exhibit10-2.htm


     
      

    

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    Exhibit
      10.2

     

    
      Medicaid
        HMO Contract

      Wellcare
        of Florida, Inc. 

      d/b/a
        Staywell Health Plan of Florida


      


      AHCA
        CONTRACT NO. FA615

      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.  

              	
                Effective
                  September 1, 2007, Attachment I, Scope of Services, is hereby amended
                  to
                  include Exhibit III-B, September 1, 2007- August 31, 2008 Medicaid
                  Non-Reform HMO Capitation Rates, attached hereto and made a part
                  of the
                  Contract.  All references in the Contract to Exhibit III-A,
                  September 1, 2007 – August 31, 2008 Medicaid Non-Reform HMO Capitation
                  Rates, shall hereinafter instead refer to Exhibit III-B, September
                  1,
                  2007- August 31, 2008 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.

      


      IN
        WITNESS WHEREOF, the parties hereto
        have caused this six (6) page Amendment (which includes all attachments hereto)
        to be executed by their officials thereunto duly authorized.

      


      
        	
                WELLCARE
                  OF FLORIDA, INC. 

                D/B/A/
                  STAYWELL
                  HEALTH PLAN OF FLORIDA

                
                

              	
                STATE
                  OF FLORIDA, AGENCY FOR 

                HEALTH
                  CARE ADMINISTRATION

              
	
                SIGNED
                  BY:  /s/
                  Todd S. Farha

              	
                SIGNED
                  BY: /s/
                  Andrew
                  C. Agwunobi

              
	
                NAME: 
                  Todd
                  S.
                  Farha                                
                  

              	
                NAME:
                  Andrew
                  C.
                  Agwunobi, M.D.

              
	
                TITLE: 
                  President
                  and
                  CEO

              	
                TITLE: 
                  Secretary

              
	
                DATE: 
                  12/7/07                      
                  

              	
                DATE:
                  12/10/07                      
                  

              
	 	 


      

      


      List
        of
        attachments included as part of this Amendment:

      


      
        	
                Specify                      
                  Type

              	
                Letter/
                  Number

              	
                Description                      
                  

              
	
                Exhibit

              	
                III-B

              	
                September
                  1, 2007- August 31, 2008 Medicaid Non-Reform HMO Capitation Rates
                  (5
                  Pages)

              


      

      


      


      



      
        
          
            AHCA
              Contract No. FA615, Amendment No. 3, Page 1 of 1

          

          
          

        

        
          
          

          
            

          

        

        
          
          

        

      


      
        	
                ATTACHMENT
                  III-B

              
	
                September
                  1, 2007- August 31,
                  2008

              
	
                MEDICAID
                  Non-Reform HMO CAPITATION
                  RATES

              
	
                By
                  Area , Age and Eligibility
                  Category

              
	
                Estimated
                  Health Plan Rates (Not
                  for use unless approved by CMS)

                 

              
	
                TABLE
                  1

              	 	 	 	 	 	 	 	 
	
                General
                  Rates:

              	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	
                 TANF

              	 	
                  SSI-N

              	 	
                SSI-B

              	 	
                SSI-AB

              
	
                Area

              	
                BTHMO

                +2MO

              	
                3MO-11MO

              	
                AGE


                (1-5)

              	
                AGE

                 (6-13)

              	
                AGE


                (14-20)

              	
                AGE


                (21-54)

              	
                AGE


                (55+)

              	 	
                BTHMO

                +2MO

              	
                3MO-11MO

              	
                AGE


                (1-5)

              	
                AGE


                (6-13)

              	
                AGE


                (14-20)

              	
                AGE


                (21-54)

              	
                AGE


                (55+)

              	 	 	 	
                AGE


                (65-)

              	
                AGE
                  (65+)

              
	 	 	 	 	 	
                Female

              	
                Male

              	
                Female

              	
                Male

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
                01

              	
                1,131.99

              	
                202.30

              	
                105.58

              	
                66.22

              	
                135.19

              	
                72.29

              	
                265.45

              	
                167.89

              	
                347.47

              	 	
                10,081.87

              	
                1,458.88

              	
                435.95

              	
                201.26

              	
                222.08

              	
                716.10

              	
                703.88

              	 	
                270.84

              	 	
                98.28

              	
                80.72

              
	
                02

              	
                1,131.99

              	
                202.30

              	
                105.58

              	
                66.22

              	
                135.19

              	
                72.29

              	
                265.45

              	
                167.89

              	
                347.47

              	 	
                10,081.87

              	
                1,458.88

              	
                435.95

              	
                201.26

              	
                222.08

              	
                716.10

              	
                703.88

              	 	
                270.84

              	 	
                98.28

              	
                80.72

              
	
                03

              	
                1,296.42

              	
                233.58

              	
                122.13

              	
                77.48

              	
                156.47

              	
                84.50

              	
                308.68

              	
                196.24

              	
                408.68

              	 	
                11,326.29

              	
                1,656.79

              	
                495.12

              	
                233.33

              	
                256.55

              	
                826.59

              	
                816.63

              	 	
                272.62

              	 	
                91.40

              	
                75.41

              
	
                04

              	
                1,128.87

              	
                203.75

              	
                106.78

              	
                67.92

              	
                136.68

              	
                74.01

              	
                269.88

              	
                171.79

              	
                358.59

              	 	
                10,675.98

              	
                1,563.58

              	
                467.86

              	
                220.87

              	
                242.36

              	
                781.86

              	
                772.10

              	 	
                329.54

              	 	
                94.19

              	
                77.67

              
	
                05

              	
                1,260.50

              	
                227.66

              	
                119.09

              	
                75.94

              	
                152.59

              	
                82.61

              	
                301.42

              	
                191.81

              	
                400.30

              	 	
                11,774.49

              	
                1,721.01

              	
                514.94

              	
                241.96

              	
                266.53

              	
                857.42

              	
                846.21

              	 	
                228.63

              	 	
                88.38

              	
                73.66

              
	
                06

              	
                1,111.64

              	
                201.87

              	
                106.04

              	
                68.10

              	
                135.60

              	
                74.02

              	
                269.07

              	
                171.81

              	
                360.32

              	 	
                10,832.05

              	
                1,590.31

              	
                475.95

              	
                225.91

              	
                247.84

              	
                799.09

              	
                790.01

              	 	
                283.50

              	 	
                85.45

              	
                70.71

              
	
