Fee:
6.00%
5.50%
Region
Aid Category
Age/Gender Group
July - Dec 2007
Jan - Jun 2008
Atlanta
Medicaid (LIM/Refugee/RSM)
0 - 2 Months, Male and Female
             1,686.95
           1,678.99
 
Medicaid (LIM/Refugee/RSM)
3 - 11 Months, Male and Female
                175.88
               175.05
 
Medicaid (LIM/Refugee/RSM)
1 - 5 Years, Male and Female
                119.24
               118.68
 
Medicaid (LIM/Refugee/RSM)
6 - 13 Years, Male and Female
                107.85
               107.34
 
Medicaid (LIM/Refugee/RSM)
14 - 20 Years, Female
                172.10
               171.28
 
Medicaid (LIM/Refugee/RSM)
14 - 20 Years, Male
                126.45
               125.85
 
Medicaid (LIM/Refugee/RSM)
21 - 44 Years, Female
                249.62
               248.45
 
Medicaid (LIM/Refugee/RSM)
21 - 44 Years, Male
                252.83
               251.63
 
Medicaid (LIM/Refugee/RSM)
45+ Years, Female
                438.16
               436.10
 
Medicaid (LIM/Refugee/RSM)
45+ Years, Male
                471.36
               469.14
 
PeachCare
0 - 2 Months, Male and Female
                179.39
               178.55
 
PeachCare
3 - 11 Months, Male and Female
                179.39
               178.55
 
PeachCare
1 - 5 Years, Male and Female
                104.48
               103.98
 
PeachCare
6 - 13 Years, Male and Female
                108.68
               108.17
 
PeachCare
14 - 20 Years, Female
                127.11
               126.51
 
PeachCare
14 - 20 Years, Male
                119.01
               118.45
 
Breast and Cervical Cancer
All Ages
             1,264.81
           1,258.84
 
Maternity Delivery/Kick Payment
             6,777.77
           6,745.80
Central
Medicaid (LIM/Refugee/RSM)
0 - 2 Months, Male and Female
             1,761.72
           1,753.41
 
Medicaid (LIM/Refugee/RSM)
3 - 11 Months, Male and Female
                215.31
               214.29
 
Medicaid (LIM/Refugee/RSM)
1 - 5 Years, Male and Female
                127.66
               127.06
 
Medicaid (LIM/Refugee/RSM)
6 - 13 Years, Male and Female
                115.61
               115.07
 
Medicaid (LIM/Refugee/RSM)
14 - 20 Years, Female
                168.58
               167.78
 
Medicaid (LIM/Refugee/RSM)
14 - 20 Years, Male
                121.55
               120.97
 
Medicaid (LIM/Refugee/RSM)
21 - 44 Years, Female
                274.58
               273.29
 
Medicaid (LIM/Refugee/RSM)
21 - 44 Years, Male
                310.79
               309.33
 
Medicaid (LIM/Refugee/RSM)
45+ Years, Female
                498.45
               496.10
 
Medicaid (LIM/Refugee/RSM)
45+ Years, Male
                604.05
               601.21
 
PeachCare
0 - 2 Months, Male and Female
                183.03
               182.16
 
PeachCare
3 - 11 Months, Male and Female
                183.03
               182.16
 
PeachCare
1 - 5 Years, Male and Female
                120.36
               119.79
 
PeachCare
6 - 13 Years, Male and Female
                119.69
               119.13
 
PeachCare
14 - 20 Years, Female
                148.84
               148.14
 
PeachCare
14 - 20 Years, Male
                124.72
               124.14
 
Breast and Cervical Cancer
All Ages
             1,161.84
           1,156.36
 
Maternity Delivery/Kick Payment
             6,631.61
           6,600.33
East
Medicaid (LIM/Refugee/RSM)
0 - 2 Months, Male and Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
3 - 11 Months, Male and Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
1 - 5 Years, Male and Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
6 - 13 Years, Male and Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
14 - 20 Years, Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
14 - 20 Years, Male
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
21 - 44 Years, Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
21 - 44 Years, Male
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
45+ Years, Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
45+ Years, Male
                         -
                        -
 
PeachCare
0 - 2 Months, Male and Female
                         -
                        -
 
PeachCare
3 - 11 Months, Male and Female
                         -
                        -
 
