exh10-2.htm


     

      

    

    Back to Form
8-K

    Exhibit 10.2

     

    
      STATE
OF CONNECTICUT

      DEPARTMENT
OF SOCIAL SERVICES

       

       

    

    CONTRACT AMENDMENT


    
      
        	
                Amendment
      Number:

              	
                8

              
	
                Contract
      #:

              	
                093-HUS-WCC-2

              
	
                Contract
      Period:

              	
                07/01/2005 –  03/31/08

              
	
                Contractor
      Name:

              	
                WELLCARE
      OF CONNECTICUT, INC.

              
	
                Contractor
      Address:

              	
                116
      Washington Avenue, 2nd
      Floor  North Haven,
  CT  06473

              


      

    

     

    
      

    

    Contract
number 093-HUS-WCC-2 by and between the Department of Social Services (the
“Department”) and WELLCARE of CONNECTICUT, Inc. (the “Contractor”) for the
provision of services under the HUSKY B program as amended through amendments 1,
2, 3, 4, 5, 6 and 7 is hereby further amended as follows:

    
       

      
        	
                1.

              	
                Paragraph
      1 of Part I as amended by Amendments 1, 2, 3, 4, 5, 6 and 7 is further
      amended to extend the contract end date from February 29, 2008 to March
      31, 2008.

              


      

       

      
        	
                2.

              	
                Part
      II “GENERAL CONTRACT TERMS FOR MCOs” dated 05/01/07 remain unchanged and
      in full force and effect subject to the provisions of this and all prior
      amendments.

              


      

       

      
        	
                3.

              	
                Effective
      February 1, 2008 the Contractor will no longer be required to administer
      the HUSKY B pharmacy benefit, however the Contractor shall retain all its
      contractual obligations with regard to pharmacy claims with dates of
      service before February 1, 2008.

              


      

       

      
        	
                4.

              	
                Paragraph
      5 of Amendment 7 is deleted in its entirety and replaced with the
      following:  The Department and the Contractor agree that the
      Contractor shall continue participating in the HUSKY B program through
      March 31, 2008 . During the period 01/01/08 through 03/31/08 , however,
      the Contractor will be operating as a Pre-paid Inpatient Health Plan
      (PIHP) and, as such, shall not be responsible for the costs of covered
      services incurred by the Contractor’s HUSKY B enrollees. The costs of such
      covered services shall be the responsibility of the Department and the
      Department shall reimburse the Contractor for any amounts paid by the
      Contractor for such covered services on a monthly basis upon the
      presentation of documentation from the Contractor to the Department for
      such paid amounts. The Department shall reimburse the Contractor for any
      amounts paid by the Contractor to providers for covered services rendered
      to its HUSKY B enrollees in accordance with the Contractor’s then current
      provider contracts, (which may include capitated and other payment
      arrangements in addition to fee for service payments), or where services
      are provided by non-contracted providers, the then current Medicaid fee
      schedule or other rate paid by the Contractor to the non-contracted
      provider.

              


      

       

      
        	
                5.

              	
                Any
      other changes to Part II “GENERAL CONTRACT TERMS FOR MCOS” dated 05/07
      that are necessitated by the transition from managed care to a PIHP
      arrangement shall be directed by Department’s authorized personnel in
      writing to the Contractor in a manner consistent with the Contract, and
      may be relied upon by Contractor.  For purposes of this
      amendment the Department’s authorized personnel shall be limited to the
      Commissioner, or his designee; the Director of Medical Care
      Administration, or his designee; the Director of Medical Administration
      Managed Care, or her designee and/or the Department’s Medical Director, or
      his designee.

              


      

       

      
        	
                6.

              	
                Effective
      January 1, 2008 through March 31, 2008 the Department shall suspend the
      Contractor’s HUSKY B new Member enrollment unless otherwise notified in
      writing by the Department.

              


      

       

      
        	
                7.

              	
                Paragraph
      10 of Amendment 7 is deleted in its entirety and replaced with the
      following: During the period January 1, 2008 through March 31, 2008 the
      Department and the Contractor shall agree to and
  implement

              


      

       

      
        
           


        

        
           


          
            

          

        

        
           


        

      


      
        	
                 
      

              	
                the
      terms of a plan to transition each of the Contractor’s HUSKY B enrollees
      to another MCO in the HUSKY B program with the understanding that the goal
      of the transition plan is to conduct an orderly transition that will
      protect the health, safety and welfare of the Contractor’s HUSKY B
      members.

              


      

       

      
        	
                8.

              	
                Paragraph
      11 and each subsection in Paragraph 11 of Amendment 7 is deleted in their
      entirety and replaced:

              


      

       

      
        	
                 
      

              	
                A.An
      administrative fee of $18.18 (which includes the administration of dental
      services) per HUSKY B member per month enrolled with Contractor, payable
      by February 15 for January enrollees,  March 15 for February
      enrollees and April 15 for March
enrollees.