                07

              	
                1,129.81

              	
                204.44

              	
                107.10

              	
                68.40

              	
                137.11

              	
                74.43

              	
                271.08

              	
                172.77

              	
                361.05

              	 	
                11,163.75

              	
                1,640.70

              	
                490.80

              	
                233.68

              	
                256.10

              	
                824.52

              	
                815.86

              	 	
                326.33

              	 	
                88.91

              	
                73.77

              
	
                08

              	
                1,059.95

              	
                192.36

              	
                100.83

              	
                64.75

              	
                129.15

              	
                70.40

              	
                255.88

              	
                163.25

              	
                342.35

              	 	
                9,491.26

              	
                1,388.78

              	
                415.62

              	
                196.24

              	
                215.38

              	
                694.16

              	
                685.42

              	 	
                190.94

              	 	
                84.41

              	
                69.83

              
	
                09

              	
                1,098.82

              	
                197.96

              	
                103.63

              	
                65.91

              	
                132.56

              	
                71.62

              	
                261.85

              	
                166.57

              	
                346.99

              	 	
                10,597.24

              	
                1,556.56

              	
                465.60

              	
                221.41

              	
                242.54

              	
                781.98

              	
                773.10

              	 	
                204.68

              	 	
                91.80

              	
                76.03

              
	
                10

              	
                1,119.46

              	
                203.01

              	
                106.51

              	
                68.32

              	
                136.20

              	
                74.23

              	
                270.06

              	
                172.18

              	
                360.84

              	 	
                13,743.01

              	
                2,028.53

              	
                606.68

              	
                290.75

              	
                319.15

              	
                1,026.77

              	
                1,016.73

              	 	
                255.52

              	 	
                105.04

              	
                86.99

              
	
                11

              	
                1,448.96

              	
                260.41

              	
                136.24

              	
                86.18

              	
                174.38

              	
                94.02

              	
                343.72

              	
                218.26

              	
                453.77

              	 	
                14,396.52

              	
                2,111.55

              	
                631.62

              	
                299.15

              	
                329.01

              	
                1,058.44

              	
                1,046.51

              	 	
                335.29

              	 	
                159.90

              	
                130.52

              
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
                TABLE
                  2

              	 	 	 	 	 	 	 
	
                General
                  + Mental Health
                  Rates:

              	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 TANF	 	
                SSI-N

              	 	
                SSI-B

              	 	
                SSI-AB

              
	
                Area

              	
                BTHMO

                +2MO

              	
                3MO-11MO

              	
                AGE


                (1-5)

              	
                AGE


                (6-13)

              	
                AGE


                (14-20)

              	
                AGE


                (21-54)

              	
                AGE


                (55+)

              	 	
                BTHMO

                +2MO

              	
                3MO-11MO

              	
                AGE


                (1-5)

              	
                AGE


                (6-13)

              	
                AGE


                (14-20)

              	
                AGE


                (21-54)

              	
                AGE


                (55+)

              	 	 	 	
                AGE


                (65-)

              	
                AGE
                  (65+)

              
	 	 	 	 	 	
                Female

              	
                Male

              	
                Female

              	
                Male

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
                01

              	
                1,132.01

              	
                202.32

              	
                107.22

              	
                77.91

              	
                146.11

              	
                83.21

              	
                269.89

              	
                172.33

              	
                351.22

              	 	
                10,081.95

              	
                1,458.96

              	
                443.39

              	
                249.30

              	
                266.06

              	
                797.48

              	
                734.86

              	 	
                271.05

              	 	
                109.93

              	
                92.37

              
	
                02

              	
                1,132.02

              	
                202.33

              	
                108.49

              	
                86.47

              	
                148.60

              	
                85.70

              	
                268.86

              	
                171.30

              	
                350.43

              	 	
                10,082.03

              	
                1,459.04

              	
                449.74

              	
                280.06

              	
                267.29

              	
                768.77

              	
                728.75

              	 	
                291.04

              	 	
                113.28

              	
                95.72

              
	
                03

              	
                1,296.43

              	
                233.59

              	
                123.45

              	
                86.66

              	
                162.55

              	
                90.58

              	
                310.23

              	
                197.79

              	
                410.02

              	 	
                11,326.36

              	
                1,656.86

              	
                501.38

              	
                269.08

              	
                277.06

              	
                850.48

              	
                827.91

              	 	
                279.47

              	 	
                100.38

              	
                84.39

              
	
                04

              	
                1,128.88

              	
                203.76

              	
                108.15

              	
                77.48

              	
                143.01

              	
                80.34

              	
                271.49

              	
                173.40

              	
                359.98

              	 	
                10,676.09

              	
                1,563.69

              	
                477.61

              	
                276.60

              	
                274.33

              	
                819.11

              	
                789.69

              	 	
                354.09

              	 	
                110.96

              	
                94.44

              
	
                05

              	
                1,260.51

              	
                227.67

              	
                120.30

              	
                84.61

              	
                160.70

              	
                90.72

              	
                304.71

              	
                195.10

              	
                403.08

              	 	
                11,774.54

              	
                1,721.06

              	
                519.96

              	
                274.37

              	
                296.20

              	
                912.32

              	
                867.11

              	 	
                231.36

              	 	
                101.19

              	
                86.47

              
	
                06

              	
                1,111.66

              	
                201.89

              	
                107.89

              	
                81.34

              	
                147.98

              	
                86.40

              	
                274.10

              	
                176.84

              	
                364.57

              	 	
                10,832.12

              	
                1,590.38

              	
                482.47

              	
                268.01

              	
                286.38

              	
                870.40

              	
                817.15

              	 	
                284.81

              	 	
                89.33

              	
                74.59

              
	
                07

              	
                1,129.83

              	
                204.46

              	
                108.88

              	
                81.08

              	
                148.96

              	
                86.28

              	
                275.90

              	
                177.59

              	
                365.12

              	 	
                11,163.81

              	
                1,640.76

              	
                496.92

              	
                273.18

              	
                292.26

              	
                891.44

              	
                841.33

              	 	
                328.92

              	 	
                99.42

              	
                84.28

              
	
