EXHIBIT 10.7.2
STATE OF ILLINOIS
AMENDMENT NO. 3
to the
CONTRACT FOR FURNISHING HEALTH SERVICES
BY A
HEALTH MAINTENANCE ORGANIZATION
2001-24-006-KA3
WHEREAS, the Illinois Department of Public Aid, ("Department") and AMERIGROUP
Illinois, Inc., formerly known as Americaid Illinois, Inc. ("Contractor")
entered into a Contract for Furnishing Health Services by a Health Maintenance
Organization, effective April 1, 2000; and
WHEREAS, the parties to the Contract have previously amended the Contract
pursuant to Article 9, Section 9.9 (a), and desire to further amend the
Contract;
Now THEREFORE, the Contract between the parties as previously amended, is hereby
further amended as follows, effective March 1, 2002:
1. Section 7.1, Payment Rates, is amended by deleting the language of
subsection (a) in its entirety, and replacing it with the following:
7.1 Payment Rates
(a) Except as stated in 7.1(a)(1) and 7.1(a)(2), the
Department will pay the Contractor on a Capitation
basis, based on the eligibility classification, age and
gender categories of the Beneficiary as shown on the
applicable tables in Attachment I, a sum equal to the
product of the approved Capitation rate and the number
of Beneficiaries enrolled in that category as of the
first day of that month.
1. An individual who is a MAG Beneficiary of an
MCO under contract with the Department at any
time on or after June 1, 2001, who remains
continuously eligible for Medical Assistance,
and whose eligibility classification is
changed by the Department but who remains an
Eligible Enrollee, shall continue to be
considered a MAG Beneficiary for the purposes
of Capitation.
2. If an individual in a Case is considered a MAG
Beneficiary for purpose of Capitation under
any MCO under contract with the Department,
any other Beneficiary in the Case shall be
considered a MAG Beneficiary for purpose of
Capitation.
All other terms and conditions of the Contract, as previously amended, shall
remain in full force and effect, unchanged except as amended hereby.
IN WITNESS WHEREOF, the Department and Contractor hereby duly execute and
deliver this Amendment Number 3, effective March 1, 2002.
Illinois Department of Public Aid AMERIGROUP Illinois, Inc.
By: /s/ Xxxxxx Xxxxxx By: /s/ Xxxxxx X. Xxxxx
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Xxxxxx X. Xxxxx
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Printed Name
Title: Director Title: Pres./CEO
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Date: 5/6/02 Date: 4/01/02
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FEIN: ------------------------
[Logo] Illinois Department of Public Aid
000 Xxxxx Xxxxx Xxxxxx Xxxx
Xxxxxxxxxxx, Xxxxxxxx 00000-0000
Xxxxxx X. Xxxx, Governor Telephone: (000) 000-0000
Xxxxxx Xxxxxx, Director TTY: (000) 000-0000
May 15, 2002
Xxxxxx Xxxxx, M.D.
President and CEO
AMERIGROUP Illinois, Inc.
000 Xxxx Xxxxxx Xxxxx, Xxxxx 0000
Xxxxxxx, Xxxxxxxx 00000
Dear Xx. Xxxxx:
Enclosed for your files is one original signature copy of the amendment to the
Contract for Furnishing Health Services which permits the State to continue
paying the capitation for the MAG category of assistance when a participant
switches to the MANG category of Assistance. The effective date of this
amendment is March 1, 2002.
Sincerely,
/s/ Xxxxx Xxxx
Xxxxx Xxxx, Deputy Administrator
Division of Medical Programs
Enclosure
E-Mail: xxxxxxxxxxxx@xxxxx.xx.xx Internet: xxxx://xxx.xxxxx.xx.xx/xxx/
REGULATORY ALERT
AMERIGROUP
CORPORATION
MEMORANDUM
A M E R I C A I D o A M E R I K I D S o A M E R I F A M o A M E R I P L U S
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AMERIGROUP CORPORMON o 0000 XXXXXXXXXXX XXXX x XXXXXXXX XXXXX, XXXXXXXX 00000 o 757 490 6900 o XXX.XXXXXXXXXXXXXX.XXX
TO: Distribution
FROM: Xxxxxxxx Xxxxx, Regulatory Compliance
DATE: March 27, 2002
SUBJECT: ILLINOIS CONTRACT AMENDMENT
Attached please find a new contract amendment from the Illinois Department of
Public Aid (IDPA). Please review the overall summary below and the attached
contract amendment to determine the impact to AMERIGROUP and/or our vendors.
