exhibit10-2.htm


    
      

    

    Back
      to Form 8-K

    Exhibit
      10.2

     

    


    AHCA
      CONTRACT NO. FAR009

    AMENDMENT
      NO. 4

    


    


    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,” is hereby amended as
      follows:

    


    
      	
               

            	
              1. 

            	
              All
                references in the Contract to the Vendor’s company name are hereby changed
                from WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida
                to
                WellCare of Florida, Inc. d/b/a Staywell.  The Vendor’s contact
                information, including names, addresses and telephone numbers and
                the
                Vendor’s FEID number remain
                unchanged.

            


    

    


    
      	
              2.  

            	
              Effective
                September 1, 2007, Standard Contract, Section II., Item A., Contract
                Amount, the first sentence, is hereby revised to change the total
                amount
                of the Contract from $214,516,613.00 to $233,738,003.00 (an increase
                of
                $19,221,390.00).

            


    

    


    
      	
              3.
                 

            	
              Effective
                September 1, 2007, Attachment I, Scope of Services, Section C., Method
                of
                Payment, Item 1., General, the first paragraph is hereby revised
                to now
                read as follows:

            


    

    


    
      	
               

            	
              Notwithstanding
                the payment amounts which may be computed with the rate tables specified
                in Tables 2 thru 8, the sum of total capitation payments under this
                Contract shall not exceed the total Contract amount of $233,738,003.00
                (an
                increase of $19,221,390.00).

            


    

    


    
      	
               

            	
              4.

            	
              Effective
                September 1, 2007, Attachment I, Scope of Services, Exhibits 1-A,
                3-A,
                4-A, 5-A, 6-A, 7-A, 8-A and 9-A, are hereby included and made a part
                of
                the Contract.  All references in the Contract to Exhibits 1, 3,
                4, 5, 6, 7, 8 and 9, shall hereinafter refer respectively to Exhibits
                1-A,
                3-A, 4-A, 5-A, 6-A, 7-A, 8-A and
                9-A.

            


    

    


    
      	
               

            	
              5.

            	
              Effective
                September 1, 2007, Attachment II, Medicaid Reform Health Plan Model
                Contract, Section XIII, Method of Payment, Section B, Capitation
                Rate
                Payments, is hereby revised as
                follows:

            


    

    


    --           Sub-item
      1.b.(1)(b), is hereby amended to include the following:

    


    Contract
      Year 2007-2008 Medicaid Reform rates under current Capitation Rate
      methodology.

    


    --           Sub-item
      1.b.(1)(i), the first paragraph is hereby amended to now read as
      follows:

    


    
      	
               

            	
              (i)

            	
              50%
                of Risk Adjusted Methodology: The capitation amount based on the
                percentage of Risk-Adjusted methodology (h) multiplied by the Base
                Rates
                column for Risk-Adjusted methodology after budget neutrality factor
                (g).

            


    

    


    --           Sub-item
      1.b.(1)(j), the first sentence is hereby amended to now read as
      follows:

    


    
      	
               

            	
              (j)

            	
              Final
                Rate (with Enhanced Benefit Adjustment): The current methodology
                capitation amount (d) added to the 50% of Risk-Adjusted methodology
                amount
                (i).

            


    

    


    
      	
               

            	
              6.

            	
              This
                Amendment shall be effective upon execution by both parties or July
                1,
                2007, whichever is later.

            


    

    


    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    All
      provisions in the Contract and any attachments thereto in conflict with this
      Amendment shall be and are hereby changed to conform with this
      Amendment.

    


    All
      provisions not in conflict with
      this Amendment are still in effect and are to be performed at the level
      specified in the Contract.

    


    This
      Amendment, and all its
      attachments, is hereby made 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 fourteen (14) page Amendment (including all attachments) to
      be
      executed by their officials thereunto duly authorized.

    


    
      	
              WELLCARE
                OF FLORIDA, INC. D/B/A STAYWELL

            	
              STATE
                OF FLORIDA, AGENCY FOR HEALTH CARE
                ADMINISTRATION

            
	
              SIGNED
                BY:  /s/ Todd S. Farha

            	
              SIGNED
                BY: /s/ Andrew Agwunobi

            
	
              NAME: Todd
                S. Farha

            	
              NAME:  Andrew
                C. Agwunobi, M.D.

