amend12-far001.htm


    Back to Form 8-K

    Exhibit 10.1

    
 

    
      	
              HealthEase
      of Florida, Inc

            	
              Medicaid
      Reform HMO Contract

            


    

    
      


       

      AHCA
CONTRACT NO. FAR001 

      AMENDMENT
NO. 12

    

    
      


       

      THIS
CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH
CARE ADMINISTRATION, hereinafter referred to as the "Agency," and HEALTHEASE OF FLORIDA, INC.,
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 now read as
follows:

              


      

    

    
       

      1.         The
Agency's Contract Manager's name, address and telephone number for this Contract
is as follows:

    

    
      	 
      	
              
                 

                Suzanne
      S. Gjevukaj

              

              
                Agency
      for Health Care Administration

              

              
                2727
      Mahan Drive, MS#50

              

              
                Tallahassee,
      FL 32308

              

              
                (850)
      487-2355

              

               

            


    

    
       

      
        	
                2.

              	
                Effective
      March 1, 2009, Attachment I, Scope of Services, is hereby amended to
      include Exhibit 3-E, Medicaid Reform HMO Capitation Rates, March 1, 2009 -
      August 31, 2009, attached hereto and made a part of the Contract. All
      references in the Contract to Exhibit 3-D, Medicaid Reform HMO Capitation
      Rates, September 1, 2008 - August 31, 2009, shall hereinafter also refer
      to Exhibit 3-E, Medicaid Reform HMO Capitation Rates, March 1, 2009 -
      August 31, 2009, 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, is 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 four (4) page Amendment
(including all attachments) to be executed by their officials thereunto duly
authorized.

    

    
      


       

    

    
      	
              HEALTHEASE
      OF FLORIDA, INC.

            	
              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

              

            	
              
                3-E

              

            	
              
                Medicaid
      Reform HMO Capitation Rates

              

              
                March
      1, 2009 - August 31, 2009 (3
Pages)

              

            


    

    
      


       

      AHCA
Contract No. FAR001, Amendment No. 12, Page 1 of 1

    

    
      AHCA Form
2100-0002 (Rev. NOV03)

    


    
      
         


      

      
         


        
          

        

      

      
         


      

    


    
      EXHIBIT
3-E

    

    
      MEDICAID
REFORM HMO CAPITATION RATES

    

    
      
        	
                 
      

              	
                (By
      Area, Age, and Eligibility Category)


              


      

      March 1, 2009 - August 31,
2009

      


    

    
      TABLE
2

    

    
      March 1,
2009

    

    
      	
              Area:

            	
              10

            	 
      	
              County:

            	
              Broward

            	 


    

    
       

      ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)

    

     

    
      	
              
                 

                Eligibility
      Category/ Population

              

            	
              
                 

                Total
      Rates for Comprehensive 

                and
      Catastrophic Components

              

            	
              
                Total
      Rate for 

                Comprehensive
      

                Component
      Only

              

            
	
              
                Children
      and Families:

              

            	 
      	 
      
	
              
                Newborns
      aged 0-2 months

              

            	
              
                $

              

            	
              
                    
      870.65

              

            	
              
                $                752.38

              

            
	
              
                Newborns
      aged 3-11 months

              

            	
              
                $

              

            	
              
                    
      194.87

              

            	
              
                $                185.35

              

            
	
              
                Age
      1 and Up - Base Rate for Risk adjustment

              

            	
              
                $

              

            	
              
                    
      107.38

              

            	
              
                $                105.65

              

            
	 
      
	
              
                Aged
      and Disabled:

              

            	 
      	 
      
	
              
                No
      Medicare

              

            	 
      	 
      
	
              
                Newborns
      aged 0-2 months

              

            	
              
                $

              

            	
              
                17,615.21

              

            	
              
                $             9,196.19

              

            
	
              
                Newborns
      aged 3-11 months

              

            	
              
                $

              

            	
              
                  3,905.88

              

            	
              
                $             2,173.23

              

            
	
              
                Age
      1 and Up - Base Rate for Risk

                Adjustment

              

            	
              
                $

              

            	
              
                    
      791.77

              

            	
              
                $                727.47

              

            
	 
      
	
              
                Medicare
      Parts A and B

              

            	 
      	 
      
	
              
                Under
      Age 65

              

            	
              
                $

              

            	
              
                    
      139.45

              

            	
              
                N/A

              

            
	
              
                Age
      65 and over

              

            	
              
                $

              

            	
              
                      
      99.73

              

            	
              
                N/A

              

