Ex101FLMMA8K


Back to Form 8-K


WellCare of Florida, Inc.
d/b/a Staywell Health Plan of Florida
Exhibit 10.1


ATTACHMENT I
EXHIBIT I-C
MANAGED CARE PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS.
REGION 2
	
																									
	REGION 2
	 
	HIV/AIDS
	Long-Term Care Program

	Age Band
	TANF
	SSI No Medicare
	Dual Eligible
	Child Welfare
	Dual Eligible
	Medicaid Only
	Dual Eligible
	Medicaid Only

	0-2 Months
	

	$1,305.22
	

	

	$20,746.91
	

	 
	

	$1,469.88
	

	 
	 
	 
	 

	3-11 Months
	

	$183.63
	

	

	$3,944.76
	

	 
	

	$421.03
	

	 
	 
	 
	 

	1-13 Years
	

	$107.01
	

	

	$355.36
	

	 
	

	$336.22
	

	 
	 
	 
	 

	14-54 Years Female
	

	$322.68
	

	 
	 
	 
	 
	 
	 
	 

	14-54 Years Male
	

	$131.26
	

	 
	 
	 
	 
	 
	 
	 

	14+ Years (Female and Male)
	 
	

	$791.75
	

	 
	

	$622.98
	

	 
	 
	 
	 

	55+ Years (Female and Male)
	

	$355.85
	

	 
	 
	 
	 
	 
	 
	 

	Under Age 65
	 
	 
	

	$161.30
	

	 
	 
	 
	

	$296.95
	

	

	$2,053.17
	


	Age 65+
	 
	 
	

	$111.44
	

	 
	 
	 
	

	$163.46
	

	

	$1,381.41
	


	Medicare Advantage/D-SNP
	 
	 
	TBD
	

	 
	 
	 
	 
	 

	HIV-AIDS
	 
	 
	 
	 
	

	$162.00
	

	

	$2,750.00
	

	 
	 






_______________
1.    This exhibit reflects the negotiated standard plan rates with the draft age factors provided in the ITN applied.  Final rates will be adjusted for effective time period for the region, changes in hospital rates, CHIP transition children, and any other program changes that may occur prior to implementation.
2.    A factor of 0.9 will be applied to the LTC Dual Eligible and LTC Medicaid Only rates for individuals enrolled in both the MMA and LTC components of a comprehensive plan.
3.    Rates shown reflect base rates and do not include the impacts of risk adjustment.


REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FP020, Attachment I, Exhibit I-C, Page 1 of 8




WellCare of Florida, Inc.
d/b/a Staywell Health Plan of Florida




ATTACHMENT I
EXHIBIT I-C
MANAGED CARE PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS.
REGION 3
	
																									
	REGION 3
	 
	HIV/AIDS
	Long-Term Care Program

	Age Band
	TANF
	SSI No Medicare
	Dual Eligible
	Child Welfare
	Dual Eligible
	Medicaid Only
	Dual Eligible
	Medicaid Only

	0-2 Months
	

	$1,524.23
	

	

	$24,932.62
	

	 
	

	$1,528.29
	

	 
	 
	 
	 

	3-11 Months
	

	$214.44
	

	

	$4,740.62
	

	 
	

	$437.76
	

	 
	 
	 
	 

	1-13 Years
	

	$124.97
	

	

	$427.05
	

	 
	

	$349.58
	

	 
	 
	 
	 

	14-54 Years Female
	

	$376.83
	

	 
	 
	 
	 
	 
	 
	 

	14-54 Years Male
	

	$153.28
	

	 
	 
	 
	 
	 
	 
	 

	14+ Years (Female and Male)
	 
	

	$951.48
	

	 
	

	$647.73
	

	 
	 
	 
	 

	55+ Years (Female and Male)
	

	$415.56
	

	 
	 
	 
	 
	 
	 
	 

	Under Age 65
	 
	 
	

	$158.08
	

	 
	 
	 
	

	$304.95
	

	

	$2,393.91
	


	Age 65+
	 
	 
	

