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Exhibit 10.8
AMENDMENT 001
Contract No. XT220
Amendment Page 1

This AMENDMENT, entered into by the State of Florida, Department of Elder
Affairs, (Department) and WellCare of Florida Inc., dba HealthEase (Contractor),
amends contract XT220.
The purpose of this amendment is to: (1) revise and replace the Standard
Contract; (2) introduce Attachment F, DOEA Cost Analysis; (3) revise and replace
the Index to Attachments; (4) amend Attachment I; (5) revise Exhibit H; (6)
revise Appendices 3 and 5; and (7) revise and replace Attachment G, Background
Screening.
The purpose of this amendment is to amend the following contract section
(Paragraphs and Attachments):
STANDARD CONTRACT:
Revise and replace the Standard Contract with an updated version which
incorporates the following changes:
(a) Amend section 5;
(b) Introduce section 6.6;
(c) Introduce section 7.6;
(d) Amend section 8; and
(d) Introduce section 32.3.

REVISE AND REPLACE THE INDEX TO ATTACHMENTS

ATTACHMENT I
(a) Introduce section 1.1.2;
(b) Amend section 1.2;
(c) Amend section 2.4.4;
(d) Amend 2.5.3.4;
(e) Introduce 2.6(6), and renumber accordingly;
(f) Introduce section 2.8.1(7), and renumber accordingly;
(g) Introduce section 2.12.4(7); and
(h) Amend section 3.2.5.

CONTRACT ATTACHMENTS:
(a) Introduce Attachment F, DOEA Cost Analysis for Non-Competitively Procured
Contracts In Excess of Category II; and
(b) Revise and replace Attachment G, Background Screening Affidavit of
Compliance.

AMEND EXHIBIT
Revise and replace Exhibit H.

AMEND APPENDICES
Revise and replace Appendices 3 and 5.

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Exhibit 10.8
AMENDMENT 001
Contract No. XT220
Amendment Page 2

_____________________________ Line denotes completion of above summary
____________
STANDARD CONTRACT:

(a) Section 5 of the Standard Contract is hereby amended to read:
5.
Renewals

By mutual agreement of the Parties, in accordance with s. 287.058(1)(g), F.S.,
the Department may renew the contract for a period not to exceed three years, or
the term of the original contract, whichever is longer. The renewal price, or
method for determining a renewal price, is set forth in the bid, proposal, or
reply. No other costs for the renewal may be charged. Any renewal is subject to
the same terms and conditions as the original contract and contingent upon
satisfactory performance evaluations by the Department and the availability of
funds.
(b) Section 6.6 of the Standard Contract is hereby introduced to read:
6.6
To comply with Presidential Executive Order 12989 and State of Florida Executive
Order Number 11-116, Contractor agrees to utilize the U.S. Department of
Homeland Security's E-verify system to verify the employment of all new
employees hired by Contractor during the contract term. Contractor shall include
in related subcontracts a requirement that subcontractors performing work or
providing services pursuant to the state contract utilize the E-verify system to
verify employment of all new employees hired by the subcontractor during the
contract term. Contractors meeting the terms and conditions of the E-Verify
System are deemed to be in compliance with this provision.

(c) Section 7.6 of the Standard Contract is hereby introduced to read:
7.6
In accordance with s. 287.135 F.S., any contractor on the Scrutinized Companies
with Activities in Sudan List or the Scrutinized Companies with Activities in
the Iran Petroleum Energy Sector List (Lists), created pursuant to s. 215.473
F.S., is ineligible to enter into or renew a contract with the Department for
goods or services of $1 million or more. Pursuant to s. 287.135 F.S., the
Department may terminate this contract if the Contractor is found to have
submitted a false certification of its status on the Lists or has been placed on
the Lists. Further, the Contractor is subject to civil penalties, attorney’s
fees and costs and any costs for investigations that led to the finding of false
certification. If this contract contains $1 million or more, the Contractor
shall complete and sign ATTACHMENT H, Certification Regarding Scrutinized
Companies Lists, prior to the execution of this contract.

(d) Section 8 of the Standard Contract is hereby amended to read as follows:
8.
Background Screening

The Contractor shall ensure that the requirements of s. 430.0402 and ch. 435,
F.S., as amended, are met regarding background screening for all persons who
meet the definition of a direct service provider and who are not excepted, from
the Department’s level 2 background screening pursuant to s. 430.0402(2)-(3),
F.S. The Contractor must also comply with any applicable rules promulgated by
the Department and the Agency for Health Care Administration regarding
implementation of s. 430.0402 and ch. 435, F.S. Further information concerning
the procedures for background screening are found at
http://elderaffairs.state.fl.us/doea/backgroundscreening.php.
(e) Section 32.3 of the Standard Contract is hereby introduced to read:
32.3
The Contractor may purchase articles that are the subject of, or required to
carry out, this contract from a nonprofit agency for the Blind or for the
Severely Handicapped that is qualified pursuant to Chapter 413, F.S., in the
same manner and under the same procedures set forth in s. 413.036(1) and (2),
F.S. For purposes of this contract, the Contractor shall be deemed to be
substituted for the Department insofar as dealings with such qualified nonprofit
agency are concerned. Additional information about the designated nonprofit
agency and the products it offers is available at
http://www.respectofflorida.org. This clause is not applicable to subcontractors
unless otherwise required by law.

