amend10-fa615.htm


    Back to Form 8-K

    Exhibit 10.4

     

     

    
       

      
        
          
            	
                    WellCare
      of Florida, Inc. d/b/a

                    Staywell Health Plan of Florida

                  	
                    Medicaid
      HMO Contract

                  


          



        AHCA
CONTRACT NO. FA615 

        AMENDMENT
NO. 10

      

      
        


         

        THIS CONTRACT, entered into
between the STATE OF FLORIDA,
AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the
"Agency," and WELLCARE OF FLORIDA, INC. D/B/A STAYWELL HEALTH
PLAN OF FLORIDA, hereinafter
referred to as the "Vendor" or "Health Plan", is hereby amended as
follows:

      

      
        


         

        
          	
                  1.

                	
                  Standard
      Contract, Section III, Item C, Contract Managers, sub-item 1, is hereby
      amended to change the Agency's Contract Manager's name to Suzanne S.
      Gjevukaj. All other contact information remains
  unchanged.

                


        

      

      
         

        
          	
                  2.

                	
                  Effective
      March 1, 2009, Attachment I, Scope of Services, is hereby amended to
      include Exhibit III-F, March 1, 2009 - August 31, 2009 Medicaid Non-Reform
      HMO Capitation Rates, attached hereto and made a part of the Contract. All
      references in the Contract to Exhibit III-E, February 1, 2009 - August 31,
      2009 Medicaid Non-Reform HMO Capitation Rates, shall hereinafter also
      refer to Exhibit III-F, March 1, 2009 - August 31, 2009 Medicaid
      Non-Reform HMO Capitation Rates, as
appropriate.

                


        

      

      
         

        All provisions in the Contract and
any attachments thereto in conflict with this Amendment shall be and are hereby
changed to conform with 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 Contract.

      

      
         

              
This Amendment and all its attachments are hereby made part of the
Contract.

      

      
         

        This Amendment cannot be executed
unless all previous Amendments to this Contract have been fully
executed.

      

      
         

        IN WITNESS WHEREOF, the parties
hereto have caused this six (6) page Amendment (which includes all attachments
hereto) to be executed by their officials thereunto duly
authorized.

      

      
        


      

      
        	
                WELLCARE
      OF FLORIDA, INC.

                D/B/A STAYWELL HEALTH PLAN

                OF FLORIDA

                 

              	
                STATE
      OF FLORIDA, AGENCY FOR

                HEALTH
      CARE ADMINISTRATION

                 

              
	
                SIGNED

                BY:
      /s/ Heath
      Schiesser             
      

              	
                SIGNED

                BY: /s/ Holly
      Benson                     
      

              
	
                 

                NAME:
      Heath
      Schiesser           
      

              	
                 

                NAME:
      Holly
      Benson                   
      

              
	
                 

                TITLE:
      President and
      CEO        

              	
                 

                TITLE:
      Secretary                            
      

              
	
                 

                DATE:

              	
                 

                DATE:
      4/22/09                                
      

              


      

      
        


      

      
        


      

      
        List of
attachments/exhibits included as part of this Amendment:

      

      
        


      

      
        	
                
                  Specify

                

                
                  Type

                

              	
                
                  Letter/

                

                
                  Number

                

              	
                
                  Description

                

              
	
                
                  Exhibit

                

              	
                
                  III-F

                

              	
                
                  March
      1, 2009 - August 31, 2009 Medicaid Non-Reform 

                  HMO
      Capitation
      Rates (5 Pages)

                

              


      

      
        


      

      
        AHCA
Contract No. FA615, Amendment No. 10, Page 1 of 1

      

      
        AHCA Form
2100-0002 (Rev. NOV03)

      


      
        
           


        

        
           


          
            

          

        

        
           


        

      


      
        EXHIBIT
III-F

      

      
        March
1, 2009 -August 31, 2009

      

      
        MEDICAID
Non-Reform HMO CAPITATION RATES

      

      
        By
Area, Age and Eligibility Category

      

      
        Revised
on February 16, 2009

      

      
        


         

        TABLE
1

      

      
        
          
            	
                    
                      General
      Rates

                    

                  	 
      	 
      	 
      	
                    
                      TANF

                    

                  	 
      	 
      	 
      	 
      	 
      	 
      	
                    
                      SSI-N

                    

                  	 
      	 
      	
                    
                      SSI-B

                    

                  	
                    
                      SSI-AB

                    

                  
	
                    
                      Area

                    

                  	
                    
                      BTHMO+2MO

                    

                  	
                    
                      3MO-11MO

                    

                  	
                    
                      AGE
      (1-5)

                    

                  	
                    
                      AGE
      (6-13)

                    

                  	
                    
                      AGE
      (14-20)

                    

                  	
                    
                      AGE
      (21-54)

                    

                  	
                    
                      AGE
      (55+)

                    

                  	
                    
                      BTHM0+2M0

                    

                  	
                    
                      3MO-11MO

                    

                  	
                    
                      AGE
      (1-5)

                    

                  	
                    
                      AGE
      (6-13)

                    

                  	
                    
                      AGE
      (14-20)

                    

                  	
                    
                      AGE
      (21-54)

                    

                  	
                    
                      AGE
      (55+)

                    

                  	 
      	
                    
                      AGE
      (65-)

                    

                  	
                    
                      AGE
      (65+)

                    

                  
	 
      	 
      	 
      	 
      	 
      	
                    
                      Female

                    

                  	
                    
                      Male

                    

                  	
                    
                      Female

                    

                  	
                    
                      Male

                    

                  	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                    
                      01

                    

                  	
                    
                      1,094.22

                    

                  	
                    
                      184.16

                    

                  	
                    
                      99.63

                    

                  	
                    
                      60.40

                    

                  	
                    
                      127.26

                    

                  	
                    
                      68.32

                    

                  	
                    
                      250.84

                    

                  	
                    
                      150.73

                    

                  	
                    
                      313.03

                    

                  	
                    
                      10,249.54

                    

                  	
                    
                      1,491.48

                    

                  	
                    
                      438.21

                    

                  	
                    
                      195.46

                    

                  	
                    
                      209.48

                    

                  	
                    
                      684.74

                    

                  	
                    
                      688.27

                    

                  	
                    
                      300.62

                    

                  	
                    
                      93.17

                    

                  	
                    
                      84.30

                    

                  
	
                    
                      02

                    

                  	
                    
                      1,094.22

                    

                  	
                    
                      184.16

                    

                  	
                    
                      99.63

                    

                  	
                    
                      60.40

                    

                  	
                    
                      127.26

                    

                  	
                    
                      68.32

                    

                  	
                    
                      250.84

                    

                  	
                    
                      150.73

                    

                  	
                    
                      313.03

                    

                  	
                    
                      10,249.54

                    

                  	
                    
                      1,491.48

                    

                  	
                    
                      438.21

                    

                  	
                    
                      195.46

                    

                  	
                    
                      209.48

                    

                  	
                    
                      684.74

                    

                  	
                    
                      688.27

                    

                  	
                    
                      300.62

                    

                  	
                    
                      93.17

                    

                  	
                    
                      84.30

                    

                  
	
                    
                      03

                    

                  	
                    
                      1,196.62

                    

                  	
                    
                      202.96

                    

                  	
                    
                      110.34

                    

                  	
                    
                      67.92

                    

                  	
                    
                      140.84

                    

                  	
                    
                      76.51

                    

                  	
                    
                      278.65

                    

                  	
                    
                      168.47

                    

                  	
                    
                      353.53

                    

                  	
                    
                      11,246.01

                    

                  	
                    
                      1,651.16

                    

                  	
                    
                      486.56

                    

                  	
                    
                      222.16

                    

                  	
                    
                      237.31

                    

                  	
                    
                      773.96

                    

                  	
                    
                      781.87

                    

                  	
                    
                      334.70

                    

                  	
                    
                      88.46

                    

                  	
                    
                      80.57

                    

                  
	
                    
                      04

                    

                  	
                    
                      1,049.14

                    

                  	
                    
                      178.79

                    

                  	
                    
                      97.34

                    

                  	
                    
                      60.45

                    

                  	
                    
                      124.13

                    

                  	
                    
                      68.04

                    

                  	
                    
                      246.51

                    

                  	
                    
                      149.64

                    

                  	
                    
                      315.69

                    

                  	
                    
                      10,783.85

                    

                  	
                    
                      1,587.50

                    

                  	
                    
                      468.19

                    

                  	
                    
                      215.03

                    

                  	
                    
                      229.34

                    

                  	
                    
                      748.28

                    

                  	
                    
                      757.29

                    

                  	
                    
                      292.70

                    

                  	
                    
                      88.80

                    

                  	
                    
                      80.98

                    

                  
	
                    
                      05

                    

                  	
                    
                      1,194.06

                    

                  	
                    
                      202.97

                    

                  	
                    
                      110.37

                    

                  	
                    
                      68.18

                    

                  	
                    
                      140.78

                    

                  	
                    
                      76.87

                    

                  	
                    
                      279.19

                    

                  	
                    
                      169.16

                    

                  	
                    
                      355.65

                    

                  	
                    
                      12,038.26

                    

                  	
                    
                      1,765.98

                    

                  	
                    
                      519.70

                    

                  	
                    
                      236.81

                    

                  	
                    
                      252.51

                    

                  	
                    
                      825.86

                    

                  	
                    
                      834.51

                    

                  	
                    
                      221.32

                    

                  	
                    
                      79.80

                    

                  	
                    
                      74.00

                    

                  
	
                    
                      06

                    

                  	
                    
                      1,038.39

                    

                  	
                    
                      178.07

                    

                  	
                    
                      97.17

                    

                  	
                    
                      60.92

                    

                  	
                    
                      124.01

                    

                  	
                    
                      68.48

                    

                  	
                    
                      247.03

                    

                  	
                    
                      150.57

                    

                  	
                    
                      319.86

                    

                  	
                    
                      10,970.19

                    

                  	
                    
                      1,617.13

                    

                  	
                    
                      476.72

                    

                  	
                    
                      220.10

                    

                  	
                    
                      233.82

                    

                  	
                    
                      764.56

                    

                  	
                    
                      774.50

                    

                  	
                    
                      270.21

                    

                  	
                    
                      77.95

                    

                  	
                    
                      71.38

                    

                  
	
                    
                      07

                    

                  	
                    
                      1,074.14

                    

                  	
                    
                      183.63

                    

                  	
                    
                      100.12

                    

                  	
                    
                      62.40

                    

                  	
                    
                      127.54

                    

                  	
                    