	$109.22
	

	 
	 
	 
	

	$167.86
	

	

	$1,610.66
	


	Medicare Advantage/D-SNP
	 
	 
	TBD
	

	 
	 
	 
	 
	 

	HIV-AIDS
	 
	 
	 
	 
	

	$190.00
	

	

	$2,800.00
	

	 
	 






_______________
1.    This exhibit reflects the negotiated standard plan rates with the draft age factors provided in the ITN applied.  Final rates will be adjusted for effective time period for the region, changes in hospital rates, CHIP transition children, and any other program changes that may occur prior to implementation.
2.    A factor of 0.9 will be applied to the LTC Dual Eligible and LTC Medicaid Only rates for individuals enrolled in both the MMA and LTC components of a comprehensive plan.
3.    Rates shown reflect base rates and do not include the impacts of risk adjustment.


REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FP020, Attachment I, Exhibit I-C, Page 2 of 8


WellCare of Florida, Inc.
d/b/a Staywell Health Plan of Florida




ATTACHMENT I
EXHIBIT I-C
MANAGED CARE PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS.
REGION 4
	
																									
	REGION 4
	 
	HIV/AIDS
	Long-Term Care Program

	Age Band
	TANF
	SSI No Medicare
	Dual Eligible
	Child Welfare
	Dual Eligible
	Medicaid Only
	Dual Eligible
	Medicaid Only

	0-2 Months
	

	$1,367.96
	

	

	$24,570.90
	

	 
	

	$1,759.83
	

	 
	 
	 
	 

	3-11 Months
	

	$192.45
	

	

	$4,671.84
	

	 
	

	$504.08
	

	 
	 
	 
	 

	1-13 Years
	

	$112.16
	

	

	$420.86
	

	 
	

	$402.54
	

	 
	 
	 
	 

	14-54 Years Female
	

	$338.19
	

	 
	 
	 
	 
	 
	 
	 

	14-54 Years Male
	

	$137.57
	

	 
	 
	 
	 
	 
	 
	 

	14+ Years (Female and Male)
	 
	

	$937.68
	

	 
	

	$745.86
	

	 
	 
	 
	 

	55+ Years (Female and Male)
	

	$372.96
	

	 
	 
	 
	 
	 
	 
	 

	Under Age 65
	 
	 
	

	$179.37
	

	 
	 
	 
	

	$294.88
	

	

	$2,571.25
	


	Age 65+
	 
	 
	

	$123.93
	

	 
	 
	 
	

	$162.32
	

	

	$1,729.98
	


	Medicare Advantage/D-SNP
	 
	 
	TBD
	

	 
	 
	 
	 
	 

	HIV-AIDS
	 
	 
	 
	 
	

	$160.00
	

	

	$2,550.00
	

	 
	 






_______________
1.    This exhibit reflects the negotiated standard plan rates with the draft age factors provided in the ITN applied.  Final rates will be adjusted for effective time period for the region, changes in hospital rates, CHIP transition children, and any other program changes that may occur prior to implementation.
2.    A factor of 0.9 will be applied to the LTC Dual Eligible and LTC Medicaid Only rates for individuals enrolled in both the MMA and LTC components of a comprehensive plan.
3.    Rates shown reflect base rates and do not include the impacts of risk adjustment.


REMAINDER OF PAGE INTENTIONALLY LEFT BLANK



AHCA Contract No. FP020, Attachment I, Exhibit I-C, Page 3 of 8


WellCare of Florida, Inc.
d/b/a Staywell Health Plan of Florida




ATTACHMENT I
EXHIBIT I-C
MANAGED CARE PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS.
REGION 5
	
																									
	REGION 5
	 
	HIV/AIDS
	Long-Term Care Program

	Age Band
	TANF
	SSI No Medicare
	Dual Eligible
	Child Welfare
	Dual Eligible
	Medicaid Only
	Dual Eligible
	Medicaid Only

	0-2 Months
	

	$1,731.48
	

	