            
	
              TITLE:
                President and
                CEO                                                                

            	
              TITLE:  Secretary                                                                

            
	
              DATE: 6/29/07

            	
              DATE:
                6/29/07

            


    

     

    List
      of
      Attachments/Exhibits included as part of this Amendment:

     

    
      	
              Specify
                Type

            	
              Letter/
                Number

            	
              Description

            
	
              Exhibit

            	
              1-A

            	
              Benefit
                Grid Effective September 1, 2007 (4 Pages)

            
	
              Exhibit

            	
              3-A

            	
              Comprehensive
                Component and Catastrophic Component Capitation Rates (2
                Pages)

            
	
              Exhibit

            	
              4-A

            	
              Comprehensive
                Component Only (1 Page)

            
	
              Exhibit

            	
              5-A

            	
              Capitation
                Rates SSI Medicare Part B Only and SSI Medicare Parts A and B Enrollees
                for All Medicaid Reform Counties (1 Page)

            
	
              Exhibit

            	
              6-A

            	
              Capitation
                Rates for HIV/AIDS Populations for Each Medicaid Reform County (1
                Page)

            
	
              Exhibit

            	
              7-A

            	
              Capitation
                Rates for Children with Chronic Conditions for All Medicaid Reform
                Counties (1 Page)

            
	
              Exhibit

            	
              8-A

            	
              Kick
                Payment Amounts for Covered Transplant Services (1
                Page)

            
	
              Exhibit

            	
              9-A

            	
              Kick
                Payment Amounts for Covered Obstetrical Delivery Services (1
                Page)

            


    

    


    


    


    REMAINDER
      OF THIS PAGE INTENTIONALLY LEFT BLANK

    


    


    
      
        
                

          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

    

    
 

    
      EXHIBIT
        1-A

      Benefit
        Grid

      Effective
        September 1, 2007

      


      (i)           Area
        10 Broward- Children and Families

       

      

    

     

    
      
        *IF
          ADDITIONAL SERVICES ARE NEEDED THEY MUST BE PRIOR AUTHORIZED.

         

        
          	
                  Enhanced
                    benefits

                
	
                  Circumcision,
                    boys up to one year

                
	
                  $25
                    OTC, per household per month

                
	
                  Adult
                    Dental – Adult Dental – Exams / X-rays / Two Annual Standard
                    Cleanings

                


        

         

        
          
            
            

          

          
            AHCA
              CONTRACT No. FAR009, Exhibit 1-A Page 1 of 4

            
              

            

          

          
            
            

          

        


        (ii)                 Area
          10 Broward- Aged and Disabled

         

        

         

        *IF
          ADDITIONAL SERVICES ARE NEEDED THEY MUST BE PRIOR AUTHORIZED.

         

        
          	
                  Enhanced
                    benefits

                
	
                  Circumcision,
                    boys up to one year

                
	
                  $25
                    OTC, per household per month

                
	
                  Meals
                    on Wheels – Home delivery up to 10 meals post
                    discharge

                
	
                  Expanded
                    dental services – Exams/Xrays/ Deep Cleaning/ Clear and Silver Fillings/
                    Crown (limited

                  Flouride/Periodontal
                    Scaling and root planing

                
	
                  Respite
                    Events - up to 1 per mont)

                


        

         

        

          
            
              AHCA
                CONTRACT No. FAR009, Exhibit 1-A
                Page 2 of 4

            

            
              
              

              
                

              

            

            
              
              

            

          


          Exhibit
            1-A

          Benefit
            Grid

          (i)           Area
            4 Duval- Children and Families

        

         

        
          


        

        
          *IF
            ADDITIONAL SERVICES ARE NEEDED THEY MUST BE PRIOR AUTHORIZED.

           

          
            	
                    Enhanced
                      benefits

                  
	
                    Circumcision,
                      boys up to one year

                  
	
                    $25
                      OTC, per household per month

                  
	
                    Adult
                      Dental Exams / X-rays / Deep Cleaning / Unlimited Silver Fillings
                      / Two
                      Annual Standard Cleanings

                  


          

           


          
            
              
              

            

            
              AHCA
                CONTRACT
                No. FAR009, Exhibit 1-A Page 3 of 4

              
                

              

            

            
              
              

            

          



      

      
        Exhibit
          1-A

        Benefit
          Grid

        


        (ii)           Area
          4 Duval- Aged and Disabled

      

       

      
        


          *IF
            ADDITIONAL SERVICES ARE NEEDED THEY MUST BE PRIOR AUTHORIZED.