                      70.12

                    

                  	
                    
                      253.83

                    

                  	
                    
                      154.32

                    

                  	
                    
                      326.38

                    

                  	
                    
                      11,607.26

                    

                  	
                    
                      1,714.80

                    

                  	
                    
                      505.56

                    

                  	
                    
                      234.47

                    

                  	
                    
                      249.87

                    

                  	
                    
                      814.51

                    

                  	
                    
                      826.24

                    

                  	
                    
                      367.55

                    

                  	
                    
                      83.10

                    

                  	
                    
                      76.28

                    

                  
	
                    
                      08

                    

                  	
                    
                      1,015.73

                    

                  	
                    
                      174.04

                    

                  	
                    
                      95.01

                    

                  	
                    
                      59.33

                    

                  	
                    
                      121.03

                    

                  	
                    
                      66.85

                    

                  	
                    
                      241.01

                    

                  	
                    
                      146.72

                    

                  	
                    
                      311.46

                    

                  	
                    
                      10,344.94

                    

                  	
                    
                      1,523.63

                    

                  	
                    
                      449.17

                    

                  	
                    
                      206.42

                    

                  	
                    
                      220.49

                    

                  	
                    
                      718.78

                    

                  	
                    
                      727.41

                    

                  	
                    
                      251.83

                    

                  	
                    
                      77.41

                    

                  	
                    
                      70.98

                    

                  
	
                    
                      09

                    

                  	
                    
                      1,049.42

                    

                  	
                    
                      178.45

                    

                  	
                    
                      97.12

                    

                  	
                    
                      60.00

                    

                  	
                    
                      123.89

                    

                  	
                    
                      67.48

                    

                  	
                    
                      245.50

                    

                  	
                    
                      148.81

                    

                  	
                    
                      312.90

                    

                  	
                    
                      10,887.75

                    

                  	
                    
                      1,607.33

                    

                  	
                    
                      473.84

                    

                  	
                    
                      219.83

                    

                  	
                    
                      233.26

                    

                  	
                    
                      762.25

                    

                  	
                    
                      772.33

                    

                  	
                    
                      215.52

                    

                  	
                    
                      82.97

                    

                  	
                    
                      75.87

                    

                  
	
                    
                      10

                    

                  	
                    
                      1,064.83

                    

                  	
                    
                      182.89

                    

                  	
                    
                      99.98

                    

                  	
                    
                      62.78

                    

                  	
                    
                      127.46

                    

                  	
                    
                      70.63

                    

                  	
                    
                      254.09

                    

                  	
                    
                      155.07

                    

                  	
                    
                      330.14

                    

                  	
                    
                      14,097.57

                    

                  	
                    
                      2,095.67

                    

                  	
                    
                      618.54

                    

                  	
                    
                      292.06

                    

                  	
                    
                      308.77

                    

                  	
                    
                      1,009.40

                    

                  	
                    
                      1,026.88

                    

                  	
                    
                      316.67

                    

                  	
                    
                      92.40

                    

                  	
                    
                      84.73

                    

                  
	
                    
                      11

                    

                  	
                    
                      1,348.59

                    

                  	
                    
                      228.59

                    

                  	
                    
                      124.07

                    

                  	
                    
                      76.21

                    

                  	
                    
                      158.52

                    

                  	
                    
                      85.96

                    

                  	
                    
                      313.61

                    

                  	
                    
                      189.56

                    

                  	
                    
                      397.28

                    

                  	
                    
                      14,238.94

                    

                  	
                    
                      2,095.21

                    

                  	
                    
                      617.24

                    

                  	
                    
                      284.21

                    

                  	
                    
                      302.64

                    

                  	
                    
                      987.26

                    

                  	
                    
                      998.51

                    

                  	
                    
                      364.12

                    

                  	
                    
                      137.86

                    

                  	
                    
                      124.45

                    

                  
	
                    
                      6B*

                    

                  	
                    
                      1,038.25

                    

                  	
                    
                      178.05

                    

                  	
                    
                      97.16

                    

                  	
                    
                      60.91

                    

                  	
                    
                      123.99

                    

                  	
                    
                      68.47

                    

                  	
                    
                      247.00

                    

                  	
                    
                      150.55

                    

                  	
                    
                      319.81

                    

                  	
                    
                      10,969.70

                    

                  	
                    
                      1,617.05

                    

                  	
                    
                      476.70

                    

                  	
                    
                      220.09

                    

                  	
                    
                      233.81

                    

                  	
                    
                      764.51

                    

                  	
                    
                      774.47

                    

                  	
                    
                      270.21

                    

                  	
                    
                      77.95

                    

                  	
                    
                      71.38

                    

                  


          

        


TABLE
2

      
        	
                
                  General
      + Mental Health Rates:

                

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	
                
                  TANF

                

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	
                
                  SSl-N

                

              	 
      	 
      	 
      	
                
                  SSI-B

                

              	
                
                  SSI-AB

                

              
	
                
                  Area

                

              	
                
                  BTHMO+2MO

                

              	
                
                  3MO-11MO

                

              	
                
                  AGE
      (1-5)

                

              	
                
                  AGE
      (6-13)

                

              	
                
                  AGE
      (14-20)

                

              	
                
                  AGE
      (21-54)

                

              	
                
                  AGE
      (55+)

                

              	
                
                  BTHM0+2M0

                

              	
                
                  3MO-11MO

                

              	
                
                  AGE
      (1-5)

                

              	
                
                  AGE
      (6-13)

                

              	
                
                  AGE
      (14-20)

                

              	
                
                  AGE
      (21-54)

                

              	
                
                  AGE
      (55+)

                

              	 
      	
                
                  AGE
      (65-)

                

              	
                
                  AGE
      (65+)

                

              
	
                 
      

              	 
      	 
      	 
      	 
      	
                
                  Female

                

              	
                
                  Male

                

              	
                
                  Female

                

              	
                
                  Male

                

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                
                  01

                

              	
                
                  1,094.24

                

              	
                
                  184.18

                

              	
                
                  101.24

                

              	
                
                  71.89

                

              	
                
                  138.00

                

              	
                
                  79.06

                

              	
                
                  255.20

                

              	
                
                  155.09

                

              	
                
                  316.71

                

              	
                
                  10,249.62

                

              	
                
                  1,491.56

                

              	
                
                  445.52

                

              	
                
                  242.68

                

              	
                
                  252.71

                

              	
                
                  764.74

                

              	
                
                  718.72

                

              	
                
                  300.83

                

              	
                
                  104.62

                

              	
                
                  95.75

                

              
	
                
                  02

                

              	
                
                  1,094.25

                

              	
                
                  184.19

                

              	
                
                  102.49

                

              	
                
                  80.31

                

              	
                
                  140.45

                

              	
                
                  81.51

                

              	
                
                  254.19

                

              	
                
                  154.08

                

              	
                
                  315.93

                

              	
                
                  10,249.69

                

              	
                
                  1,491.63

                

              	
                
                  451.77

                

              	
                
                  272.92

                

              	
                
                  253.92

                

              	
                
                  736.51

                

              	
                
                  712.72

                

              	
                
                  320.48

                

              	
                
                  107.92

                

              	
                
                  99.05

                

              
	
                
                  03

                

              	
                
                  1,196.63

                

              	
                
                  202.97

                

              	
                
                  111.64

                

              	
                
                  76.94

                

              	
                
                  146.82

                

              	
                
                  82.49

                

              	
                
                  280.17

                

              	
                
                  169.99

                

              	
                
                  354.85

                

              	
                
                  11,246.08

                

              	
                
                  1,651.23

                

              	
                
                  492.71

                

              	
                
                  257.30

                

              	
                
                  257.47

                

              	
                
                  797.45

                

              	
                
                  792.96

                

              	
                
                  341.43

                

              	
                
                  97.29

                

              	
                
                  89.40

                

              
	
                
                  04

                

              	
                
                  1,049.15

                

              	
                
                  178.80

                

              	
                
                  98.69

                

              	
                
                  69.84

                

              	
                
                  130.36

                

              	
                
                  74.27

                

              	
                
                  248.09

                

              	
                
                  151.22

                

              	
                
                  317.06

                

              	
                
                  10,783.96

                

              	
                
                  1,587.61

                

              	
                
                  477.78

                

              	
                
                  269.81

                

              	
                
                  260.77

                

              	
                
                  784.90

                

              	
                
                  774.58

                

              	
                
                  316.83

                

              	
                
                  105.28

                

              	
                
                  97.46

                

              
	
                
                  05

                

              	
                
                  1,194.07

                

              	
                
                  202.98

                

              	
                
                  111.56

                

              	
                
                  76.71

                

              	
                
                  148.75

                

              	
                
                  84.84

                

              	
                
                  282.43

                

              	
                
                  172.40

                

              	
                
                  358.38

                

              	
                
                  12,038.31

                

              	
                
                  1,766.03

                

              	
                
                  524.64

                

              	
                
                  268.67

                

              	
                
                  281.68

                

              	
                
                  879.83

                

              	
                
                  855.05

                

              	
                
                  224.00

                

              	
                
                  92.40

                

              	
                
                  86.60

                

              
	
                
                  06

                

              	
                
                  1,038.41

                

              	
                
                  178.09

                

              	
                
                  98.99

                

              	
                
                  73.94

                

              	
                
                  136.17

                

              	
                
                  80.64

                

              	
                
                  251.97

                

              	
                
                  155.51

                

              	
                
                  324.03

                

              	
                
                  10,970.26

                

              	
                
                  1,617.20

                

              	
                
                  483.13

                

              	
                
                  261.48

                

              	
                
                  271.70

                

              	
                
                  834.66

                

              	
                
                  801.18

                

              	
                
                  271.50

                

              	
                
                  81.77

                

              	
                
                  75.20

                

              
	
                
                  07

                

              	
                
                  1,074.16

                

              	
                
                  183.65

                

              	
                
                  101.87

                

              	
                
                  74.87

                

              	
                
                  139.19

                

              	
                
                  81.77

                

              	
                
                  258.57

                

              	
                
                  159.06

                

              	
                
                  330.38

                

              	
                
                  11,607.32

                

              	
                
                  1,714.86

                

              	
                
                  511.58

                

              	
                
                  273.30

                

              	
                
                  285.42

                

              	
                
                  880.29

                

              	
                
                  851.28

                

              	
                
                  370.10

                

              	
                
                  93.44

                

              	
                
                  86.62

                

              
	
                
                  08

                

              	
                
                  1,015.74

                

              	
                
                  174.05

                

              	
                
