nysamendment6.htm


    
      
        
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8-K                                                                                                                       Exhibit
10.1

           

          APPENDIX
X [Amendment Number 6]

        

        
          


        

        
          	
                  Agency
      Code 12000

                	
                  Contract
      No. C020454

                
	
                  Period
      10/1/07-9/30/08

                	
                  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), to modify Contract Number
C020454 as set forth below. The effective date of these modifications is
October 1, 2007, unless otherwise noted below.

        

        
           

          1.          
Amend Section 11.5
"Corrective and Remedial Actions" to read as follows:

        

        
          


          11.5       Corrective
and Remedial Actions

        

        
           

          
            	
                     

                  	a)	
                    If
      the Contractor's Marketing activities do not comply with the Marketing
      Guidelines set forth in Appendix D of this Agreement or
      the Contractor's approved
      Marketing plan, the SDOH, in consultation with the LDSS, may take any of
      the following actions as
      it, in its sole discretion, deems necessary
      to protect the interests of Enrollees and the integrity of the MMC and
      FHPlus Programs.
      The Contractor shall take the corrective and
      remedial actions directed by the SDOH within the specified
      timeframes.

                  


          

        

        
           

          
            	
                     
      

                  	 i)	
                     If
      the Contractor or its representative commits a first time infraction of
      the Marketing Guidelines and/or the Contractor's approved Marketing plan,
      and the SDOH, in consultation with the LDSS, deems the infraction to be
      minor or unintentional in nature, the SDOH and/or the LDSS may issue a
      warning letter to the
Contractor.

                  


          

        

        
           

          
            	
                     
      

                  	 ii)	
                    If
      the Contractor engages in Marketing activities that SDOH determines, in it
      sole discretion, to be an intentional or serious breach of the Marketing
      Guidelines or the Contractor's approved Marketing plan, or a pattern of
      minor breaches, SDOH, in consultation with the LDSS, may require the
      Contractor to, and the Contractor shall, prepare and implement a
      corrective action plan acceptable to SDOH within a specified timeframe. In
      addition, or alternatively, SDOH may impose sanctions, including monetary
      penalties, as permitted by
law.

                  


          

        

        
           

          
            	
                     

                  	 iii)	
                     If
      the Contractor commits further infractions, fails to pay monetary
      penalties within the specified timeframe, fails to implement a corrective
      action plan in a timely manner or commits an egregious first-time
      infraction, the SDOH, in consultation with the LDSS, may in addition to
      any other legal remedy available to SDOH in law or
  equity:

                  


          

        

        
           

          
            	
                     

                  	 A)	
                    direct
      the Contractor to suspend its Marketing activities for a period up to the
      end of the Agreement period;

                  


          

        

        
           

          
            	
                     

                  	 B)	
                    suspend
      new Enrollments, other than newborns, for a period up to the remainder of
      the Agreement period; or

                  


          

        

        
           

          
            	
                     

                  	 C)	
                    
                      terminate
      this Agreement pursuant to termination procedures described in Section 2.7
      of this Agreement.

                    

                  


          

           

        

        
          
            
               

              
                Appendix
X

              

              
                MMC/FHPlus
Contract Amendment

              

              
                October
1, 2007

              

              
                Page
1

              

              


            

          

          
            
              

            

          

           

        

         

        
          
            	
                     

                  	 b)	
                    The
      corrective and remedial actions described in Section 11.5 a) apply to
      violations of the reporting requirements in Section 18.5 a)
      xiii).

                  


          

        

        
          


        

        
          
            	
                    2.

                  	
                    Amend Section 18.5
      "Reporting Requirements" to read as
  follows:

                  


          

        

        
           

          
            	
                    18.5

                  	
                    Reporting
      Requirements

                  


          

        

        
           

          
            	
                     

                  	 a)	
                    The
      Contractor shall submit the following reports to SDOH (unless otherwise
      specified).   The Contractor will certify the data
      submitted pursuant to this section as required by SDOH. The certification
      shall be in the manner and format established by SDOH and must
      attest,   based on best knowledge, information, and belief
      to the accuracy, completeness and  truthfulness of the data
      being submitted.

                  


          

        

        
           

          
            	
                     
      

                  	 i)	
                    Annual
      Financial Statements:

                  

      


        

        
          Contractor
shall submit Annual Financial Statements to SDOH. The due date for annual
statements shall be April 1 following the report closing
date.