           

          
            	
                    Enhanced
                      benefits

                  
	
                     Circumcision,
                      boys up to one year

                  
	
                     $25
                      OTC, per household per month

                  
	
                    Meals
                      on Wheels – Home delivery up to 10 meals post
                      discharge

                  
	
                     Adult
                      Dental – Exams / X-rays / Deep Cleaning / Clear and Silver Fillings
                      /
                      Crown (limited) / Fluoride / Periodontal Scaling and Root
                      Planing)

                  
	
                    Respite
                      Events - up to 1 per month

                  


          

          



          
            
              
              

            

            
              
              

              
                

              

            

            
              
              

            

          

        

      

    

    

      EXHIBIT
        3-A

       

      COMPREHENSIVE
        COMPONENT AND CATASTROPHIC COMPONENT CAPITATION
        RATES


      
        	
                TABLE  
                  2

              	 	 
	
                Area:  4

              	
                County:  Duval,
                  Clay, Baker and Nassau

              	
                September
                  1, 2007

              


      

    

     

    
      
        	
                Age
                  Range

              	 	 	
                FY0708
                  Discounted Reform rates Under Current Methodology

              	 	 	
                Percentage
                  of Current Methodology

              	 	 	
                50%
                  of Current Methodology

              	 	 	
                Preliminary
                  FY0708 Base rates for Risk Adjusted Methodology

              	 	 	
                Budget
                  Neutrality Factor

              	 	 	
                FY0708
                  Base rates for Risk Adjusted Methodology after Budget
                  Neutrality

              	 	 	
                Percentage
                  of Risk Adjusted Methodology

              	 	 	
                50%
                  of Risk Adjusted Methodology

              	 	 	
                Final
                  Rates (with Enhanced Benefit Adjustment)

              	 
	 a	
                 

              	 	 	 	
                b

              	
                 

              	 	 	
                c

              	 	 	 	
                d

              	 	 	 	
                e

              	 	 	 	
                f

              	 	 	 	
                g

              	 	 	 	
                h

              	 	 	 	
                i

              	 	 	 	
                j

              	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
                Eligibility
                  Category:

              	 	 	
                Children
                  and Family

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
                Month
                  0-2 All

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	$	
                942.31

              	 
	
                Month
                  3-11 All

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	$	
                218.74

              	 
	
                1-5
                  All

              	 	 	$	
                113.17

              	 	 	 	
                50

              	%	 	$	
                56.58

              	 	 	$	
                124.53

              	 	 	 	
                1.04120

              	 	 	$	
                129.66

              	 	 	 	
                50

              	%	 	$	
                64.83

              	 	 	$	
                118.98

              	 
	
                6-13
                  All

              	 	 	$	
                82.75

              	 	 	 	
                50

              	%	 	$	
                41.37

              	 	 	$	
                124.53

              	 	 	 	
                1.04120

              	 	 	$	
                129.66

              	 	 	 	
                50

              	%	 	$	
                64.83

              	 	 	$	
                104.08

              	 
	
                14-20
                  Female

              	 	 	$	
                119.81

              	 	 	 	
                50

              	%	 	$	
                59.91

              	 	 	$	
                124.53

              	 	 	 	
                1.04120

              	 	 	$	
                129.66

              	 	 	 	
                50

              	%	 	$	
                64.83

              	 	 	$	
                122.24

              	 
	
                14-20
                  Male

              	 	 	$	
                81.70

              	 	 	 	
                50

              	%	 	$	
                40.85

              	 	 	$	
                124.53

              	 	 	 	
                1.04120

              	 	 	$	
                129.66

              	 	 	 	
                50

              	%	 	$	
                64.83

              	 	 	$	
                103.56

              	 
	
                21-54
                  Female

              	 	 	$	
                218.13

              	 	 	 	
                50

              	%	 	$	
                109.06

              	 	 	$	
                124.53

              	 	 	 	
                1.04120

              	 	 	$	
                129.66

              	 	 	 	
                50

              	%	 	$	
                64.83

              	 	 	$	
                170.41

              	 
	
                21-54
                  Male

              	 	 	$	
                158.54

              	 	 	 	
                50

              	%	 	$	
                79.27

              	 	 	$	
                124.53

              	 	 	 	
                1.04120

              	 	 	$	
                129.66

              	 	 	 	
                50

              	%	 	$	
                64.83

              	 	 	$	
                141.22

              	 
	
                55+
                  All

              	 	 	$	
                350.55

              	 	 	 	
                50

              	%	 	$	
                175.28

              	 	 	$	
                124.53

              	 	 	 	
                1.04120

              	 	 	$	
                129.66

              	 	 	 	
                50

              	%	 	$	
                64.83

              	 	 	$	
                235.30

              	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
                 

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
                Composite
                  Based on Total Casemonths

              	 	 	$	
                119.40

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	$	
                129.66

              	 	 	 	 	 	 	$	
                0.00

              	 	 	$	
                122.04

              	 
	 	 	 	 	 	
                 

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
                 

              	 	 	 	 	 	 	 	 	 	 	 	
                 

              	 
	
                Eligibility
                  Category:

              	 	 	
                Aged
                  and Disabled

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
                 

              	 	 	 	 	 	 	 	 	 	 	 	
                 