	$27,327.79
	

	 
	

	$2,112.01
	

	 
	 
	 
	 

	3-11 Months
	

	$243.60
	

	

	$5,196.03
	

	 
	

	$604.96
	

	 
	 
	 
	 

	1-13 Years
	

	$141.96
	

	

	$468.08
	

	 
	

	$483.10
	

	 
	 
	 
	 

	14-54 Years Female
	

	$428.06
	

	 
	 
	 
	 
	 
	 
	 

	14-54 Years Male
	

	$174.13
	

	 
	 
	 
	 
	 
	 
	 

	14+ Years (Female and Male)
	 
	

	$1,042.89
	

	 
	

	$895.12
	

	 
	 
	 
	 

	55+ Years (Female and Male)
	

	$472.07
	

	 
	 
	 
	 
	 
	 
	 

	Under Age 65
	 
	 
	

	$135.35
	

	 
	 
	 
	

	$283.14
	

	

	$2,592.37
	


	Age 65+
	 
	 
	

	$93.52
	

	 
	 
	 
	

	$155.86
	

	

	$1,744.19
	


	Medicare Advantage/D-SNP
	 
	 
	TBD
	

	 
	 
	 
	 
	 

	HIV-AIDS
	 
	 
	 
	 
	

	$158.00
	

	

	$3,000.00
	

	 
	 






_______________
1.    This exhibit reflects the negotiated standard plan rates with the draft age factors provided in the ITN applied.  Final rates will be adjusted for effective time period for the region, changes in hospital rates, CHIP transition children, and any other program changes that may occur prior to implementation.
2.    A factor of 0.9 will be applied to the LTC Dual Eligible and LTC Medicaid Only rates for individuals enrolled in both the MMA and LTC components of a comprehensive plan.
3.    Rates shown reflect base rates and do not include the impacts of risk adjustment.


REMAINDER OF PAGE INTENTIONALLY LEFT BLANK



AHCA Contract No. FP020, Attachment I, Exhibit I-C, Page 4 of 8


WellCare of Florida, Inc.
d/b/a Staywell Health Plan of Florida




ATTACHMENT I
EXHIBIT I-C
MANAGED CARE PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS.
REGION 6
	
																									
	REGION 6
	 
	HIV/AIDS
	Long-Term Care Program

	Age Band
	TANF
	SSI No Medicare
	Dual Eligible
	Child Welfare
	Dual Eligible
	Medicaid Only
	Dual Eligible
	Medicaid Only

	0-2 Months
	

	$1,506.57
	

	

	$24,186.03
	

	 
	

	$1,574.26
	

	 
	 
	 
	 

	3-11 Months
	

	$211.95
	

	

	$4,598.67
	

	 
	

	$450.93
	

	 
	 
	 
	 

	1-13 Years
	

	$123.52
	

	

	$414.27
	

	 
	

	$360.10
	

	 
	 
	 
	 

	14-54 Years Female
	

	$372.46
	

	 
	 
	 
	 
	 
	 
	 

	14-54 Years Male
	

	$151.51
	

	 
	 
	 
	 
	 
	 
	 

	14+ Years (Female and Male)
	 
	

	$922.99
	

	 
	

	$667.22
	

	 
	 
	 
	 

	55+ Years (Female and Male)
	

	$410.75
	

	 
	 
	 
	 
	 
	 
	 

	Under Age 65
	 
	 
	

	$131.77
	

	 
	 
	 
	

	$290.00
	

	

	$2,503.12
	


	Age 65+
	 
	 
	

	$91.04
	

	 
	 
	 
	

	$159.63
	

	

	$1,684.14
	


	Medicare Advantage/D-SNP
	 
	 
	TBD
	

	 
	 
	 
	 
	 

	HIV-AIDS
	 
	 
	 
	 
	

	$168.00
	

	

	$3,050.00
	

	 
	 






_______________
1.    This exhibit reflects the negotiated standard plan rates with the draft age factors provided in the ITN applied.  Final rates will be adjusted for effective time period for the region, changes in hospital rates, CHIP transition children, and any other program changes that may occur prior to implementation.
2.    A factor of 0.9 will be applied to the LTC Dual Eligible and LTC Medicaid Only rates for individuals enrolled in both the MMA and LTC components of a comprehensive plan.
3.    Rates shown reflect base rates and do not include the impacts of risk adjustment.