                  96.25

                

              	
                
                  67.97

                

              	
                
                  126.75

                

              	
                
                  72.57

                

              	
                
                  242.47

                

              	
                
                  148.18

                

              	
                
                  312.72

                

              	
                
                  10,345.01

                

              	
                
                  1,523.70

                

              	
                
                  455.07

                

              	
                
                  240.11

                

              	
                
                  239.83

                

              	
                
                  741.30

                

              	
                
                  738.04

                

              	
                
                  258.56

                

              	
                
                  90.40

                

              	
                
                  83.97

                

              
	
                
                  09

                

              	
                
                  1,049.44

                

              	
                
                  178.47

                

              	
                
                  98.64

                

              	
                
                  70.62

                

              	
                
                  130.92

                

              	
                
                  74.51

                

              	
                
                  247.29

                

              	
                
                  150.60

                

              	
                
                  314.45

                

              	
                
                  10,887.82

                

              	
                
                  1,607.40

                

              	
                
                  480.06

                

              	
                
                  255.35

                

              	
                
                  253.65

                

              	
                
                  785.99

                

              	
                
                  783.54

                

              	
                
                  222.25

                

              	
                
                  92.39

                

              	
                
                  85.29

                

              
	
                
                  10

                

              	
                
                  1,064.85

                

              	
                
                  182.91

                

              	
                
                  101.87

                

              	
                
                  75.91

                

              	
                
                  136.16

                

              	
                
                  79.33

                

              	
                
                  256.30

                

              	
                
                  157.28

                

              	
                
                  332.06

                

              	
                
                  14,097.66

                

              	
                
                  2,095.76

                

              	
                
                  626.75

                

              	
                
                  338.95

                

              	
                
                  335.68

                

              	
                
                  1,040.74

                

              	
                
                  1,041.68

                

              	
                
                  323.40

                

              	
                
                  100.32

                

              	
                
                  92.65

                

              
	
                
                  11

                

              	
                
                  1,348.61

                

              	
                
                  228.61

                

              	
                
                  125.66

                

              	
                
                  87.31

                

              	
                
                  165.88

                

              	
                
                  93.32

                

              	
                
                  315.48

                

              	
                
                  191.43

                

              	
                
                  398.90

                

              	
                
                  14,239.02

                

              	
                
                  2,095.29

                

              	
                
                  624.09

                

              	
                
                  323.33

                

              	
                
                  325.08

                

              	
                
                  1,013.40

                

              	
                
                  1,010.85

                

              	
                
                  371.22

                

              	
                
                  145.78

                

              	
                
                  132.37

                

              
	
                
                  6B*

                

              	
                
                  1,038.27

                

              	
                
                  178.07

                

              	
                
                  98.88

                

              	
                
                  73.21

                

              	
                
                  135.48

                

              	
                
                  79.96

                

              	
                
                  251.67

                

              	
                
                  155.22

                

              	
                
                  323.75

                

              	
                
                  10,969.77

                

              	
                
                  1,617.12

                

              	
                
                  483.09

                

              	
                
                  261.35

                

              	
                
                  271.58

                

              	
                
                  834.41

                

              	
                
                  801.07

                

              	
                
                  271.50

                

              	
                
                  81.77

                

              	
                
                  75.20

                

              


      

      
        


         

        AHCA
Contract No. FA615, Exhibit III-F, Page 1 of 5

      


      
        
           


        

        
           


          
            

          

        

        
           


        

      


      
        EXHIBIT
III-F

      

      
        March
1, 2009 - August 31, 2009

      

      
        MEDICAID
Non-Reform HMO CAPITATION RATES

      

      
        By
Area, Age and Eligibility Category

      

      
        Revised
on February 16, 2009

      

      
        


         

        TABLE
3

      

      
        	
                
                  General
      + WIH + Dental Rates

                

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	
                
                  TANF

                

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	
                
                  SSI-N

                

              	 
      	 
      	 
      	
                
                  SSI-B

                

              	
                
                  SSI-AB

                

              
	
                
                  Area

                

              	
                
                  BTHMO+2MO

                

              	
                
                  3MO-11MO

                

              	
                
                  AGE
      (1-5)

                

              	
                
                  AGE
      (6-13)

                

              	              AGE
      (14-20)         AGE
      (21-54)	
                
                  AGE
      (55+)

                

              	
                
                  BTHMO+2MO

                

              	
                
                  3MO-11MO

                

              	
                
                  AGE
      (1-5)

                

              	
                
                   
      AGE (6-13)      AGE (14-20)    
       AGE (21-54)

                

              	
                
                  AGE
      (55+)

                

              	 
      	
                
                  AGE
      (65-)

                

              	
                
                  AGE
      (65+)

                

              
	
                 
      

              	 
      	 
      	 
      	 
      	
                
                  Female

                

              	
                
                  Male

                

              	
                
                  Female

                

              	
                
                  Male

                

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                
                  01

                

              	
                
                  1,094.24

                

              	
                
                  184.19

                

              	
                
                  102.89

                

              	
                
                  74.95

                

              	
                
                  141.13

                

              	
                
                  81.70

                

              	
                
                  256.40

                

              	
                
                  156.33

                

              	
                
                  319.45

                

              	
                
                  10,249.62

                

              	
                
                  1,491.56

                

              	
                
                  447.11

                

              	
                
                  245.04

                

              	
                
                  254.73

                

              	
                
                  766.05

                

              	
                
                  720.55

                

              	
                
                  301.27

                

              	
                
                  105.72

                

              	
                
                  96.60

                

              
	
                
                  02

                

              	
                
                  1,094.25

                

              	
                
                  184.20

                

              	
                
                  104.14

                

              	
                
                  83.37

                

              	
                
                  143.58

                

              	
                
                  84.15

                

              	
                
                  255.39

                

              	
                
                  155.32

                

              	
                
                  318.67

                

              	
                
                  10,249.69

                

              	
                
                  1,491.63

                

              	
                
                  453.36

                

              	
                
                  275.28

                

              	
                
                  255.94

                

              	
                
                  737.82

                

              	
                
                  714.55

                

              	
                
                  320.92

                

              	
                
                  109.02

                

              	
                
                  99.90

                

              
	
                
                  03

                

              	
                
                  1,196.64

                

              	
                
                  202.99

                

              	
                
                  114.64

                

              	
                
                  82.50

                

              	
                
                  152.49

                

              	
                
                  87.29

                

              	
                
                  281.88

                

              	
                
                  171.74

                

              	
                
                  358.75

                

              	
                
                  11,246.08

                

              	
                
                  1,651.24

                

              	
                
                  495.79

                

              	
                
                  261.86

                

              	
                
                  261.39

                

              	
                
                  799.30

                

              	
                
                  795.56

                

              	
                
                  342.44

                

              	
                
                  98.91

                

              	
                
                  90.64

                

              
	
                
                  04

                

              	
                
                  1,049.16

                

              	
                
                  178.81

                

              	
                
                  100.50

                

              	
                
                  73.20

                

              	
                
                  133.80

                

              	
                
                  77.17

                

              	
                
                  249.73

                

              	
                
                  152.91

                

              	
                
                  320.81

                

              	
                
                  10,783.96

                

              	
                
                  1,587.61

                

              	
                
                  479.53

                

              	
                
                  272.40

                

              	
                
                  263.00

                

              	
                
                  786.75

                

              	
                
                  777.17

                

              	
                
                  318.97

                

              	
                
                  106.84

                

              	
                
                  98.65

                

              
	
                
                  05

                

              	
                
                  1,194.08

                

              	
                
                  203.00

                

              	
                
                  114.91

                

              	
                
                  82.93

                

              	
                
                  155.11

                

              	
                
                  90.22

                

              	
                
                  285.78

                

              	
                
                  175.85

                

              	
                
                  366.04

                

              	
                
                  12,038.32

                

              	
                
                  1,766.04

                

              	
                
                  528.79

                

              	
                
                  274.83

                

              	
                
                  286.97

                

              	
                
                  883.47

                

              	
                
                  860.16

                

              	
                
                  227.60

                

              	
                
                  96.12

                

              	
                
                  89.44

                

              
	
                
                  06

                

              	
                
                  1,038.42

                

              	
                
                  178.10

                

              	
                
                  101.61

                

              	
                
                  78.81

                

              	
                
                  141.14

                

              	
                
                  84.85

                

              	
                
                  253.82

                

              	
                
                  157.42

                

              	
                
                  328.26

                

              	
                
                  10,970.26

                

              	
                
                  1,617.21

                

              	
                
                  486.12

                

              	
                
                  265.90

                

              	
                
                  275.50

                

              	
                
                  837.12

                

              	
                
                  804.63

                

              	
                
                  273.23

                

              	
                
                  83.98

                

              	
                
                  76.88

                

              
	
                
                  07

                

              	
                
                  1,074.17

                

              	
                
                  183.66

                

              	
                
                  104.23

                

              	
                
                  79.24

                

              	
                
                  143.65

                

              	
                
                  85.54

                

              	
                
                  259.88

                

              	
                
                  160.40

                

              	
                
                  333.37

                

              	
                
                  11,607.32

                

              	
                
                  1,714.87

                

              	
                
                  514.53

                

              	
                
                  277.66

                

              	
                
                  289.17

                

              	
                
                  881.81

                

              	
                
                  853.42

                

              	
                
                  370.57

                

              	
                
                  94.93

                

              	
                
                  87.76

                

              
	
                
                  08

                

              	
                
                  1,015.75

                

              	
                
                  174.07

                

              	
                
                  99.83

                

              	
                
                  74.59

                

              	
                
                  133.52

                

              	
                
                  78.30

                

              	
                
                  244.46

                

              	
                
                  150.21

                

              	
                
                  317.24

                

              	
                
                  10,345.01

                

              	
                
                  1,523.71

                

              	
                
                  458.43

                

              	
                
                  245.10

                

              	
                
                  244.12

                

              	
                
                  743.54

                

              	
                
                  741.18

                

              	
                
                  260.07

                

              	
                
                  92.04

                

              	
                
                  85.22

                

              
	
                
                  09

                

              	
                
                  1,049.45

                

              	
                
                  178.49

                

              	
                
                  101.52

                

              	
                
                  75.97

                

              	
                
                  136.38

                

              	
                
                  79.13

                

              	
                
                  248.23

                

              	
                
                  151.56

                

              	
                
                  316.60

                

              	
                
                  10,887.82

                

              	
                
                  1,607.41

                

              	
                
                  482.61

                

              	
                
                  259.13

                

              	
                
                  256.90

                