              


      

       

      
        	
                 
      

              	
                B.The
      Department may withhold up to 8% of each of the payments described in
      subsections C through H of this section to be kept by the Department in a
      reserve account for medical expenses.  The reserve account shall
      not exceed $500,000 and shall be used for the final reconciliation of
      medical expense as set forth in Section 8 M of this
    amendment.

              


      

       

      
        	
                 
      

              	
                C.On
      or before February 15, 2008, the Department shall advance a payment to the
      Contractor for medical services furnished in January 2008 to Contractor’s
      enrollees.  The payment shall be equal to 60% of
      Contractor’s  monthly claims PMPM experience for covered
      services  calculated in accordance with the provision of Section
      8 L of this amendment applied to the number of Contractor’s enrollees in
      January 2008.

              


      

       

      
        	
                 
      

              	
                D.On
      or before March 15, 2008 the Department shall advance a payment to the
      Contractor for medical services furnished in January 2008 to Contractor’s
      enrollees.  The payment shall be equal to 20% of
      Contractor’s  monthly claims PMPM  experience for
      covered services calculated in accordance with the provision of Section 8
      L of this amendment applied to the number of Contractor’s enrollees in
      January 2008.

              


      

       

      
        	
                 
      

              	
                 

              	
                
                  E.
      On or before April 15, 2008 the Department shall advance a payment
      to the Contractor for medical services furnished in January 2008 to
      Contractor’s enrollees.  The payment shall be equal to 20% of
      Contractor’s  monthly claims experience for covered calculated
      in accordance with the provision of Section 8 L of this amendment applied
      to the number of Contractor’s enrollees in January
    2008.

                

              


      

       

      
        	
                 
      

              	
                 

              	
                
                  F.
      On or before March 15, 2008, the Department shall advance a payment
      to the Contractor for medical services furnished in February 2008 to
      Contractor’s enrollees.  The payment  shall be equal
      to 60% of Contractor’s  monthly claims PMPM experience for
      covered services calculated in accordance with the provision of Section 8
      L of this amendment applied to the number of Contractor’s enrollees in
      February 2008.

                

              


      

       

      
        	
                 
      

              	
                G.On
      or before April 15, 2008 the Department shall advance a payment to the
      Contractor for medical services furnished in February 2008 to Contractor’s
      enrollees.  The payment shall be equal to 20% of
      Contractor’s  monthly claims PMPM  experience for
      covered services calculated in accordance with the provision of Section 8
      L of this amendment applied to the number of Contractor’s enrollees in
      February 2008.

              


      

       

      
        	
                 
      

              	
                H.On
      or before May 15, 2008 the Department shall advance a payment to the
      Contractor for medical services furnished in February 2008 to Contractor’s
      enrollees.  The payment shall be equal to 20% of
      Contractor’s  monthly claims experience for covered calculated
      in accordance with the provision of Section 8 L of this amendment applied
      to the number of Contractor’s enrollees in February
  2008.

              


      

       

      
        	
                 
      

              	
                 

              	
                
                  I.
      On or before April 15, 2008, the Department shall advance a payment
      to the Contractor for medical services furnished in March 2008 to
      Contractor’s enrollees.  The payment  shall be equal
      to 60% of Contractor’s  monthly claims PMPM experience for
      covered services calculated in accordance with the provision of Section 8
      L of this amendment applied to the number of Contractor’s enrollees in
      March 2008.

                

              


      

       

      
        	
                 
      

              	
                 

              	
                
                  J.
      On or before May  15, 2008 the Department shall advance a
      payment to the Contractor for medical services furnished in March 2008 to
      Contractor’s enrollees.  The payment shall be equal to 20% of
      Contractor’s  monthly claims PMPM  experience for
      covered services calculated in accordance with the provision of Section 8
      L of this amendment applied to the number of Contractor’s enrollees in
      March 2008.

                

              


      

       


      
        
           


        

        
           


          
            

          

        

        
           


        

      


      
        	
                 
      

              	
                K.On
      or before June  15, 2008 the Department shall advance a payment
      to the Contractor for medical services furnished in March 2008 to
      Contractor’s enrollees.  The payment shall be equal to 20% of
      Contractor’s  monthly claims experience for covered calculated
      in accordance with the provision of Section 8 L of this amendment applied
      to the number of Contractor’s enrollees in March
  2008.

              


      

       

      
        	
                 
      

              	
                 

              	
                
                  L.
      For the purposes of calculating the Contractor’s  monthly
      claims PMPM experience for covered services, the Department shall
      calculate a PMPM that shall be applied to the number of Contractor
      enrollees for a specified month.  The PMPM shall equal 85% of
      the risk-based average PMPM premium payment paid to the Contractor in
      January 2008 for December 2007
enrollees.

