STATE OF CONNECTICUT DEPARTMENT OF SOCIAL SERVICES
CONTRACT AMENDMENT
Amendment Number:
9
Contract #:
093-MED-FCHP-1
Contract Period:
08/11/2001 – 9/30/2004
Contract Name:
FIRST CHOICE HEALTH PLAN OF CONNECTICUT, INC.
Contractor Address:
23 Maiden Lane, North Haven, CT 06473-4201
Contract number 093-MED-FCHP-1 by and between the Department of Social Services (the “Department”) and Firstchoice Health Plan of CT (the “Contractor”) for the provision of services under the HUSKY A program as amended by Amendments 1, 2, 3, 4, 5, 6, 7 and 8 is hereby further amended as follows:
1.
Paragraph 1 of Part I as amended by Amendments 1, 2, 3, 4, 5, 6, 7 and 8 is further amended to extend the contract end date from December 30, 2003 to September 30, 2004.
2.
Part II ‘GENERAL CONTRACT TERMS FOR MCOs” is deleted in its entirety and replaced with Part II “GENERAL CONTRACT TERMS FOR MCOS” dated December 12, 2003 pages 1 through 113 attached hereto and incorporated herein by reference.
3.
Appendix B Provider Credentialing and Enrollment, Appendix C EPSDT Periodicity Schedule, Appendix D DSS Marketing Guidelines, Appendix E Quality Assurance Program; Appendix F Unaudited Quarterly Financial Reports; Appendix H Managed Care Policy Transmittals; Appendix J Physician Incentive Payments; and Appendix K Recategorization Chart which became effective on August 11, 2001 remain unchanged and in full force and effect.
4.
Appendix A HUSKY Covered Benefits; Appendix G Medicaid Managed Care Eligibility Categories and Appendix L Quarterly Pharmacy Report which became effective August 13, 2003 remain unchanged and in full force and effect.
5.
Appendix I is deleted in its entirety and replaced with Appendix I attached hereto and incorporated herein by reference. The capitation rates set forth in Appendix I attached hereto and incorporated herein by reference are effective for the period 10/01/03 through 9/30/04.
6.
Appendix M Non-Hyde Amendment Abortions is deleted in its entirety and replaced with Appendix M dated December 12, 2003 Actuarial Certifications of Rates attached hereto and incorporated herein by reference.
1
ACCEPTANCES AND APPROVALS
This document constitutes an amendment to the above numbered contract. All provisions of that contract and prior amendments, except those explicitly changed or described above by this amendment, shall remain in full force and effect.
CONTRACTOR
DEPARTMENT
FirstChoice HealthPlans of Connecticut, Inc.
Department of Social Services
Todd S. Farha 12/29/03
_Michael P. Starkowski 12/30/03_
Signature (Authorized Official) Date
Signature (Authorized Official) Date
Todd S. Farha Pres & CEO
_Michael P. Starkowski Deputy Commissioner
Signature (Authorized Official) Title
Signature (Authorized Official) Title
OFFICE OF THE ATTORNEY GENERAL
Attorney General (as to form) Date
( ) This contract does not require the signature of the Attorney General pursuant to an agreement between the Department and the Office of the Attorney General dated:
2
APPENDIX A – Amended
Plan Name FirstChoice
Capitation Rates 10/01/03 – 09/30/04
Fairfield
Hartford
Litchfield
Middlesex
New Haven
New London
Tolland
Windham
Under One
$
557.90
$
631.16
$
629.32
$
745.86
$
627.09
$
624.00
$
753.77
$
604.77
Ages 1 to 14
$
106.42
$
114.88
$
114.56
$
135.30
$
114.18
$
113.60
$
136.72
$
112.01
Male – Ages
$
132.31
$
143.96
$
143.55
$
169.02
$
143.10
$
142.41
$
170.74
$
140.59
15 to 39 Female – Ages
$
216.08
$
240.74
$
240.04
$
284.72
$
239.19
$
237.99
$
287.77
$
231.99
15-39 Male – Ages 40
$
236.43
$
264.41
$
263.62
$
313.22
$
262.69
$
261.37
$
316.58
$
254.47
and over Female – Ages
$
227.26
$
253.91
$
253.15
$
300.77
$
252.26
$
250.97
$
304.02
$
244.44
40 and over
3
We use cookies on this site to provide a more responsive and personalized service. Continuing to browse, clicking I Agree, or closing this banner indicates agreement. See our Cookie Policy for more information.