                08

              	
                1,059.96

              	
                192.37

              	
                102.09

              	
                73.55

              	
                134.98

              	
                76.23

              	
                257.36

              	
                164.73

              	
                343.63

              	 	
                9,491.33

              	
                1,388.85

              	
                421.62

              	
                230.52

              	
                235.05

              	
                717.07

              	
                696.24

              	 	
                197.79

              	 	
                97.63

              	
                83.05

              
	
                09

              	
                1,098.84

              	
                197.98

              	
                105.18

              	
                76.72

              	
                139.72

              	
                78.78

              	
                263.67

              	
                168.39

              	
                348.57

              	 	
                10,597.31

              	
                1,556.63

              	
                471.93

              	
                257.55

              	
                263.28

              	
                806.13

              	
                784.51

              	 	
                211.53

              	 	
                101.39

              	
                85.62

              
	
                10

              	
                1,119.48

              	
                203.03

              	
                108.43

              	
                81.68

              	
                145.05

              	
                83.08

              	
                272.31

              	
                174.43

              	
                362.79

              	 	
                13,743.10

              	
                2,028.62

              	
                615.03

              	
                338.45

              	
                346.52

              	
                1,058.65

              	
                1,031.78

              	 	
                262.37

              	 	
                113.09

              	
                95.04

              
	
                11

              	
                1,448.98

              	
                260.43

              	
                137.86

              	
                97.47

              	
                181.86

              	
                101.50

              	
                345.62

              	
                220.16

              	
                455.42

              	 	
                14,396.60

              	
                2,111.63

              	
                638.59

              	
                338.94

              	
                351.84

              	
                1,085.04

              	
                1,059.07

              	 	
                342.52

              	 	
                167.95

              	
                138.57

              
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 


      

       

      AHCA
        Contract No. FA615,
        Attachment III-B, Page 1 of 5

       

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

        
          	
                  ATTACHMENT
                    III-B

                
	
                  September
                    1, 2007- August 31,
                    2008

                
	
                  MEDICAID
                    Non-Reform HMO CAPITATION
                    RATES

                
	
                  By
                    Area , Age and Eligibility
                    Category

                
	
                  Estimated
                    Health Plan Rates (Not
                    for use unless approved by
                    CMS)

                


        

         

      

      
        	
                TABLE
                  3

              	 	 	 	 	 	 	 	 	 
	
                General
                  + MH + Dental
                  Rates:

              	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	
                TANF

              	 	 SSI-N	 	
                SSI-B

              	 	
                SSI-AB

              
	
                Area

              	
                BTHMO

                +2MO

              	
                3MO-11MO

              	
                AGE


                (1-5)

              	
                AGE


                (6-13)

              	
                AGE


                (14-20)

              	
                AGE


                (21-54)

              	
                AGE


                (55+)

              	 	
                BTHMO

                +2MO

              	
                3MO-11MO

              	
                AGE


                (1-5)

              	
                AGE


                (6-13)

              	
                AGE


                (14-20)

              	
                AGE


                (21-54)

              	
                AGE


                (55+)

              	 	 	 	
                AGE


                (65-)

              	
                AGE
                  (65+)

              
	 	 	 	 	 	
                Female

              	
                Male

              	
                Female

              	
                Male

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
                01

              	
                1,132.02

              	
                202.33

              	
                109.31

              	
                82.23

              	
                150.59

              	
                86.99

              	
                271.74

              	
                173.97

              	
                354.63

              	 	
                10,081.95

              	
                1,458.97

              	
                445.59

              	
                253.12

              	
                269.40

              	
                800.35

              	
                738.28

              	 	
                271.55

              	 	
                112.24

              	
                93.85

              
	
                02

              	
                1,132.03

              	
                202.34

              	
                110.58

              	
                90.79

              	
                153.08

              	
                89.48

              	
                270.71

              	
                172.94

              	
                353.84

              	 	
                10,082.03

              	
                1,459.05

              	
                451.94

              	
                283.88

              	
                270.63

              	
                771.64

              	
                732.17

              	 	
                291.54

              	 	
                115.59

              	
                97.20

              
	
                03

              	
                1,296.44

              	
                233.60

              	
                126.52

              	
                93.00

              	
                169.14

              	
                96.13

              	
                313.24

              	
                200.46

              	
                415.57

              	 	
                11,326.37

              	
                1,656.88

              	
                504.76

              	
                274.93

              	
                282.17

              	
                854.04

              	
                832.15

              	 	
                280.01

              	 	
                103.46

              	
                86.37

              
	
                04

              	
                1,128.89

              	
                203.77

              	
                110.20

              	
                81.71

              	
                147.39

              	
                84.03

              	
                274.30

              	
                175.89

              	
                365.17

              	 	
                10,676.09

              	
                1,563.70

              	
                479.82

              	
                280.43

              	
                277.68

              	
                822.42

              	
                793.64

              	 	
                356.10

              	 	
                114.04

              	
                96.42

              
	
                05

              	
                1,260.52

              	
                227.69

              	
                123.77

              	
                91.76

              	
                168.12

              	
                96.98

              	
                311.90

              	
                201.49

              	
                416.36

              	 	
                11,774.55

              	
                1,721.08

              	
                524.88

              	
                282.89

              	
                303.65

              	
                919.87

              	
                876.10

              	 	
                235.79

              	 	
                109.53

              	
                91.82

              
	
                06

              	
                1,111.67

              	
                201.90

              	
                110.53

              	
                86.79

              	
                153.63

              	
                91.17

              	
                277.72

              	
                180.05

              	
                371.26

              	 	
                10,832.13

              	
                1,590.40

              	
                485.64

              	
                273.51

              	
                291.19

              	
                874.82

              	
                822.42

              	 	
                286.65

              	 	
                94.11

              	
                77.66

              
	
                07

              	
                1,129.84

              	
                204.47

              	
                111.04

              	
                85.54

              	
                153.58

              	
                90.17

              	
                278.43

              	
                179.84

              	
                369.79

              	 	
                11,163.81

              	
                1,640.77

              	
                500.03

              	
                278.58

              	
                296.97

              	
                894.55

              	
                845.04

              	 	
                330.54

              	 	
                102.58

              	
                86.31

              
	
                08

              	
                1,059.97

              	
                192.38

              	
                105.11

              	
                79.80

              	
                141.46

              	
                81.69

              	
                260.37

              	
                167.40

              	
                349.19

              	 	
                9,491.34

              	
                1,388.87

              	
                424.74

              	
                235.93

              	
                239.77

              	
                720.67

              	
                700.54

              	 	
                199.27

              	 	
                100.78

              	
                85.06

              
	
