WCG-EX10.2_FA971Amendment3


Exhibit 10.2


AHCA CONTRACT NO. FA971
AMENDMENT NO. 3


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 B., Contract Managers, sub-item 1., is hereby amended to now read as follows:


		
	1.
	The Agency’s Contract Manager’s contact information is as follows:


Kenyatta Smith
Agency for Health Care Administration
2727 Mahan Drive, MS #50
Tallahassee, FL 32308
(850) 412-4068
		
	2.
	Effective January 1, 2013, Attachment I, Scope of Services, Capitated Health Plans, Section D., Service(s) to be Provided, Item 2., Approved Expanded Benefits, sub-item a., Table 6, Effective Date:  09/01/12 – 08/31/15, Non-Reform Expanded Services,, is hereby deleted in its entirety and replaced with Table 6, Effective Date 01/01/13 – 08/31/15 (010113), Non-Reform Expanded Services, as follows:


	
	
	TABLE 6
Effective Date: 01/01/13 – 08/31/15 (010113)

	Non-Reform Expanded Services

	Not limited to three (3) home health visits per day

	One (1) general office visit per day

	Up to $25 credit per household each month for selected over the counter drugs and/or health supplies.






		
	3.
	Effective January 1, 2013, Attachment I, Scope of Services, Capitated Health Plans, Section G., Benefit Grid/Customized Benefit Package – Reform Capitated Plans Only, is hereby amended to include the Benefit Grids as follows::


REMAINDER OF PAGE INTENTIONALLY LEFT BLANK



AHCA Contract No. FA971, Amendment No. 3, Page 1 of 6




Exhibit 10.2


Area 10 Broward- Children and Families    
	
							
	COVERED SERVICE CATEGORY
	Visit/Script Limit
	Limit Period (Annual/Monthly)
	Dollar Limit
	Limit Period (Annual)
	Copay Amount
	Copay Application

	Hospital Inpatient
	 
	 
	 
	 
	 
	 

	Behavioral Health
	 
	 
	 
	 
	$
	admit

	Physical Health
	 
	 
	 
	 
	$
	admit

	 
	 
	 
	 
	 
	 
	 

	Transplant Services
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Outpatient Services
	 
	 
	 
	 
	 
	 

	Emergency Room
	 
	 
	 
	 
	 
	 

	Medical/Drug Therapies (Chemo, Dialysis)
	 
	 
	 
	 
	 
	 

	Ambulatory Surgery – ASC
	 
	 
	 
	 
	 
	 

	Hospital Outpatient Surgery
	 
	 
	 
	 
	$
	visit

	Lab / X-ray
	 
	 
	 
	 
	$
	day

	Hospital Outpatient Services NOS
	 
	 
	 
	Annual
	$
	visit

	Outpatient Therapy (PT/RT)
	 
	 
	 
	Annual
	 
	 

	Outpatient Therapy (OT/ST)
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Maternity and Family Planning Services
	 
	 
	 
	 
	 
	 

	Inpatient Hospital
	 
	 
	 
	 
	 
	 

	Birthing Centers
	 
	 
	 
	 
	 
	 

	Physician Care
	 
	 
	 
	 
	 
	 

	Family Planning
	 
	 
	 
	 
	 
	 

	Pharmacy
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Physician and Phys Extender Services (non maternity)
	 
	 
	 
	 
	 
	 

	EPSDT
	 
	 
	 
	 
	 
	 

	Primary Care Physician
	 
	 
	 
	 
	$
	visit

	Specialty Physician
	 
	 
	 
	 
	$
	visit

	ARNP / Physician Assistant
	 
	 
	 
	 
	$
	visit

	Clinic (FQHC, RHC)
	 
	 
	 
	 
	$
	visit

	Clinic (CHD)
	 
	 
	 
	 
	 
	 

	Other
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Other Outpatient Professional Services
	 
	 
	 
	 
	 
	 

	Home Health Services
	 
	Annual
	 
	Annual
	$
	visit

	Chiropractor
	 
	Annual
	 
	Annual
	$
	visit

	Podiatrist
	 
	Annual
	 
	Annual
	$
	visit

	Dental Services
	 
	 
	$
	Annual
	0%
	coinsurance

	Vision Services
	 
	 
	 
