Exhibit 10.4

 

APPENDIX X

 

Agency Code 12000    Contract No. C017720 Period 4/20/05 – 9/30/05    Funding
Amount for Period Based on approved capitation rates

 

This is an AGREEMENT between THE STATE OF NEW YORK, acting by and through The
New York State Department of Health, having its principal office at Corning
Tower, Room 2001, Empire State Plaza, Albany, NY 12237, (hereinafter referred to
as the STATE), and WellCare of New York, Inc., (hereinafter referred to as the
CONTRACTOR), for modification of Contract Number C017720 as amended as follows:

 

Appendix Q, Section II, entitled “Obligations and Activities of the Business
Associate” paragraphs (b) and (d) are hereby amended to comply with new federal
Health Insurance Portability and Accountability (“HIPAA”) regulations governing
security of electronic information by addition of new provisions, appearing here
in italics:

 

(b) The Business Associate agrees to use the appropriate safeguards to prevent
use or disclosure of the Protected Health Information other than as provided for
by this Agreement and to implement administrative, physical and technical
safeguards that reasonably and appropriately protect the confidentiality,
integrity and availability of any electronic Protected Health Information that
it creates, receives, maintains or transmits on behalf of the Covered Entity
pursuant to this Agreement.

 

(d) The Business Associate agrees to report to the Covered Program, any use or
disclosure of the Protected Health Information not provided for by this
Agreement, as soon as reasonably practicable of which it becomes aware. The
Business Associate also agrees to report to the Covered Entity any security
incident of which it becomes aware.

 

All other provisions of said AGREEMENT shall remain in full force and effect.

 

IN WITNESS WHEREOF, the parties hereto have executed this AGREEMENT as of the
dates appearing under their signatures.

 

CONTRACTOR SIGNATURE   STATE AGENCY SIGNATURE By:   Todd S. Farha   By:   Donna
Frescatore Title:   President and Chief   Title:   Deputy Director, OMC    
Executive Officer         Date:   3/17/05   Date:   3/18/05         State Agency
Certification:         In addition to the acceptance of this contract,         I
also certify that original copies of this         signature page will be
attached to all other         exact copies of this contract.

 

STATE OF FLORIDA      )               )      SS.: COUNTY OF HILLSBOROUGH      )
      

 

On the 17th day of March, 2005, before me personally appeared Todd S. Farha, to
me known, who being by me duly sworn, did depose and say that he resides at
Tampa, Florida, that he is the President and CEO of WellCare of New York, the
corporation described herein which executed the foregoing instrument; and that
he signed his name thereto by order of the board of directors of said
corporation.

 

(Notary)                    Kathleen R. Casey         STATE COMPTROLLER’S
SIGNATURE   Title:  

--------------------------------------------------------------------------------

                   

--------------------------------------------------------------------------------

  Date:  

--------------------------------------------------------------------------------