                09

              	
                1,098.85

              	
                197.99

              	
                108.10

              	
                82.75

              	
                145.98

              	
                84.06

              	
                265.42

              	
                169.94

              	
                351.80

              	 	
                10,597.31

              	
                1,556.64

              	
                474.66

              	
                262.28

              	
                267.41

              	
                807.81

              	
                786.52

              	 	
                212.26

              	 	
                103.23

              	
                86.80

              
	
                10

              	
                1,119.49

              	
                203.04

              	
                111.29

              	
                87.56

              	
                151.15

              	
                88.23

              	
                274.13

              	
                176.05

              	
                366.16

              	 	
                13,743.11

              	
                2,028.64

              	
                618.77

              	
                344.93

              	
                352.19

              	
                1,060.76

              	
                1,034.30

              	 	
                264.42

              	 	
                115.66

              	
                96.69

              
	
                11

              	
                1,448.99

              	
                260.44

              	
                141.58

              	
                105.13

              	
                189.81

              	
                108.20

              	
                347.23

              	
                221.59

              	
                458.40

              	 	
                14,396.61

              	
                2,111.65

              	
                642.83

              	
                346.28

              	
                358.26

              	
                1,088.67

              	
                1,063.40

              	 	
                346.92

              	 	
                172.01

              	
                141.17

              
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
                TABLE
                  4

              	 	 	 	 	 	 	 	 	 
	
                General
                  + MH + Transportation
                  Rates:

              	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	
                  TANF

              	 	
                  SSI-N

              	 	
                SSI-B

              	 	
                SSI-AB

              
	
                Area

              	
                BTHMO

                +2MO

              	
                3MO-11MO

              	
                AGE


                (1-5)

              	
                AGE


                (6-13)

              	
                AGE


                (14-20)

              	
                AGE


                (21-54)

              	
                AGE


                (55+)

              	 	
                BTHMO

                +2MO

              	
                3MO-11MO

              	
                AGE


                (1-5)

              	
                AGE


                (6-13)

              	
                AGE


                (14-20)

              	
                AGE


                (21-54)

              	
                AGE


                (55+)

              	 	 	 	
                AGE


                (65-)

              	
                AGE
                  (65+)

              
	 	 	 	 	 	
                Female

              	
                Male

              	
                Female

              	
                Male

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
                01

              	
                1,137.56

              	
                203.71

              	
                108.08

              	
                78.43

              	
                148.03

              	
                84.47

              	
                272.98

              	
                174.71

              	
                354.40

              	 	
                10,125.36

              	
                1,486.99

              	
                449.03

              	
                251.78

              	
                272.18

              	
                817.47

              	
                751.37

              	 	
                277.82

              	 	
                123.66

              	
                101.13

              
	
                02

              	
                1,137.57

              	
                203.72

              	
                109.35

              	
                86.99

              	
                150.52

              	
                86.96

              	
                271.95

              	
                173.68

              	
                353.61

              	 	
                10,125.44

              	
                1,487.07

              	
                455.38

              	
                282.54

              	
                273.41

              	
                788.76

              	
                745.26

              	 	
                297.81

              	 	
                127.01

              	
                104.48

              
	
                03

              	
                1,303.13

              	
                235.26

              	
                124.49

              	
                87.29

              	
                164.87

              	
                92.09

              	
                313.95

              	
                200.67

              	
                413.86

              	 	
                11,381.17

              	
                1,692.25

              	
                508.50

              	
                272.20

              	
                284.79

              	
                875.73

              	
                848.76

              	 	
                288.09

              	 	
                120.22

              	
                97.05

              
	
                04

              	
                1,133.91

              	
                205.01

              	
                108.93

              	
                77.95

              	
                144.75

              	
                81.48

              	
                274.28

              	
                175.56

              	
                362.87

              	 	
                10,720.46

              	
                1,592.34

              	
                483.38

              	
                279.13

              	
                280.59

              	
                839.55

              	
                806.56

              	 	
                361.06

              	 	
                126.74

              	
                104.50

              
	
                05

              	
                1,264.71

              	
                228.72

              	
                120.95

              	
                85.01

              	
                162.15

              	
                91.67

              	
                307.04

              	
                196.90

              	
                405.49

              	 	
                11,809.84

              	
                1,743.85

              	
                524.54

              	
                276.38

              	
                301.18

              	
                928.58

              	
                880.53

              	 	
                237.24

              	 	
                115.22

              	
                95.42

              
	
                06

              	
                1,115.71

              	
                202.90

              	
                108.52

              	
                81.72

              	
                149.38

              	
                87.31

              	
                276.35

              	
                178.58

              	
                366.89

              	 	
                10,866.95

              	
                1,612.87

              	
                487.00

              	
                270.00

              	
                291.30

              	
                886.44

              	
                830.40

              	 	
                290.13

              	 	
                100.93

              	
                81.99

              
	
                07

              	
                1,133.77

              	
                205.44

              	
                109.49

              	
                81.45

              	
                150.32

              	
                87.17

              	
                278.09

              	
                179.28

              	
                367.38

              	 	
                11,201.13

              	
                1,664.85

              	
                501.77

              	
                275.30

              	
                297.53

              	
                908.63

              	
                855.51

              	 	
                334.56

              	 	
                111.55

              	
                92.03

              
	
                08

              	
                1,065.54

              	
                193.77

              	
                102.95

              	
                74.07

              	
                136.91

              	
                77.49

              	
                260.46

              	
                167.12

              	
                346.83

              	 	
                9,532.67

              	
                1,415.54

              	
                427.00

              	
                232.88

              	
                240.88

              	
                736.11

              	
                711.96

              	 	
                203.87

              	 	
                112.43

              	
                92.50

              
	
                09

              	
                1,104.22

              	
                199.32

              	
                106.02

              	
                77.23

              	
                141.58

              	
                79.99

              	
                266.66

              	
                170.70

              	
                351.65

              	 	
                10,640.50

              	
                1,584.51

              	
                477.55

              	
                260.02

              	
                269.38

              	
                826.01

              	
                800.93

              	 	
                218.45

              	 	
                117.20

              	
                95.70

              
	