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Exhibit 10.8
AMENDMENT 001
Contract No. XT220
Amendment Page 3

INDEX CONTRACT ATTACHMENTS
The Index to Contract Attachments is hereby replaced with the revised Index to
Contract Attachments and attached hereto.
ATTACHMENT I
(a) Section 1.1.2 is hereby introduced to read as follows:
Payment Discrepancy - Where the Contractor provided services under this contract
to an eligible enrollee and requested payment, but has not received said funds;
or conversely where the Contractor did not provide services to an individual
under this contract but received payment. A payment discrepancy also includes
any situation where the Contractor was paid an incorrect capitation amount for
an enrollee.
(b) Section 1.2 is hereby amended to read as follows:
1.2
DEPARTMENT MISSION STATEMENT

To foster an environment that promotes well-being for Florida’s elders and
enables them to remain in their homes and communities. The Department’s vision
is of all Floridians aging with dignity, purpose, and independence. Area
agencies, lead agencies and local service providers as partners and stakeholders
in Florida’s aging services network are expected to support the Department’s
mission, vision, and program priorities.
(c) Section 2.4.4 is hereby amended to read as follows:
2.4.4
Performance Measures

The Contractor shall collect, calculate, and report Department-selected
performance measures as specified by the Department. The Contractor shall submit
such performance measures to the Department and the Agency contracted EQRO
according to the following schedule: 1st quarter (January 1-March 31) and 2nd
quarter (April 1- June 30) rates should be submitted to the EQRO prior to the
performance measure site visit; 3rd quarter (July1- September 30), 4th quarter
(October 1 – December 31) and annual roll-up rates shall be submitted by
February 13 of the contract year. The Contractor shall collect the performance
measures based on the previous calendar year (January 1 through December 31)
unless otherwise specified. The Contractor is required to participate with the
EQRO on all performance measure validation activities, including a site visit
and submission of requested documentation. The Department may add, modify or
remove reporting requirements with thirty (30) days advance notice. See EXHIBIT
M for definitions and due dates.
(d) Section 2.5.3.4 is hereby amended to read as follows:
2.5.3.4
Requirements

When handling grievances and appeals, the Contractor shall take the following
actions:
(1)
Provide the enrollee a reasonable opportunity to present evidence and
allegations of fact or law in person as well as in writing;

(2)
Ensure the enrollee understands any time limits that may apply;

(3)
Provide opportunity before and during the process for the enrollee or an
authorized representative to examine the case file, including medical records,
and any other material to be considered during the process; and

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Exhibit 10.8
AMENDMENT 001
Contract No. XT220
Amendment Page 4

(4)
Consider as parties to the appeal the enrollee or an authorized representative
or, if the enrollee is deceased, the legal representative of the estate.

(e) Section 2.6(6) is hereby introduced and renumbered to read as follows:
2.6
MEDICAID FAIR HEARINGS

(1)
The Medicaid Fair Hearing policy and process is detailed in Department of
Children and Families Rule 65-2.042 – 2.069, F.A.C. Fair Hearings may be
requested verbally or in writing. No specific form is required.

(2)
An enrollee may seek a Medicaid Fair Hearing without having first exhausted the
Contractor’s grievance and appeal process.

a. An enrollee who chooses to exhaust the Contractor’s grievance and appeal
process may still file for a Medicaid Fair Hearing within ninety (90) calendar
days of receipt of the Contractor’s notice of resolution.
b. An enrollee who chooses to seek a Medicaid Fair Hearing without pursuing the
Contractor’s grievance and appeal process must do so within ninety (90) calendar
days of receipt of the Contractor’s notice of action.
(3)
In accordance with 42 CFR 438.400, the Contractor is required to inform an
individual of his/her right to a Medicaid Fair Hearing when the Contractor takes
action to deny, reduce, suspend, limit or terminate previously authorized
services. This includes services requested by the enrollee and those determined
to be unnecessary by the Contractor’s routine review of the care plans.

(4)
Enrollees may request a Medicaid Fair Hearing pursuant to 42 CFR 431.200 -
431.250 if they are denied the choice of home and community-based waiver
services as an alternative to institutional level of care specified for in this
waiver; or if their services are denied, reduced, suspended or terminated.

(5)
Parties to the Medicaid Fair Hearing include the Contractor, the enrollee or the
enrollee’s authorized representative.

(6)
To continue disputed services during a pending fair hearing, the enrollee must
request a fair hearing within 20 days of receipt of notification of his or her
fair hearing rights. Pursuant to 42 CFR 438.424(b), the MCO or the State must
pay for disputed services, in accordance with State policy and regulations, if
the MCO or the State Fair Hearing officer reverses a decision to deny
authorization of services, and the enrollee received the disputed services while
the appeal was pending.

(7)
The notice of Fair Hearing rights must contain the following language: “If you
disagree with this decision, you have a right to file an appeal with our Plan or
to request a State Fair Hearing. You do not need to file an appeal before you
request a Fair Hearing. If you would like to request a Fair Hearing you must do
so no later than ninety (90) days from the date of this letter. If you want to
have services continued, you must request a Fair Hearing within ten (10) days
from the date of this letter. You may have to pay for services that you get if
the decision is to uphold the action the Plan has taken.”

(8)
The notice must also contain the address and phone number for information and
assistance filing a Fair Hearing. The address is as follows:

Department of Children and Families
Office of Public Assistance Appeal Hearings
1317 Winewood Blvd.
Building 5, Room 203
Tallahassee, Florida 32399-0700
(850) 488-1429

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Exhibit 10.8
AMENDMENT 001
Contract No. XT220
Amendment Page 5

(9)
To assist enrollees who wish to file a Medicaid Fair Hearing for financial or
medical eligibility determinations, the Contractor must direct the enrollee to
contact the Department of Children & Families and provide the appropriate
contact information.

(10)
The Contractor must provide information pertaining to the Medicaid Fair Hearing
process and procedure in the member handbook and it must be shared with members
upon enrollment and annually.

