IASIS Healthcare LLC - FORM 10-K - EX-10.18 - December 21, 2016

Attached files

file filename
10-K - FORM 10-K - IASIS Healthcare LLCd275632d10k.htm
EX-31.2 - EX-31.2 - IASIS Healthcare LLCd275632dex312.htm
EX-31.1 - EX-31.1 - IASIS Healthcare LLCd275632dex311.htm
EX-21 - EX-21 - IASIS Healthcare LLCd275632dex21.htm
EX-10.28 - EX-10.28 - IASIS Healthcare LLCd275632dex1028.htm
EX-10.26 - EX-10.26 - IASIS Healthcare LLCd275632dex1026.htm
EX-10.24 - EX-10.24 - IASIS Healthcare LLCd275632dex1024.htm
EX-10.21 - EX-10.21 - IASIS Healthcare LLCd275632dex1021.htm
EX-10.20 - EX-10.20 - IASIS Healthcare LLCd275632dex1020.htm
EX-10.19 - EX-10.19 - IASIS Healthcare LLCd275632dex1019.htm
EX-10.17 - EX-10.17 - IASIS Healthcare LLCd275632dex1017.htm
EX-10.14 - EX-10.14 - IASIS Healthcare LLCd275632dex1014.htm
EX-10.13 - EX-10.13 - IASIS Healthcare LLCd275632dex1013.htm
EX-10.12 - EX-10.12 - IASIS Healthcare LLCd275632dex1012.htm

Exhibit 10.18

 

LOGO    CONTRACT AMENDMENT    ARIZONA DEPARTMENT
      OF HEALTH SERVICES
      1740 W. Adams, Room 303
      Phoenix, Arizona 85007
   Contract No: ADHS15-085892    Amendment No. 2    (602) 542-1040
        

Procurement Specialist

Ana Shoshtarikj

PROGRAM: Behavioral Health Services Administration – Health Choice Integrated Care-HCIC

Effective October 1, 2015, it is mutually agreed that the Contract referenced is amended as follows:

 

1. Pursuant to Uniform Terms and Conditions, Paragraph 5. Contract Changes, 1. Amendments and Special Terms and Conditions, Paragraph 16. Contract Changes, Exhibit 11 Capitation Rates are hereby replaced with the CAPITATION RATES of this amendment.

All other provisions shall remain in their entirety.

 

Contractor hereby acknowledges receipt and acceptance of above amendment and that a signed copy must be filed with the Procurement Office before the effective date.     The above referenced Contract Amendment is hereby executed this
         day of             , 2015
    at Phoenix, Arizona

    

    
Signature   Date                    
Authorized Signatory’s Name and Title:     Procurement Officer:

Mary Jo Gregory

    
Contractor’s Name:    
HEALTH CHOICE INTEGRATED CARE    

 

1

LOGO    CONTRACT AMENDMENT    ARIZONA DEPARTMENT
      OF HEALTH SERVICES
      1740 W. Adams, Room 303
      Phoenix, Arizona 85007
   Contract No: ADHS15-085892    Amendment No. 2    (602) 542-1040
        

Procurement Specialist

Ana Shoshtarikj

 

EXHIBIT – 11

CAPITATION RATES

CONTRACT NO: AHDS15-085892

 

Health Choice Integrated Care   
Capitation Rate for GSA 7   
Effective Dates October 1, 2015 to September 30, 2016   

Title XIX and Title XXI eligible children, under the age of 18 (represents the cost of providing covered behavioral health services to children), not enrolled in CMDP:

    $ 39.14 pm/pm   

Title XIX eligible children, under the age of 18 (represents the cost of providing covered behavioral health services to children), enrolled in CMDP:

    $ 1,273.31 pm/pm   

Title XIX and Title XXI eligible adults, age 18 and older (represents the cost of providing covered behavioral health services to adult members without serious mental illness):

    $ 39.42 pm/pm   

Title XIX eligible adults, age 18 and older (represents the cost of providing covered behavioral health services to adult members with serious mental illness, who are not receiving physical health services under this contract):

    $ 2.92 pm/pm   

Title XIX eligible adults, age 18 and older (represents the cost of providing covered behavioral health services to adult members with serious mental illness, who are receiving physical health services under this contract):

    $ 1,467.89 pm/pm   

DES DD ALTCS eligible children representing the cost of providing covered behavioral health services to DES DD ALTCS children.

    $ 334.85 pm/pm   

DES DD ALTCS eligible adults representing the cost of providing covered behavioral health services to DES DD ALTCS adults.

    $ 147.57 pm/pm   

 

2

IASIS Healthcare LLC Reports