                10

              	
                1,123.27

              	
                203.97

              	
                109.01

              	
                82.04

              	
                146.35

              	
                83.94

              	
                274.42

              	
                176.05

              	
                364.96

              	 	
                13,782.23

              	
                2,053.89

              	
                620.11

              	
                340.69

              	
                352.05

              	
                1,076.67

              	
                1,046.66

              	 	
                269.67

              	 	
                130.75

              	
                106.30

              
	
                11

              	
                1,452.24

              	
                261.24

              	
                138.36

              	
                97.78

              	
                182.98

              	
                102.24

              	
                347.43

              	
                221.56

              	
                457.29

              	 	
                14,425.98

              	
                2,130.60

              	
                642.40

              	
                340.62

              	
                355.99

              	
                1,098.57

              	
                1,070.25

              	 	
                347.44

              	 	
                180.46

              	
                146.55

              
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 


      

       

      AHCA Contract No. FA615, Attachment
        III-B, Page 2 of 5

       

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

        
          	
                  ATTACHMENT
                    III-B

                
	
                  September
                    1, 2007- August 31,
                    2008

                
	
                  MEDICAID
                    Non-Reform HMO CAPITATION
                    RATES

                
	
                  By
                    Area , Age and Eligibility
                    Category

                
	
                  Estimated
                    Health Plan Rates (Not
                    for use unless approved by
                    CMS)

                


        

      

      
        	
                TABLE
                  5

              	 	 	 	 	 	 	 	 	 
	
                General
                  + Transportation
                  Rates:

              	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	
                TANF

              	 	 SSI-N	 	
                SSI-B

              	 	
                SSI-AB

              
	
                Area

              	
                BTHMO

                +2MO

              	
                3MO-11MO

              	
                AGE


                (1-5)

              	
                AGE


                (6-13)

              	
                AGE


                (14-20)

              	
                AGE


                (21-54)

              	
                AGE


                (55+)

              	 	
                BTHMO

                +2MO

              	
                3MO-11MO

              	
                AGE


                (1-5)

              	
                AGE


                (6-13)

              	
                AGE


                (14-20)

              	
                AGE


                (21-54)

              	
                AGE


                (55+)

              	 	 	 	
                AGE
                  (65-)

              	
                AGE
                  (65+)

              
	 	 	 	 	 	
                Female

              	
                Male

              	
                Female

              	
                Male

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
                01

              	
                1,137.54

              	
                203.69

              	
                106.44

              	
                66.74

              	
                137.11

              	
                73.55

              	
                268.54

              	
                170.27

              	
                350.65

              	 	
                10,125.28

              	
                1,486.91

              	
                441.59

              	
                203.74

              	
                228.20

              	
                736.09

              	
                720.39

              	 	
                277.61

              	 	
                112.01

              	
                89.48

              
	
                02

              	
                1,137.54

              	
                203.69

              	
                106.44

              	
                66.74

              	
                137.11

              	
                73.55

              	
                268.54

              	
                170.27

              	
                350.65

              	 	
                10,125.28

              	
                1,486.91

              	
                441.59

              	
                203.74

              	
                228.20

              	
                736.09

              	
                720.39

              	 	
                277.61

              	 	
                112.01

              	
                89.48

              
	
                03

              	
                1,303.12

              	
                235.25

              	
                123.17

              	
                78.11

              	
                158.79

              	
                86.01

              	
                312.40

              	
                199.12

              	
                412.52

              	 	
                11,381.10

              	
                1,692.18

              	
                502.24

              	
                236.45

              	
                264.28

              	
                851.84

              	
                837.48

              	 	
                281.24

              	 	
                111.24

              	
                88.07

              
	
                04

              	
                1,133.90

              	
                205.00

              	
                107.56

              	
                68.39

              	
                138.42

              	
                75.15

              	
                272.67

              	
                173.95

              	
                361.48

              	 	
                10,720.35

              	
                1,592.23

              	
                473.63

              	
                223.40

              	
                248.62

              	
                802.30

              	
                788.97

              	 	
                336.51

              	 	
                109.97

              	
                87.73

              
	
                05

              	
                1,264.70

              	
                228.71

              	
                119.74

              	
                76.34

              	
                154.04

              	
                83.56

              	
                303.75

              	
                193.61

              	
                402.71

              	 	
                11,809.79

              	
                1,743.80

              	
                519.52

              	
                243.97

              	
                271.51

              	
                873.68

              	
                859.63

              	 	
                234.51

              	 	
                102.41

              	
                82.61

              
	
                06

              	
                1,115.69

              	
                202.88

              	
                106.67

              	
                68.48

              	
                137.00

              	
                74.93

              	
                271.32

              	
                173.55

              	
                362.64

              	 	
                10,866.88

              	
                1,612.80

              	
                480.48

              	
                227.90

              	
                252.76

              	
                815.13

              	
                803.26

              	 	
                288.82

              	 	
                97.05

              	
                78.11

              
	
                07

              	
                1,133.75

              	
                205.42

              	
                107.71

              	
                68.77

              	
                138.47

              	
                75.32

              	
                273.27

              	
                174.46

              	
                363.31

              	 	
                11,201.07

              	
                1,664.79

              	
                495.65

              	
                235.80

              	
                261.37

              	
                841.71

              	
                830.04

              	 	
                331.97

              	 	
                101.04

              	
                81.52

              
	
                08

              	
                1,065.53

              	
                193.76

              	
                101.69

              	
                65.27

              	
                131.08

              	
                71.66

              	
                258.98

              	
                165.64

              	
                345.55

              	 	
                9,532.60

              	
                1,415.47

              	
                421.00

              	
                198.60

              	
                221.21

              	
                713.20

              	
                701.14

              	 	
                197.02

              	 	
                99.21

              	
                79.28

              
	
                09

              	
                1,104.20

              	
                199.30

              	
                104.47

              	
                66.42

              	
                134.42

              	
                72.83

              	
                264.84

              	
                168.88

              	
                350.07

              	 	
                10,640.43

              	
                1,584.44

              	
                471.22

              	
                223.88

              	
                248.64

              	
                801.86

              	
                789.52

              	 	
                211.60

              	 	
                107.61

              	
                86.11

              
	
                10

              	
                1,123.25

              	
                203.95

              	
                107.09

              	
                68.68

              	
                137.50

              	
                75.09

              	
                272.17

              	
                173.80

              	
                363.01

              	 	
                13,782.14

              	
                2,053.80

              	
                611.76

              	
                292.99

              	
                324.68

              	
                1,044.79

              	
                1,031.61

              	 	
                262.82

              	 	
                122.70

              	
                98.25

              
	
