exv10w2






Exhibit 10.2




			
	 	 	 
	Amerigroup Florida, Inc. 

d/b/a Amerigroup Community Care
	 	Medicaid HMO Contract






AHCA CONTRACT NO. FA614

AMENDMENT NO. 13



THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,
hereinafter referred to as the “Agency” and AMERIGROUP FLORIDA, INC. D/B/A AMERIGROUP COMMUNITY
CARE, 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:


Felicia Wilhelmy

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 I-E, Fifth Revised Maximum Enrollment Levels, attached hereto and made a part of
the Contract. All references in the Contract to Exhibit I-D, Fourth Revised Maximum
Enrollment Levels, shall hereinafter also refer to Exhibit I-E, Fifth Revised Maximum
Enrollment Levels, as appropriate.
	 
	3.	 	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 a part of the Contract.



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



REMAINDER OF PAGE INTENTIONALLY LEFT BLANK




AHCA Contract No. FA614, Amendment No. 13, Page 1 of 2




 









 





			
	Amerigroup Florida, Inc. 

d/b/a Amerigroup Community Care
	 	Medicaid HMO Contract






     IN WITNESS WHEREOF, the parties hereto have caused this eight (8) page Amendment (which
includes all attachments hereto) to be executed by their officials thereunto duly authorized.



	 	 	 	 	 	 	 	 	 	 	 	 	 
	AMERIGROUP FLORIDA, INC. 

D/B/A/ AMERIGROUP COMMUNITY
CARE	 	STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 
	Signed By:	 	/s/ William L. McHugh	 	Signed By:	 	/s/ Holly Benson	 	 
	 	 	 	 	 	 	 	 	 
	 

	 	NAME:
	 	William L. McHugh
	 	 	 	NAME:
	 	Holly Benson	 	 
	 

	 	TITLE:
	 	CEO
	 	 	 	TITLE:
	 	Secretary	 	 
	 

	 	DATE:
	 	3/20/09
	 	 	 	DATE:
	 	3/26/09	 	 






List of Attachments/Exhibits included as part of this Amendment:




	 	 	 	 	 
	Specify	 	Letter/	 	 
	Type	 	Number	 	Description
	Exhibit

	 	I-E
	 	Fifth Revised Maximum Enrollment Levels (1 Page)
	Exhibit

	 	III- F
	 	March 1, 2009 — August 31, 2009 Medicaid Non-Reform
HMO Capitation RatesS (5 Pages)






REMAINDER OF PAGE INTENTIONALLY LEFT BLANK




AHCA Contract No. FA614, Amendment No. 13, Page 2 of 2




 









 





			
	Amerigroup Florida, Inc. 

d/b/a Amerigroup Community Care
	 	Medicaid HMO Contract






EXHIBIT I-E




FIFTH REVISED MAXIMUM ENROLLMENT LEVELS




TABLE 1

FOURTH REVISED ENROLLMENT LEVELS




	 	 	 	 	 
	County	 	Maximum Enrollment Level
	Brevard
	 	 	8,000	 
	Broward
	 	 	14,000	 
	Miami-Dade
	 	 	25,000	 
	Hernando
	 	 	8,000	 
	Hillsborough
	 	 	40,000	 
	Lake
	 	 	8,000	 
	Lee
	 	 	18,000	 
	Manatee
	 	 	8,000	 
	Orange
	 	 	30,000	 
	Osceola
	 	 	8,500	 
	Pasco
	 	 	15,000	 
	Pinellas
	 	 	25,000	 
	Polk
	 	 	30,000	 
	Sarasota
	 	 	8,000	 
	Seminole
	 	 	8,000	 
	Volusia
	 	 	8,000	 






REMAINDER OF PAGE INTENTIONALLY LEFT BLANK




AHCA Contract No. FA614, Exhibit I-E, Page 1 of 1




 









 







			
	Amerigroup Florida, Inc. 

d/b/a Amerigroup Community Care
	 	Medicaid HMO Contract






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	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	AGE (14-20)	 	 	 	 	 	AGE (21-54)	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-N	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-AB	 	 
	Area	 	BTHM0+2M0	 	3M0.11MO	 	AGE (1-5)	 	AGE (6-13)	 	Female	 	Male	 	Female	 	Male	 	AGE (55+)	 	BTHMO+2M0	 	3M0-11MO	 	AGE (1-5)	 	AGE (6-13)	 	AGE (14-20)	 	AGE (21-54)	 	AGE (55+)	 	SSI-B	 	AGE (65-)	 	AGE (65+)
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	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	 	 	 	249.97	 	 	 	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	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	AGE (14-20)	 	 	 	 	 	AGE (21-54)	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-N	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-AB	 	 
	Area	 	BTHM0+2M0	 	3M0.11MO	 	AGE (1-5)	 	AGE (6-13)	 	Female	 	Male	 	Female	 	Male	 	AGE (55+)	 	BTHMO+2M0	 	3M0-11MO	 	AGE (1-5)	 	AGE (6-13)	 	AGE (14-20)	 	AGE (21-54)	 	AGE (55+)	 	SSI-B	 	AGE (65-)	 	AGE (65+)
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	01
	 	 	1,094.24	 	 	 	184.16	 	 	 	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	 	 	 	184.16	 	 	 	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	 	 	 	202.96	 	 	 	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	 	 	 	791.96	 	 	 	341.43	 	 	 	97.29	 	 	 	89.40	 
	04
	 	 	1,049.15	 	 	 	178.79	 	 	 	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	 	 	 	97.45	 
	05
	 	 	1,194.07	 	 	 	202.97	 	 	 	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	 	 	 	178.07	 	 	 	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	 	 	 	183.63	 	 	 	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	 	 	 	174.04	 	 	 	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	 	 	 	332.60	 	 	 	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	 	 	 	1,617.72	 	 	 	483.09	 	 	 	261.35	 	 	 	271.58	 	 	 	834.41	 	 	 	801.07	 	 	 	271.50	 	 	 	81.77	 	 	 	75.20	 