            
	 
      
	
              
                Medicare
      Part B Only

              

            	 
      	 
      
	
              
                All
      ages

              

            	
              
                $

              

            	
              
                     265.82

              

            	
              
                N/A

              

            
	
              
                 

              

            
	
              
                HIV/AIDS
      Specialty Population

              

            	 
      	 
      
	
              
                No
      Medicare HIV

              

            	
              
                $

              

            	
              
                 
      1,828.67

              

            	
              
                N/A

              

            
	
              
                No
      Medicare AIDS

              

            	
              
                $

              

            	
              
                 
      3,431.73

              

            	
              
                N/A

              

            
	
              
                Medicare
      HIV

              

            	
              
                $

              

            	
              
                    
      256.73

              

            	
              
                N/A

              

            
	
              
                Medicare
      AIDS

              

            	
              
                $

              

            	
              
                    
      548.09

              

            	
              
                N/A

              

            


    

    
       

    

    
      	
              
                 

                Kick
      Payments Amounts for Covered Obstetrical Delivery
      Services:

                 

              

            
	
              
                CPT
      

                Code

              

            	
              
                 

                Obstetrical
      Delivery CPT Code Description

              

            	
              
                Payment
      

                Amount

              

            
	
              
                59409

              

            	
              
                Vaginal
      delivery only

              

            	
              
                $3,941.45

              

            
	
              
                59410

              

            	
              
                Vaginal
      delivery including postpartum care

              

            
	
              
                59515

              

            	
              
                Cesarean
      delivery including postpartum care

              

            
	
              
                59612

              

            	
              
                Vaginal
      delivery only, after previous cesarean delivery

              

            
	
              
                59614

              

            	
              
                Vaginal
      delivery only, after previous cesarean delivery including postpartum
      care

              

            
	
              
                59622

              

            	
              
                Cesarean
      delivery only, following attempted vaginal delivery after previous
      cesarean delivery inc postpartum
care

              

            


    

    
      


       

      AHCA
Contract No. FAR001, Exhibit 3-E, Page 1 of 3

    


    
      
         


      

      
         


        
          

        

      

      
         


      

    


    
      EXHIBIT
3-E

    

    
      MEDICAID
REFORM HMO CAPITATION RATES

    

    
      
        	
                 
      

              	
                (By
      Area, Age, and Eligibility Category)


              


      

    

    
      March 1, 2009 - August 31, 2009


       

      March 1,
2009

    

    
      	
              Area:

            	
              4

            	 
      	
              County:

            	
              Duval,
      Baker, Clay and Nassau

            	 


    

    
       

       

      (ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)

    

    


     

    
      	
              
                Eligibility
      Category/ Population

              

            	
              
                Total
      Rates for 

                Comprehensive
      and 

                Catastrophic
      Component

              

            	
              
                Total
      Rate for 

                Comprehensive
      

                Component
      Only

              

            
	
              
                Children
      and Families:

              

            	 
      	 
      
	
              
                Newborns
      aged 0-2 months

              

            	
              
                $               897.40

              

            	
              
                $         
            775.51

              

            
	
              
                Newborns
      aged 3-11 months

              

            	
              
                $               197.22

              

            	
              
                $                187.59

              

            
	
              
                Age
      1 and Up - Base Rate for Risk 

                Adjustment

              

            	
              
                $               110.51

              

            	
              
                $                108.73

              

            
	 
      
	
              
                Aged
      and Disabled:

              

            	 
      	 
      
	
              
                No
      Medicare

              

            	 
      	 
      
	
              
                Newborns
      aged 0-2 months

              

            	
              
                $          14,269.34

              

            	
              
                $             7,449.45

              

            
	
              
                Newborns
      aged 3-11 months

              

            	
              
                $       
          3,180.71

              

            	
              
                $             1,769.74

              

            
	
              
                Age
      1 and Up - Base Rate for Risk 

                Adjustment

              

            	
              
                $               612.15
      

              

            	
              
                $                562.43

              

            
	 
      	 
      
	
              
                Medicare
      Parts A and B

              

            	 
      	 
      
	
              
                Under
      Age 65

              

            	
              
                $               158.45

              

            	
              
                N/A

              

            
	
              
                Age
      65 and over

              

            	
              
                $               113.24

              

            	
              
                N/A

              

            
	 
      	 
      
	
              
                Medicare
      Part B Only

              

            	 
      	 
      
	
              
                All
      ages

              

            	
              
                $               327.22

              

            	
              
                N/A

              

            
	 
      	 
      