                11

              	
                1,452.22

              	
                261.22

              	
                136.74

              	
                86.49

              	
                175.50

              	
                94.76

              	
                345.53

              	
                219.66

              	
                455.64

              	 	
                14,425.90

              	
                2,130.52

              	
                635.43

              	
                300.83

              	
                333.16

              	
                1,071.97

              	
                1,057.69

              	 	
                340.21

              	 	
                172.41

              	
                138.50

              
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
                TABLE
                  6

              	 	 	 	 	 	 	 
	
                General
                  + Dental
                  Rates:

              	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	
                TANF

              	 	
                 SSI-N

              	 	
                SSI-B

              	 	
                SSI-AB

              
	
                Area

              	
                BTHMO

                +2MO

              	
                3MO-11MO

              	
                AGE


                (1-5)

              	
                AGE


                (6-13)

              	
                AGE


                (14-20)

              	
                AGE


                (21-54)

              	
                AGE


                (55+)

              	 	
                BTHMO

                +2MO

              	
                3MO-11MO

              	
                AGE


                (1-5)

              	
                AGE


                (6-13)

              	
                AGE


                (14-20)

              	
                AGE


                (21-54)

              	
                AGE


                (55+)

              	 	 	 	
                AGE
                  (65-)

              	
                AGE
                  (65+)

              
	 	 	 	 	 	
                Female

              	
                Male

              	
                Female

              	
                Male

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
                01

              	
                1,132.00

              	
                202.31

              	
                107.67

              	
                70.54

              	
                139.67

              	
                76.07

              	
                267.30

              	
                169.53

              	
                350.88

              	 	
                10,081.87

              	
                1,458.89

              	
                438.15

              	
                205.08

              	
                225.42

              	
                718.97

              	
                707.30

              	 	
                271.34

              	 	
                100.59

              	
                82.20

              
	
                02

              	
                1,132.00

              	
                202.31

              	
                107.67

              	
                70.54

              	
                139.67

              	
                76.07

              	
                267.30

              	
                169.53

              	
                350.88

              	 	
                10,081.87

              	
                1,458.89

              	
                438.15

              	
                205.08

              	
                225.42

              	
                718.97

              	
                707.30

              	 	
                271.34

              	 	
                100.59

              	
                82.20

              
	
                03

              	
                1,296.43

              	
                233.59

              	
                125.20

              	
                83.82

              	
                163.06

              	
                90.05

              	
                311.69

              	
                198.91

              	
                414.23

              	 	
                11,326.30

              	
                1,656.81

              	
                498.50

              	
                239.18

              	
                261.66

              	
                830.15

              	
                820.87

              	 	
                273.16

              	 	
                94.48

              	
                77.39

              
	
                04

              	
                1,128.88

              	
                203.76

              	
                108.83

              	
                72.15

              	
                141.06

              	
                77.70

              	
                272.69

              	
                174.28

              	
                363.78

              	 	
                10,675.98

              	
                1,563.59

              	
                470.07

              	
                224.70

              	
                245.71

              	
                785.17

              	
                776.05

              	 	
                331.55

              	 	
                97.27

              	
                79.65

              
	
                05

              	
                1,260.51

              	
                227.68

              	
                122.56

              	
                83.09

              	
                160.01

              	
                88.87

              	
                308.61

              	
                198.20

              	
                413.58

              	 	
                11,774.50

              	
                1,721.03

              	
                519.86

              	
                250.48

              	
                273.98

              	
                864.97

              	
                855.20

              	 	
                233.06

              	 	
                96.72

              	
                79.01

              
	
                06

              	
                1,111.65

              	
                201.88

              	
                108.68

              	
                73.55

              	
                141.25

              	
                78.79

              	
                272.69

              	
                175.02

              	
                367.01

              	 	
                10,832.06

              	
                1,590.33

              	
                479.12

              	
                231.41

              	
                252.65

              	
                803.51

              	
                795.28

              	 	
                285.34

              	 	
                90.23

              	
                73.78

              
	
                07

              	
                1,129.82

              	
                204.45

              	
                109.26

              	
                72.86

              	
                141.73

              	
                78.32

              	
                273.61

              	
                175.02

              	
                365.72

              	 	
                11,163.75

              	
                1,640.71

              	
                493.91

              	
                239.08

              	
                260.81

              	
                827.63

              	
                819.57

              	 	
                327.95

              	 	
                92.07

              	
                75.80

              
	
                08

              	
                1,059.96

              	
                192.37

              	
                103.85

              	
                71.00

              	
                135.63

              	
                75.86

              	
                258.89

              	
                165.92

              	
                347.91

              	 	
                9,491.27

              	
                1,388.80

              	
                418.74

              	
                201.65

              	
                220.10

              	
                697.76

              	
                689.72

              	 	
                192.42

              	 	
                87.56

              	
                71.84

              
	
                09

              	
                1,098.83

              	
                197.97

              	
                106.55

              	
                71.94

              	
                138.82

              	
                76.90

              	
                263.60

              	
                168.12

              	
                350.22

              	 	
                10,597.24

              	
                1,556.57

              	
                468.33

              	
                226.14

              	
                246.67

              	
                783.66

              	
                775.11

              	 	
                205.41

              	 	
                93.64

              	
                77.21

              
	
                10

              	
                1,119.47

              	
                203.02

              	
                109.37

              	
                74.20

              	
                142.30

              	
                79.38

              	
                271.88

              	
                173.80

              	
                364.21

              	 	
                13,743.02

              	
                2,028.55

              	
                610.42

              	
                297.23

              	
                324.82

              	
                1,028.88

              	
                1,019.25

              	 	
                257.57

              	 	
                107.61

              	
                88.64

              
	
                11

              	
                1,448.97

              	
                260.42

              	
                139.96

              	
                93.84

              	
                182.33

              	
                100.72

              	
                345.33

              	
                219.69

              	
                456.75

              	 	
                14,396.53

              	
                2,111.57

              	
                635.86

              	
                306.49

              	
                335.43

              	
                1,062.07

              	
                1,050.84

              	 	
                339.69

              	 	
                163.96

              	
                133.12

              


      

       