AHCA Contract No. FA614, Exhibit III-F, Page 1 of 1

















 






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 + MH + Dental Rates:




	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	TANF	 	 	 	 	 	 	 	 	 	 	 	 	 	AGE (14-20)	 	 	 	 	 	AGE (21.54)	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-N	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-AB
	Area	 	BTHM0+2M0	 	3M0.11MO	 	AGE (1-5)	 	AGE (6-13)	 	Female	 	Male	 	Female	 	Male	 	AGE (55+)	 	BTHMO+2M0	 	3M0-11MO	 	AGE (1-5)	 	AGE (6-13)	 	AGE (14-20)	 	AGE (21-54)	 	AGE (55+)	 	SSI-B	 	AGE (65-)	 	AGE (65+)
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	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	 	 	 	256.39	 	 	 	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	 	 	 	151.66	 	 	 	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 + Mental Health + Transportation Rates:




	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	TANF	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	AGE (14-20)	 	 	 	 	 	AGE (21-54)	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-N	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-AB
	Area	 	BTHM0+2M0	 	3M0.11MO	 	AGE (1-5)	 	AGE (6-13)	 	Female	 	Male	 	Female	 	Male	 	AGE (55+)	 	BTHMO+2M0	 	3M0-11MO	 	AGE (1-5)	 	AGE (6-13)	 	AGE (14-20)	 	AGE (21-54)	 	AGE (55+)	 	SSI-B	 	AGE (65-)	 	AGE (65+)
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	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	 	 	 	160.19	 	 	 	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. FA614, Exhibit III-F, Page 2 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 5




General + Transportation Rates:




	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	TANF	 	 	 	 	 	 	 	 	 	 	 	 	 	AGE (14-20)	 	 	 	 	 	AGE (21.54)	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-N	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-AB
	Area	 	BTHM0+2M0	 	3M0.11MO	 	AGE (1-5)	 	AGE (6-13)	 	Female	 	Male	 	Female	 	Male	 	AGE (55+)	 	BTHMO+2M0	 	3M0-11MO	 	AGE (1-5)	 	AGE (6-13)	 	AGE (14-20)	 	AGE (21-54)	 	AGE (55+)	 	SSI-B	 	AGE (65-)	 	AGE (65+)
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	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	 	 	 	 	 	 	 	 	 	 	 	 	 	AGE (14-20)	 	 	 	 	 	AGE (21-54)	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-N	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-AB
	Area	 	BTHM0+2M0	 	3M0.11MO	 	AGE (1-5)	 	AGE (6-13)	 	Female	 	Male	 	Female	 	Male	 	AGE (55+)	 	BTHMO+2M0	 	3M0-11MO	 	AGE (1-5)	 	AGE (6-13)	 	AGE (14-20)	 	AGE (21-54)	 	AGE (55+)	 	SSI-B	 	AGE (65-)	 	AGE (65+)
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	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	 	 	 	10,969.71	 	 	 	1,617.06	 	 	 	479.69	 	 	 	224.51	 	 	 	237.61	 	 	 	764.51	 	 	 	774.47	 	 	 	271.94	 	 	 	80.16	 	 	 	73.06	 






AHCA Contract No. FA614, 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	 	 	 	 	 	 	 	 	 	 	 	 	 	AGE (14-20)	 	 	 	 	 	AGE (21.54)	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-N	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-AB
	Area	 	BTHM0+2M0	 	3M0.11MO	 	AGE (1-5)	 	AGE (6-13)	 	Female	 	Male	 	Female	 	Male	 	AGE (55+)	 	BTHMO+2M0	 	3M0-11MO	 	AGE (1-5)	 	AGE (6-13)	 	AGE (14-20)	 	AGE (21-54)	 	AGE (55+)	 	SSI-B	 	AGE (65-)	 	AGE (65+)
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	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	 	 	 	 	 	 	 	 	 	 	 	 	 	AGE (14-20)	 	 	 	 	 	AGE (21-54)	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-N	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-AB
	Area	 	BTHM0+2M0	 	3M0.11MO	 	AGE (1-5)	 	AGE (6-13)	 	Female	 	Male	 	Female	 	Male	 	AGE (55+)	 	BTHMO+2M0	 	3M0-11MO	 	AGE (1-5)	 	AGE (6-13)	 	AGE (14-20)	 	AGE (21-54)	 	AGE (55+)	 	SSI-B	 	AGE (65-)	 	AGE (65+)
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	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	 	 	 	787.53	 	 	 	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	 	 	 	322.26	 	 	 	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. FA614, 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, Marlon, Putnam, Sumter, Suwannee, Union
	 
	 	 
	Area 4

	 	Baker, Clay, Duval, Flagler, Nassau, St. Johns, Volusia
	 
	 	 
	Area 5

	 	Pasco, Pinellas
	 
	 	 
	Area 6

	 	Hardee, Highlands, Hillsborough, Manatee, Polk
	 
	 	 
	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. FA614, Exhibit III-F, Page 5 of 5