REMAINDER OF PAGE INTENTIONALLY LEFT BLANK



AHCA Contract No. FP020, Attachment I, Exhibit I-C, Page 5 of 8


WellCare of Florida, Inc.
d/b/a Staywell Health Plan of Florida




ATTACHMENT I
EXHIBIT I-C
MANAGED CARE PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS.
REGION 7
	
																									
	REGION 7
	 
	HIV/AIDS
	Long-Term Care Program

	Age Band
	TANF
	SSI No Medicare
	Dual Eligible
	Child Welfare
	Dual Eligible
	Medicaid Only
	Dual Eligible
	Medicaid Only

	0-2 Months
	

	$1,404.70
	

	

	$24,057.01
	

	 
	

	$1,802.88
	

	 
	 
	 
	 

	3-11 Months
	

	$197.62
	

	

	$4,574.13
	

	 
	

	$516.42
	

	 
	 
	 
	 

	1-13 Years
	

	$115.17
	

	

	$412.06
	

	 
	

	$412.39
	

	 
	 
	 
	 

	14-54 Years Female
	

	$347.28
	

	 
	 
	 
	 
	 
	 
	 

	14-54 Years Male
	

	$141.26
	

	 
	 
	 
	 
	 
	 
	 

	14+ Years (Female and Male)
	 
	

	$918.07
	

	 
	

	$764.11
	

	 
	 
	 
	 

	55+ Years (Female and Male)
	

	$382.97
	

	 
	 
	 
	 
	 
	 
	 

	Under Age 65
	 
	 
	

	$132.24
	

	 
	 
	 
	

	$289.80
	

	

	$2,705.38
	


	Age 65+
	 
	 
	

	$91.37
	

	 
	 
	 
	

	$159.53
	

	

	$1,820.23
	


	Medicare Advantage/D-SNP
	 
	 
	TBD
	

	 
	 
	 
	 
	 

	HIV-AIDS
	 
	 
	 
	 
	

	$168.00
	

	

	$2,925.00
	

	 
	 






_______________
1.    This exhibit reflects the negotiated standard plan rates with the draft age factors provided in the ITN applied.  Final rates will be adjusted for effective time period for the region, changes in hospital rates, CHIP transition children, and any other program changes that may occur prior to implementation.
2.    A factor of 0.9 will be applied to the LTC Dual Eligible and LTC Medicaid Only rates for individuals enrolled in both the MMA and LTC components of a comprehensive plan.
3.    Rates shown reflect base rates and do not include the impacts of risk adjustment.


REMAINDER OF PAGE INTENTIONALLY LEFT BLANK



AHCA Contract No. FP020, Attachment I, Exhibit I-C, Page 6 of 8


WellCare of Florida, Inc.
d/b/a Staywell Health Plan of Florida




ATTACHMENT I
EXHIBIT I-C
MANAGED CARE PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS.
REGION 8
	
																									
	REGION 8
	 
	HIV/AIDS
	Long-Term Care Program

	Age Band
	TANF
	SSI No Medicare
	Dual Eligible
	Child Welfare
	Dual Eligible
	Medicaid Only
	Dual Eligible
	Medicaid Only

	0-2 Months
	

	$1,505.48
	

	

	$25,939.47
	

	 
	

	$1,391.90
	

	 
	 
	 
	 

	3-11 Months
	

	$211.80
	

	

	$4,932.06
	

	 
	

	$398.70
	

	 
	 
	 
	 

	1-13 Years
	

	$123.43
	

	

	$444.30
	

	 
	

	$318.38
	

	 
	 
	 
	 

	14-54 Years Female
	

	$372.19
	

	 
	 
	 
	 