              	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
                 

              	 	 	 	 	 	 	 	 	 	 	 	
                 

              	 
	
                Month
                  0-2 All

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
                 

              	 	 	 	 	 	 	 	 	 	 	$	
                14,803.79

              	 
	
                Month
                  3-11 All

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
                 

              	 	 	 	 	 	 	 	 	 	 	$	
                3,019.63

              	 
	
                1-5
                  All

              	 	 	$	
                537.41

              	 	 	 	
                50

              	%	 	$	
                268.70

              	 	 	$	
                657.05

              	 	 	 	
                1.05080

              	 	 	$	
                690.42

              	 	 	 	
                50

              	%	 	$	
                345.21

              	 	 	$	
                601.64

              	 
	
                6-13
                  All

              	 	 	$	
                312.13

              	 	 	 	
                50

              	%	 	$	
                156.06

              	 	 	$	
                657.05

              	 	 	 	
                1.05080

              	 	 	$	
                690.42

              	 	 	 	
                50

              	%	 	$	
                345.21

              	 	 	$	
                491.25

              	 
	
                14-20
                  All

              	 	 	$	
                296.53

              	 	 	 	
                50

              	%	 	$	
                148.27

              	 	 	$	
                657.05

              	 	 	 	
                1.05080

              	 	 	$	
                690.42

              	 	 	 	
                50

              	%	 	$	
                345.21

              	 	 	$	
                483.61

              	 
	
                21-54
                  All

              	 	 	$	
                790.16

              	 	 	 	
                50

              	%	 	$	
                395.08

              	 	 	$	
                657.05

              	 	 	 	
                1.05080

              	 	 	$	
                690.42

              	 	 	 	
                50

              	%	 	$	
                345.21

              	 	 	$	
                725.49

              	 
	
                55+
                  All

              	 	 	$	
                809.32

              	 	 	 	
                50

              	%	 	$	
                404.66

              	 	 	$	
                657.05

              	 	 	 	
                1.05080

              	 	 	$	
                690.42

              	 	 	 	
                50

              	%	 	$	
                345.21

              	 	 	$	
                734.88

              	 
	 	 	 	 	 	
                 

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
                 

              	 	 	 	
                 

              	 	 	 	 	 	 	 	
                 

              	 
	
                Composite
                  Based on Total Casemonths

              	 	 	$	
                623.67

              	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	$	
                690.42

              	 	 	 	 	 	 	$	
                0.00

              	 	 	$	
                643.91

              	 


      



      AHCA
        Contract No. FAR009, Exhibit 3-A, Page 1 of 2


        
          
            
            

          

          
            
            

            
              

            

          

          
            
            

          

        



      EXHIBIT
        3-A

       

      COMPREHENSIVE
        COMPONENT AND CATASTROPHIC COMPONENT CAPITATION
        RATES

                                                                                                                                      

      


      
        	 TABLE
                2  	 	 	 	 	 September
                1, 2007


        	
                Area:
                  10

              	
                 

              	
                County:
                  Broward

              	
                 

              	 	 


      

      


      


      ESTIMATED
        HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)

      


      
        	
                Age
                  Range

              	
                FY0708

                 Discounted

                Reform
                  rates

                Under
                  Current Methodology

              	
                Percentage
                  of Current Methodology

              	
                50%
                  of Current Methodology

              	
                Preliminary
                  FY0708 Base rates for Risk Adjusted Methodology

              	
                Budget
                  Neutrality Factor

              	
                FY0708
                  Base rates for Risk Adjusted Methodology after Budget
                  Neutrality

              	
                Percentage
                  of Risk Adjusted Methodology

              	
                50%
                  of Risk Adjusted Methodology

              	
                 

                 

                Final
                  Rates (with Enhanced Benefit Adjustment)

              
	
                a

              	
                b

              	
                c

              	
                d

              	
                e

              	
                f

              	
                g

              	
                h

              	
                i

              	
                 

                j

              
	 	 	 	 	 	 	 	 	 	 
	
                Eligibility
                  Category:

              	
                Children
                  and Family

              	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 
	
                 Month
                  0-2 All

              	 	 	 	 	 	 	 	 	
                $907.28

              
	
                Month
                  3-11 All

              	 	 	 	 	 	 	 	 	
                $208.49

              
	
                1-5
                  All

              	
                $106.14

              	
                50%

              	
                $53.07

              	
                $117.69

              	
                1.07460

              	
                $126.47

              	
                50%

              	
                $63.23

              	
                $113.98

              
	
                6-13
                  All

              	
                $82.94

              	
                50%

              	
                $41.47

              	
                $117.69

              	
                1.07460

              	
                $126.47

              	
                50%

              	
                $63.23

              	
                $102.61

              
	
