exhibit10-1.htm


    
      

    

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    Exhibit
      10.1

     

    

      AHCA
        CONTRACT NO. FAR001

      AMENDMENT
        NO. 4

      


      


      THIS
        CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH
        CARE ADMINISTRATION, hereinafter referred to as the “Agency,” and
HEALTHEASE HEALTH PLAN OF FLORIDA, INC., 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 HealthEase Health Plan of Florida, Inc. to HealthEase of Florida,
                  Inc. d/b/a HealthEase.  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 $399,853,991.00 to $410,329,182.00 (an increase
                  of
                  $10,475,191.00).

              


      

      


      
        	
                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 $410,329,182.00.00
                  (an increase of $10,475,191.00).

              


      

      


      
        	
                 

              	
                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.

       

      


      
        	
                HEALTHEASE
                  OF FLORIDA, INC. D/B/A
                  HEALTHEASE

              	
                STATE
                  OF FLORIDA, AGENCY FOR HEALTH CARE
                  ADMINISTRATION

              
	
                SIGNED BY: /s/  Todd
                  Farha

              	
                SIGNED
                  BY: /s/  Andrew Agwunobi

              
	
                NAME:   Todd
                  S. Farha

              	
                NAME:  Andrew
                  C. Agwunobi, M.D.

              
	
                TITLE:   
                  President and
                  CEO                                                                

              	
                TITLE:  
                  Secretary                                                                

              
	
                DATE:   
                  6/29/2007                                           

              	
                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. FAR001, 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
                    month)

                


        



      
        
          
            
              AHCA
                Contract No. FAR001, Exhibit 1-A, Page 2 of
                4    

            

            
            

          

          
            
            

            
              

            

          

          
            
            

          

        

      

      


      


      (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. FAR001, Exhibit 1-A, Page 3 of
                4    

            

            
            

          

          
            
            

            
              

            

          

          
            
            

          

        

      

      (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)

                
	
                  (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)

                


        




      
        
          
            
              AHCA
                Contract No. FAR001, Exhibit 1-A, Page 4 of 4

            

            
            

          

          
            
            

            
              

            

          

          
            
            

          

        

      

       

      
        EXHIBIT
          3-A

        COMPREHENSIVE
          COMPONENT AND CATASTROPHIC COMPONENT CAPITATION
          RATES

        


        
          	
                  TABLE
                    2

                	 	 
	
                  Area:                      4

                	
                  County:                      Duval,
                    Clay, Baker and Nassau

                	
                  September
                    1, 2007

                


        

        


        


        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

                	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	$	
                  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

                	 


        

        


        
          
            
              
              

            

            
              
                REMAINDER
                  OF PAGE INTENTIONALLY LEFT BLANK

                
 
AHCA
                Contract No. FAR001, Exhibit 3-A, Page 1
                of 2    

              
                

              

            

            
              
              

            

          

        

        


        EXHIBIT
          3-A

        COMPREHENSIVE
          COMPONENT AND CATASTROPHIC COMPONENT CAPITATION
          RATES

      

       

      
        
          
            	
                    TABLE
                      2

                  	 	 
	
                    Area:                      10           

                  	
                    County:                      Broward                      

                  	
                    September
                      1, 2007

                  


          

          


          


              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

                  	 


          

          


          


          REMAINDER
            OF PAGE INTENTIONALLY LEFT BLANK



          
            
              AHCA
                Contract No. FAR001, Exhibit 3-A, Page 2 of 2

              
              

            

            
              
              

              
                

              

            

            
              
              

            

          

        

      

    

     

    
      EXHIBIT
        4-A

      COMPREHENSIVE
        COMPONENT ONLY


    

    
      	
              TABLE
                3

               

            	 	 
	
              Area:
                ________________

            	
              County:
                _________________

            	
              September
                1, 2007

               

            


    

    


    
      	
              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

            	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	$	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 


    

    


    


    REMAINDER
      OF PAGE INTENTIONALLY LEFT BLANK

     

    

      AHCA
        Contract No. FAR001, 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. FAR001, 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

        


        
          
            
              
              

            

            
              
              

              
                

              

            

            
              
              

            

          

        

        


        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. FAR001, 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. FAR001, 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. FAR001, Exhibit 9-A, Page 1 of 1