        

        
           

          
            	
                     
      

                  	 ii)	
                     Quarterly
      Financial Statements:

                  


          

        

        
           

          Contractor
shall submit Quarterly Financial Statements to SDOH. The due date for quarterly
reports shall be forty-five (45) days after the end of the calendar
quarter.

           

          
            	
                     
      

                  	 iii)	
                     Other
      Financial Reports:

                  


          

        

        
          
          

        

        
           

          Contractor
shall submit financial reports, including certified annual financial statements,
and make available documents relevant to its financial condition to SDOH and the
State Insurance Department (SID) in a timely manner as required by State laws
and regulations, including but not limited to PHL §§ 4403-a, 4404
and 4409, Title 10 NYCRR Part 98; and when applicable, SIL §§ 304, 305, 306,
and 310. The SDOH may require the Contractor to submit such relevant financial
reports and documents related to its financial condition to the
LDSS.

        

        
           

          
            	
                     
      

                  	 iv)	
                     Encounter
      Data:

                  


          

           

        

        
          The
Contractor shall prepare and submit encounter data on a monthly basis to SDOH
through SDOH's designated Fiscal Agent. Each provider is required to have a
unique identifier. Submissions shall be comprised of encounter records or
adjustments to previously submitted records, which the Contractor has received
and processed from provider encounter or claim records of all contracted
services rendered to the Enrollee in the current or any preceding months.
Monthly submissions must be received by the Fiscal Agent in accordance with the
time frames specified in the MEDS II data dictionary on the HPN to assure the
submission is included in the Fiscal Agent's monthly production
processing.

        

        
           

          
            	
                     
      

                  	 v)	
                     Quality
      of Care Performance Measures:

                  


          

           

          The
Contractor shall prepare and submit reports to SDOH, as specified in the Quality
Assurance Reporting Requirements (QARR). The Contractor must arrange for an
NCQA-certified entity to audit the QARR data prior to its submission to the SDOH
unless this requirement is specifically waived by the SDOH. The SDOH will select
the measures which will be audited. 

        

        
          
            
               

              
                Appendix
X

              

              
                MMC/FHPlus
Contract Amendment

              

              
                October
1, 2007

              

              
                Page
2

              

              


            

          

          
            
              

            

          

           

        

        
           

        

        
          
            	
                     

                  	 vi)	
                    Complaint
      and Action Appeal Reports:

                  


          

        

        
           

          
            	
                     

                  	 A)	
                    The
      Contractor must provide the SDOH on a quarterly basis, and within fifteen
      (15) business days of the close of the quarter, a summary of all
      Complaints and Action Appeals subject to PHL § 4408-a
      received during the preceding quarter via the Summary Complaint Form on
      the Health Provider Network. The Summary Complaint Form has been developed
      by the SDOH to categorize the type of Complaints and Action Appeals
      subject to PHL § 4408-a
      received by the Contractor.

                  


          

        

        
           

          
            	
                     

                  	 B)	
                    The
      Contractor agrees to provide on a quarterly basis, via Summary Complaint
      Form on the HPN, the total number of Complaints and Action Appeals subject
      to PHL § 4408-a that
      have been unresolved for more than forty-five (45) days. The Contractor
      shall maintain records on these and other Complaints, Complaint Appeals
      and Action Appeals pursuant to Appendix F of this
    Agreement.

                  


          

        

        
           

          
            	
                     

                  	 C)	
                    Nothing
      in this Section is intended to limit the right of the SDOH or its designee
      to obtain information immediately from a Contractor pursuant to
      investigating a particular Enrollee or provider Complaint, Complaint
      Appeal or Action Appeal.

                  


          

        

        
           

          
            	
                     
      

                  	 vii)	
                    Fraud
      and Abuse Reporting
Requirements:

                  


          

        

        
           

          
            	
                     

                  	 A)	
                    The
      Contractor must submit quarterly, via the HPN Complaint reporting format,
      the number of Complaints of fraud or abuse made to the Contractor that
      warrant preliminary investigation by the
  Contractor.