                14-20
                  Female

              	
                $115.00

              	
                50%

              	
                $57.50

              	
                $117.69

              	
                1.07460

              	
                $126.47

              	
                50%

              	
                $63.23

              	
                $118.32

              
	
                14-20
                  Male

              	
                $79.98

              	
                50%

              	
                $39.99

              	
                $117.69

              	
                1.07460

              	
                $126.47

              	
                50%

              	
                $63.23

              	
                $101.16

              
	
                21-54
                  Female

              	
                $202.08

              	
                50%

              	
                $101.04

              	
                $117.69

              	
                1.07460

              	
                $126.47

              	
                50%

              	
                $63.23

              	
                $160.99

              
	
                21-54
                  Male

              	
                $146.71

              	
                50%

              	
                $73.35

              	
                $117.69

              	
                1.07460

              	
                $126.47

              	
                50%

              	
                $63.23

              	
                $133.86

              
	
                55+
                  All

              	
                $325.58

              	
                50%

              	
                $162.79

              	
                $117.69

              	
                1.07460

              	
                $126.47

              	
                50%

              	
                $63.23

              	
                $221.50

              
	 	
                 

              	
                 

              	 	 	 	 	
                 

              	 	 
	
                Composite
                  Based on Total Casemonths

              	
                $108.91

              	 	 	 	 	
                $126.47

              	 	
                $0.00

              	
                $115.34

              
	 	 	 	 	 	 	 	 	
                 

              	 
	
                Eligibility
                  Category:

              	
                Aged
                  and Disabled

              	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 
	
                Month
                  0-2 All

              	 	 	 	 	 	 	 	 	
                $17,822.94

              
	
                Month
                  3-11 All

              	 	 	 	 	 	 	 	 	
                $3,594.38

              
	
                1-5
                  All

              	
                $631.27

              	
                50%

              	
                $315.63

              	
                $813.28

              	
                1.06682

              	
                $867.63

              	
                50%

              	
                $433.81

              	
                $734.46

              
	
                6-13
                  All

              	
                $355.68

              	
                50%

              	
                $177.84

              	
                $813.28

              	
                1.06682

              	
                $867.63

              	
                50%

              	
                $433.81

              	
                $599.42

              
	
                14-20
                  All

              	
                $343.79

              	
                50%

              	
                $171.90

              	
                $813.28

              	
                1.06682

              	
                $867.63

              	
                50%

              	
                $433.81

              	
                $593.59

              
	
                21-54
                  All

              	
                $930.27

              	
                50%

              	
                $465.13

              	
                $813.28

              	
                1.06682

              	
                $867.63

              	
                50%

              	
                $433.81

              	
                $880.97

              
	
                55+
                  All

              	
                $965.71

              	
                50%

              	
                $482.85

              	
                $813.28

              	
                1.06682

              	
                $867.63

              	
                50%

              	
                $433.81

              	
                $898.33

              
	 	 	 	 	 	 	 	 	
                 

              	
                 

              
	
                Composite
                  Based on Total Casemonths

              	
                $758.94

              	 	 	 	 	
                $867.63

              	 	
                $0.00

              	
                $797.02

              


      

      


      


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        OF PAGE INTENTIONALLY LEFT BLANK

      

        AHCA
          Contract No. FAR009, Exhibit 3-A, Page2 of 2


        
          
            
            

          

          
            
            

            
              

            

          

          
            
            

          

        


        EXHIBIT
          4-A

        COMPREHENSIVE
          COMPONENT ONLY

      

      TABLE
        3

      September
        1, 2007

      Area:______    County:______________

      
        


        
          	
                  ESTIMATED
                    HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY
                    CMS)

                


        

        
          	
                  Area
                    ________

                	 	 	 	 	 	 	 	 	 	 	 
	
                  Age
                    Range

                	 	
                  FY0607
                    Discounted Reform rates Under Current Methodology

                	
                  Percentage
                    of Current Methodology

                	
                  75%
                    of Current Methodology

                	
                  FY0607
                    Base Rates for Risk-Adjusted Methodology

                	
                  Percentage
                    of Risk-Adjusted 

                  Methodology

                	
                  25%
                    of Risk-Adjusted 

                  Methodology

                	
                  Budget
                    Neutrality Factor

                	
                  Budget
                    Adjusted of 25% of Risk Adjusted Methodology

                	
                  Blended
                    Rate 

                  (Risk
                    = 1.00)

                	
                  Final
                    Rate (with Enhanced Benefit Adjustment)

                
	
                  (a)

                	 	
                  (b)

                	
                  (c)

                	
                  (d)

                	
                  (e)

                	
                  (f)

                	
                  (g)