	Annual
	$
	visit

	Hearing Services
	 
	 
	 
	Annual
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Outpatient Mental Health
	 
	 
	 
	 
	$
	visit

	 
	 
	 
	 
	 
	 
	 

	Outpatient Pharmacy
	10
	Monthly
	 
	Annual
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Other Services
	 
	 
	 
	 
	 
	 

	Ambulance
	 
	 
	 
	 
	 
	 

	Non-emergent Transportation
	 
	 
	 
	 
	$
	trip

	Durable Medical Equipment
	 
	 
	 
	Annual
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Expanded benefits

	Not limited to three (3) home health visits per day

	One (1) general office visit per day

	Up to $25 credit per household each month for selected over the counter drugs and/or health supplies.

	 

	 











AHCA Contract No. FA971, Amendment No. 3, Page 2 of 6




Exhibit 10.2


Area 10 Broward- Aged and Disabled    
	
							
	COVERED SERVICE CATEGORY
	Visit/Script Limit
	Limit Period (Annual/Monthly)
	Dollar Limit
	Limit Period (Annual)
	Copay Amount
	Copay Application

	Hospital Inpatient
	 
	 
	 
	 
	 
	 

	Behavioral Health
	 
	 
	 
	 
	$
	admit

	Physical Health
	 
	 
	 
	 
	$
	admit

	 
	 
	 
	 
	 
	 
	 

	Transplant Services
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Outpatient Services
	 
	 
	 
	 
	 
	 

	Emergency Room
	 
	 
	 
	 
	 
	 

	Medical/Drug Therapies (Chemo, Dialysis)
	 
	 
	 
	 
	 
	 

	Ambulatory Surgery – ASC
	 
	 
	 
	 
	 
	 

	Hospital Outpatient Surgery
	 
	 
	 
	 
	$
	visit

	Lab / X-ray
	 
	 
	 
	 
	$
	day

	Hospital Outpatient Services NOS
	 
	 
	 
	Annual
	$
	visit

	Outpatient Therapy (PT/RT)
	 
	 
	 
	Annual
	 
	 

	Outpatient Therapy (OT/ST)
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Maternity and Family Planning Services
	 
	 
	 
	 
	 
	 

	Inpatient Hospital
	 
	 
	 
	 
	 
	 

	Birthing Centers
	 
	 
	 
	 
	 
	 

	Physician Care
	 
	 
	 
	 
	 
	 

	Family Planning
	 
	 
	 
	 
	 
	 

	Pharmacy
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Physician and Phys Extender Services (non maternity)
	 
	 
	 
	 
	 
	 

	EPSDT
	 
	 
	 
	 
	 
	 

	Primary Care Physician
	 
	 
	 
	 
	$
	visit

	Specialty Physician
	 
	 
	 
	 
	$
	visit

	ARNP / Physician Assistant
	 
	 
	 
	 
	$
	visit

	Clinic (FQHC, RHC)
	 
	 
	 
	 
	$
	visit

	Clinic (CHD)
	 
	 
	 
	 
	 
	 

	Other
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Other Outpatient Professional Services
	 
	 
	 
	 
	 
	 

	Home Health Services
	 
	Annual
	 
	Annual
	$
	visit

	Chiropractor
	 
	Annual
	 
	Annual
	$
	visit

	Podiatrist
	 
	Annual
	 
	Annual
	$
	visit

	Dental Services
	 
	 
	$
	Annual
	0%
	coinsurance

	Vision Services
	 
	 
	 
	Annual
	$
	visit

	Hearing Services
	 
	 
	 
	Annual
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Outpatient Mental Health
	 
	 
	 
	 
	$
	visit

	 
	 
	 
	 
	 
	 
	 

	Outpatient Pharmacy
	20
	Monthly
	 
	Annual
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Other Services
	 
	 
	 
	 
	 
	 

	Ambulance
	 
	 
	 
	 
	 
	 

	Non-emergent Transportation
	 
	 
	 
	 
	$
	trip

	Durable Medical Equipment
	 
	 
	 
	Annual
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Expanded benefits

	Not limited to three (3) home health visits per day

	One (1) general office visit per day

	Up to $25 credit per household each month for selected over the counter drugs and/or health supplies.