                  


          

        

        
           

          
            	
                     

                  	 B)	
                    The
      Contractor also must submit to the SDOH the following information on an
      ongoing basis for each confirmed case of fraud and abuse it identifies
      through Complaints, organizational monitoring, contractors,
      subcontractors, providers, beneficiaries, Enrollees, or any other
      source:

                  


          

        

        
           

          
            	
                     

                  	I)	
                    The
      name of the individual or entity that committed the fraud or
      abuse;

                  


          

                              

          
            	
                     

                  	II)	
                    The
      source that identified the fraud or
abuse;

                  


          

        

        
                               

        

        
          
            	
                     

                  	 III)	
                    The
      type of provider, entity or organization that committed the fraud or
      abuse;

                  


          

        

        
                                 

            	
                     

                  	IV)	
                    A
      description of the fraud or abuse;

                  


          

                          

          
            	
                     

                  	V)	
                    The
      approximate dollar amount of the fraud or
abuse;

                  


          

        

        
                                

           

        

        
          
            	
                     

                  	 VI)	
                    The
      legal and administrative disposition of the case, if available, including
      actions taken by law enforcement officials to whom the case has been
      referred; and

                  


          

        

        
                            

          
            	
                     

                  	VII)	
                    Other
      data/information as prescribed by
SDOH;

                  

  

        

        
          
            	
                     

                  	 C)	
                    Such
      report shall be submitted when cases of fraud and abuse are confirmed, and
      shall be reviewed and signed by an executive officier of the
      Contractor.

                  


          

        

        
           

        

        
          
            
               

              
                Appendix
X

              

              
                MMC/FHPlus
Contract Amendment

              

              
                October
1, 2007

              

              
                Page
3

                 

              

            

          

          
            
              

            

          

           

        

        
           

          
            	
                     
      

                  	 viii)	
                    Participating
      Provider Network Reports:

                  


          

           

          The
Contractor shall submit electronically, the the HPN, an updated provider network
report on a quarterly basis. The Contractor shall submit an annual notarized
attestation that the providers listed in each submission have executed an
agreement with the Contractor to serve Contractor's MMC and/or FHPlus Enrollees,
as applicable. The report submission must comply with the Managed Care Provider
Network Data Dictionary. Networks must be reported separately for each county in
which the Contractor operates.

        

        
           

          
            	
                     
      

                  	 ix)	
                     Appointment
      Availability/Twenty-four (24) Hour Access and Availability
      Surveys:

                  


          

        

        
           

          The
Contractor will conduct a county specific (or service area if appropriate)
review of appointment availability and twenty-four (24) hour access and
availability surveys annually. Results of such surveys must be kept on file and
be readily available for review by the SDOH or LDSS, upon
request.

        

        
           

          
            	
                     

                  	 x)	
                    Clinical
      Studies:

                  


          

        

        
           

          
            	
                     

                  	 A)	
                    The
      Contractor will participate in up to four (4) SDOH sponsored focused
      clinical studies annually. The purpose of these studies will be to promote
      quality improvement.

                  


          

        

        
           

          
            	
                     

                  	 B)	
                    The
      Contractor is required to conduct at least one (1) internal performance
      improvement project each year in a priority topic area of its choosing
      with the mutual agreement of the SDOH and SDOH's external quality review
      organization. The Contractor may conduct its performance improvement
      project in conjunction with one or more MCOs. The purpose of these
      projects will be to promote quality improvement within the Contractor's
      MMC and/or FHPlus product. SDOH will provide guidelines which address
      study structure and reporting format. Written reports of these projects
      will be provided to the SDOH and validated by the external quality review
      organization.

                  


          

        

        
           

          
            	
                     

                  	 xi)	
                     Independent
      Audits:

                  


          

        

        
           

          The
Contractor must submit copies of all certified financial statements and QARR
validation audits by auditors independent of the Contractor to the SDOH within
thirty (30) days of receipt by the Contractor.

        

        
           

          
            	
                     
      

                  	 xii)	
                     New
      Enrollee Health Screening Completion
Report:

                  


          

        

        
          


          The
Contractor shall submit a quarterly report within thirty (30) days of the close
of the quarter showing the percentage of new Enrollees for which the Contractor
was able to complete a health screening consistent with Section 13.6(a)(ii) of
this Agreement.

        

        
           

          
            	
                     

                  	 xiii)	
                    Marketing
      and Facilitated Enroller Staffing
Reports:

                  


          

        

        
           

          The
Contractor shall submit a monthly staffing report during the last fifteen (15)
calendar days of each month showing the number of full-time equivalents (FTEs)
employed or funded for purposes of marketing, facilitated enrollment, and/or
community outreach designed to develop enrollment opportunities or present
coverage options for the Medicaid, Family Health Plus, and Child Health Plus
programs, and solely for Medicaid Advantage and/or Medicaid Advantage Plus
programs, as applicable. 