                

              


      

       

      
        	
                 
      

              	
                M.Through
      July 31, 2008 the Contractor shall be responsible for adjudicating claims
      for services rendered from January 1, 2008 through March 31, 2008 to
      Contractor’s enrollees.  From the effective date of this
      amendment through September 15, 2008 the Contractor shall, on a monthly
      basis  submit  to the Department capitated payment
      data  and HIPAA-compliant paid claims file that must report the
      following data elements:  date of service, date of payment,
      Member name, Member Medicaid Eligibility ID number, Provider name,
      Provider FEIN, claim number, location of service, service
      diagnosis/procedure and paid amount for claims adjudicated by the
      Contractor for services rendered from January 1, 2008 through March 31,
      2008  to Contractor’s enrollees.  On or
      before  September 15, 2008 the Contractor shall submit to the
      Department final HIPAA-compliant paid claims data and capitated payment
      data for claims adjudicated by the Contractor for services rendered from
      January 1, 2008 through March 31, 2008  to Contractor’s
      enrollees.  By October 31, 2008 the Department shall conduct a
      reconciliation of actual medical expenses incurred by Contractor’s
      enrollees  from January 1, 2008 through March 31, 2008 utilizing
      the paid claims data file supplied by the Contractor to the Department
      with the Contractor’s invoice for payment and the Contractor’s encounter
      data required including the following data elements: date of service, date
      of payment, member name, Member Medicaid Eligibility ID number, provider
      name, provider FEIN, claim number, location of service, service
      diagnosis/procedure and paid amount.  If following the
      completion of the reconciliation the payments made by the Department to
      the Contractor under subsections C through K exceed the actual medical
      expenses incurred by the Contractor for services rendered from January 1,
      2008 through March 31, 2008 to Contractor’s enrollees, the Contractor
      shall reimburse the Department the excess payment.  If, however,
      following the completion of the reconciliation the payments made by the
      Department to the Contractor under subsections C through K were less than
      the actual medical expenses incurred by the Contractor for services
      rendered from January 1, 2008 through March 31, 2008 to Contractor’s
      enrollees, the Department shall reimburse the Contractor the difference
      between the total of the payments made by the Department to the Contractor
      for medical expenses and the total actual medical expenses incurred from
      January 1, 2008 through March 31, 2008 by the Contractor’s enrollees.
      Payment to the Department or the Contractor in accordance with this
      subsection shall be made by November 30,
2008.

              


      

       

      
        	
                9.

              	
                Paragraphs
      13 through and including 17 of Amendment 7 remain in full force and effect
      through March 31, 2008.

              


      

       

      
        	
                10.

              	
                Pursuant
      to Public Act 07-1, An Act Concerning the State Contractor Contribution
      Ban and Gifts to State and Quasi-Public Agencies the Department must
      provide and each Contractor must acknowledge receipt of the State
      Elections Enforcement Commission’s notice advising state contractors of
      state campaign contribution and solicitation
      prohibitions.  Through the execution of this amendment the
      Department certifies that SEEC FORM 11 -
      NOTICE TO EXECUTIVE BRANCH STATE CONTRACTORS AND PROSPECTIVE STATE
      CONTRACTORS OF CAMPAIGN CONTRIBUTION AND SOLICITATION BAN has been
      provided to the Contractor and the Contractor acknowledges receipt of the
      same.

              


      

       

    

    
      ACCEPTANCES
AND APPROVALS

       

       

      This
document constitutes an amendment to the above numbered contract. All provisions
of that contract, except those explicitly changed or described above
in  this or in all prior amendments,  remain in full force
and effect.

      
        


        
          
             

          

          
             

            
              

            

          

          
             

          

        

         

      

      
        	
                CONTRACTOR

              	
                DEPARTMENT

              
	
                WellCare
      of Connecticut, Inc.

              	
                Department
      of Social Services

              
	
                  /s/  Heath
      Schiesser

              	
                2/28/2008

              	
                /s/  Michael
      P. Starkowski

              	
                2/29/08

              
	
                Signature
      (Authorized Official)

              	
                Date

                 

              	
                Signature
      (Authorized Official)

              	
                Date

              
	
                Heath
      Schiesser

              	
                President
      & CEO

              	
                Michael
      P. Starkowski

              	
                Commissioner

              
	
                Typed
      Name (Authorized Official)

              	
                Title

              	
                Typed
      Name (Authorized Official)

              	
                Title

              


      

      


      


       OFFICE
OF THE ATTORNEY GENERAL

      


      


      
        Attorney
General (as to
form)                                                                                                                        Date

        


      

      (  ) This contract does not
require the signature of the Attorney General pursuant to an agreement between
the Department and the Office of the Attorney General dated:
______________