              	
                
                  787.15

                

              	
                
                  785.16

                

              	
                
                  224.05

                

              	
                
                  93.44

                

              	
                
                  86.09

                

              
	
                
                  10

                

              	
                
                  1,064.86

                

              	
                
                  182.92

                

              	
                
                  104.26

                

              	
                
                  80.34

                

              	
                
                  140.69

                

              	
                
                  83.16

                

              	
                
                  257.02

                

              	
                
                  158.02

                

              	
                
                  333.69

                

              	
                
                  14,097.66

                

              	
                
                  2,095.77

                

              	
                
                  629.49

                

              	
                
                  343.02

                

              	
                
                  339.18

                

              	
                
                  1,041.67

                

              	
                
                  1,042.99

                

              	
                
                  324.21

                

              	
                
                  101.60

                

              	
                
                  93.61

                

              
	
                
                  11

                

              	
                
                  1,348.62

                

              	
                
                  228.62

                

              	
                
                  129.33

                

              	
                
                  94.86

                

              	
                
                  173.71

                

              	
                
                  99.92

                

              	
                
                  316.33

                

              	
                
                  192.29

                

              	
                
                  400.83

                

              	
                
                  14,239.03

                

              	
                
                  2,095.31

                

              	
                
                  628.29

                

              	
                
                  330.59

                

              	
                
                  331.44

                

              	
                
                  1,015.15

                

              	
                
                  1,013.31

                

              	
                
                  374.50

                

              	
                
                  147.90

                

              	
                
                  133.99

                

              
	
                
                  6B-

                

              	
                
                  1,038.28

                

              	
                
                  178.08

                

              	
                
                  101.50

                

              	
                
                  78.08

                

              	
                
                  140.45

                

              	
                
                  84.17

                

              	
                
                  251.67

                

              	
                
                  155.22

                

              	
                
                  323.75

                

              	
                
                  10,969.77

                

              	
                
                  1,617.13

                

              	
                
                  486.08

                

              	
                
                  265.77

                

              	
                
                  275.38

                

              	
                
                  834.41

                

              	
                
                  801.07

                

              	
                
                  273.23

                

              	
                
                  83.98

                

              	
                
                  76.88

                

              


      

      
        


      

      
        TABLE
4

      

      
        	
                
                  General
      + MH + Transportation Rates:

                

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	
                
                  TANF

                

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	
                
                  SSI-N

                

              	 
      	 
      	 
      	
                
                  SSI-B

                

              	
                
                  SSI-AB

                

              
	
                
                  Area

                

              	
                
                  BTHMO+2MO

                

              	
                
                  3MO-11MO

                

              	
                
                  AGE
      (1-5)

                

              	
                
                  AGE
      (6-13)

                

              	
                
                  AGE
      (14-20)

                

              	
                
                  AGE
      (21-54)

                

              	
                
                  AGE
      (55+)

                

              	
                
                  BTHMO+2MO

                

              	
                
                  3MO-11MO

                

              	
                
                  AGE
      (1-5)

                

              	
                
                  AGE
      (6-13)

                

              	
                
                  AGE
      (14-20)

                

              	
                
                  AGE
      (21-54)

                

              	
                
                  AGE
      (55+)

                

              	 
      	
                
                  AGE
      (65-)

                

              	
                
                  AGE
      (65+)

                

              
	 
      	 
      	 
      	 
      	 
      	
                
                  Female

                

              	
                
                  Male

                

              	
                
                  Female

                

              	
                
                  Male

                

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                
                  01

                

              	
                
                  1,099.50

                

              	
                
                  185.53

                

              	
                
                  102.06

                

              	
                
                  72.38

                

              	
                
                  140.00

                

              	
                
                  80.38

                

              	
                
                  258.44

                

              	
                
                  157.56

                

              	
                
                  320.16

                

              	
                
                  10,288.04

                

              	
                
                  1,516.79

                

              	
                
                  450.72

                

              	
                
                  245.07

                

              	
                
                  258.73

                

              	
                
                  784.45

                

              	
                
                  735.36

                

              	
                
                  308.17

                

              	
                
                  118.10

                

              	
                
                  104.44

                

              
	
                
                  02

                

              	
                
                  1,099.51

                

              	
                
                  185.54

                

              	
                
                  103.31

                

              	
                
                  80.80

                

              	
                
                  142.45

                

              	
                
                  82.83

                

              	
                
                  257.43

                

              	
                
                  156.55

                

              	
                
                  319.38

                

              	
                
                  10,288.11

                

              	
                
                  1,516.86

                

              	
                
                  456.97

                

              	
                
                  275.31

                

              	
                
                  259.94

                

              	
                
                  756.22

                

              	
                
                  729.36

                

              	
                
                  327.82

                

              	
                
                  121.40

                

              	
                
                  107.74

                

              
	
                
                  03

                

              	
                
                  1,202.95

                

              	
                
                  204.60

                

              	
                
                  112.62

                

              	
                
                  77.53

                

              	
                
                  149.22

                

              	
                
                  84.07

                

              	
                
                  284.07

                

              	
                
                  172.96

                

              	
                
                  359.00

                

              	
                
                  11,294.54

                

              	
                
                  1,683.05

                

              	
                
                  499.28

                

              	
                
                  260.32

                

              	
                
                  265.06

                

              	
                
                  822.32

                

              	
                
                  813.95

                

              	
                
                  349.99

                

              	
                
                  116.72

                

              	
                
                  101.92

                

              
	
                
                  04

                

              	
                
                  1,053.64

                

              	
                
                  179.96

                

              	
                
                  99.39

                

              	
                
                  70.26

                

              	
                
                  132.07

                

              	
                
                  75.40

                

              	
                
                  250.86

                

              	
                
                  153.32

                

              	
                
                  320.01

                

              	
                
                  10,821.63

                

              	
                
                  1,612.34

                

              	
                
                  482.87

                

              	
                
                  272.15

                

              	
                
                  266.67

                

              	
                
                  804.22

                

              	
                
                  790.89

                

              	
                
                  323.89

                

              	
                
                  120.86

                

              	
                
                  107.50

                

              
	
                
                  05

                

              	
                
                  1,197.87

                

              	
                
                  203.96

                

              	
                
                  112.15

                

              	
                
                  77.06

                

              	
                
                  150.19

                

              	
                
                  85.79

                

              	
                
                  284.77

                

              	
                
                  174.18

                

              	
                
                  360.87

                

              	
                
                  12,069.58

                

              	
                
                  1,786.55

                

              	
                
                  528.88

                

              	
                
                  270.62

                

              	
                
                  286.57

                

              	
                
                  895.87

                

              	
                
                  868.59

                

              	
                
                  230.44

                

              	
                
                  106.24

                

              	
                
                  95.51

                

              
	
                
                  06

                

              	
                
                  1,042.14

                

              	
                
                  179.05

                

              	
                
                  99.57

                

              	
                
                  74.29

                

              	
                
                  137.59

                

              	
                
                  81.57

                

              	
                
                  254.28

                

              	
                
                  157.27

                

              	
                
                  326.48

                

              	
                
                  11,001.22

                

              	
                
                  1,637.53

                

              	
                
                  487.33

                

              	
                
                  263.40

                

              	
                
                  276.55

                

              	
                
                  850.54

                

              	
                
                  814.59

                

              	
                
                  277.11

                

              	
                
                  93.13

                

              	
                
                  82.52

                

              
	
                
                  07

                

              	
                
                  1,078.12

                

              	
                
                  184.66

                

              	
                
                  102.49

                

              	
                
                  75.24

                

              	
                
                  140.69

                

              	
                
                  82.77

                

              	
                
                  261.02

                

              	
                
                  160.93

                

              	
                
                  332.97

                

              	
                
                  11,641.47

                

              	
                
                  1,737.28

                

              	
                
                  516.20

                

              	
                
                  275.41

                

              	
                
                  290.77

                

              	
                
                  897.81

                

              	
                
                  866.07

                

              	
                
                  375.39

                

              	
                
                  105.36

                

              	
                
                  94.30

                

              
	
                
                  08

                

              	
                
                  1,020.94

                

              	
                
                  175.39

                

              	
                
                  97.07

                

              	
                
                  68.46

                

              	
                
                  128.74

                

              	
                
                  73.88

                

              	
                
                  245.67

                

              	
                
                  150.62

                

              	
                
                  316.13

                

              	
                
                  10,382.57

                

              	
                
                  1,548.36

                

              	
                
                  460.15

                

              	
                
                  242.45

                

              	
                
                  245.71

                

              	
                
                  760.56

                

              	
                
                  754.32

                

              	
                
                  264.39

                

              	
                
                  104.94

                

              	
                
                  93.33

                

              
	
                
                  09

                

              	
                
                  1,054.46

                

              	
                
                  179.77

                

              	
                
                  99.43

                

              	
                
                  71.09

                

              	
                
                  132.83

                

              	
                
                  75.77

                

              	
                
                  250.39

                

              	
                
                  152.96

                

              	
                
                  317.74

                

              	
                
                  10,926.48

                

              	
                
                  1,632.80

                

              	
                
                  485.30

                

              	
                
                  257.76

                

              	
                
                  259.70

                

              	
                
                  805.82

                

              	
                
                  800.29

                

              	
                
                  228.70

                

              	
                
                  107.92

                

              	
                
                  95.29

                

              
	
                
                  10

                

              	
                
                  1,067.79

                

              	
                
                  183.68

                

              	
                
                  102.33

                

              	
                
                  76.19

                

              	
                
                  137.28

                

              	
                
                  80.07

                

              	
                
                  258.11

                

              	
                
                  158.66

                

              	
                
                  333.99

                

              	
                
                  14,123.46

                

              	
                
                  2,112.70

                

              	
                
                  630.24

                

              	
                
                  340.55

                

              	
                
                  339.72

                

              	
                
                  1,053.97

                

              	
                
                  1,052.85

                

              	
                
                  328.61

                

              	
                
                  112.45

                

              	
                
                  100.46

                

              
	
                
                  11

                

              	
                
                  1,351.65

                

              	
                
                  229.39

                

              	
                
                  126.13

                

              	
                
                  87.60

                

              	
                
                  167.04

                

              	
                
                  94.09

                

              	
                
                  317.36

                

              	
                
                  192.86

                

              	
                
                  400.90

                

              	
                
                  14,265.93

                

              	
                
                  2,112.95

                

              	
                
                  627.73

                

              	
                
                  325.00

                

              	
                
                  329.30

                

              	
                
                  1,027.20

                

              	
                
                  1,022.51

                