(f) Section 2.8.1(7) is hereby replaced by new language and renumbered
accordingly.
(7)
Pursuant to 42 CFR 438.102(a)(1)(i-iv)’s anti-gag clause, the MCO may not
prohibit, or otherwise restrict, a health care professional acting within the
lawful scope of practice, from advising or advocating on behalf of an enrollee
who is his or her patient:

a. For the enrollee's health status, medical care, or treatment options,
including any alternative treatment that may be self-administered.
b. For any information the enrollee needs in order to decide among all relevant
treatment options.
c. For the risks, benefits, and consequences of treatment or non-treatment.
d. For the enrollee's right to participate in decisions regarding his or her
health care, including the right to refuse treatment, and to express preferences
about future treatment decisions.
(8)
Pursuant to 42 CFR 438.608, the Contractor shall maintain a mandatory compliance
plan that is designed to guard against fraud and abuse.

a. The Contractor shall develop and maintain written policies, procedures and
standards of conduct that states the Contractor’s commitment to comply with all
applicable federal and state standards.
b. The Contractor shall designate a compliance officer and a compliance
committee that is accountable to senior management.
c. The Contractor shall ensure effective training and education for the
compliance officer and the Contractor’s employees.
d. The Contractor shall ensure there are effective lines of communication
between the compliance officer and the Contractor’s employees.
e. The Contractor shall enforce standards through well-published disciplinary
guidelines.
f. The Contractor shall have a provision for internal monitoring and auditing.
g. The Contractor shall have a provision for prompt response to detected
offenses, and for development of corrective action initiatives relating to this
contract.
(g) Section 2.12.4(7) is hereby introduced and reads as follows:
(7)
Pursuant to 42 CFR 431.55(h) and 42 CFR 438.808, FFP is not available for
amounts expended for providers excluded by Medicare, Medicaid, or CHIP, except
for emergency services.

(h) Section 3.2.5 is hereby amended to read as follows:
3.2.5
Payment Discrepancies

(1) The Contractor shall prepare all reports and monthly payment requests for
submission to the Department. If after an enrollment and disenrollment
submission to the fiscal agent or receipt of the fiscal agent remittance voucher
a

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Exhibit 10.8
AMENDMENT 001
Contract No. XT220
Amendment Page 6

payment discrepancy is discovered, the Contractor must submit detailed
information on the Reconciliation Form (EXHIBIT H) to the Department within the
following time frames:
(i) The Contractor has 30 calendar days to review and address any payment
discrepancies before submitting them to the Department on the next
Reconciliation Form. Detailed information regarding the discrepancy must be
included on the following Reconciliation Form which is due to the Department on
the 5th day of each month. If a discrepancy is resolved during the month between
the discovery date and Reconciliation Form due date, the Contractor is not
required to include it on the Reconciliation Form.
(ii) If the payment discrepancy was discovered by the Department, the Contractor
has 30 calendar days to review and address the discrepancy before submitting it
on the next Reconciliation Form. Detailed information regarding the discrepancy
must be included on the following Reconciliation Form, which is due to the
Department on the 5th day of each month.
(2) Failure to submit a discovered payment discrepancy to the Department within
the time frames listed above shall result in a loss of any money requested by
the Contractor for such errors.
(3) For the purposes of this section, detailed information is defined as a
description of the payment discrepancy that includes, at a minimum, whether the
payment discrepancy is a situation where the plan is requesting payment, one
where the plan is requesting a recoupment of payment(s) made, or one where an
incorrect capitation rate was paid.
(4) Pursuant to the timeframes established in 42 CFR 447.45(d), regardless of
the date the payment discrepancy is discovered, the Contractor must submit all
payment discrepancies on the Reconciliation Form (EXHIBIT H) to the Department
no later than 12 months from the date of services. Failure to report a payment
discrepancy within this time frame will result in a loss of any money requested
by the Contractor for such errors. For the purposes of this section, the "12
months from the date of service" will begin on the first day of the month
following the month of service for which payment is requested. This time limit
does not apply to payment discrepancies where the Contractor received payment in
excess, as determined by the Department and/or Agency. For months of service
during which the enrollee was designated Medicaid Pending, the 12 months will
begin on the first day of the month following the month in which the enrollee’s
Medicaid eligibility was determined.
CONTRACT ATTACHMENTS:
(a) Attachment F, DOEA Cost Analysis for Non-Competitively Procured Contracts in
Excess of Category II is hereby introduced and attached hereto; and
(b) Attachment G, Background Screening Affidavit of Compliance is hereby
replaced with the revised Attachment G, Background Screening Affidavit of
Compliance.
AMENDED EXHIBIT
Exhibit H, Long-Term Care Community Diversion Pilot Project Reconciliation
Report is hereby replaced with the revised Exhibit H, Long-Term Care Community
Diversion Pilot Project Reconciliation Report and attached hereto.
APPENDIX 3, Programmatic Reports is hereby replaced with the revised Appendix 3,
Programmatic Reports and attached hereto.

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Exhibit 10.8
AMENDMENT 001
Contract No. XT220
Amendment Page 7

APPENDIX 5, Enrollee Roster Template and Instructions is hereby replaced with
the revised Appendix 5, Enrollee Roster Template and Instructions and attached
hereto.

This amendment shall be effective on the last date that the amendment has been
signed by both Parties.
All provisions in the agreement and any attachments thereto in conflict with
this amendment shall be and are hereby changed to conform to this amendment.
All provisions not in conflict with this amendment are still in effect and are
to be performed at the level specified in the agreement.
This amendment and all of its attachments are hereby made a part of this
agreement.
IN WITNESS WHEREOF, the Parties hereto have caused this 18 page amendment to be
executed by their officials there unto duly authorized.