                	
                  (h)

                	
                  (i)

                	
                  (j)

                	
                  (k)

                
	
                  Eligibility
                    Category:

                	
                  Children
                    and Family

                	 	 	 	 	 	 	 	 	 
	
                  Month
                    0-2 All

                	 	
                  $

                	
                  75%

                	
                  $

                	
                  $

                	
                  25%

                	
                  $

                	
                  $

                	 	
                  $

                	 
	
                  Month
                    3-11 All

                	 	
                  $

                	
                  75%

                	
                  $

                	
                  $

                	
                  25%

                	
                  $

                	
                  $

                	 	
                  $

                	 
	
                  1-5
                    All

                	 	
                  $

                	
                  75%

                	
                  $

                	
                  $

                	
                  25%

                	
                  $

                	
                  $

                	 	
                  $

                	 
	
                  6-13
                    All

                	 	
                  $

                	
                  75%

                	
                  $

                	
                  $

                	
                  25%

                	
                  $

                	
                  $

                	 	
                  $

                	 
	
                  14-20
                    Female

                	 	
                  $

                	
                  75%

                	
                  $

                	
                  $

                	
                  25%

                	
                  $

                	
                  $

                	 	
                  $

                	 
	
                  14-20
                    Male

                	 	
                  $

                	
                  75%

                	
                  $

                	
                  $

                	
                  25%

                	
                  $

                	
                  $

                	 	
                  $

                	 
	
                  21-54
                    Female

                	 	
                  $

                	
                  75%

                	
                  $

                	
                  $

                	
                  25%

                	
                  $

                	
                  $

                	 	
                  $

                	 
	
                  21-54
                    Male

                	 	
                  $

                	
                  75%

                	
                  $

                	
                  $

                	
                  25%

                	
                  $

                	
                  $

                	 	
                  $

                	 
	
                  55+
                    All

                	 	
                  $

                	
                  75%

                	
                  $

                	
                  $

                	
                  25%

                	
                  $

                	
                  $

                	 	
                  $

                	 
	
                  Composite

                	 	 	
                   

                	 	 	
                   

                	 	
                  $

                	 	
                  $

                	 
	 	 	 	
                   

                	 	 	
                   

                	 	 	 	 	 
	
                  Eligibility
                    Category:

                	 	
                  Aged
                    and Disabled

                	
                   

                	 	 	
                   

                	 	 	 	 	 
	
                  Month
                    0-2 All

                	 	
                  $

                	
                  75%

                	
                  $

                	
                  $

                	
                  25%

                	
                  $

                	
                  $

                	 	
                  $

                	 
	
                  Month
                    3-11 All

                	 	
                  $

                	
                  75%

                	
                  $

                	
                  $

                	
                  25%

                	
                  $

                	
                  $

                	 	
                  $

                	 
	
                  1-5
                    All

                	 	
                  $

                	
                  75%

                	
                  $

                	
                  $

                	
                  25%

                	
                  $

                	
                  $

                	 	
                  $

                	 
	
                  6-13
                    All

                	 	
                  $

                	
                  75%

                	
                  $

                	
                  $

                	
                  25%

                	
                  $

                	
                  $

                	 	
                  $

                	 
	
                  14-20
                    All

                	 	
                  $

                	
                  75%

                	
                  $

                	
                  $

                	
                  25%

                	
                  $

                	
                  $

                	 	
                  $

                	 
	
                  21-54
                    All

                	 	
                  $

                	
                  75%

                	
                  $

                	
                  $

                	
                  25%

                	
                  $

                	
                  $

                	 	
                  $

                	 
	
                  55+
                    All

                	 	
                  $

                	
                  75%

                	
                  $

                	
                  $

                	
                  25%

                	
                  $

                	
                  $

                	 	
                  $

                	 
	
                  Composite

                	 	 	 	 	 	 	 	
                  $

                	 	
                  $

                	 
	 	 	 	 	 	 	 	 	 	 	 	 


        

        


        


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          OF PAGE INTENTIONALLY LEFT BLANK

        


        


        
          
            
              
                AHCA
                  Contract No. FAR009, Exhibit 4-A, Page 1 of
                  1    

              

              
              

            

            
              
              

              
                

              

            

            
              
              

            

          

        

        


        EXHIBIT
          5-A

        CAPITATION
          RATES

        SSI
          MEDICARE PART B ONLY

        AND

        SSI
          MEDICARE PARTS A AND B ENROLLEES

        FOR
          ALL MEDICAID REFORM COUNTIES

      

       

      
        
          TABLE
            4

          


          
            	
                    Area:

                  	
                    4

                  	
                    County:

                  	
                    Duval,
                      Baker, Clay and Nassau

                  	 	 