	 

	 











AHCA Contract No. FA971, Amendment No. 3, Page 3 of 6




Exhibit 10.2


Area 4 Baker, Clay, Duval & Nassau- Children and Families    
	
							
	COVERED SERVICE CATEGORY
	Visit/Script Limit
	Limit Period (Annual/Monthly)
	Dollar Limit
	Limit Period (Annual)
	Copay Amount
	Copay Application

	Hospital Inpatient
	 
	 
	 
	 
	 
	 

	Behavioral Health
	 
	 
	 
	 
	$
	admit

	Physical Health
	 
	 
	 
	 
	$
	admit

	 
	 
	 
	 
	 
	 
	 

	Transplant Services
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Outpatient Services
	 
	 
	 
	 
	 
	 

	Emergency Room
	 
	 
	 
	 
	 
	 

	Medical/Drug Therapies (Chemo, Dialysis)
	 
	 
	 
	 
	 
	 

	Ambulatory Surgery – ASC
	 
	 
	 
	 
	 
	 

	Hospital Outpatient Surgery
	 
	 
	 
	 
	$
	visit

	Lab / X-ray
	 
	 
	 
	 
	$
	day

	Hospital Outpatient Services NOS
	 
	 
	 
	Annual
	$
	visit

	Outpatient Therapy (PT/RT)
	 
	 
	 
	Annual
	 
	 

	Outpatient Therapy (OT/ST)
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Maternity and Family Planning Services
	 
	 
	 
	 
	 
	 

	Inpatient Hospital
	 
	 
	 
	 
	 
	 

	Birthing Centers
	 
	 
	 
	 
	 
	 

	Physician Care
	 
	 
	 
	 
	 
	 

	Family Planning
	 
	 
	 
	 
	 
	 

	Pharmacy
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Physician and Phys Extender Services (non maternity)
	 
	 
	 
	 
	 
	 

	EPSDT
	 
	 
	 
	 
	 
	 

	Primary Care Physician
	 
	 
	 
	 
	$
	visit

	Specialty Physician
	 
	 
	 
	 
	$
	visit

	ARNP / Physician Assistant
	 
	 
	 
	 
	$
	visit

	Clinic (FQHC, RHC)
	 
	 
	 
	 
	$
	visit

	Clinic (CHD)
	 
	 
	 
	 
	 
	 

	Other
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Other Outpatient Professional Services
	 
	 
	 
	 
	 
	 

	Home Health Services
	 
	Annual
	 
	Annual
	$
	visit

	Chiropractor
	 
	Annual
	 
	Annual
	$
	visit

	Podiatrist
	 
	Annual
	 
	Annual
	$
	visit

	Dental Services
	 
	 
	$
	Annual
	0%
	coinsurance

	Vision Services
	 
	 
	 
	Annual
	$
	visit

	Hearing Services
	 
	 
	 
	Annual
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Outpatient Mental Health
	 
	 
	 
	 
	$
	visit

	 
	 
	 
	 
	 
	 
	 

	Outpatient Pharmacy
	10
	Monthly
	 
	Annual
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Other Services
	 
	 
	 
	 
	 
	 

	Ambulance
	 
	 
	 
	 
	 
	 

	Non-emergent Transportation
	 
	 
	 
	 
	$
	trip

	Durable Medical Equipment
	 
	 
	 
	Annual
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Expanded benefits

	Not limited to three (3) home health visits per day

	One (1) general office visit per day

	Up to $25 credit per household each month for selected over the counter drugs and/or health supplies.