              	
                
                  376.25

                

              	
                
                  158.01

                

              	
                
                  140.24

                

              
	
                
                  6B*

                

              	
                
                  1,042.00

                

              	
                
                  179.03

                

              	
                
                  99.46

                

              	
                
                  73.56

                

              	
                
                  136.90

                

              	
                
                  80.89

                

              	
                
                  253.98

                

              	
                
                  156.98

                

              	
                
                  326.20

                

              	
                
                  11,000.73

                

              	
                
                  1,637.45

                

              	
                
                  487.29

                

              	
                
                  263.27

                

              	
                
                  276.43

                

              	
                
                  850.29

                

              	
                
                  814.48

                

              	
                
                  277.11

                

              	
                
                  93.13

                

              	
                
                  82.52

                

              


      

      
        


         

        AHCA
Contract No. FA615, Exhibit III-F, Page 2 of 5

      


      
        
           


        

        
           


          
            

          

        

        
           


        

      


      
        EXHIBIT
III-F

      

      
        March
1, 2009 -August31, 2009

      

      
        MEDICAID
Non-Reform HMO CAPITATION RATES

      

      
        By
Area, Age and Eligibility Category

      

      
        Revised
on February 16, 2009

      

      
        


         

        TABLE
5

      

      
        	
                
                  General
      + Transportation Rates:

                

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	
                
                  TANF

                

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	
                
                  SSl-N

                

              	 
      	 
      	 
      	 
      	 
      	
                
                  SSI-B

                

              	
                
                  SSI-AB

                

              
	
                
                  Area

                

              	
                
                  BTHMO+2MO

                

              	
                
                  3MO-11MO

                

              	
                
                  AGE
      (1-5)

                

              	
                
                  AGE
      (6-13)

                

              	
                
                  AGE
      (14-20)

                

              	
                
                  AGE
      (21-54)

                

              	
                
                  AGE
      (55+)

                

              	
                
                  BTHMO+2MO

                

              	
                
                  3MO-11MO

                

              	
                
                  AGE
      (1-5)

                

              	
                
                  AGE
      (6-13)

                

              	
                
                  AGE
      (14-20)

                

              	
                
                  AGE
      (21-54)

                

              	
                
                  AGE
      (55+)

                

              	 
      	
                
                  AGE
      (65-)

                

              	
                
                  AGE
      (65+)

                

              
	 
      	 
      	 
      	 
      	 
      	
                
                  Female

                

              	
                
                  Male

                

              	
                
                  Female

                

              	
                
                  Male

                

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                
                  01

                

              	
                
                  1,099.48

                

              	
                
                  185.51

                

              	
                
                  100.45

                

              	
                
                  60.89

                

              	
                
                  129.26

                

              	
                
                  69.64

                

              	
                
                  254.08

                

              	
                
                  153.20

                

              	
                
                  316.48

                

              	
                
                  10,287.96

                

              	
                
                  1,516.71

                

              	
                
                  443.41

                

              	
                
                  197.85

                

              	
                
                  215.50

                

              	
                
                  704.45

                

              	
                
                  704.91

                

              	
                
                  307.96

                

              	
                
                  106.65

                

              	
                
                  92.99

                

              
	
                
                  02

                

              	
                
                  1,099.48

                

              	
                
                  185.51

                

              	
                
                  100.45

                

              	
                
                  60.89

                

              	
                
                  129.26

                

              	
                
                  69.64

                

              	
                
                  254.08

                

              	
                
                  153.20

                

              	
                
                  316.48

                

              	
                
                  10,287.96

                

              	
                
                  1,516.71

                

              	
                
                  443.41

                

              	
                
                  197.85

                

              	
                
                  215.50

                

              	
                
                  704.45

                

              	
                
                  704.91

                

              	
                
                  307.96

                

              	
                
                  106.65

                

              	
                
                  92.99

                

              
	
                
                  03

                

              	
                
                  1,202.94

                

              	
                
                  204.59

                

              	
                
                  111.32

                

              	
                
                  68.51

                

              	
                
                  143.24

                

              	
                
                  78.09

                

              	
                
                  282.55

                

              	
                
                  171.44

                

              	
                
                  357.68

                

              	
                
                  11,294.47

                

              	
                
                  1,682.98

                

              	
                
                  493.13

                

              	
                
                  225.18

                

              	
                
                  244.90

                

              	
                
                  798.83

                

              	
                
                  802.86

                

              	
                
                  343.26

                

              	
                
                  107.89

                

              	
                
                  93.09

                

              
	
                
                  04

                

              	
                
                  1,053.63

                

              	
                
                  179.95

                

              	
                
                  98.04

                

              	
                
                  60.87

                

              	
                
                  125.84

                

              	
                
                  69.17

                

              	
                
                  249.28

                

              	
                
                  151.74

                

              	
                
                  318.64

                

              	
                
                  10,821.52

                

              	
                
                  1,612.23

                

              	
                
                  473.28

                

              	
                
                  217.37

                

              	
                
                  235.24

                

              	
                
                  767.60

                

              	
                
                  773.60

                

              	
                
                  299.76

                

              	
                
                  104.38

                

              	
                
                  91.02

                

              
	
                
                  05

                

              	
                
                  1,197.86

                

              	
                
                  203.95

                

              	
                
                  110.96

                

              	
                
                  68.53

                

              	
                
                  142.22

                

              	
                
                  77.82

                

              	
                
                  281.53

                

              	
                
                  170.94

                

              	
                
                  358.14

                

              	
                
                  12,069.53

                

              	
                
                  1,786.50

                

              	
                
                  523.94

                

              	
                
                  238.76

                

              	
                
                  257.40

                

              	
                
                  841.90

                

              	
                
                  848.05

                

              	
                
                  227.76

                

              	
                
                  93.64

                

              	
                
                  82.91

                

              
	
                
                  06

                

              	
                
                  1,042.12

                

              	
                
                  179.03

                

              	
                
                  97.75

                

              	
                
                  61.27

                

              	
                
                  125.43

                

              	
                
                  69.41

                

              	
                
                  249.34

                

              	
                
                  152.33

                

              	
                
                  322.31

                

              	
                
                  11,001.15

                

              	
                
                  1,637.46

                

              	
                
                  480.92

                

              	
                
                  222.02

                

              	
                
                  238.67

                

              	
                
                  780.44

                

              	
                
                  787.91

                

              	
                
                  275.82

                

              	
                
                  89.31

                

              	
                
                  78.70

                

              
	
                
                  07

                

              	
                
                  1,078.10

                

              	
                
                  184.64

                

              	
                
                  100.74

                

              	
                
                  62.77

                

              	
                
                  129.04

                

              	
                
                  71.12

                

              	
                
                  256.28

                

              	
                
                  156.19

                

              	
                
                  328.97

                

              	
                
                  11,641.41

                

              	
                
                  1,737.22

                

              	
                
                  510.18

                

              	
                
                  236.58

                

              	
                
                  255.22

                

              	
                
                  832.03

                

              	
                
                  841.03

                

              	
                
                  372.84

                

              	
                
                  95.02

                

              	
                
                  83.96

                

              
	
                
                  08

                

              	
                
                  1,020.93

                

              	
                
                  175.38

                

              	
                
                  95.83

                

              	
                
                  59.82

                

              	
                
                  123.02

                

              	
                
                  68.16

                

              	
                
                  244.21

                

              	
                
                  149.16

                

              	
                
                  314.87

                

              	
                
                  10,382.50

                

              	
                
                  1,548.29

                

              	
                
                  454.25

                

              	
                
                  208.76

                

              	
                
                  226.37

                

              	
                
                  738.04

                

              	
                
                  743.69

                

              	
                
                  257.66

                

              	
                
                  91.95

                

              	
                
                  80.34

                

              
	
                
                  09

                

              	
                
                  1,054.44

                

              	
                
                  179.75

                

              	
                
                  97.91

                

              	
                
                  60.47

                

              	
                
                  125.80

                

              	
                
                  68.74

                

              	
                
                  248.60

                

              	
                
                  151.17

                

              	
                
                  316.19

                

              	
                
                  10,926.41

                

              	
                
                  1,632.73

                

              	
                
                  479.08

                

              	
                
                  222.24

                

              	
                
                  239.31

                

              	
                
                  782.08

                

              	
                
                  789.08

                

              	
                
                  221.97

                

              	
                
                  98.50

                

              	
                
                  85.87

                

              
	
                
                  10

                

              	
                
                  1,067.77

                

              	
                
                  183.66

                

              	
                
                  100.44

                

              	
                
                  63.06

                

              	
                
                  128.58

                

              	
                
                  71.37

                

              	
                
                  255.90

                

              	
                
                  156.45

                

              	
                
                  332.07

                

              	
                
                  14,123.37

                

              	
                
                  2,112.61

                

              	
                
                  622.03

                

              	
                
                  293.66

                

              	
                
                  312.81

                

              	
                
                  1,022.63

                

              	
                
                  1,038.05

                

              	
                
                  321.88

                

              	
                
                  104.53

                

              	
                
                  92.54

                

              
	
                
                  11

                

              	
                
                  1,351.63

                

              	
                
                  229.37

                

              	
                
                  124.54

                

              	
                
                  76.50

                

              	
                
                  159.68

                

              	
                
                  86.73

                

              	
                
                  315.49

                

              	
                
                  190.99

                

              	
                
                  399.28

                

              	
                
                  14,265.85

                

              	
                
                  2,112.87

                

              	
                
                  620.88

                

              	
                
                  285.88

                

              	
                
                  306.86

                

              	
                
                  1,001.06

                

              	
                
                  1,010.17

                

              	
                
                  369.15

                

              	
                
                  150.09

                

              	
                
                  132.32

                

              
	
                
                  6B*

                

              	
                
                  1,041.98

                

              	
                
                  179.01

                

              	
                
                  97.74

                

              	
                
                  61.26

                

              	
                
                  125.41

                

              	
                
                  69.40

                

              	
                
                  249.31

                

              	
                
                  152.31

                

              	
                
                  322.26

                

              	
                
                  11,000.66

                

              	
                
                  1,637.38

                

              	
                
                  480.90

                

              	
                
                  222.01

                

              	
                
                  238.66

                

              	
                
                  780.39

                

              	
                
                  787.88

                

              	
                
                  275.82

                

              	
                
                  89.31

                

              	
                
                  78.70

                

              


      

      
        


      

      
        TABLE
6

      

      
        	
                
                  General
      + Dental Rates:

                

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	
                
                  TANF

                

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	
                
                  SSI-N

                