Contractor: WELLCARE OF FLORIDA INC., dba    STATE OF FLORIDA,
HEALTHEASE    DEPARTMENT OF ELDER AFFAIRS

SIGNED BY: /s/ Christina Cooper        SIGNED BY:/s/ Charles T. Corley    
NAME: Christina Cooper        NAME: CHARLES T. CORLEY
TITLE: President FL & HI Division         TITLE: SECRETARY
DATE: 7/31/12         DATE: 8/2/12    
Federal Tax ID: 592583622
Fiscal Year Ending Date: 12/31

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Exhibit 10.8
AMENDMENT 001
Contract No. XT220
Amendment Page 8

Table of Contents
ATTACHMENT I
SECTION I
SERVICES TO BE PROVIDED……………………………………………………………..
17

1.1
DEFINITIONS OF TERMS AND ACRONYMS……………………………………………...
17

1.1.1
CONTRACT ACRONYMS……………………………………………………………………
17

1.1.2
PROGRAM SPECIFIC TERMS……………………………………………………………….
17

1.2
DEPARTMENT MISSION STATEMENT……………………………………………………
21

1.3
GENERAL DESCRIPTION……………………………………………………………………
22

1.3.1
General Statement………………………………………………………………………………
22

1.3.2
Authority………………………………………………………………………………………..
22

1.3.2.1
Incorporation of Reference Memoranda……………………………………………………….
22

1.3.3
Contract Terms and Conditions………………………………………………………………...
22

1.3.3.1
Required Long-Term Care Services……..……………………………………………………..
22

1.3.3.2
Case Management Services………………………………………………………….…………
25

1.3.3.3
Acute-Care Services……………………………………………………………………………
25

1.3.3.3.1
Acute-Care Provider Qualifications……………………………………………………………
26

1.3.3.4
Expanded Services……………………………………………………………………………...
27

1.4
INDIVIDUALS TO BE SERVED……………………………………………………………..
27

1.4.1
Eligibility for Program…………………………………………………………………………
27

1.4.2
Ineligibility for the Program……………………………………………………………………
27

1.4.3
“Medicaid Pending”……………………………………………………………………………
27

SECTION II
MANNER OF SERVICE PROVISION……………………………………………………..
28

2.1
SERVICE TASKS……………………………………………………………………………...
28

2.1.1
ENROLLMENT AND DISENROLLMENT………………………………..…………………
28

2.1.1.1
Enrollment Process…………………………………………………………………………….
28

2.1.1.2
Optional State Supplementation (OSS)………………………………………………………..
29

2.1.1.3
Changes in Eligibility and Reenrollment………………………………………………………
29

2.1.1.4
Effective Date of Enrollment…………………………………………………………………..
29

2.1.1.5
Transition Care Planning…………………………………………………………….…………
29

2.1.1.6
Orientation……………………………………………………………………………………..
30

2.1.1.7
Enrollee Handbook…………………………………………………………………………….
30

2.1.1.8
Provider Directory……………………………………………………………………………..
32

2.1.1.9
Plan ID Card……………………………………………………………………………………
32

2.1.1.10
Annual Notification…………………………………………………………………………….
32

2.1.1.11
Care Plan and Service Delivery Requirements………………………………………………...
32

2.1.1.12
Initial Care Plan Distribution…………………………………………………………………..
33

2.1.1.13
Care Plan Review………………………………………………………………………………
34

2.1.1.14
Coordination and Continuity of Care…………………………………………………………..
34

2.1.1.15
Assessments and Reassessments…………………………………………….…………………
35

2.1.1.16
Level of Care…………………………………………………………………………………...
35

2.1.1.17
Disenrollment Requested by the Enrollee……………………………………………………...
35

2.1.1.18
Disenrollment Requested by the Contractor………………………………………………….
36

2.1.1.19
Disenrollment Requests………………………………………………………………………..
36

2.1.1.20
Cancellations …………………………………………………………………………………..
36

2.2
RECORDS MANAGEMENT AND HEALTH INFORMATION SYSTEMS……………….
37

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Exhibit 10.8
AMENDMENT 001
Contract No. XT220
Amendment Page 9

