AcuteHospitalRFARY14Amendment1082813.DOC

AMENDMENT 1

to the Executive Office of Health and Human Services

Office of Medicaid

Rate Year 2014 Acute Hospital Request for Applications (Issued August 19, 2013)

Document number: 14LCEHSACUTEHOSPITAL

August 28, 2014 In accordance with Section 12.F of the Rate Year 2014 Acute Hospital Request for Applications and Contract (RY14 RFA), the Executive Office of Health and Human Services (EOHHS) is hereby amending the RY14 RFA as follows:

1.

In Section 12.C, Inquiries, in the first sentence, replace the date “August 30, 2013” (i.e., the deadline for written questions) with “September 4, 2013”. The revised sentence now reads as follows:

“Prospective applicants may submit written business and contractual questions concerning this RFA no later than September 4, 2013 at 5:00 PM, to the address specified in Section 9.B. Inquiries may also be faxed to Kiki Feldmar at 617-847-3476 or e-mailed to the following address:

kiki.feldmar@state.ma.us”

2. In Section 13.3 of the Timetable, replace the date “August 30, 2013” (i.e., the Deadline for Written Questions) with “September 4, 2013 at 5:00 P.M.”.

3. In Appendix A, MassHealth Hospital Contract, delete pages 13 and 14 in their entirety and replace them with the attached pages 13 and 14.

1.

Any special conditions that indicate they are to be incorporated into this Contract and that are signed by both parties to this Contract;

2.

The Acute Hospital RFA dated August 19, 2013, and amended on August 28, 2013, and all appendices and attachments thereto;

3.

Information and documentation required by EOHHS in response to the Acute Hospital RFA; and

4.

The Provider application(s) and supporting documentation of the above-named Contractor, which is required to be on file with MassHealth and supporting documentation and any changes or amendments thereto accepted and agreed to by EOHHS.

In the event of any conflict among the documents that are a part of this Contract and any regulation now existing or hereinafter adopted by MassHealth, the terms of the Contract shall prevail.

The Contractor hereby represents and warrants that it is the licensee of the below-named Hospital facility(ies).

The person signing this Agreement on behalf of the Contractor warrants that he/she has actual authority to bind the Contractor.

Contractor Executive Office of Health and Human Services (Legal Name of Licensee)

(Name[s] of Hospital[s], if Different)

(Signature)

(Signature)

Name

Name

Title

Title

Date

Date

RY2014 Acute Hospital RFA – Amendment #1