OVERALL SUMMARY:
Due to a new policy and systems change at IDPA, some members who were previously
considered MAG were transferred to the MANG category code. MCOs were
subsequently paid the MANG capitation rate for these members. In order to
reverse the inadvertent impact of the change, the attached amendment allows IDPA
to continue to pay the MAG cap rate for those members who were transferred.
It is estimated that 2,300 AMERIGROUP members were affected.
FOLLOW UP REQUIRED:
Response required back to Regulatory Manager by [date]
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XX Informational only. Response is not required
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If you have further questions or concerns regarding this request Please contact
Xxx Xxxxx, extension 2722.
Distribution
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Xxxxxxxx Xxxxx
[LOGO} Illinois Department of Public Aid
000 Xxxxx Xxxxx Xxxxxx Xxxx
Xxxxxxxxxxx, Xxxxxxxx 00000-0000
Xxxxxx X. Xxxx, Governor Telephone: (000) 000-0000
Xxxxxx Xxxxxx, Director TTY: (000) 000-0000
March 11, 2002
Xxx X. Xxxxxx, Xx.
Chief Operating Officer
AMERIGROUP Illinois, Inc.
0000 Xxxxxxxxxxx Xxxx, Xxxxx 000
Xxxxxxxx Xxxxx, Xxxxxxxx 00000-0000
Dear Mr. Willie,
The Department issued new policy to ensure Medicaid eligibility is de-linked
from TANF cash assistance. Two policy and system changes made as part of that
delinking had an inadvertent effect on managed care enrollment. These two
policies are:
o Cases eligible due to continuous eligibility appear on the system as an
active 94 or 96 case (MANG), instead of a canceled 04 or 06 case (MAG) with
continuous eligibility; and
o Cases eligible due to extended medical appear on the system as an active 94
or 96 case (MANG), instead of a canceled 04 or 06 case (MAG) with extended
medical.
The impact of this swap in category of assistance for the managed care program
is that a portion of beneficiaries who were previously considered MAG were
transferred to MANG, and the MCO was subsequently paid the MANG capitation rate.
[MCO capitation rates were calculated for the contract not assuming this policy
change and subsequent swap.] While the category of assistance may have changed
for these beneficiaries due to administrative changes by the Department, the
cost of providing services, the medical needs, and the medical utilization by
these Beneficiaries did not change.
The Department estimates the impact of the August 2001 swap to the MCOs to be
approximately 14,200 beneficiaries overall. AMERIGROUP's estimated impact of the
August swap is 2,300 beneficiaries. The exact number will not be known until the
adjustment is made.
E-mail: xxx_xxxxxxxxx@xxxxx.xx.xx Internet:http//xxx.xxxxx.xx.xx/xxx/
Xxx X. Xxxxxx, Xx.
AMERIGROUP Illinois, INC.
Page Two
In order to reverse this unanticipated impact the Department proposes the
attached contract amendment to continue to pay the capitation rate for
beneficiaries who are swapped from MAG to MANG at the MAG rate. Enclosed please
find four originals of an amendment to the Contract for Furnishing Health
Services between AMERIGROUP Illinois, Inc. and the Department. Please have all
four originals completed and signed, and return them to my attention as soon as
possible. If you have any questions, please feel free to contact me at (217)
000-0000.
Sincerely,
/s/ Xxxxx Xxxx
Xxxxx Xxxx, Deputy Administrator
Division of Medical Programs
Attachments
cc: Xxxxxx Xxxxx, M.D., President and CEO, AMERIGROUP Illinois, Inc.
E-mail: xxx_xxxxxxxxx@xxxxx.xx.xx Internet: xxxx://xxx.xxxxx.xx.xx/xxx/
XxXxxx, Xxxxxxx
From: Xxxxx, Xxx
Sent: Wednesday, March 06, 2002 9:50 AM
To: XxXxxx, Xxxxxxx
Subject: Alert
Xxxxxxx, would you please prepare this and send out? Please use the
standard distribution list (all people). I'll bring you the attachment. Thanks!