              	 
      	 
      	 
      	 
      	 
      	
                
                  SSI-B

                

              	
                
                  SSI-AB

                

              
	
                
                  Area

                

              	
                
                  BTHMO+2MO

                

              	
                
                  3MO-11MO

                

              	
                
                  AGE
      (1-5)

                

              	
                
                  AGE
      (6-13)

                

              	
                
                  AGE
      (14-20)

                

              	
                
                  AGE
      (21-54)

                

              	
                
                  AGE
      (55+)

                

              	
                
                  BTHMO+2MO

                

              	
                
                  3MO-11MO

                

              	
                
                  AGE
      (1-5)

                

              	
                
                  AGE
      (6-13)

                

              	
                
                  AGE
      (14-20)

                

              	
                
                  AGE
      (21-54)

                

              	
                
                  AGE
      (55+)

                

              	 
      	
                
                  AGE
      (65-)

                

              	
                
                  AGE
      (65+)

                

              
	 
      	 
      	 
      	 
      	 
      	
                
                  Female

                

              	
                
                  Male

                

              	
                
                  Female

                

              	
                
                  Male

                

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                
                  01

                

              	
                
                  1,094.22

                

              	
                
                  184.17

                

              	
                
                  101.28

                

              	
                
                  63.46

                

              	
                
                  130.39

                

              	
                
                  70.96

                

              	
                
                  252.04

                

              	
                
                  151.97

                

              	
                
                  315.77

                

              	
                
                  10,249.54

                

              	
                
                  1,491.48

                

              	
                
                  439.80

                

              	
                
                  197.82

                

              	
                
                  211.50

                

              	
                
                  686.05

                

              	
                
                  690.10

                

              	
                
                  301.06

                

              	
                
                  94.27

                

              	
                
                  85.15

                

              
	
                
                  02

                

              	
                
                  1,094.22

                

              	
                
                  184.17

                

              	
                
                  101.28

                

              	
                
                  63.46

                

              	
                
                  130.39

                

              	
                
                  70.96

                

              	
                
                  252.04

                

              	
                
                  151.97

                

              	
                
                  315.77

                

              	
                
                  10,249.54

                

              	
                
                  1,491.48

                

              	
                
                  439.80

                

              	
                
                  197.82

                

              	
                
                  211.50

                

              	
                
                  686.05

                

              	
                
                  690.10

                

              	
                
                  301.06

                

              	
                
                  94.27

                

              	
                
                  85.15

                

              
	
                
                  03

                

              	
                
                  1,196.63

                

              	
                
                  202.98

                

              	
                
                  113.34

                

              	
                
                  73.48

                

              	
                
                  146.51

                

              	
                
                  81.31

                

              	
                
                  280.36

                

              	
                
                  170.22

                

              	
                
                  357.43

                

              	
                
                  11,246.01

                

              	
                
                  1,651.17

                

              	
                
                  489.64

                

              	
                
                  226.72

                

              	
                
                  241.23

                

              	
                
                  775.81

                

              	
                
                  784.47

                

              	
                
                  335.71

                

              	
                
                  90.08

                

              	
                
                  81.81

                

              
	
                
                  04

                

              	
                
                  1,049.15

                

              	
                
                  178.80

                

              	
                
                  99.15

                

              	
                
                  63.81

                

              	
                
                  127.57

                

              	
                
                  70.94

                

              	
                
                  248.15

                

              	
                
                  151.33

                

              	
                
                  319.44

                

              	
                
                  10,783.85

                

              	
                
                  1,587.50

                

              	
                
                  469.94

                

              	
                
                  217.62

                

              	
                
                  231.57

                

              	
                
                  750.13

                

              	
                
                  759.88

                

              	
                
                  294.84

                

              	
                
                  90.36

                

              	
                
                  82.17

                

              
	
                
                  05

                

              	
                
                  1,194.07

                

              	
                
                  202.99

                

              	
                
                  113.72

                

              	
                
                  74.40

                

              	
                
                  147.14

                

              	
                
                  82.25

                

              	
                
                  282.54

                

              	
                
                  172.61

                

              	
                
                  363.31

                

              	
                
                  12,038.27

                

              	
                
                  1,765.99

                

              	
                
                  523.85

                

              	
                
                  242.97

                

              	
                
                  257.80

                

              	
                
                  829.50

                

              	
                
                  839.62

                

              	
                
                  224.92

                

              	
                
                  83.52

                

              	
                
                  76.84

                

              
	
                
                  06

                

              	
                
                  1,038.40

                

              	
                
                  178.08

                

              	
                
                  99.79

                

              	
                
                  65.79

                

              	
                
                  128.98

                

              	
                
                  72.69

                

              	
                
                  248.88

                

              	
                
                  152.48

                

              	
                
                  324.09

                

              	
                
                  10,970.19

                

              	
                
                  1,617.14

                

              	
                
                  479.71

                

              	
                
                  224.52

                

              	
                
                  237.62

                

              	
                
                  767.02

                

              	
                
                  777.95

                

              	
                
                  271.94

                

              	
                
                  80.16

                

              	
                
                  73.06

                

              
	
                
                  07

                

              	
                
                  1,074.15

                

              	
                
                  183.64

                

              	
                
                  102.48

                

              	
                
                  66.77

                

              	
                
                  132.00

                

              	
                
                  73.89

                

              	
                
                  255.14

                

              	
                
                  155.66

                

              	
                
                  329.37

                

              	
                
                  11,607.26

                

              	
                
                  1,714.81

                

              	
                
                  508.51

                

              	
                
                  238.83

                

              	
                
                  253.62

                

              	
                
                  816.03

                

              	
                
                  828.38

                

              	
                
                  368.02

                

              	
                
                  84.59

                

              	
                
                  77.42

                

              
	
                
                  08

                

              	
                
                  1,015.74

                

              	
                
                  174.06

                

              	
                
                  98.59

                

              	
                
                  65.95

                

              	
                
                  127.80

                

              	
                
                  72.58

                

              	
                
                  243.00

                

              	
                
                  148.75

                

              	
                
                  315.98

                

              	
                
                  10,344.94

                

              	
                
                  1,523.64

                

              	
                
                  452.53

                

              	
                
                  211.41

                

              	
                
                  224.78

                

              	
                
                  721.02

                

              	
                
                  730.55

                

              	
                
                  253.34

                

              	
                
                  79.05

                

              	
                
                  72.23

                

              
	
                
                  09

                

              	
                
                  1,049.43

                

              	
                
                  178.47

                

              	
                
                  100.00

                

              	
                
                  65.35

                

              	
                
                  129.35

                

              	
                
                  72.10

                

              	
                
                  246.44

                

              	
                
                  149.77

                

              	
                
                  315.05

                

              	
                
                  10,887.75

                

              	
                
                  1,607.34

                

              	
                
                  476.39

                

              	
                
                  223.61

                

              	
                
                  236.51

                

              	
                
                  763.41

                

              	
                
                  773.95

                

              	
                
                  217.32

                

              	
                
                  84.02

                

              	
                
                  76.67

                

              
	
                
                  10

                

              	
                
                  1,064.84

                

              	
                
                  182.90

                

              	
                
                  102.37

                

              	
                
                  67.21

                

              	
                
                  131.99

                

              	
                
                  74.46

                

              	
                
                  254.81

                

              	
                
                  155.81

                

              	
                
                  331.77

                

              	
                
                  14,097.57

                

              	
                
                  2,095.68

                

              	
                
                  621.28

                

              	
                
                  296.13

                

              	
                
                  312.27

                

              	
                
                  1,010.33

                

              	
                
                  1,028.19

                

              	
                
                  317.48

                

              	
                
                  93.68

                

              	
                
                  85.69

                

              
	
                
                  11

                

              	
                
                  1,348.60

                

              	
                
                  228.60

                

              	
                
                  127.74

                

              	
                
                  83.76

                

              	
                
                  166.35

                

              	
                
                  92.56

                

              	
                
                  314.46

                

              	
                
                  190.42

                

              	
                
                  399.21

                

              	
                
                  14,238.95

                

              	
                
                  2,095.23

                

              	
                
                  621.44

                

              	
                
                  291.47

                

              	
                
                  309.00

                

              	
                
                  989.01

                

              	
                
                  1,000.97

                

              	
                
                  367.40

                

              	
                
                  139.98

                

              	
                
                  126.07

                

              
	
                
                  6B*

                

              	
                
                  1,038.26

                

              	
                
                  178.06

                

              	
                
                  99.78

                

              	
                
                  65.78

                

              	
                
                  128.96

                

              	
                
                  72.68

                

              	
                
                  247.00

                

              	
                
                  150.55

                

              	
                
                  319.81

                

              	
                
                  10,969.70

                

              	
                
                  1,617.06

                

              	
                
                  479.69

                

              	
                
                  224.51

                

              	
                
                  237.61

                

              	
                
                  764.51

                

              	
                
                  774.47

                

              	
                
                  271.94

                

              	
                
                  80.16

                

              	
                
                  73.06

                

              


      

      
        


         

        AHCA
Contract No. FA615, Exhibit III-F, Page 3 of 5

      


      
        
           


        

        
           


          
            

          

        

        
           


        

      


      
        EXHIBIT
III-F

      

      
        March
1, 2009 - August 31, 2009

      

      
        MEDICAID
Non-Reform HMO CAPITATION RATES

      

      
        By
Area, Age and Eligibility Category

      

      
        Revised
on February 16, 2009

      

      
        


        TABLE 7

        
          
            
              	
                      
                        General
      + Dental + Transportation Rates:

                      

                    	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	
                      
                        TANF

                      

                    	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	
                      
                        SSI-N

                      

                    	 
      	 
      	 
      	 
      	 
      	
                      
                        SSI-B

                      

                    	
                      
                        SSI-AB

                      

                    
	
                      
                        Area

                      

                    	
                      
                        BTHMO+2MO

                      

                    	
                      
                        3MO-11MO

                      

                    	
                      
                        AGE
      (1-5)

                      

                    	
                      
                        AGE
      (6-13)

                      

                    	
                      
                        AGE
      (14-20)

                      

                    	
                      
                        AGE
      (21-54)

                      

                    	
                      
                        AGE
      (55+)

                      

                    	
                      
                        BTHMO+2MO

                      

                    	
                      
                        3MO-11MO

                      

                    	
                      
                        AGE
      (1-5)

                      

                    	
                      
                        AGE
      (6-13)

                      

                    	
                      
                        AGE
      (14-20)

                      

                    	
                      
                        AGE
      (21-54)

                      