        

        
          
            
               

              Appendix
X

              
                MMC/FHPlus
Contract Amendment

              

              
                October
1, 2007

              

              
                Page
4

                 

              

            

            
              

            

            
              
                
                

              

               

              
                	
                          

                      	 xiv)   	
                        Additional
      Reports

                      


              

               

              Upon
request by the SDOH, the Contractor shall prepare and submit other operational
data reports. Such requests will be limited to situations in which the desired
data is considered essential and cannot be obtained through existing Contractor
reports. Whenever possible, the Contractor will be provided with ninety (90)
days notice and the opportunity to discuss and comment on the proposed
requirements before work is begun. However, the SDOH reserves the right to give
thirty (30) days notice in circumstances where time is of the
essence.

            

          

        

        
          


        

        
          
            	
                    3.

                  	
                    Amend Section 21.21
      "Federally Qualified Health Centers (FQHCs)" to read as
      follows:

                  


          

        

        
          


        

        
          
            	
                    21.21

                  	
                    Federally
      Qualified Health Centers
(FQHCs)

                  


          

        

        
           

          
            	
                     

                  	 a)	
                    In
      a county where Enrollment in the Contractor's MMC product is voluntary,
      the Contractor is not required to contract with FQHCs. However, when an
      FQHC is a Participating Provider of the Contractor network, the Provider
      Agreement must include a provision whereby the Contractor agrees to
      compensate the FQHC for services provided to Enrollees at a payment rate
      that is not less than the level and amount that the Contractor would pay
      another Participating Provider that is not an FQHC for a similar set of
      services.

                  


          

        

        
           

          
            	
                     

                  	 b)	
                    In
      a county where Enrollment in the Contractor's MMC product is mandatory
      and/or the Contractor offers an FHPlus product, the Contractor shall
      contract with FQHCs operating in that county. The contract with the FQHC
      must be between the Contractor and the FQHC clinic, not between the
      Contractor and an individual practitioner at the
  clinic.

                  


          

        

        
           

          
            	
                     

                  	c)	
                    The
      Department may on a case-by-case basis defer the contracting
      contracting  requirement
      if it determines there is sufficient access to FQHC services in a county.
      The Department reserves the right to rescind the deferment at any time
      should access
      to FQHC services in the county
change.

                  


          

           

          
            
              
                	
                         

                      	d)	
                        When
      an MCO does not contract with an FQHC, but another MCO in the county contracts
      with an FQHC, marketing and educational materials must inform Potential
      Enrollees
      and Enrollees about the availability of FQHC services. These materials
      should also advise Potential Enrollees and Enrollees that they have good
      cause to
      disenroll from an MCO when the MCO does not contract with an FQHC and
      another MCO in the county contracts with an FQHC or is an FQHC sponsored
      MCO.

                      


              

            

          

        

        
           

        

        
          4.      
   Amend
Section 22.7 "Recovery of Overpayments to Providers" to read as
follows:

        

        
           

          
            	
                     
      22.7

                  	
                    Recovery
      of Overpayments to Providers

                  


          

        

        
           

          Consistent
with the exception language in Section 3224-b of the Insurance Law, the
Contractor shall have and retain the right to audit participating providers'
claims for a six year period from the date the care, services or supplies were
provided or billed, whichever is later, and to recoup any overpayments
discovered as a result of the audit. This six year limitation does not apply to
situations in which fraud may be involved or in which the provider or an agent
of the provider prevents or obstructs the Contractor's
auditing.

        

        
          
            
               

              
                Appendix
X

              

              
                MMC/FHPlus
Contract Amendment

              

              
                October
1, 2007

              

              
                Page
5

              

              


            

          

          
            
              

            

          

           

        

        
           

        

        
          
            	
                    5.

                  	
                    Amend Appendix D "New
      York State Department of Health Marketing Guidelines," Section
      D.3,

                  


          

        

        
          
            	 	
                    3. c) to add paragraph
      iv) to read as
follows:

                  


          

        

        
          


        

        
          
            	
                     
      

                  	
                    c)

                  	
                    The
      Contractor shall not offer compensation to Marketing Representatives,
      including salary increases or bonuses, based solely on the number of
      individuals they enroll. However, the Contractor may base compensation of
      Marketing Representatives on periodic performance evaluations which
      consider Enrollment productivity as one of several performance factors
      during a performance period, subject to the following
      requirements:

                  


          

        

        
           

          
            	
                     
      

                  	 i)	
                     "Compensation"
      shall mean any remuneration required to be reported as income or
      compensation for federal tax
purposes;