2.2.1
Background Screening Affidavit of Compliance
38

2.3
UTILIZATION MANAGEMENT…………………………………………………………….
38

2.4
QUALITY ASSURANCE……………………………………………………………………..
39

2.4.1
Quality Assurance Program………………………………………………………….…………
39

2.4.2
Quality Assurance Committee………………………………………………………………….
39

2.4.3
Quality Improvement and Performance Measures……………………………………………..
40

2.4.4
Performance Measures…………………………………………………………………………
41

2.4.5
Incident Reporting……………………………………………………………………………...
41

2.5
GRIEVANCES AND APPEALS……..……………………………………………………..…
41

2.5.1
General Requirements………………………………………………………………………….
41

2.5.2
Categories of Challenges………………………………………………………….……………
42

2.5.3
Filing Grievances and Appeals…………………………………………………………………
42

2.5.3.1
Time Limits…………………………………………………………………………………….
42

2.5.3.2
Expedited Appeals……………………………………………………………………………...
43

2.5.3.3
Assistance………………………………………………………………………………………
43

2.5.3.4
Requirements…………………………………………………………………………………...
43

2.5.4
Notification of Action………………………………………………………………………….
43

2.5.5
Resolution and Notification………………………………………………………….…………
44

2.6
MEDICAID FAIR HEARINGS……..………………………………………………………...
44

2.6.1
Continuation of Benefits………………………………………………………………………..
45

2.7
STAFFING REQUIREMENTS………………………………………………………………..
46

2.7.1
Staffing Levels……………………………………………………………………….…………
46

2.7.2
Positions Required……………………………………………………………………………...
46

2.7.3
Staff Training…………………………………………………………………………………...
46

2.7.4
Staffing Changes………………………………………………………………………………..
47

2.8
SERVICE PROVISIONS………………………………………………………………………
47

2.8.1
General Provisions……………………………………………………………………………..
47

2.8.2
Availability/Accessibility of Services…………………………………………………………
48

2.8.3
Adult Protective Services………………………………………………………………………
49

2.8.4
Network Expansion………………………………………………………….……….………..
50

2.8.5
Access to Services……………………………………………………………..……………….
50

2.9
CONTRACTOR’S FINANCIAL OBLIGATIONS……………………………………………
50

2.9.1
Insolvency Protection…………………………………………………………………………..
50

2.9.2
Surplus Requirements…………………………………………………………………………..
51

2.9.3
Insurance……………………………………………………………………………………….
51

2.9.4
Interest and Savings………………………………………………………………….…………
51

2.9.5
Third Party Resources…………………………………………………………….……………
52

2.10
FINANCIAL REPORTING……………………………………………………………………
52

2.10.1
Enrollee Payment Liability Protection…………………………………………….…………..
52

2.10.2
Audited Financial Statements…………………………………………………………………..
52

2.10.3
Unaudited Quarterly Financial Statements……………………………………………………..
52

2.11
CONTRACT MANAGEMENT………………………………………………………………..
53

2.11.1
Independent Medical Review…………………………………………………………………..
53

2.12
CONTRACTOR RESPONSIBILITIES………………………………………………………..
53

2.12.1
Contractor Qualifications………………………………………………………….…………...
53

2.12.2
Contractor Tasks……………………………………………………………………………….
53

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Exhibit 10.8
AMENDMENT 001
Contract No. XT220
Amendment Page 10

2.12.3
Reporting……………………………………………………………………………………….
55

2.12.4
Provider Relations and Subcontracts…………………………………………………………...
56

2.12.4.1
Credentialing…………………………………………………………………………………...
57

2.12.4.2
Re-Credentialing……………………………………………………………………………….
58

2.12.4.3
Delegated Credentialing………………….…………………………………………………….
58

2.12.4.4
Identification of Conditions and Method of Payment………………………………………….
58

2.12.5
Provisions for Monitoring and Inspections….…………………………………………………
58

2.12.6
Subcontractor Termination………….………………………………………………………….
58

2.12.7
Ownership and Management Disclosure……………………………………………………….
58

2.12.8
Damages from Federal Disallowance…………………………………………………………..
59

2.12.9
Legal Action Notification………………………………………………………………………
59

2.12.10
Conflict…………………………………………………………………………………………
59

2.12.11
Prospective Enrollee Materials…………………………………………………………………
59

2.12.12
Prohibited Activities……………………………………………………………………………
59

2.12.13
Sanctions……………………………………………………………………………………….
60

2.12.14
Assignment of Contract………………………………………………………………………..
61

2.12.15
Contract Termination…………………………………………………………………………..
61

SECTION III
METHOD OF PAYMENT…………………………………………………………………...
62

3.1
REQUEST FOR PAYMENT…………………………………………………………………..
62

3.2
METHOD OF PAYMENT…………………………………………………………………….
62

3.2.1
Capitation Rates…….……………………………………………………………….…………
62

3.2.2
834 Transactions…….…………………………………………………………………………
62

3.2.3
Payment in Full…………………………………………………………………………………
63

3.2.4
Capitation Payments……………………………………………………………………………
63

3.2.5
Payment Discrepancies…………………………………………………………………………
63

ATTACHMENTS
II – X, B, D, F – H and J

 
ATTACHMENT II
CERTIFICATION REGARDING LOBBYING………………………………………
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND AGREEMENTS
64
 
ATTACHMENT III
FINANCIAL AND COMPLIANCE AUDIT
65
 
ATTACHMENT IV
CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR AGREEMENTS, GRANTS, LOANS,
AND COOPERATIVE AGREEMENTS
70
 
ATTACHMENT V
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY
EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
71
 
ATTACHMENT VI
ASSURANCES—NON-CONSTRUCTION PROGRAMS
72
 
ATTACHMENT VII
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
74
 
ATTACHMENT VIII
PUBLIC ENTITY CRIMES
77
 
ATTACHMENT IX
MULTIPLE SIGNATURE VERIFICATION
79
 
ATTACHMENT X
AGREEMENT TO PROVIDE SERVICES TO INDIVIDUALS IDENTIFIED AS MEDICAID PENDING
81
 
ATTACHMENT B
CIVIL RIGHTS COMPLIANCE CHECKLIST
82
 
ATTACHMENT D
PROVIDER’S STATE CONTRACTS LIST
86
 
ATTACHMENT F

ATTACHMENT G
DOEA COST ANAYLSIS FOR NON-COMPETITIVELY PROCURED CONTRACTS
BACKGROUND SCREENING AFFIDAVIT OF COMPLIANCE
87

88
 

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

    
Back to 10-Q
 
Exhibit 10.8
AMENDMENT 001
Contract No. XT220
Amendment Page 11

ATTACHMENT H
CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS
89
 
ATTACHMENT J
VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION
90
 
 
 
 
 
 
EXHIBITS
A - M
 
 
 
EXHIBIT A
CAPITATION RATES
91
 
 
EXHIBIT B
DISENROLLMENT SUMMARY REPORT
92
 
 
EXHIBIT C
ENCOUNTER DATA REPORT
93
 
 
EXHIBIT D
REPORT OF GRIEVANCES AND APPEALS
98
 
 
EXHIBIT E
PROVIDER NETWORK AND STAFFING REPORT
99
 
 
EXHIBIT F
ENROLLEE SATISFACTION SURVEY
102
 
 
EXHIBIT G
SUBCONTRACTOR CONFORMATION
105
 
 
EXHIBIT H
RECONCILIATION REPORT
106
 
 
EXHIBIT I
REQUEST FOR DISENROLLMENT
107
 
 
EXHIBIT J
SUBCONTRACTOR TRAINING ATTESTATION REPORT
109
 
 
EXHIBIT K
FINANCIAL REPORTING PACKAGE
110
 
 
EXHIBIT L
LEVEL OF CARE (LOC) REDERTERMINATION FORM
128
 
 
EXHIBIT M
QUALITY IMPROVEMENT
129
 
 
 