                    	
                      
                        AGE
      (55+)

                      

                    	 
      	
                      
                        AGE
      (65-)

                      

                    	
                      
                        AGE
      (65+)

                      

                    
	 
      	 
      	 
      	 
      	 
      	
                      
                        Female

                      

                    	
                      
                        Male

                      

                    	
                      
                        Female

                      

                    	
                      
                        Male

                      

                    	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                      
                        01

                      

                    	
                      
                        1,099.48

                      

                    	
                      
                        185.52

                      

                    	
                      
                        102.10

                      

                    	
                      
                        63.95

                      

                    	
                      
                        132.39

                      

                    	
                      
                        72.28

                      

                    	
                      
                        255.28

                      

                    	
                      
                        154.44

                      

                    	
                      
                        319.22

                      

                    	
                      
                        10,287.96

                      

                    	
                      
                        1,516.71

                      

                    	
                      
                        445.00

                      

                    	
                      
                        200.21

                      

                    	
                      
                        217.52

                      

                    	
                      
                        705.76

                      

                    	
                      
                        706.74

                      

                    	
                      
                        308.40

                      

                    	
                      
                        107.75

                      

                    	
                      
                        93.84

                      

                    
	
                      
                        02

                      

                    	
                      
                        1,099.48

                      

                    	
                      
                        185.52

                      

                    	
                      
                        102.10

                      

                    	
                      
                        63.95

                      

                    	
                      
                        132.39

                      

                    	
                      
                        72.28

                      

                    	
                      
                        255.28

                      

                    	
                      
                        154.44

                      

                    	
                      
                        319.22

                      

                    	
                      
                        10,287.96

                      

                    	
                      
                        1,516.71

                      

                    	
                      
                        445.00

                      

                    	
                      
                        200.21

                      

                    	
                      
                        217.52

                      

                    	
                      
                        705.76

                      

                    	
                      
                        706.74

                      

                    	
                      
                        308.40

                      

                    	
                      
                        107.75

                      

                    	
                      
                        93.84

                      

                    
	
                      
                        03

                      

                    	
                      
                        1,202.95

                      

                    	
                      
                        204.61

                      

                    	
                      
                        114.32

                      

                    	
                      
                        74.07

                      

                    	
                      
                        148.91

                      

                    	
                      
                        82.89

                      

                    	
                      
                        284.26

                      

                    	
                      
                        173.19

                      

                    	
                      
                        361.58

                      

                    	
                      
                        11,294.47

                      

                    	
                      
                        1,682.99

                      

                    	
                      
                        496.21

                      

                    	
                      
                        229.74

                      

                    	
                      
                        248.82

                      

                    	
                      
                        800.68

                      

                    	
                      
                        805.46

                      

                    	
                      
                        344.27

                      

                    	
                      
                        109.51

                      

                    	
                      
                        94.33

                      

                    
	
                      
                        04

                      

                    	
                      
                        1,053.64

                      

                    	
                      
                        179.96

                      

                    	
                      
                        99.85

                      

                    	
                      
                        64.23

                      

                    	
                      
                        129.28

                      

                    	
                      
                        72.07

                      

                    	
                      
                        250.92

                      

                    	
                      
                        153.43

                      

                    	
                      
                        322.39

                      

                    	
                      
                        10,821.52

                      

                    	
                      
                        1,612.23

                      

                    	
                      
                        475.03

                      

                    	
                      
                        219.96

                      

                    	
                      
                        237.47

                      

                    	
                      
                        769.45

                      

                    	
                      
                        776.19

                      

                    	
                      
                        301.90

                      

                    	
                      
                        105.94

                      

                    	
                      
                        92.21

                      

                    
	
                      
                        05

                      

                    	
                      
                        1,197.87

                      

                    	
                      
                        203.97

                      

                    	
                      
                        114.31

                      

                    	
                      
                        74.75

                      

                    	
                      
                        148.58

                      

                    	
                      
                        83.20

                      

                    	
                      
                        284.88

                      

                    	
                      
                        174.39

                      

                    	
                      
                        365.80

                      

                    	
                      
                        12,069.54

                      

                    	
                      
                        1,786.51

                      

                    	
                      
                        528.09

                      

                    	
                      
                        244.92

                      

                    	
                      
                        262.69

                      

                    	
                      
                        845.54

                      

                    	
                      
                        853.16

                      

                    	
                      
                        231.36

                      

                    	
                      
                        97.36

                      

                    	
                      
                        85.75

                      

                    
	
                      
                        06

                      

                    	
                      
                        1,042.13

                      

                    	
                      
                        179.04

                      

                    	
                      
                        100.37

                      

                    	
                      
                        66.14

                      

                    	
                      
                        130.40

                      

                    	
                      
                        73.62

                      

                    	
                      
                        251.19

                      

                    	
                      
                        154.24

                      

                    	
                      
                        326.54

                      

                    	
                      
                        11,001.15

                      

                    	
                      
                        1,637.47

                      

                    	
                      
                        483.91

                      

                    	
                      
                        226.44

                      

                    	
                      
                        242.47

                      

                    	
                      
                        782.90

                      

                    	
                      
                        791.36

                      

                    	
                      
                        277.55

                      

                    	
                      
                        91.52

                      

                    	
                      
                        80.38

                      

                    
	
                      
                        07

                      

                    	
                      
                        1,078.11

                      

                    	
                      
                        184.65

                      

                    	
                      
                        103.10

                      

                    	
                      
                        67.14

                      

                    	
                      
                        133.50

                      

                    	
                      
                        74.89

                      

                    	
                      
                        257.59

                      

                    	
                      
                        157.53

                      

                    	
                      
                        331.96

                      

                    	
                      
                        11,641.41

                      

                    	
                      
                        1,737.23

                      

                    	
                      
                        513.13

                      

                    	
                      
                        240.94

                      

                    	
                      
                        258.97

                      

                    	
                      
                        833.55

                      

                    	
                      
                        843.17

                      

                    	
                      
                        373.31

                      

                    	
                      
                        96.51

                      

                    	
                      
                        85.10

                      

                    
	
                      
                        08

                      

                    	
                      
                        1,020.94

                      

                    	
                      
                        175.40

                      

                    	
                      
                        99.41

                      

                    	
                      
                        66.44

                      

                    	
                      
                        129.79

                      

                    	
                      
                        73.89

                      

                    	
                      
                        246.20

                      

                    	
                      
                        151.19

                      

                    	
                      
                        319.39

                      

                    	
                      
                        10,382.50

                      

                    	
                      
                        1,548.30

                      

                    	
                      
                        457.61

                      

                    	
                      
                        213.75

                      

                    	
                      
                        230.66

                      

                    	
                      
                        740.28

                      

                    	
                      
                        746.83

                      

                    	
                      
                        259.17

                      

                    	
                      
                        93.59

                      

                    	
                      
                        81.59

                      

                    
	
                      
                        09

                      

                    	
                      
                        1,054.45

                      

                    	
                      
                        179.77

                      

                    	
                      
                        100.79

                      

                    	
                      
                        65.82

                      

                    	
                      
                        131.26

                      

                    	
                      
                        73.36

                      

                    	
                      
                        249.54

                      

                    	
                      
                        152.13

                      

                    	
                      
                        318.34

                      

                    	
                      
                        10,926.41

                      

                    	
                      
                        1,632.74

                      

                    	
                      
                        481.63

                      

                    	
                      
                        226.02

                      

                    	
                      
                        242.56

                      

                    	
                      
                        783.24

                      

                    	
                      
                        790.70

                      

                    	
                      
                        223.77

                      

                    	
                      
                        99.55

                      

                    	
                      
                        86.67

                      

                    
	
                      
                        10

                      

                    	
                      
                        1,067.78

                      

                    	
                      
                        183.67

                      

                    	
                      
                        102.83

                      

                    	
                      
                        67.49

                      

                    	
                      
                        133.11

                      

                    	
                      
                        75.20

                      

                    	
                      
                        256.62

                      

                    	
                      
                        157.19

                      

                    	
                      
                        333.70

                      

                    	
                      
                        14,123.37

                      

                    	
                      
                        2,112.62

                      

                    	
                      
                        624.77

                      

                    	
                      
                        297.73

                      

                    	
                      
                        316.31

                      

                    	
                      
                        1,023.56

                      

                    	
                      
                        1,039.36

                      

                    	
                      
                        322.69

                      

                    	
                      
                        105.81

                      

                    	
                      
                        93.50

                      

                    
	
                      
                        11

                      

                    	
                      
                        1,351.64

                      

                    	
                      
                        229.38

                      

                    	
                      
                        128.21

                      

                    	
                      
                        84.05

                      

                    	
                      
                        167.51

                      

                    	
                      
                        93.33

                      

                    	
                      
                        316.34

                      

                    	
                      
                        191.85

                      

                    	
                      
                        401.21

                      

                    	
                      
                        14,265.86

                      

                    	
                      
                        2,112.89

                      

                    	
                      
                        625.08

                      

                    	
                      
                        293.14

                      

                    	
                      
                        313.22

                      

                    	
                      
                        1,002.81

                      

                    	
                      
                        1,012.63

                      

                    	
                      
                        372.43

                      

                    	
                      
                        152.21

                      

                    	
                      
                        133.94

                      

                    
	
                      
                        6B*

                      

                    	
                      
                        1,041.99

                      

                    	
                      
                        179.02

                      

                    	
                      
                        100.36

                      

                    	
                      
                        66.13

                      

                    	
                      
                        130.38

                      

                    	
                      
                        73.61

                      

                    	
                      
                        249.31

                      

                    	
                      
                        152.31

                      

                    	
                      
                        322.26

                      

                    	
                      
                        11,000.66

                      

                    	
                      
                        1,637.39

                      

                    	
                      
                        483.89

                      

                    	
                      
                        226.43

                      

                    	
                      
                        242.46

                      

                    	
                      
                        .   780.39

                      

                    	
                      
                        787.88

                      

                    	
                      
                        277.55

                      

                    	
                      
                        91.52

                      

                    	
                      
                        80.38

                      

                    


            

          

        

         

      

      
        TABLE
8

      

      
        	
                
                  General
      + Mental Health + Dental + Transportation Rates:

                

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	
                
                  TANF

                

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	
                
                  SSI-N

                

              	 
      	 
      	 
      	 
      	 
      	
                
                  SSI-B

                

              	
                
                  SSI-AB

                

              
	
                
                  Area

                

              	
                
                  BTHMO+2MO

                

              	
                
                  3MO-11MO

                

              	
                
                  AGE
      (1-5)