                  


          

        

        
           

          
            	
                     
      

                  	 ii)	
                      The
      Contractor may not pay a "commission" or fixed amount per
      enrollment;

                  


          

        

        
           

          
            	
                     

                  	 iii)	
                     The
      Contractor may not award bonuses more frequently than quarterly, or for
      an   annual amount that exceeds ten percent (10%) of a
      Marketing Representative's total annual
  compensation;

                  


          

        

        
           

          
            	
                     

                  	 iv)	
                     Sign-on
      bonuses for Marketing Representatives are
  prohibited;

                  


          

        

        
          


        

        
          
            	
                    6.

                  	
                    Effective January 1,
      2008, amend Appendix D "New York State Department of Health Marketing
      Guidelines." Section
      D.3, 3. c) to add paragraphs v), vi), vii) viii), and ix) to read as
      follows:

                  


          

        

        
          
          

        

        
           

          
            	
                     

                  	 v)	
                     Where
      productivity is a factor in the bonus determination, bonuses must be
      structured in such a way that productivity carries a weight of no more
      than 30% of the total bonus and that application quality/accuracy must
      carry a weight equal to or greater than the productivity
      component;

                  


          

        

        
           

          
            	
                     
      

                  	 vi)	
                     The
      Contractor must limit salary adjustments for Marketing Representatives to
      annual adjustments except where the adjustment occurs during the first
      year of employment after a traditional trainee/probationary period or in
      the event of a company wide
adjustment;

                  


          

        

        
           

          
            	
                     

                  	 vii)	
                    The
      Contractor is prohibited from reducing base salaries for Marketing
      Representatives for failure to meet productivity
  targets;

                  


          

        

        
           

          
            	
                     

                  	 viii)	
                    The
      Contractor is prohibited from offering non-monetary compensation such as
      gifts and trips to Marketing
Representatives;

                  


          

        

        
           

          
            	
                     
      

                  	 ix)	
                      The
      Contractor shall have human resources policies and procedures for the
      earning and payment of overtime and must be able to provide documentation
      (such as time sheets) to support overtime
  compensation.

                  


          

        

        
           

        

        
          
            
              
                
                   

                  
                    Appendix
X

                  

                  
                    MMC/FHPlus
Contract Amendment

                  

                  
                    October
1, 2007

                  

                  
                    Page
6

                  

                  


                

              

              
                
                  

                

              

               

            

          

        

        
          
          

          
            	
                    7.

                  	
                    Amend Appendix D "New
      York State Department of Health Marketing Guidelines," Section
      D.3.3. to
      add paragraph e) to read as
follows:

                  


          

           

          
            	
                      

                  	 e)	
                     The
      Contractor shall limit the staffing (FTE's) involved in the
      marketing/facilitated enrollment process. The limit shall be set at 150
      FTEs for New York City, 75 for MCOs that serve county service areas
      outside New York City, and 225 for MCOs that serve both, with no more than
      150 operating in New York City. FTEs subject to the limit include
      Marketing Representatives, Facilitated Enrollers and any other staff that
      conduct new enrollments, provide community presentations on coverage
      options and/or engage in outreach activities designed to develop
      enrollment leads. Managers are not included in the limit as long as they
      do not personally conduct enrollments. Retention staff are not subject to
      the limit.

                  


          

        

        
           

          
            	
                    8.

                  	
                    Amend Appendix D "New
      York State Department of Health Marketing Guidelines," Section D.3. 4. a)
      to add paragraph v) to read as
follows:

                  


          

        

        
          


        

        
          
            	
                      

                  	a)	
                    The
      Contractor shall not engage in the following
  practices:

                  


          

           

        

        
          
            	
                     
      

                  	 i)	
                    misrepresenting
      the Medicaid fee-for-service, MMC Program or FHPlus Program, or the
      program or policy requirements of the LDSS or the SDOH, in Marketing
      encounters or materials;

                  


          

        

        
           

          
            	
                     

                  	 ii)	
                    purchasing
      or otherwise acquiring or using mailing lists of Eligible Persons from
      third party vendors, including providers and LDSS
  offices;

                  


          

        

        
           

          
            	
                     
      

                  	 iii)	
                    using
      raffle tickets or event attendance or sign-in sheets to develop mailing
      lists of Prospective
Enrollees;

                  


          

        

        
           

          
            	
                     

                  	 iv)	
                    offering
      incentives (i.e., any type of inducement whose receipt is contingent upon
      the individual's Enrollment) of any kind to Prospective Enrollees to
      enroll in the Contractor's MMC or FHPlus
  product;

                  


          

        

        
           

          
            	
                     
      

                     

                  	 v)	
                    marketing
      to enrollees of other health plans. If the Contractor becomes aware during
      a marketing encounter that an individual is enrolled in another health
      plan, the marketing encounter must be promptly terminated. If the
      individual voluntarily suggests dissatisfaction with the health plan in
      which he or she is enrolled, the individual should be referred to the
      enrollment broker or LDSS for
assistance.