	 
	 
	 

	14-54 Years Male
	

	$151.40
	

	 
	 
	 
	 
	 
	 
	 

	14+ Years (Female and Male)
	 
	

	$989.91
	

	 
	

	$589.93
	

	 
	 
	 
	 

	55+ Years (Female and Male)
	

	$410.45
	

	 
	 
	 
	 
	 
	 
	 

	Under Age 65
	 
	 
	

	$139.16
	

	 
	 
	 
	

	$238.14
	

	

	$2,387.98
	


	Age 65+
	 
	 
	

	$96.15
	

	 
	 
	 
	

	$131.09
	

	

	$1,606.67
	


	Medicare Advantage/D-SNP
	 
	 
	TBD
	

	 
	 
	 
	 
	 

	HIV-AIDS
	 
	 
	 
	 
	

	$172.00
	

	

	$2,950.00
	

	 
	 






_______________
1.    This exhibit reflects the negotiated standard plan rates with the draft age factors provided in the ITN applied.  Final rates will be adjusted for effective time period for the region, changes in hospital rates, CHIP transition children, and any other program changes that may occur prior to implementation.
2.    A factor of 0.9 will be applied to the LTC Dual Eligible and LTC Medicaid Only rates for individuals enrolled in both the MMA and LTC components of a comprehensive plan.
3.    Rates shown reflect base rates and do not include the impacts of risk adjustment.


REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FP020, Attachment I, Exhibit I-C, Page 7 of 8


WellCare of Florida, Inc.
d/b/a Staywell Health Plan of Florida




ATTACHMENT I
EXHIBIT I-C
MANAGED CARE PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS.
REGION 11
	
																									
	REGION 11
	 
	HIV/AIDS
	Long-Term Care Program

	Age Band
	TANF
	SSI No Medicare
	Dual Eligible
	Child Welfare
	Dual Eligible
	Medicaid Only
	Dual Eligible
	Medicaid Only

	0-2 Months
	

	$1,582.86
	

	

	$29,647.73
	

	 
	

	$2,292.43
	

	 
	 
	 
	 

	3-11 Months
	

	$222.69
	

	

	$5,637.14
	

	 
	

	$656.64
	

	 
	 
	 
	 

	1-13 Years
	

	$129.78
	

	

	$507.82
	

	 
	

	$524.37
	

	 
	 
	 
	 

	14-54 Years Female
	

	$391.32
	

	 
	 
	 
	 
	 
	 
	 

	14-54 Years Male
	

	$159.18
	

	 
	 
	 
	 
	 
	 
	 

	14+ Years (Female and Male)
	 
	

	$1,131.42
	

	 
	

	$971.60
	

	 
	 
	 
	 

	55+ Years (Female and Male)
	

	$431.55
	

	 
	 
	 
	 
	 
	 
	 

	Under Age 65
	 
	 
	

	$178.07
	

	 
	 
	 
	

	$289.82
	

	

	$2,787.50
	


	Age 65+
	 
	 
	

	$123.03
	

	 
	 
	 
	

	$159.53
	

	

	$1,875.48
	


	Medicare Advantage/D-SNP
	 
	 
	TBD
	

	 
	 
	 
	 
	 

	HIV-AIDS
	 
	 
	 
	 
	

	$165.00
	

	

	$3,525.00
	

	 
	 






_______________
1.    This exhibit reflects the negotiated standard plan rates with the draft age factors provided in the ITN applied.  Final rates will be adjusted for effective time period for the region, changes in hospital rates, CHIP transition children, and any other program changes that may occur prior to implementation.
2.    A factor of 0.9 will be applied to the LTC Dual Eligible and LTC Medicaid Only rates for individuals enrolled in both the MMA and LTC components of a comprehensive plan.
3.    Rates shown reflect base rates and do not include the impacts of risk adjustment.


REMAINDER OF PAGE INTENTIONALLY LEFT BLANK



AHCA Contract No. FP020, Attachment I, Exhibit I-C, Page 8 of 8