REGULATORY ALERT
AMERIGROUP
C O R P O R A T I O N
M E M O R A N D U M
A M E R I C A I D o A M E R I K I D S o A M E R I F A M o A M E R I P L U S
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AMERIGROUP CORPORATION o 0000 XXXXXXXXXXX XXXX x XXXXXXXX XXXXX,XXXXXXXX 00000 o 757 490 6900 o XXX.XXXXXXXXXXXXXX.XXX
TO: Distribution
FROM: Xxxxxxxx Xxxxx, Regulatory Compliance
DATE: March 6, 2002
SUBJECT: ILLINOIS CONTRACT AMENDMENT
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Attached please find a copy of an amendment to the contract between AMERIGROUP
Illinois, Inc. and the Illinois Department of Public Aid. Please review the
overall summary below and the attached amendment to determine the impact to
AMERIGROUP and/or our vendors.
OVERALL SUMMARY:
This amendment reflects a 4.5% rate reduction to each age and gender cell,
effective January 1, 2002. The rate sheets are attached.
FOLLOW UP REOUIRED:
_______ Response required back to Regulatory Manager by [date]
XX Informational only. Response is not required.
________
If you have further questions or concerns regarding this request, please contact
Xxx Xxxxx, extension 2722.
cc: Xxxx-Xxx Xxxxxxx
REGULATORY ALERT
AMERIGROUP
C O R P O R A T I O N
M E M O R A N D U M
A M E R I C A I D o A M E R I K I D S o A M E R I F A M o A M E R I P L U S
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AMERIGROUP CORPORATION o 0000 XXXXXXXXXXX XXXX x XXXXXXXX XXXXX,XXXXXXXX 00000 o 757 490 6900 o XXX.XXXXXXXXXXXXXX.XXX
TO: Distribution
FROM: Xxxxxxxx Xxxxx, Regulatory Compliance
DATE: March 6, 2002
SUBJECT: ILLINOIS CONTRACT AMENDMENT
--------------------------------------------------------------------------------
Attached please find a copy of an amendment to the contract between AMERIGROUP
Illinois, Inc. and the Illinois Department of Public Aid . Please review the
overall summary below and the attached amendment to determine the impact to
AMERIGROUP and/or our vendors.
OVERALL SUMMARY:
This amendment reflects a 4.5% rate reduction to each age and gender cell,
effective January 1, 2002. The rate sheets are attached.
FOLLOW UP REOUIRED:
_______ Response required back to Regulatory Manager by [date]
XX
________ Informational only. Response is not required.
If you have further questions or concerns regarding this request, please contact
Xxx Xxxxx, extension 2722.
cc: Xxxx-Xxx Xxxxxxx
Distribution
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Xxxxxx Xxxxxxxxxx
Xxx Xxxxxxx
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Xxxxx Xxxx
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Xxxx Xxxxxx
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Xxxxxxxx Xxxxxx
Xxxxxxxx Xxxxx
[LOGO] Illinois Department of Public Aid
000 Xxxxx Xxxxx Xxxxxx Xxxx
Xxxxxxxxxxx, Xxxxxxxx 00000-0000
Xxxxxx X. Xxxx, Governor Telephone: (000) 000-0000
Xxxxxx Xxxxxx, Director TTY: (000) 000-0000
February 19, 2002
Xxxxxx Xxxxx, M.D.
President and CEO
AMERIGROUP Illinois, Inc.
000 X. Xxxxxx Xxxxx, Xxxxx #0000
Xxxxxxx, XX 00000
Dear Xx. Xxxxx,
Enclosed please find four originals of an amendment to the Contract for
Furnishing Health Services between AMERIGROUP Illinois, Inc. and the Department.
This amendment reflects a 4.5% rate reduction to each age and gender cell,
effective January 1, 2002.
Please have all four originals completed and signed, and return them to my
attention as soon as possible.
If you have any questions, please feel free to contact me at (000) 000-0000.
Sincerely,
/s/ Xxxxx Xxxx
Xxxxx Xxxx, Deputy Administrator
Division of Medical Programs
Attachments
E-mail: xxx_xxxxxxxxx@xxxxx.xx.xx Internet: xxxx://xxx.xxxxx.xx.xx/xxx/
