EX-10.1






AHCA CONTRACT NO. FA523




AMENDMENT NO. 6




THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE
ADMINISTRATION, hereinafter referred to as the “Agency” and AMERIGROUP FLORIDA, INC., hereinafter
referred to as the “Vendor”, is hereby amended as follows:



1. Standard Contract, Section II.A, Contract Amount, the first sentence is hereby amended to now
read:



To pay for contracted services according to the conditions of Attachment I in an amount not
to exceed $668,923,610.00, (an increase of $2,139,090.00), subject to the availability of
funds.




	 	2.	 	Attachment I, section 90.0, Payment and Authorized Enrollment Levels, Table 2 is hereby
amended to read as follows:





	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Table 2.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Area wide Age-banded Capitation Rates for All Agency Areas of the State other than Areas 5, 6, 7, and 8.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Area 09
	 	 	 	 	 	General Rates              
	 	 	 	 	 	 	 	 	 	Plan -                     
	 	015005310(PALM BEACH)	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 		1-5		 		6-13		 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 		55-64		 		65+	
	TANF/FC/SOBRA
	 		316.78		 		70.74		 		44.52		 		49.17		 		101.48		 		125.24		 		190.60		 		266.97		 		266.97	
	SSI/No Medicare
	 		3344.05		 		405.22		 		211.12		 		221.15		 		221.15		 		633.22		 		633.22		 		610.93		 		610.93	
	SSI/Part B
	 		267.20		 		267.20		 		267.20		 		267.20		 		267.20		 		267.20		 		267.20		 		267.20		 		267.20	
	SSI/Part A & B
	 		320.32		 		320.32		 		320.32		 		320.32		 		320.32		 		320.32		 		320.32		 		320.32		 		224.19	
	Area 10
	 	 	 	 	 	General Rates              
	 	 	 	 	 	Plan -                     
	 	015005311(BROWARD)	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 		1-5		 		6-13		 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 		55-64		 		65+	
	TANF/FC/SOBRA
	 		328.74		 		73.77		 		46.68		 		51.61		 		105.94		 		131.31		 		199.49		 		280.33		 		280.33	
	SSI/No Medicare
	 		4151.82		 		503.54		 		263.75		 		275.32		 		275.32		 		788.23		 		788.23		 		761.08		 		761.08	
	SSI/Part B
	 		287.04		 		287.04		 		287.04		 		287.04		 		287.04		 		287.04		 		287.04		 		287.04		 		287.04	
	SSI/Part A & B
	 		351.55		 		351.55		 		351.55		 		351.55		 		351.55		 		351.55		 		351.55		 		351.55		 		245.95	
	Area 11
	 	 	 	 	 	General Rates              
	 	 	 	 	 	Plan -                     
	 	015005312(DADE)	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 		1-5		 		6-13		 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 		55-64		 		65+	
	TANF/FC/SOBRA
	 		409.16		 		91.08		 		56.97		 		62.97		 		130.55		 		160.40		 		244.76		 		341.98		 		341.98	
	SSI/No Medicare
	 		4551.55		 		550.33		 		286.57		 		299.62		 		299.62		 		857.90		 		857.90		 		827.83		 		827.83	
	SSI/Part B
	 		449.17		 		449.17		 		449.17		 		449.17		 		449.17		 		449.17		 		449.17		 		449.17		 		449.17	
	SSI/Part A & B
	 		416.90		 		416.90		 		416.90		 		416.90		 		416.90		 		416.90		 		416.90		 		416.90		 		292.00	








	 	3.	 	Attachment I, section 90.0, Payment and Authorized Enrollment Levels, Table 3 is hereby
amended to read as follows:





Table 3



Area



Age-banded Capitation Rates, Including Community Mental Health and Mental Health Targeted
Case Management



Table 3.


Areas 5, 6, 7, and 8 Age-banded Capitation Rates, Including Community Mental Health and Mental
Health Targeted Case Management



Area 05 General Rates plus Mental Health Plan — 015005304(PASCO) 015005305(PINELLAS)