 
 
 
 
APPENDICES
1 – 6
 
 
 
 
 
 
 
 
APPENDIX 1
ADDITIONAL SUB-CONTRACT REQUIREMENTS
130
 
 
APPENDIX 2
ADDITIONAL OWNERSHIP AND MANAGEMENT REQUIREMENTS
132
 
 
APPENDIX 3
PROGRAMMATIC REPORTS
133
 
 
APPENDIX 4
SERVICE PROVIDER QUALIFICATIONS
135
 
 
APPENDIX 5
ENROLLEE ROSTER REPORT
140
 
 
APPENDIX 6
INCIDENT REPORTING LOG
142
 
 

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

    
Back to 10-Q
 
Exhibit 10.8
AMENDMENT 001
Contract No. XT220
Amendment Page 12

EXHIBIT H

Long-Term Care Community Diversion Pilot Project
Reconciliation Report
For (Contractor name) (Month/Year)

TAB 1
Recipient Medicaid ID
Recipient
Last Name
Recipient
First Name
Provider ID
Enrollment Span
Plan Comments
DOEA Comments from LAST month
DOEA Comments from THIS month
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Items on this tab of the report (Tab 1) include those which fall into the
following categories:
- New items that have never been submitted on the Reconciliation Form before.
- Items AHCA is in the process of updating.
- Items the Contractor has resolved with DCF/SSA that are ready for AHCA to
update.
- Items for which the Contractor has submitted the documents requested by DOEA.
- Items the Contractor was told to resubmit via 834 on the last Reconciliation
Form, but which rejected again for unknown reason(s).

The Contractor is responsible for moving any new items to Tab #2 if DOEA
identifies them as one of the types of issues that go on that tab.

The Contractor is responsible for adding new items to Tab #1, and for removing
any resolved items from Tab #1 before submitting the Reconciliation Form to DOEA
each month.

TAB 2
Recipient Medicaid ID
Recipient
Last Name
Recipient
First Name
Provider ID
Enrollment Span
Plan Comments
DOEA Comments when moved to Tab 2
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Items on this tab of the report (Tab 2) include those which fall into the
following categories:
 - DOEA has requested documentation, and the Contractor has not yet submitted
it.
 - County of Residence discrepancies that DCF/SSA have not yet resolved.
 - Medicaid eligibility issues that DCF/SSA have not yet resolved.

DOEA Reviews these items every three (3) months to see if changes have been
made.

In the interim, it is the Contractor's responsibility to identify any items DOEA
should review again and move the item to Tab #1. The items moved to Tab #1
should only be items the Contractor has good reason to believe have been fixed
(received a NOCA, submitted the documents, etc.).

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

    
Back to 10-Q
 
Exhibit 10.8
AMENDMENT 001
Contract No. XT220
Amendment Page 13

APPENDIX 3

Programmatic Reports

All reports containing PHI will be password protected, zipped and encrypted
using WinZip version 9.0 or higher. Use standard passwords for both the WinZip
file as well as the report files. Unless otherwise indicated, electronic reports
will be sent to DiversionReports@elderaffairs.org and a copy to the Contract
Manager.

Level of Analysis: The following levels of analysis will be used, as indicated,
for the required reports:
1.
Individual Level - One report is required for each enrollee, e.g., one grievance
record for each grievance, one record per long-term care service.

2.
Location Level - One report required for each nine-digit Medicaid provider
number the Contractor has under contract.

3.
Contractor Level - One report is required for each seven-digit Medicaid provider
number the Contractor has under contract.

Report Name
Level of Analysis
Reporting Frequency
Submission Method
Reporting Location
File Type
File Name
834 Transactions
Individual
Monthly the Wednesday preceding the second to last Saturday for enrollments and
for disenrollments the prior day
Secured Web site supplied by the fiscal agent, file upload and download
Fiscal agent
834 format Prescribed by the Fiscal Agent
Prescribed by the Fiscal Agent
Disenrollment Summary Report
Location
Monthly within 15 calendar days after the beginning of the reporting month
Electronic Mail
Department
Excel (template in contract)
Plan_Report Name_Date
Encounter Data Report
Individual
Quarterly, within 3 months of the end of reporting calendar quarter
FTP Site
Department
PDF/text file see contract
Plan_Report Name_Quarter #_Year
Grievance, Appeals, Complaints Report
Individual
Quarterly, within 5 calendar days of end or reporting calendar quarter
Electronic Mail
Department
Excel (template in contract)
Plan_Report Name_Quarter #_ Year
Provider Network and Staff Listing
Location
Quarterly, within 5 calendar days of end of reporting calendar quarter
Electronic Mail
Department
Excel (template in contract)
Plan_Report Name_ Quarter #_ Year

Emergency Management Plan
Contractor
Annually, April 30
Electronic Mail
Department
Word/PDF
Plan_Report Name_Date

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

    
Back to 10-Q
 
Exhibit 10.8
AMENDMENT 001
Contract No. XT220
Amendment Page 14

 
Emergency Management Plan Verification
Contractor
Verification of plan within 30 days of execution of contract
Electronic Mail
Department
Word/ PDF
Plan_Report Name_Date
 
