Exhibit 10.82
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| | ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION
DIVISION OF BUSINESS AND FINANCE
SECTION A: CONTRACT |
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| 1. AMENDMENT | | 2. CONTRACT | | 3. EFFECTIVE DATE OF | | 4. PROGRAM |
| NUMBER: | | NO.: | | AMENDMENT: | | |
14 | | YH09-0001-07 | | April 1,2011 | | DHCM — ACUTE |
5. CONTRACTOR’S NAME AND ADDRESS:
VHS Phoenix Health Plan, LLC
7878 N. 16th St., Suite 105
Phoenix, AZ 85020
6. PURPOSE OF AMENDMENT: To amend Section B, Capitation Rates, effective October 1, 2010 through September 30, 2011.
7. THE CONTRACT REFERENCED ABOVE FOLLOWS
To amend Section B, Capitation Rates, effective April 1, 2011 through September 30, 2011.
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| NOTE: Please sign, date, and return executed file by E-Mail to: | | Mark Heldat Mark.Held@azahcccs.gov |
| | | Sr. Procurement Specialist |
| | | AHCCCS Contracts and Purchasing |
| | | and Linda Barry atLinda.Barry@azahcccs.gov |
8. EXCEPT AS PROVIDED FOR HEREIN, ALL TERMS AND CONDITIONS OF THE ORIGINAL CONTRACT NOT HERETOFORE CHANGED AND/OR AMENDED REMAIN UNCHANGED AND IN FULL EFFECT.
IN WITNESS WHEREOF THE PARTIES HERETO SIGN THEIR NAMES IN AGREEMENT
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| 9. SIGNATURE OF AUTHORIZED REPRESENTATIVE: | | 10. SIGNATURE OF AHCCCSA CONTRACTING OFFICER: |
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/s/ NANCY NOVICK | | /s/ MICHAEL VEIT |
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TYPED NAME:NANCY NOVICK | | TYPED NAME:MICHAEL VEIT |
TITLE:CHIEF EXECUTIVE OFFICER | | TITLE:CONTRACTS & PURCHASING ADMINISTRATOR |
DATE:2/9/11 | | DATE:JANUARY 26, 2011 |
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
CAPITATION RATE SUMMARY — ACUTE RATES (Risk Adjusted with 100% of 2010 factor)
Phoenix Health Plan
04/1/11—9/30/11
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| | | TANF | | | TANF | | | TANF | | | TANF | | | TANF | | | SSI | | | SSI | | | | | | | Delivery | | | | | | | |
| Title XIX and KidsCare Rates1: | | <1. M/F | | | 1-13. M/F | | | 14-44. F | | | 14-44. M | | | 45+. M/F | | | w/ Med | | | w/o Med | | | SFP | | | Supplement | | | Non-MED | | | MED | |
| 4 Apache/Coconino/Mohave/Navajo | | $ | 515.15 | | | $ | 108.92 | | | $ | 263.67 | | | $ | 159.67 | | | $ | 360.89 | | | $ | 102.81 | | | $ | 783.78 | | | $ | 11.98 | | | $ | 6,113.85 | | | $ | 441.33 | | | $ | 1,273.31 | |
| 6 Yavapai | | $ | 526.21 | | | $ | 108.07 | | | $ | 272.39 | | | $ | 171.71 | | | $ | 398.55 | | | $ | 127.51 | | | $ | 843.42 | | | $ | 15.43 | | | $ | 6,608.20 | | | $ | 514.54 | | | $ | 1,291.38 | |
| 8 Gila/Pinal | | $ | 457.67 | | | $ | 104.82 | | | $ | 254.05 | | | $ | 169.23 | | | $ | 365.57 | | | $ | 128.13 | | | $ | 855.22 | | | $ | 13.12 | | | $ | 6,447.38 | | | $ | 468.85 | | | $ | 1,421.57 | |
| 10 Pima | | $ | 517.79 | | | $ | 86.01 | | | $ | 202.26 | | | $ | 117.49 | | | $ | 311.96 | | | $ | 97.63 | | | $ | 787.71 | | | $ | 16.06 | | | $ | 6,190.45 | | | $ | 365.35 | | | $ | 1,426.97 | |
| 12 Maricopa | | $ | 478.69 | | | $ | 108.52 | | | $ | 234.12 | | | $ | 152.48 | | | $ | 399.44 | | | $ | 140.20 | | | $ | 704.87 | | | $ | 14.21 | | | $ | 6,387.19 | | | $ | 447.67 | | | $ | 1,383.39 | |
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| | | TANF | | | TANF | | | TANF | | | TANF | | | TANF | | | SSI | | | SSI | | | | | | | | | | | | | | | |
| PPC Rates: | | <1. M/F | | | 1-13. M/F | | | 14-44. F | | | 14-44. M | | | 45+.M/F | | | w/Med | | | w/o Med | | | | | | | | | | | Non-MED | | | MED | |
| 4 Apache/Coconino/Mohave/Navajo | | $ | 898.13 | | | $ | 44.73 | | | $ | 211.82 | | | $ | 143.77 | | | $ | 417.96 | | | $ | 120.40 | | | $ | 417.56 | | | | | | | | | | | $ | 867.02 | | | $ | 5,081.66 | |
| 6 Yavapai | | $ | 867.45 | | | $ | 63.40 | | | $ | 218.09 | | | $ | 205.52 | | | $ | 339.14 | | | $ | 141.98 | | | $ | 366.19 | | | | | | | | | | | $ | 828.77 | | | $ | 5,217.28 | |
| 8 Gila/Pinal | | $ | 852.75 | | | $ | 58.73 | | | $ | 219.53 | | | $ | 152.26 | | | $ | 285.76 | | | $ | 115.54 | | | $ | 409.86 | | | | | | | | | | | $ | 773.35 | | | $ | 6,678.09 | |
| 10 Pima | | $ | 997.46 | | | $ | 52.67 | | | $ | 179.43 | | | $ | 129.99 | | | $ | 352.47 | | | $ | 115.08 | | | $ | 299.72 | | | | | | | | | | | $ | 573.25 | | | $ | 4,997.42 | |
| 12 Maricopa | | $ | 931.34 | | | $ | 55.08 | | | $ | 194.27 | | | $ | 162.53 | | | $ | 301.22 | | | $ | 134.79 | | | $ | 362.89 | | | | | | | | | | | $ | 763.47 | | | $ | 6,528.61 | |
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| | | Option 1 | | | Option 2 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Other Rates: | | Transplant | | | Transplant | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| 4 Apache/Coconino/Mohave/Navajo | | $ | 16.50 | | | $ | 16.50 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| 6 Yavapai | | $ | 16.50 | | | $ | 16.50 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| 8 Gila/Pinal | | $ | 16.50 | | | $ | 16.50 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| 10 Pima | | $ | 16.50 | | | $ | 16.50 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| 12 Maricopa | | $ | 16.50 | | | $ | 16.50 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
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| 1. | | Rates have been adjusted for $35,000 Reinsurance Deductible |