          

          


          
            ESTIMATED
              HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)



          
            	
                     

                  	
                  


          

          
            	 	
                    Under
                      Age 65

                  	
                    Age
                      65 & Over

                  
	
                    SSI/Parts
                      A & B

                  	
                    $200.51

                  	
                    $135.15

                  
	
                    SSI/Part
                      B Only

                  	
                    $369.64

                  	
                    $369.64

                  


          

          


          


          
            	
                    Area:  

                  	  10           	  County: 	 Broward 


          

                                                                      

          


          
            ESTIMATED
              HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)



          
            	
                     

                  	
                     

                  


          

          
            	 	
                    Under
                      Age 65

                  	
                    Age
                      65 & Over

                  
	
                    SSI/Parts
                      A & B

                  	
                    $192.29

                  	
                    $129.85

                  
	
                    SSI/Part
                      B Only

                  	
                    $249.37

                  	
                    $249.37

                  


          

          


          REMAINDER
            OF PAGE INTENTIONALLY LEFT BLANK


          
            
              
                AHCA
                  Contract No. FAR009, Exhibit 5-A, Page 1 of 1

              

              
              

            

            
              
              

              
                

              

            

            
              
              

            

          

        

      

    

    
 

    
      EXHIBIT
        6-A

       

      CAPITATION
        RATES FOR HIV/AIDS POPULATIONS FOR EACH MEDICAID REFORM
        COUNTY


      TABLE
        5


      


      
        	
                Area:

              	
                4

              	
                County:

              	Duval,
                Baker, Clay and Nassau	
                 

              	 


      

      


      


      ESTIMATED
        HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)

      
        	 	
                Capitation
                  Rate

              
	 	 
	
                HIV
                  (no medicare)

              	
                $1,216.29

              
	
                AIDS
                  (no medicare)

              	
                $2,394.42

              
	
                HIV-SSI/Parts
                  A & B, SSI Part B Only

              	
                $   294.90

              
	
                AIDS-SSI/Parts
                  A & B, SSI Part B Only

              	
                $   291.91

              


      

      


      


      
        	
                Area:

              	
                10

              	
                County:

              	
                Broward

              	 	 


      

      


      


      ESTIMATED
        HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)

      
        	 	
                Capitation
                  Rate

              
	 	 
	
                HIV
                  (no medicare)

              	
                $1,966.44

              
	
                AIDS
                  (no medicare)

              	
                $3,690.27

              
	
                HIV-SSI/Parts
                  A & B, SSI Part B Only

              	
                $   331.60

              
	
                AIDS-SSI/Parts
                  A & B, SSI Part B Only

              	
                $   708.10

              


      

      


      


      REMAINDER
        OF PAGE INTENTIONALLY LEFT BLANK

        
          
                  

              AHCA
                Contract No. FAR009, Exhibit 6-A, Page 1 of 1

            

            
            

          

          
            
            

            
              

            

          

          
            
            

          

        

EXHIBIT
        7-A            

                CAPITATION
          RATES FOR CHILDREN WITH CHRONIC CONDITIONS FOR ALL MEDICAID REFORM
          COUNTIES

         

        
          TABLE
            6

        

        


        
          	
                  Area:_____________

                	County:
                  _____________________ 	
                   

                


        

        


        


        
          	
                  ESTIMATED
                    HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY
                    CMS)

                


        

        
          	 	
                  Age
                    <
                    1 Yr

                	
                  Age
                    1 Yr

                	
                  Age
                    2 - 20 Yrs

                
	 	 	 	 
	
                  Children
                    with Chronic Conditions

                	
                  $

                   

                	
                  $

                	
                  $

                


        

        


        


        


        


        REMAINDER
          OF PAGE INTENTIONALLY LEFT BLANK


        
          
                  

                      AHCA
                Contract No. FAR009, Exhibit 7-A, Page 1 of
                1      
    

            
            

          

          
            
            

            
              

            

          

          
            
            

          

        

      

       

      

        EXHIBIT
          8-A

        KICK
          PAYMENT AMOUNTS FOR COVERED

        TRANSPLANT
          SERVICES

         

        
          
            	
                    
                      TABLE
                        7

                    

                  	
                     

                  


          

          


          
            	
                    Area:

                  	
                    4

                  	
                    County:

                  	Duval,
                    Baker, Clay and Nassau	
                     

                  	 


          

          


          
            	
                    Area:

                  	
                    10

                  	
                    County:

                  	
                    Broward

                  	 	 


          

          


          


          
            	
                    CPT
                      Code

                  	
                    Transplant
                      CPT Code Description

                  	
                    Children/Adolescents
                      or Adult

                  	
                    Payment
                      Amount

                  
	