Report Name
Level of Analysis
Reporting Frequency
Submission Method
Reporting Location
File Type
File Name
 
Enrollee Satisfaction Survey
Contractor
Annually, May 15
Electronic Mail
Department
Word/PDF (template in contract)
Plan_Report Name_Date
 
Reconciliation Report
Individual
Within 10 days of receipt of remittance vouchers
Electronic Mail
Department
Excel
Plan_Report Name_Date
 
Insolvency Fund Statements
Contractor
Monthly Statements
Electronic Mail or Hard Copy
Department
PDF copy
Plan_Report Name_Date
 
Audited Financial Statement
Contractor
Annually, within 120 days of end of Contractor’s fiscal year (4 months)
Electronic Mail, Compact Disc or Hard Copy
Department
Word/PDF
Plan_Report Name_Date
 
Performance Measures
Contractor
Report to HSAG
Electronic Mail to HSAG
HSAG
Format prescribed by HSAG
Plan_Report Name_Date
  
Unaudited Financial Statements
Contractor
Quarterly, within 60 days of end of reporting quarter (2 months)
Electronic Mail on Department supplied template
Department
Excel
Plan_Report Name_Quarter#_Year
  
Performance Improvement Measures
Contractor
Report to HSAG
Electronic Mail to HSAG
HSAG
Format prescribed by HSAG
Plan_Report Name_Date
  
Staff Changes
Individual
As Needed
Electronic Mail, hard copy or compact disk
Department
Word
Plan_Report Name_Date
  
Subcontractor Training Attestation
Subcontractor
Annually, July 5
Electronic Mail
Department
Excel
Plan_Report Name_Date
 
Enrollee Roster
Contractor
Monthly, the 8th of every month
FTP Site
Department
Excel
Plan_Report Name_Date

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

Back to 10-Q
 
Exhibit 10.8
AMENDMENT 001
Contract No. XT219
Amendment Page 15

Appendix 5
Enrollee Roster Template and Instructions
TAB 1
PLAN NAME
SUBMISSION MONTH
Non-Medicaid Pending Enrollees
Medicaid ID
Social Security Number
Last Name
First Name
Physical Address
City
Zip Code
County
Type of Facility
Name of Facility
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Roster Tab (Tab 1):
This tab is for the basic enrollee roster. It consists of the basic enrollee
demographic information, as well as the type and name of facility the enrollee
is in, if applicable. For this tab, do NOT include Medicaid Pending individuals.
TAB 2
PLAN NAME
SUBMISSION MONTH
Medicaid Pending
Medicaid ID
Social Security Number
Last Name
First Name
Physical Address
City
Zip Code
County
Type of Facility
Name of Facility
Date Application to DCF
606 or 608?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Medicaid Pending Tab (Tab 2):
This tab is for only those individuals that are Medicaid Pending. Please ensure
that the date the application was sent to DCF is included for each individual.
This list should be maintained in a chronological order, beginning with the
earliest date, and ending with the most recent. Please ensure that this tab is
updated prior to each submission to DOEA, removing any individuals that are no
longer Medicaid Pending and adding those individuals to the Roster tab when
appropriate.
TAB 3
PLAN NAME
SUBMISSION MONTH
Contracted Facilities
Facility Name
Facility Type
Address
City
Zip Code
County
Number of Enrollees
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Network Tab (Tab 3):
This tab is a listing of all contracted facilities in the network. Please verify
that the "Number of Enrollees" column is filled out and updated prior to each
submission

      

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

Back to 10-Q
 
Exhibit 10.8
AMENDMENT 001
Contract No. XT219
Amendment Page 16

PSA #
 
 
 
ATTACHMENT F
Contract #
 
 
 
Exhibit 1
 
 
 
 
 
DOEA Cost Analysis For Non-Competitively Procured Contracts
In Excess Of Category II
 
 
 
 
 
Program:
 

Contract period:    
 
 
 
 
 
 
TYPE OF SERVICE:
 
 

            
1
2
Column 3
Column 4
Column 5
6
7
8
 
 
(to be completed by the Contractor)
(to be completed by the DOEA ContractManager
Budget
Category
 
Line Item
Amount
% Allocated to
this Agreement
Allowable
Reasonable
Necessary
Administration
a.
Salaries (List position titles and salaries below; add rows as necessary)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sub-total Salaries
 
#DIV/0!
 
 
 
b.
Fringe Benefits
 
#DIV/0!
 
 
 
c.
Equipment
 
#DIV/0!
 
 
 
d.
Telephone & Utilities
 
#DIV/0!
 
 
 
e.
Travel
 
#DIV/0!
 
 
 
f.
Printing & Supplies
 
#DIV/0!
 
 
 
g.
Building Space
 
#DIV/0!
 
 
 
h.
Other (List below; add rows as necessary)
 
 
 
 
 
 
 
 
#DIV/0!
 
 
 
 
 
#DIV/0!
 
 
 
 
 
#DIV/0!
 
 
 
 
 
#DIV/0!
 
 
 
 
 
#DIV/0!
 
 
 
 
 
#DIV/0!
 
 
 
 
 
#DIV/0!
 
 
 
 
 
#DIV/0!
 
 
 
 
 
#DIV/0!
 
 
 
 
total administration
 
 
 
 
 
Services
 
Client Services (Attach details per instructions)
 
#DIV/0!
 
 
 
 
TOTAL SERVICES
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CONTRACT TOTAL
 
#DIV/0!
 
 
 
 
 
 
 
 
 
 
 
CERTIFICATION (to be signed by DOEA Contract Manager)
I certify that the cost for each line item has been evaluated and determined to
be allowable, reasonable, and
necessary as required by Section 216.3475, Florida Statutes.
 