PeachCare
1 - 5 Years, Male and Female
                         -
                        -
 
PeachCare
6 - 13 Years, Male and Female
                         -
                        -
 
PeachCare
14 - 20 Years, Female
                         -
                        -
 
PeachCare
14 - 20 Years, Male
                         -
                        -
 
Breast and Cervical Cancer
All Ages
                         -
                        -
 
Maternity Delivery/Kick Payment
                         -
                        -
North
Medicaid (LIM/Refugee/RSM)
0 - 2 Months, Male and Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
3 - 11 Months, Male and Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
1 - 5 Years, Male and Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
6 - 13 Years, Male and Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
14 - 20 Years, Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
14 - 20 Years, Male
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
21 - 44 Years, Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
21 - 44 Years, Male
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
45+ Years, Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
45+ Years, Male
                         -
                        -
 
PeachCare
0 - 2 Months, Male and Female
                         -
                        -
 
PeachCare
3 - 11 Months, Male and Female
                         -
                        -
 
PeachCare
1 - 5 Years, Male and Female
                         -
                        -
 
PeachCare
6 - 13 Years, Male and Female
                         -
                        -
 
PeachCare
14 - 20 Years, Female
                         -
                        -
 
PeachCare
14 - 20 Years, Male
                         -
                        -
 
Breast and Cervical Cancer
All Ages
                         -
                        -
 
Maternity Delivery/Kick Payment
                         -
                        -
Southeast
Medicaid (LIM/Refugee/RSM)
0 - 2 Months, Male and Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
3 - 11 Months, Male and Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
1 - 5 Years, Male and Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
6 - 13 Years, Male and Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
14 - 20 Years, Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
14 - 20 Years, Male
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
21 - 44 Years, Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
21 - 44 Years, Male
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
45+ Years, Female
                         -
                        -
 
Medicaid (LIM/Refugee/RSM)
45+ Years, Male
                         -
                        -
 
PeachCare
0 - 2 Months, Male and Female
                         -
                        -
 
PeachCare
3 - 11 Months, Male and Female
                         -
                        -
 
PeachCare
1 - 5 Years, Male and Female
                         -
                        -
 
PeachCare
6 - 13 Years, Male and Female
                         -
                        -
 
PeachCare
14 - 20 Years, Female
                         -
                        -
 
PeachCare
14 - 20 Years, Male
                         -
                        -
 
Breast and Cervical Cancer
All Ages
                         -
                        -
 
Maternity Delivery/Kick Payment
                         -
                        -
Southwest
Medicaid (LIM/Refugee/RSM)
0 - 2 Months, Male and Female
             1,766.20
           1,757.87
 
Medicaid (LIM/Refugee/RSM)
3 - 11 Months, Male and Female
                242.09
               240.95
 
Medicaid (LIM/Refugee/RSM)
1 - 5 Years, Male and Female
                145.16
               144.48
 
Medicaid (LIM/Refugee/RSM)
6 - 13 Years, Male and Female
                119.44
               118.88
 
Medicaid (LIM/Refugee/RSM)
14 - 20 Years, Female
                187.18
               186.30
 
Medicaid (LIM/Refugee/RSM)
14 - 20 Years, Male
                121.48
               120.90
 
Medicaid (LIM/Refugee/RSM)
21 - 44 Years, Female
                287.41
               286.05
 
Medicaid (LIM/Refugee/RSM)
21 - 44 Years, Male
                287.79
               286.44
 
Medicaid (LIM/Refugee/RSM)
45+ Years, Female
                500.44
               498.08
 
Medicaid (LIM/Refugee/RSM)
45+ Years, Male
                594.62
               591.81
 
PeachCare
0 - 2 Months, Male and Female
                183.74
               182.87
 
PeachCare
3 - 11 Months, Male and Female
                191.63
               190.73
 
PeachCare
1 - 5 Years, Male and Female
                129.04
               128.43
 
PeachCare
6 - 13 Years, Male and Female
                127.79
               127.19
 
PeachCare
14 - 20 Years, Female
                144.83
               144.15
 
PeachCare
14 - 20 Years, Male
                127.16
               126.56
 
Breast and Cervical Cancer
All Ages
             1,167.98
           1,162.47
 
Maternity Delivery/Kick Payment
             6,679.51
           6,648.01