                    32851

                  	
                    lung
                      single, without bypass

                  	
                    Children/Adolescents

                  	
                    $320,800.00

                  
	
                    32851

                  	
                    lung
                      single, without bypass

                  	
                    Adult

                  	
                    $238,000.00

                  
	
                    32852

                  	
                    lung
                      single, with bypass

                  	
                    Children/Adolescents

                  	
                    $320,800.00

                  
	
                    32852

                  	
                    lung
                      single, with bypass

                  	
                    Adult

                  	
                    $238,000.00

                  
	
                    32853

                  	
                    lung
                      double, without bypass

                  	
                    Children/Adolescents

                  	
                    $320,800.00

                  
	
                    32853

                  	
                    lung
                      double, without bypass

                  	
                    Adult

                  	
                    $238,000.00

                  
	
                    32854

                  	
                    lung
                      double, with bypass

                  	
                    Children/Adolescents

                  	
                    $320,800.00

                  
	
                    32854

                  	
                    lung
                      double, with bypass

                  	
                    Adult

                  	
                    $238,000.00

                  
	
                    33945

                  	
                    heart
                      transplant with or without recipient cardiectomy

                  	
                    Children/Adolescents

                  	
                    $162,000.00

                  
	
                    33945

                  	
                    heart
                      transplant with or without recipient cardiectomy

                  	
                    Adult

                  	
                    $162,000.00

                  
	
                    47135

                  	
                    liver,
                      allotransplation, orthotopic, partial or whole from cadaver
                      or living
                      donor

                  	
                    Children/Adolescents

                  	
                    $122,600.00

                  
	
                    47135

                  	
                    liver,
                      allotransplation, orthotopic, partial or whole from cadaver
                      or living
                      donor

                  	
                    Adult

                  	
                    $122,600.00

                  
	
                    47136

                  	
                    liver,
                      heterotopic, partial or whole from cadaver or living donor
                      any
                      age

                  	
                    Children/Adolescents

                  	
                    $122,600.00

                  
	
                    47136

                  	
                    liver,
                      heterotopic, partial or whole from cadaver or living donor
                      any
                      age

                  	
                    Adult

                  	
                    $122,600.00

                  


          

          


          


          REMAINDER
            OF PAGE INTENTIONALLY LEFT BLANK

          



          
            
                    

                        AHCA
                  Contract No. FAR009, Exhibit 8-A, Page 1 of
                  1      
    

              
              

            

            
              
              

              
                

              

            

            
              
              

            

          

EXHIBIT 9-A

      

      KICK
        PAYMENT AMOUNTS FOR COVERED      


      OBSTETRICAL
        DELIVERY SERVICES

       

      TABLE
        8

      
        


        
          	 Area:                 4  	 County: 	  Duval,
                  Baker, Clay & Nassau 	 


        

                                                                                                               

        


        
          	
                  CPT
                    Code

                	
                  Obstetrical
                    Delivery CPT Code Description

                	
                  Payment
                    Amount

                
	
                  59409

                	
                  Vaginal
                    delivery only

                	
                  $3,982.26

                
	
                  59410

                	
                  Vaginal
                    delivery including postpartum care

                
	
                  59515

                	
                  Cesarean
                    delivery including postpartum care

                
	
                  59612

                	
                  Vaginal
                    delivery only, after previous cesarean delivery

                
	
                  59614

                	
                  Vaginal
                    delivery only, after previous cesarean delivery including postpartum
                    care

                
	
                  59622

                	
                  Cesarean
                    delivery only, following attempted vaginal delivery after previous
                    cesarean delivery including postpartum
                    care

                


        

        


        


        
          	
                  Area:

                	
                  10

                	
                  County:

                	
                  Broward

                	 	 


        

        


        
          	
                  CPT
                    Code

                	
                  Obstetrical
                    Delivery CPT Code Description

                	
                  Payment
                    Amount

                
	
                  59409

                	
                  Vaginal
                    delivery only

                	
                  $3,997.99

                
	
                  59410

                	
                  Vaginal
                    delivery including postpartum care

                
	
                  59515

                	
                  Cesarean
                    delivery including postpartum care

                
	
                  59612

                	
                  Vaginal
                    delivery only, after previous cesarean delivery

                
	
                  59614

                	
                  Vaginal
                    delivery only, after previous cesarean delivery including postpartum
                    care

                
	
                  59622

                	
                  Cesarean
                    delivery only, following attempted vaginal delivery after previous
                    cesarean delivery including postpartum
                    care

                


        

        


        


        


        REMAINDER
          OF PAGE INTENTIONALLY LEFT BLANK 
          AHCA
            Contract No. FAR009, Exhibit 9-A, Page 1 of
            1