 
 
 
 
 
 
 
 
 
 
 
Government Operations Consultant III
 
Name
 
Title
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Signature
 
Date
 
 
 
 
 
 
 
 
 
 

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

Back to 10-Q
 
Exhibit 10.8
AMENDMENT 001
Contract No. XT219
Amendment Page 17

 
 
 
 
ATTACHMENT F
 
 
 
 
Exhibit 2

INSTRUCTIONS:
Cost Analysis For Non-Competively Procured Contracts
In Excess Of Category II
The purpose of the ATTACHMENT F, Exhibit 1, is to document that costs in
non-competitively procured contracts in excess of $35,000 are allowable,
reasonable and necessary.
Upon receipt of the form completed by the AAA, the DOEA contract manager will:
1.Evaluate each separate line item to determine whether the cost is allowable,
reasonable and necessary.
a.To be allowable, a cost must be allowable pursuant to state and federal
expenditure laws, rules and regulations and authorized by the agreement between
the state and the contractor.
b.To be reasonable, a cost must be evaluated to determine that the amount does
not exceed what a prudent person would incur given the specific circumstances.
c.To be necessary, a cost must be essential to the successful completion of the
program.
2.Place the Cost Analysis for Non-Competitively Procured Agreements in Excess of
Category II form in the official file for this contract at the Department of
Elder Affairs.

(1)    In accordance with the following instructions for the DOEA Cost Analysis
For Non-Competitively Procured Contracts in Excess Of Category II worksheet
(ATTACHMENT F, EXHIBIT 1), the contractor must complete COLUMNS 3 and 4 AND
ensure COLUMN 5 calculates accurately. This for is required for the original
contract and for any amendment that affects the amount of compensation and/or
the level of services provided.
(2)    Definition of Administrative Costs -

a.    Salaries/Wages: The charges to directly hire someone and put them on
payroll.
b.    Fringe Benefits: The costs of health insurance, Social Security, Medicare,
unemployment and other benefits paid on behalf of each employee. If fringe
benefits will be based on a specified percentage, rather than the actual cost of
fringe benefits, then the calculation for the fringe benefits must also be
shown.

c.    Equipment: An article of expendable, tangible personal property generally
having a useful life of more than one year and an acquisition cost that equals
or exceeds the lesser of the established capitalization level of $5,000 (federal
funds) or $1,000 or hardback bound books not circulated, with a value of $250.00
or more (state funds).
d.    Telephone and Utilities: Expenses such as utilities and telephone service
costs.
e.    Travel: Expenses that are necessary, reasonable and allowable for carrying
our the project. Travel must be in accordance with Section 112.061, Florida
Statutes, which includes submission of the claim on the approved State travel
voucher or electronic means and at the authorized meal, per diem and state
mileage reimbursement rates.
f.    Printing and Supplies: Expenses such as office supplies, postage, and
printing.

g.    Building Space: Costs related to lease or mortgage payments.
h.    Other Costs: Identify these by individual lien item and include their
associated costs.
(3)    Client Service costs should be documented via Area Agency or Aging Area
Plans, Unit Cost information input into WebDB, or some other form of
documentation to support the cost analysis.
(4)    The allocation to the agreement will be calculated based on the cost by
line item cost divided by the total agreement amount.

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

Back to 10-Q
 
Exhibit 10.8
AMENDMENT 001
Contract No. XT219
Amendment Page 18

Department of

[logo]

ELDER AFFAIRS State of Florida
ATTACHMENT G
 
 
BACKGROUND SCREENING
 
Affidavit of Compliance - Employer
 
 
 
 
AUTHORITY: This form is required annually of all employers to comply with the
attestation requirements set forth in section 435.05(3), Florida Statutes.

•
The term “employer” means any person or entity required by law to conduct
background screening, including but not limited to, Area Agencies on Aging,
Aging Resource Centers, Aging and Disability Resource Centers, Lead Agencies,
Long-Term Care Ombudsman Program, Serving Health Insurance Needs of Elders
Program, Service Providers, Diversion Providers, and any other person or entity
which hires employees or has volunteers in service who meet the definition of a
direct service provider. See §§ 435.02, 430.0402, Fla. Stat.

•
A direct service provider is “a person 18 years of age or older who, pursuant to
a program to provide services to the elderly, has direct, face-to-face contact
with a client while providing services to the client and has access to the
client's living area, funds, personal property, or personal identification
information as defined in s. 817.568. The term includes coordinators, managers,
and supervisors of residential facilities; and volunteers.” § 430.0402(1)(b),
Fla. Stat.

ATTESTATION:
As the duly authorized representative of WellCare of Florida, Inc. dba
HealthEase
 
located at 8735 Henderson Road, Tampa, Florida 33634
 
Street Address
City
State
Zip code
 
I, Christina Cooper do hereby affirm under penalty of perjury
 
Name of Representative
 
 
 
 
that the above names employer is in compliance with the provisions of Chapter
435 and section
 
430.0402, Florida Statutes, regarding level 2 background screening.
 
 
 
 
 
 
/s/ Christina Cooper 7/31/12
 
 
 
Signature of Representative
 
Date

STATE OF FLORIDA, COUNTY OF HILLSBOROUGH    

Sworn to (or affirmed) and subscribed before me this 31st day of July 2012 , by

Christina Cooper Name of Representative) who is personally known

to me or produced________________________as proof of identification:
[NOTARY STAMP]
 
/s/ Emily A. Merlin
 
 
Print, Type, or Stamp Commissioned Name of Notary Public
Notary Public
 
 

            
 
DOEA Form 235, Affidavit of Compliance-Employer, Effective April 2012
Section 435.05(3), F.S.

Form available at:
http://elderaffairs.state.fl.us/english/backgroundscreening.php