                

              	
                
                  AGE
      (6-13)

                

              	
                
                  AGE
      (14-20)

                

              	
                
                  AGE
      (21-54)

                

              	
                
                  AGE
      (55+)

                

              	
                
                  BTHMO+2MO

                

              	
                
                  3MO-11MO

                

              	
                
                  AGE
      (1-5)

                

              	
                
                  AGE
      (6-13)

                

              	
                
                  AGE
      (14-20)

                

              	
                
                  AGE
      (21-54)

                

              	
                
                  AGE
      (55+)

                

              	 
      	
                
                  AGE
      (65-)

                

              	
                
                  AGE
      (65+)

                

              
	 
      	 
      	 
      	 
      	 
      	
                
                  Female

                

              	
                
                  Male

                

              	
                
                  Female

                

              	
                
                  Male

                

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                
                  01

                

              	
                
                  1,099.50

                

              	
                
                  185.54

                

              	
                
                  103.71

                

              	
                
                  75.44

                

              	
                
                  143.13

                

              	
                
                  83.02

                

              	
                
                  259.64

                

              	
                
                  158.80

                

              	
                
                  322.90

                

              	
                
                  10,288.04

                

              	
                
                  1,516.79

                

              	
                
                  452.31

                

              	
                
                  247.43

                

              	
                
                  260.75

                

              	
                
                  785.76

                

              	
                
                  737.19

                

              	
                
                  308.61

                

              	
                
                  119.20

                

              	
                
                  105.29

                

              
	
                
                  02

                

              	
                
                  1,099.51

                

              	
                
                  185.55

                

              	
                
                  104.96

                

              	
                
                  83.86

                

              	
                
                  145.58

                

              	
                
                  85.47

                

              	
                
                  258.63

                

              	
                
                  157.79

                

              	
                
                  322.12

                

              	
                
                  10,288.11

                

              	
                
                  1,516.86

                

              	
                
                  458.56

                

              	
                
                  277.67

                

              	
                
                  261.96

                

              	
                
                  757.53

                

              	
                
                  731.19

                

              	
                
                  328.26

                

              	
                
                  122.50

                

              	
                
                  108.59

                

              
	
                
                  03

                

              	
                
                  1,202.96

                

              	
                
                  204.62

                

              	
                
                  115.62

                

              	
                
                  83.09

                

              	
                
                  154.89

                

              	
                
                  88.87

                

              	
                
                  285.78

                

              	
                
                  174.71

                

              	
                
                  362.90

                

              	
                
                  11,294.54

                

              	
                
                  1,683.06

                

              	
                
                  502.36

                

              	
                
                  264.88

                

              	
                
                  268.98

                

              	
                
                  824.17

                

              	
                
                  816.55

                

              	
                
                  351.00

                

              	
                
                  118.34

                

              	
                
                  103.16

                

              
	
                
                  04

                

              	
                
                  1,053.65

                

              	
                
                  179.97

                

              	
                
                  101.20

                

              	
                
                  73.62

                

              	
                
                  135.51

                

              	
                
                  78.30

                

              	
                
                  252.50

                

              	
                
                  155.01

                

              	
                
                  323.76

                

              	
                
                  10,821.63

                

              	
                
                  1,612.34

                

              	
                
                  484.62

                

              	
                
                  274.74

                

              	
                
                  268.90

                

              	
                
                  806.07

                

              	
                
                  793.48

                

              	
                
                  326.03

                

              	
                
                  122.42

                

              	
                
                  108.69

                

              
	
                
                  05

                

              	
                
                  1,197.88

                

              	
                
                  203.98

                

              	
                
                  115.50

                

              	
                
                  83.28

                

              	
                
                  156.55

                

              	
                
                  91.17

                

              	
                
                  288.12

                

              	
                
                  177.63

                

              	
                
                  368.53

                

              	
                
                  12,069.59

                

              	
                
                  1,786.56

                

              	
                
                  533.03

                

              	
                
                  276.78

                

              	
                
                  291.86

                

              	
                
                  899.51

                

              	
                
                  873.70

                

              	
                
                  234.04

                

              	
                
                  109.96

                

              	
                
                  98.35

                

              
	
                
                  06

                

              	
                
                  1,042.15

                

              	
                
                  179.06

                

              	
                
                  102.19

                

              	
                
                  79.16

                

              	
                
                  142.56

                

              	
                
                  85.78

                

              	
                
                  256.13

                

              	
                
                  159.18

                

              	
                
                  330.71

                

              	
                
                  11,001.22

                

              	
                
                  1,637.54

                

              	
                
                  490.32

                

              	
                
                  267.82

                

              	
                
                  280.35

                

              	
                
                  853.00

                

              	
                
                  818.04

                

              	
                
                  278.84

                

              	
                
                  95.34

                

              	
                
                  84.20

                

              
	
                
                  07

                

              	
                
                  1,078.13

                

              	
                
                  184.67

                

              	
                
                  104.85

                

              	
                
                  79.61

                

              	
                
                  145.15

                

              	
                
                  86.54

                

              	
                
                  262.33

                

              	
                
                  162.27

                

              	
                
                  335.96

                

              	
                
                  11,641.47

                

              	
                
                  1,737.29

                

              	
                
                  519.15

                

              	
                
                  279.77

                

              	
                
                  294.52

                

              	
                
                  899.33

                

              	
                
                  868.21

                

              	
                
                  375.86

                

              	
                
                  106.85

                

              	
                
                  95.44

                

              
	
                
                  08

                

              	
                
                  1,020.95

                

              	
                
                  175.41

                

              	
                
                  100.65

                

              	
                
                  75.08

                

              	
                
                  135.51

                

              	
                
                  79.61

                

              	
                
                  247.66

                

              	
                
                  152.65

                

              	
                
                  320.65

                

              	
                
                  10,382.57

                

              	
                
                  1,548.37

                

              	
                
                  463.51

                

              	
                
                  247.44

                

              	
                
                  250.00

                

              	
                
                  762.80

                

              	
                
                  757.46

                

              	
                
                  265.90

                

              	
                
                  106.58

                

              	
                
                  94.58

                

              
	
                
                  09

                

              	
                
                  1,054.47

                

              	
                
                  179.79

                

              	
                
                  102.31

                

              	
                
                  76.44

                

              	
                
                  138.29

                

              	
                
                  80.39

                

              	
                
                  251.33

                

              	
                
                  153.92

                

              	
                
                  319.89

                

              	
                
                  10,926.48

                

              	
                
                  1,632.81

                

              	
                
                  487.85

                

              	
                
                  261.54

                

              	
                
                  262.95

                

              	
                
                  806.98

                

              	
                
                  801.91

                

              	
                
                  230.50

                

              	
                
                  108.97

                

              	
                
                  96.09

                

              
	
                
                  10

                

              	
                
                  1,067.80

                

              	
                
                  183.69

                

              	
                
                  104.72

                

              	
                
                  80.62

                

              	
                
                  141.81

                

              	
                
                  83.90

                

              	
                
                  258.83

                

              	
                
                  159.40

                

              	
                
                  335.62

                

              	
                
                  14,123.46

                

              	
                
                  2,112.71

                

              	
                
                  632.98

                

              	
                
                  344.62

                

              	
                
                  343.22

                

              	
                
                  1,054.90

                

              	
                
                  1,054.16

                

              	
                
                  329.42

                

              	
                
                  113.73

                

              	
                
                  101.42

                

              
	
                
                  11

                

              	
                
                  1,351.66

                

              	
                
                  229.40

                

              	
                
                  129.80

                

              	
                
                  95.15

                

              	
                
                  174.87

                

              	
                
                  100.69

                

              	
                
                  318.21

                

              	
                
                  193.72

                

              	
                
                  402.83

                

              	
                
                  14,265.94

                

              	
                
                  2,112.97

                

              	
                
                  631.93

                

              	
                
                  332.26

                

              	
                
                  335.66

                

              	
                
                  1,028.95

                

              	
                
                  1,024.97

                

              	
                
                  379.53

                

              	
                
                  160.13

                

              	
                
                  141.86

                

              
	
                
                  6B*

                

              	
                
                  1,042.01

                

              	
                
                  179.04

                

              	
                
                  102.08

                

              	
                
                  78.43

                

              	
                
                  141.87

                

              	
                
                  85.10

                

              	
                
                  253.98

                

              	
                
                  156.98

                

              	
                
                  326.20

                

              	
                
                  11,000.73

                

              	
                
                  1,637.46

                

              	
                
                  490.28

                

              	
                
                  267.69

                

              	
                
                  280.23

                

              	
                
                  850.29

                

              	
                
                  814.48

                

              	
                
                  278.84

                

              	
                
                  95.34

                

              	
                
                  84.20

                

              


      

      
        


         

        AHCA
Contract No. FA615, Exhibit III-F, Page 4 of 5

      


      
        
           


        

        
           


          
            

          

        

        
           


        

      


      
        EXHIBIT
III-F

      

      
        March
1, 2009 -August 31, 2009

      

      
        MEDICAID
Non-Reform HMO CAPITATION RATES

      

      
        By
Area, Age and Eligibility Category

        Revised on February 16,
2009

      

      
         

      

      


      
        	
                Area

              	
                Corresponding
      Counties

                 

                 

              
	
                Area
      1

              	
                Escambia,
      Okaloosa, Santa Rosa, Walton

                 

              
	
                Area
      2

              	
                Bay,
      Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon,
      Liberty, Madison, Taylor, Washington, Wakulla

                 

              
	
                Area
      3

              	
                Alachua,
      Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando,
      Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee,
Union

                 

              
	
                Area
      4

              	
                Baker,
      Clay, Duval, Flagler, Nassau, St. Johns, Volusia

                 

              
	
                Area
      5

              	
                Pasco,
      Pinellas

                 

              
	
                Area
      6

              	
                Hardee,
      Highlands, Manatee, Polk

                 

              
	
                Area
      6B *

              	
                Hillsborough

                 

              
	
                Area
      7

              	
                Brevard,
      Orange, Osceola, Seminole

                 

              
	
                Area
      8

              	
                Charlotte,
      Collier, De Soto, Glades, Hendry, Lee, Sarasota

                 

              
	
                Area
      9

              	
                Indian
      River, Okeechobee, St. Lucie, Martin, Palm Beach

                 

              
	
                Area
      10

              	
                Broward

                 

              
	
                Area
      11

              	
                Dade,
      Monroe

                 

              


      

      
        


      

      
         

      

      
        AHCA
Contract No. FA615, Exhibit III-F, Page 5 of
5