	
              
                HIV/AIDS
      Specialty Population

              

            	 
      	 
      
	
              
                No
      Medicare HIV

              

            	
              
                $            1,163.67

              

            	
              
                N/A

              

            
	
              
                No
      Medicare AIDS

              

            	
              
                $            2,290.84

              

            	
              
                N/A

              

            
	
              
                Medicare
      HIV

              

            	
              
                $               157.74

              

            	
              
                N/A

              

            
	
              
                Medicare
      AIDS

              

            	
              
                $               336.77

              

            	
              
                N/A

              

            


    

    


     

    
      	
              
                 

                Kick
      Payments Amounts for Covered Obstetrical Delivery
      Services:

                 

              

            
	
              
                CPT
      

                Code

              

            	
              
                 

              

              
                Obstetrical
      Delivery CPT Code Description

              

            	
              
                Payment
      

                Amount

              

            
	
              
                59409

              

            	
              
                Vaginal
      delivery only

              

            	
              
                $3,977.49

              

            
	
              
                59410

              

            	
              
                Vaginal
      delivery including postpartum care

              

            
	
              
                59515

              

            	
              
                Cesarean
      delivery including postpartum care

              

            
	
              
                59612

              

            	
              
                Vaginal
      delivery only, after previous cesarean delivery

              

            
	
              
                59614

              

            	
              
                Vaginal
      delivery only, after previous cesarean delivery including postpartum
      care

              

            
	
              
                59622

              

            	
              
                Cesarean
      delivery only, following attempted vaginal delivery after previous
      cesarean delivery inc postpartum
care

              

            


    

    
      


       

      AHCA
Contract No. FAR001, Exhibit 3-E, Page 2 of 3

    


    
      
         


      

      
         


        
          

        

      

      
         


      

    


    
      EXHIBIT
3-E

    

    
      MEDICAID
REFORM HMO CAPITATION RATES

    

    
      (By Area,
Age, and Eligibility Category)

    

    
      March
1, 2009 - August 31, 2009

    

    
      


       

      March 1,
2009

    

    
       

    

    
      	
              Area:

            	
              10

            	 
      	
              County:

            	
              Broward

            	 


    

    
       

    

    
      	
              Area:

            	
              4

            	 
      	
              County:

            	
              Duval,
      Baker, Clay and Nassau

            	 


    

    
       

    

    
      	
              
                CPT


                Code

              

            	
              
                Transplant CPT Code
      Description

              

            	
              
                Children/Adolescents    or
      

                Adult

              

            	
              
                Payment
      

                Amount

              

            
	
              
                32851

              

            	
              
                lung
      single, without bypass

              

            	
              
                Children/Adolescents

              

            	
              
                $320,800.00

              

            
	
              
                32851

              

            	
              
                lung
      single, without bypass

              

            	
              
                Adult

              

            	
              
                $238,000.00

              

            
	
              
                32852

              

            	
              
                lung
      single, with bypass

              

            	
              
                Children/Adolescents

              

            	
              
                $320,800.00

              

            
	
              
                32852

              

            	
              
                lung
      single, with bypass

              

            	
              
                Adult

              

            	
              
                $238,000.00

              

            
	
              
                32853

              

            	
              
                lung
      double, without bypass

              

            	
              
                Children/Adolescents

              

            	
              
                $320,800.00

              

            
	
              
                32853

              

            	
              
                lung
      double, without bypass

              

            	
              
                Adult

              

            	
              
                $238,000.00

              

            
	
              
                32854

              

            	
              
                lung
      double, with bypass

              

            	
              
                Children/Adolescents

              

            	
              
                $320,800.00

              

            
	
              
                32854

              

            	
              
                lung
      double, with bypass

              

            	
              
                Adult

              

            	
              
                $238,000.00

              

            
	
              
                33945

              

            	
              
                heart
      transplant with or without recipient cardiectomy

              

            	
              
                All
      Age Groups

              

            	
              
                $162,000.00

              

            
	
              
                47135

              

            	
              
                liver,
      allotransplation, orthotopic, partial or whole from cadaver or living
      donor

              

            	
              
                All
      Age Groups

              

            	
              
                $122,600.00

              

            
	
              
                47136

              

            	
              
                liver,
      heterotopic, partial or whole from cadaver or living donor any
      age

              

            	
              
                All
      Age Groups

              

            	
              
                $122,600.00

              

            


    

    
      


       

      REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK

    

    
      


       

      AHCA
Contract No. FAR001, Exhibit 3-E, Page 3 of 3