	 

	 











AHCA Contract No. FA971, Amendment No. 3, Page 4 of 6




Exhibit 10.2


Area 4 Baker, Clay, Duval & Nassau- Aged and Disabled    
	
							
	COVERED SERVICE CATEGORY
	Visit/Script Limit
	Limit Period (Annual/Monthly)
	Dollar Limit
	Limit Period (Annual)
	Copay Amount
	Copay Application

	Hospital Inpatient
	 
	 
	 
	 
	 
	 

	Behavioral Health
	 
	 
	 
	 
	$
	admit

	Physical Health
	 
	 
	 
	 
	$
	admit

	 
	 
	 
	 
	 
	 
	 

	Transplant Services
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Outpatient Services
	 
	 
	 
	 
	 
	 

	Emergency Room
	 
	 
	 
	 
	 
	 

	Medical/Drug Therapies (Chemo, Dialysis)
	 
	 
	 
	 
	 
	 

	Ambulatory Surgery – ASC
	 
	 
	 
	 
	 
	 

	Hospital Outpatient Surgery
	 
	 
	 
	 
	$
	visit

	Lab / X-ray
	 
	 
	 
	 
	$
	day

	Hospital Outpatient Services NOS
	 
	 
	 
	Annual
	$
	visit

	Outpatient Therapy (PT/RT)
	 
	 
	 
	Annual
	 
	 

	Outpatient Therapy (OT/ST)
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Maternity and Family Planning Services
	 
	 
	 
	 
	 
	 

	Inpatient Hospital
	 
	 
	 
	 
	 
	 

	Birthing Centers
	 
	 
	 
	 
	 
	 

	Physician Care
	 
	 
	 
	 
	 
	 

	Family Planning
	 
	 
	 
	 
	 
	 

	Pharmacy
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Physician and Phys Extender Services (non maternity)
	 
	 
	 
	 
	 
	 

	EPSDT
	 
	 
	 
	 
	 
	 

	Primary Care Physician
	 
	 
	 
	 
	$
	visit

	Specialty Physician
	 
	 
	 
	 
	$
	visit

	ARNP / Physician Assistant
	 
	 
	 
	 
	$
	visit

	Clinic (FQHC, RHC)
	 
	 
	 
	 
	$
	visit

	Clinic (CHD)
	 
	 
	 
	 
	 
	 

	Other
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Other Outpatient Professional Services
	 
	 
	 
	 
	 
	 

	Home Health Services
	 
	Annual
	 
	Annual
	$
	visit

	Chiropractor
	 
	Annual
	 
	Annual
	$
	visit

	Podiatrist
	 
	Annual
	 
	Annual
	$
	visit

	Dental Services
	 
	 
	$
	Annual
	0%
	coinsurance

	Vision Services
	 
	 
	 
	Annual
	$
	visit

	Hearing Services
	 
	 
	 
	Annual
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Outpatient Mental Health
	 
	 
	 
	 
	$
	visit

	 
	 
	 
	 
	 
	 
	 

	Outpatient Pharmacy
	20
	Monthly
	 
	Annual
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Other Services
	 
	 
	 
	 
	 
	 

	Ambulance
	 
	 
	 
	 
	 
	 

	Non-emergent Transportation
	 
	 
	 
	 
	$
	trip

	Durable Medical Equipment
	 
	 
	 
	Annual
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Expanded benefits

	Not limited to three (3) home health visits per day

	One (1) general office visit per day

	Up to $25 credit per household each month for selected over the counter drugs and/or health supplies.

	 

	 







AHCA Contract No. FA971, Amendment No. 3, Page 5 of 6




Exhibit 10.2


Unless otherwise stated, this Amendment shall be effective upon execution by both Parties.
All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in this Contract.
This Amendment and all its attachments are hereby made part of this 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 to be executed by their officials thereunto duly authorized.
	
					
	 
	WELLCARE OF FLORIDA, INC., D/B/A
	 
	 
	STATE OF FLORIDA, AGENCY FOR

	 
	STAYWELL HEALTH PLAN OF
	 
	 
	HEALTH CARE ADMINISTRATION

	 
	FLORIDA
	 
	 
	 

	SIGNED
	 
	 
	SIGNED
	 

	BY:
	/s/ Christina Cooper
	 
	BY:
	/s/ Elizabeth Dudek

	NAME:
	Christina Cooper
	 
	NAME:
	Elizabeth Dudek

	TITLE:
	President, FL and HI Division
	 
	TITLE:
	Secretary

	DATE:
	3/13/2013
	 
	DATE:
	3/14/2013














REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FA971, Amendment No. 3, Page 6 of 6