                  


          

        

        
          


        

        
          
            	
                    9.

                  	
                    Amend Appendix G "SDOH
      Requirements for the Provision of Emergency Care and Services." Section 5
      to read as follows:

                  


          

        

        
           

          5.        Emergency
Transportation

        

        
          


        

        
          When
emergency transportation is included in the Contractor's Benefit Package, the
Contractor shall reimburse the transportation provider for all emergency
ambulance services, without regard to final diagnosis or prudent layperson
standards. Payment by the Contractor for emergency transportation services
provided to an Enrollee by Participating Provider shall be at the rate or rates
of payment specified in the contract between the Contractor and the
transportation provider. Payment by the Contractor for emergency transportation
services provided to an Enrollee by a Non-Participating Provider
shall be at the Medicaid fee-for-service rate in effect on the date the service
was rendered.

        

        
          


        

        
          
            	
                    10.
      

                  	
                     

                  	
                    Amend paragraph K and
      add paragraph L of Section 6 (a) (v) of Appendix H, "New York State
      Department of Health Requirements for the Processing of Enrollments and
      Disenrollments in the MMC and FHPlus Programs," to read as
      follows:

                  


          

        

        
          


        

        
          
            	
                    K)      
      An FHPlus Enrollee is pregnant;
or

                  


          

        

        
          
            
               

              
                Appendix
X

              

              
                MMC/FHPlus
Contract Amendment

              

              
                October
1, 2007

              

              
                Page
7

              

              


            

          

          
            
              

            

          

           

        

        
          


        

        
          
            	
                    L)

                  	
                    The
      Contractor does not contract with an FQHC and one or more other MCOs in
      the Enrollee's count of fiscal responsibility provide the
      service

                  


          

        

        
                 

        

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

        

        
          
            
               

              
                Appendix
X

              

              
                MMC/FHPlus
Contract Amendment

              

              
                October
1, 2007

              

              
                Page
8

              

              


            

          

          
            
              

            

          

           

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

      
        


        CONTRACTOR
SIGNATURE                                                                    STATE
AGENCY SIGNATURE

      

      
         

         

         

      

      
        By:        /s/ Heath
Schiesser                                                                   By:       /s/ Vallencia
Lloyd                                   
  

      

      
                   

                     Heath
Schiesser                                                                                       Vallencia Lloyd    
                                     


      

      
                             (Printed
Name)                                                                                         (Printed
Name)

      

      
         

      

      
        Title:    President &
CEO                                                                        Title:     Deputy Director, DMC &
PE                   



      

      
        Date:    4/15/08                                                                                    
    Date:    5/1/08                                                         
  

        
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
15th day of April 2008, before me personally appeared
Heath Schiesser, to me
known, who being by me duly sworn, did depose and say
that he/she resides at 5416 Avenue Simone, Lutz, Florida
33558, that
he/she is the President & CEO of WellCare of NY, the corporation
described herein which executed the foregoing instrument; and that he/she signed
his/her name thereto by order of the board of directors of said
corporation.

      

      
        


         

         

        /s/
Sara Gallo

        (Notary)

         

         

         

      

      
        
          	Approved:        	 Approved:
	
                   

                   

                	 
	ATTORNEY
      GENERAL            	 Thomas P.
      DiNapoli                   
	 	 STATE
      COMPTROLLER

     

      

      
        
          	Title:  Approved as to Form NYS Attorney
      General    	Title:  Approved,
      Dept. of Audit & Control
	Date:  May 7,
      2008                                                           	Date:  June 5,
      2008                                                
      
	          
      /s/ Lorraine I.
      Remo                                        
          	          
      /s/
      Illegible                                                
        


        

                                                                                

      

      
        
          
             

            
              Appendix
X

            

            
              MMC/FHPlus
Contract Amendment

            

            
              October
1, 2007

            

            
              Page
9