EXHIBIT 10.1
Contract/RFP N. YH8-0001
Page 1 of 2
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
[AHCCCS LOGO] ADMINISTRATION
DIVISION OF BUSINESS AND FINANCE
CONTRACT AMENDMENT
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1. AMENDMENT 2. CONTRACT 3. EFFECTIVE DATE OF 4. PROGRAM:
NUMBER: NO: AMENDMENT:
17 YH8-0001-05 April 1, 2002 OMC
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5. CONTRACTOR'S NAME AND ADDRESS:
HEALTH CHOICE ARIZONA
1600 W. BROADWAY SUITE 260
TEMPE AZ 85282-1502
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6. PURPOSE OF AMENDMENT: TO ESTABLISH NEW CAPITATION RATES FOR TITLE XIX
WAIVER GROUP EFFECTIVE APRIL 1, 2002.
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7. THE CONTRACT REFERENCED ABOVE IS AMENDED AS FOLLOWS:
A. New Capitation Rates for Title XIX Waiver Group are changed to the
rates provided on page two (2) of this amendment effective April 1,
2002.
NOTE: PLEASE SIGN AND DATE BOTH AND THEN RETURN ONE TO:
MICHAEL VEIT, MD 5700
AHCCCS CONTRACTS AND PURCHASING
701 E. JEFFERSON STREET
PHOENIX, AZ 85034
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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 10. SIGNATURE OF AHCCCSA CONTRACTING
REPRESENTATIVE: OFFICER:
/s/ Carolyn Rose /s/ Michael Veit
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TYPED NAME: CAROLYN ROSE MICHAEL VEIT
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TITLE: CHIEF EXECUTIVE OFFICER- CONTRACTS & PURCHASING
HEALTH CHOICE ARIZONA ADMINISTRATOR
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DATE: DATE:
5-17-02 MAY 14 2002
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Page 2 of 2
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
CAPITATION RATE SUMMARY - ACUTE RATES
HEALTH CHOICE ARIZONA
CYE '02 (AS OF 4/01/02)
TITLE XIX
TITLE XIX RATES: WAIVER GROUP
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10 Pima $198.11
12 Maricopa $183.60
PPC RATES:
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10 Pima $174.32
12 Maricopa $170.52