      AHCA Contract No. FA615, Attachment
        III-B, Page 3 of 5

       

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

        
          	
                  ATTACHMENT
                    III-B

                
	
                  September
                    1, 2007- August 31,
                    2008

                
	
                  MEDICAID
                    Non-Reform HMO CAPITATION
                    RATES

                
	
                  By
                    Area , Age and Eligibility
                    Category

                
	
                  Estimated
                    Health Plan Rates (Not
                    for use unless approved by
                    CMS)

                


        

      

      
        	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
                TABLE
                  7

              	 	 	 	 	 	 	 	 	 
	
                General
                  + Dental + Transportation
                  Rates:

              	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	
                TANF

              	 	
                 SSI-N

              	 	
                SSI-B

              	 	
                SSI-AB

              
	
                Area

              	
                BTHMO

                +2MO

              	
                3MO-11MO

              	
                AGE


                (1-5)

              	
                AGE


                (6-13)

              	
                AGE

                 (14-20)

              	
                AGE


                (21-54)

              	
                AGE


                (55+)

              	 	
                BTHMO

                +2MO

              	
                3MO-11MO

              	
                AGE


                (1-5)

              	
                AGE


                (6-13)

              	
                AGE


                (14-20)

              	
                AGE


                (21-54)

              	
                AGE


                (55+)

              	 	 	 	
                AGE
                  (65-)

              	
                AGE
                  (65+)

              
	 	 	 	 	 	
                Female

              	
                Male

              	
                Female

              	
                Male

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
                01

              	
                1,137.55

              	
                203.70

              	
                108.53

              	
                71.06

              	
                141.59

              	
                77.33

              	
                270.39

              	
                171.91

              	
                354.06

              	 	
                10,125.28

              	
                1,486.92

              	
                443.79

              	
                207.56

              	
                231.54

              	
                738.96

              	
                723.81

              	 	
                278.11

              	 	
                114.32

              	
                90.96

              
	
                02

              	
                1,137.55

              	
                203.70

              	
                108.53

              	
                71.06

              	
                141.59

              	
                77.33

              	
                270.39

              	
                171.91

              	
                354.06

              	 	
                10,125.28

              	
                1,486.92

              	
                443.79

              	
                207.56

              	
                231.54

              	
                738.96

              	
                723.81

              	 	
                278.11

              	 	
                114.32

              	
                90.96

              
	
                03

              	
                1,303.13

              	
                235.26

              	
                126.24

              	
                84.45

              	
                165.38

              	
                91.56

              	
                315.41

              	
                201.79

              	
                418.07

              	 	
                11,381.11

              	
                1,692.20

              	
                505.62

              	
                242.30

              	
                269.39

              	
                855.40

              	
                841.72

              	 	
                281.78

              	 	
                114.32

              	
                90.05

              
	
                04

              	
                1,133.91

              	
                205.01

              	
                109.61

              	
                72.62

              	
                142.80

              	
                78.84

              	
                275.48

              	
                176.44

              	
                366.67

              	 	
                10,720.35

              	
                1,592.24

              	
                475.84

              	
                227.23

              	
                251.97

              	
                805.61

              	
                792.92

              	 	
                338.52

              	 	
                113.05

              	
                89.71

              
	
                05

              	
                1,264.71

              	
                228.73

              	
                123.21

              	
                83.49

              	
                161.46

              	
                89.82

              	
                310.94

              	
                200.00

              	
                415.99

              	 	
                11,809.80

              	
                1,743.82

              	
                524.44

              	
                252.49

              	
                278.96

              	
                881.23

              	
                868.62

              	 	
                238.94

              	 	
                110.75

              	
                87.96

              
	
                06

              	
                1,115.70

              	
                202.89

              	
                109.31

              	
                73.93

              	
                142.65

              	
                79.70

              	
                274.94

              	
                176.76

              	
                369.33

              	 	
                10,866.89

              	
                1,612.82

              	
                483.65

              	
                233.40

              	
                257.57

              	
                819.55

              	
                808.53

              	 	
                290.66

              	 	
                101.83

              	
                81.18

              
	
                07

              	
                1,133.76

              	
                205.43

              	
                109.87

              	
                73.23

              	
                143.09

              	
                79.21

              	
                275.80

              	
                176.71

              	
                367.98

              	 	
                11,201.07

              	
                1,664.80

              	
                498.76

              	
                241.20

              	
                266.08

              	
                844.82

              	
                833.75

              	 	
                333.59

              	 	
                104.20

              	
                83.55

              
	
                08

              	
                1,065.54

              	
                193.77

              	
                104.71

              	
                71.52

              	
                137.56

              	
                77.12

              	
                261.99

              	
                168.31

              	
                351.11

              	 	
                9,532.61

              	
                1,415.49

              	
                424.12

              	
                204.01

              	
                225.93

              	
                716.80

              	
                705.44

              	 	
                198.50

              	 	
                102.36

              	
                81.29

              
	
                09

              	
                1,104.21

              	
                199.31

              	
                107.39

              	
                72.45

              	
                140.68

              	
                78.11

              	
                266.59

              	
                170.43

              	
                353.30

              	 	
                10,640.43

              	
                1,584.45

              	
                473.95

              	
                228.61

              	
                252.77

              	
                803.54

              	
                791.53

              	 	
                212.33

              	 	
                109.45

              	
                87.29

              
	
                10

              	
                1,123.26

              	
                203.96

              	
                109.95

              	
                74.56

              	
                143.60

              	
                80.24

              	
                273.99

              	
                175.42

              	
                366.38

              	 	
                13,782.15

              	
                2,053.82

              	
                615.50

              	
                299.47

              	
                330.35

              	
                1,046.90

              	
                1,034.13

              	 	
                264.87

              	 	
                125.27

              	
                99.90

              
	
                11

              	
                1,452.23

              	
                261.23

              	
                140.46

              	
                94.15

              	
                183.45

              	
                101.46

              	
                347.14

              	
                221.09

              	
                458.62

              	 	
                14,425.91

              	
                2,130.54

              	
                639.67

              	
                308.17

              	
                339.58

              	
                1,075.60

              	
                1,062.02

              	 	
                344.61

              	 	
                176.47

              	
                141.10

              
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
                TABLE
                  8

              	 	 	 	 	 
	
                General
                  + Mental Health + Dental +
                  Transportation Rates:

              	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	
                TANF

              	 	
                 SSI-N

              	 	
                SSI-B

              	 	
                SSI-AB

              
	
                Area

              	
                BTHMO

                +2MO

              	
                3MO-11MO

              	
                AGE


                (1-5)

              	
                AGE


                (6-13)

              	
                AGE


                (14-20)

              	
                AGE


                (21-54)

              	
                AGE


                (55+)

              	 	
                BTHMO

                +2MO

              	
                3MO-11MO

              	
                AGE


                (1-5)

              	
                AGE


                (6-13)

              	
                AGE


                (14-20)

              	
                AGE


                (21-54)

              	
                AGE


                (55+)

              	 	 	 	
                AGE
                  (65-)

              	
                AGE
                  (65+)

              
	 	 	 	 	 	
                Female

              	
                Male

              	
                Female

              	
                Male

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
                01

              	
                1,137.57

              	
                203.72

              	
                110.17

              	
                82.75

              	
                152.51

              	
                88.25

              	
                274.83

              	
                176.35

              	
                357.81

              	 	
                10,125.36

              	
                1,487.00

              	
                451.23

              	
                255.60

              	
                275.52

              	
                820.34

              	
                754.79

              	 	
                278.32

              	 	
                125.97

              	
                102.61

              
	
                02

              	
                1,137.58

              	
                203.73

              	
                111.44

              	
                91.31

              	
                155.00

              	
                90.74

              	
                273.80

              	
                175.32

              	
                357.02

              	 	
                10,125.44

              	
                1,487.08

              	
                457.58

              	
                286.36

              	
                276.75

              	
                791.63

              	
                748.68

              	 	
                298.31

              	 	
                129.32

              	
                105.96

              
	
                03

              	
                1,303.14

              	
                235.27

              	
                127.56

              	
                93.63

              	
                171.46

              	
                97.64

              	
                316.96

              	
                203.34

              	
                419.41

              	 	
                11,381.18

              	
                1,692.27

              	
                511.88

              	
                278.05

              	
                289.90

              	
                879.29

              	
                853.00

              	 	
                288.63

              	 	
                123.30

              	
                99.03

              
	
                04

              	
                1,133.92

              	
                205.02

              	
                110.98

              	
                82.18

              	
                149.13

              	
                85.17

              	
                277.09

              	
                178.05

              	
                368.06

              	 	
                10,720.46

              	
                1,592.35

              	
                485.59

              	
                282.96

              	
                283.94

              	
                842.86

              	
                810.51

              	 	
                363.07

              	 	
                129.82

              	
                106.48

              
	
                05

              	
                1,264.72

              	
                228.74

              	
                124.42

              	
                92.16

              	
                169.57

              	
                97.93

              	
                314.23

              	
                203.29

              	
                418.77

              	 	
                11,809.85

              	
                1,743.87

              	
                529.46

              	
                284.90

              	
                308.63

              	
                936.13

              	
                889.52

              	 	
                241.67

              	 	
                123.56

              	
                100.77

              
	
                06

              	
                1,115.72

              	
                202.91

              	
                111.16

              	
                87.17

              	
                155.03

              	
                92.08

              	
                279.97

              	
                181.79

              	
                373.58

              	 	
                10,866.96

              	
                1,612.89

              	
                490.17

              	
                275.50

              	
                296.11

              	
                890.86

              	
                835.67

              	 	
                291.97

              	 	
                105.71

              	
                85.06

              
	
                07

              	
                1,133.78

              	
                205.45

              	
                111.65

              	
                85.91

              	
                154.94

              	
                91.06

              	
                280.62

              	
                181.53

              	
                372.05

              	 	
                11,201.13

              	
                1,664.86

              	
                504.88

              	
                280.70

              	
                302.24

              	
                911.74

              	
                859.22

              	 	
                336.18

              	 	
                114.71

              	
                94.06

              
	
                08

              	
                1,065.55

              	
                193.78

              	
                105.97

              	
                80.32

              	
                143.39

              	
                82.95

              	
                263.47

              	
                169.79

              	
                352.39

              	 	
                9,532.68

              	
                1,415.56

              	
                430.12

              	
                238.29

              	
                245.60

              	
                739.71

              	
                716.26

              	 	
                205.35

              	 	
                115.58

              	
                94.51

              
	
                09

              	
                1,104.23

              	
                199.33

              	
                108.94

              	
                83.26

              	
                147.84

              	
                85.27

              	
                268.41

              	
                172.25

              	
                354.88

              	 	
                10,640.50

              	
                1,584.52

              	
                480.28

              	
                264.75

              	
                273.51

              	
                827.69

              	
                802.94

              	 	
                219.18

              	 	
                119.04

              	
                96.88

              
	
                10

              	
                1,123.28

              	
                203.98

              	
                111.87

              	
                87.92

              	
                152.45

              	
                89.09

              	
                276.24

              	
                177.67

              	
                368.33

              	 	
                13,782.24

              	
                2,053.91

              	
                623.85

              	
                347.17

              	
                357.72

              	
                1,078.78

              	
                1,049.18

              	 	
                271.72

              	 	
                133.32

              	
                107.95

              
	
                11

              	
                1,452.25

              	
                261.25

              	
                142.08

              	
                105.44

              	
                190.93

              	
                108.94

              	
                349.04

              	
                222.99

              	
                460.27

              	 	
                14,425.99

              	
                2,130.62

              	
                646.64

              	
                347.96

              	
                362.41

              	
                1,102.20

              	
                1,074.58

              	 	
                351.84

              	 	
                184.52

              	
                149.15

              
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 


      

       

      AHCA Contract No. FA615, Attachment
        III-B, Page 4 of 5

       

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

        
          	
                  ATTACHMENT
                    III-B

                
	
                  September
                    1, 2007- August 31,
                    2008

                
	
                  MEDICAID
                    Non-Reform HMO CAPITATION
                    RATES

                
	
                  By
                    Area , Age and Eligibility
                    Category

                
	
                  Estimated
                    Health Plan Rates (Not
                    for use unless approved by
                    CMS)

                


        

         

      

      
        	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
                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, Hamiliton, Hernando, Lafayette, Lake,
                  Levy,
                  Marion, 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

              	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
                Created
                  on August 10,
                  2007

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 


      

AHCA Contract No. FA615, Attachment III-B, Page 5 of
      5