<1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+



	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	TANF/FC/SOBRA
	 	 	345.77	 	 	 	79.28	 	 	 	51.94	 	 	 	57.32      114.37	 	 	 	139.01	 	 	 	210.44	 	 	 	291.84	 	 	 	291.84	 
	SSI/No Medicare
	 	 	3265.63	 	 	 	429.24	 	 	 	240.86	 	 	 	235.59      235.59	 	 	 	628.37	 	 	 	628.37	 	 	 	594.95	 	 	 	594.95	 
	SSI/Part B
	 	 	266.87	 	 	 	266.87	 	 	 	266.87	 	 	 	266.87      266.87	 	 	 	266.87	 	 	 	266.87	 	 	 	266.87	 	 	 	266.87	 
	SSI/Part A & B
	 	 	318.72	 	 	 	318.72	 	 	 	318.72	 	 	 	318.72      318.72	 	 	 	318.72	 	 	 	318.72	 	 	 	318.72	 	 	 	225.77	 







Area 06 General Rates plus Mental Health Plan — 015005300(HILLSBOROUGH) 015005307(POLK)
015005318(MANATEE)




<1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+



	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	TANF/FC/SOBRA
	 	 	330.07	 	 	 	75.91	 	 	 	61.92	 	 	 	67.67      122.23	 	 	 	135.83	 	 	 	204.29	 	 	 	282.98	 	 	 	282.98	 
	SSI/No Medicare
	 	 	3017.05	 	 	 	371.69	 	 	 	265.72	 	 	 	243.82      243.82	 	 	 	647.81	 	 	 	647.81	 	 	 	587.26	 	 	 	587.26	 
	SSI/Part B
	 	 	242.29	 	 	 	242.29	 	 	 	242.29	 	 	 	242.29      242.29	 	 	 	242.29	 	 	 	242.29	 	 	 	242.29	 	 	 	242.29	 
	SSI/Part A & B
	 	 	288.09	 	 	 	288.09	 	 	 	288.09	 	 	 	288.09      288.09	 	 	 	288.09	 	 	 	288.09	 	 	 	288.09	 	 	 	202.64	 







AHCA Contract No. FA523, Amendment No. 6, Page 1 of 2




AHCA Form 2100-0002 (Rev. NOV03)





1





AMERIGROUP FLORIDA, INC. Medicaid HMO Contract



Area 07 General Rates plus Mental Health Plan — 015005308(ORANGE) 015005313(SEMINOLE)
015005314(OSCEOLA)



	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male  14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	337.20	 	 	 	76.92	 	 	 	58.07	 	 	 	59.10          114.69	 	 	 	136.45	 	 	 	206.32	 	 	 	287.87	 	 		287.87	







SSI/No Medicare 3217.90 406.84 260.45 239.73 239.73 628.24 628.24 594.96 594.96


SSI/Part B 266.03 266.03 266.03 266.03 266.03 266.03 266.03 266.03 266.03


SSI/Part A & B 293.59 293.59 293.59 293.59 293.59 293.59 293.59 293.59 208.25



Area 08 General Rates plus Mental Health Plan — 015005302(LEE) 015005306(SARASOTA)




<1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+



TANF/FC/SOBRA 296.69 67.77 46.25 49.88 98.88 119.48 180.88 251.72 251.72


SSI/No Medicare 3079.31 393.43 223.95 221.50 221.50 594.93 594.93 563.76 563.76


SSI/Part B 243.57 243.57 243.57 243.57 243.57 243.57 243.57 243.57 243.57


SSI/Part A & B 292.10 292.10 292.10 292.10 292.10 292.10 292.10 292.10 206.49




	 	4.	 	Attachment I, Section 90.0, Payment and Authorized Enrollment Levels, Table 3, the second
paragraph is hereby amended to now read:






Notwithstanding the payment amounts which may be computed with the above rate table, the sum of
total capitation payments under this contract shall not exceed the total contract amount of
$668,923,610.00, (an increase of $2,139,090.00), expressed on page seven of this contract.




	 	5.	 	This amendment shall begin on May 1, 2005, or the date on which the amendment has been signed
by both parties, whichever is later.






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.



IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment (including all
attachments) to be executed by their officials thereunto duly authorized.



	 	 	 	 	 	 	 
	AMERIGROUP FLORIDA, INC.	 	STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION
	SIGNED

BY: BY:

	 	SIGNED



	 	



	 	



	 
	 	 	 	 	 	 
	 
	 	 	 	 
	 
	 	 	 	 	 	 
	NAME: Don Gilmore

TITLE:CEO

	 	NAME: Alan Levine
	 	

TITLE:
	 	

Secretary
	 

	 	 	 	 	 	 
	DATE:

	 	DATE:
	 	

	 	









	 	 	 	THE REMAINDER OF THIS PAGE LEFT BLANK INTENTIONALLY AHCA
Contract No. FA523, Amendment No. 6, Page 2 of 2	 





AHCA Form 2100-0002 (Rev. NOV03)




2