fa905amend9.htm


 



	 Back to 10-Q	 	Exhibit 10.3
	 	 	 
	HealthEase of Florida, Inc.	 	Medicaid HMO Non-Reform Contract
	 	 	 
	 	AHCA CONTRACT NO. FA905	 
	 	AMENDMENT NO. 9	 





 




                THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the "Agency" and HEALTHEASE OF FLORIDA, INC., hereinafter referred to as the "Vendor" or “Health Plan”, is hereby amended as follows:


 



	
 1.

	
Effective March 1, 2012, Attachment I, Scope of Services, Capitated Health Plans, is hereby amended to include Attachment I, Exhibit 1-C, Revised Maximum Enrollment Levels, attached hereto and made a part of the Contract. All references in the Contract to Attachment I, Exhibits 1, 1-A, and 1-B, shall hereinafter also refer to Attachment I, Exhibit 1-C, as appropriate.


 








	 	
Unless otherwise stated, this amendment is effective upon execution by both parties.


 


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


 


	 	
This amendment and all its attachments are hereby made a part of the Contract.


 


	 	This amendment cannot be executed unless all previous amenments to this Contract have been fully executed. 





 


                IN WITNESS WHEREOF, the Parties hereto have caused this five (5) page amendment (including all attachments) to be executed by their officials thereunto duly authorized.


 


 



	HEALTHEASE OF FLORIDA, INC.	 	STATE OF FLORIDA, AGENCY FOR	 	 
	 	 	HEALTH CARE ADMINISTRATION	 	 
	 	 	 	 	 
	SIGNED	 	SIGNED 	 	 
	BY:	 /s/ Christina Cooper	 	 	BY:	 /s/ Elizabeth Dudek	 	 	 
	 	 	 	 	 
	NAME:	 Christina Cooper	 	 	NAME:	 Elizabeth Dudek	 	 	 
	 	 	 	 	 
	TITLE:	 President, FL & HI Division	 	 	TITLE:	 Secretary	 	 	 
	 	 	 	 	 
	DATE:	 3/8/12	 	 	DATE:	 3/12/12	 	 	 
	 	 	 	 	 





 


 


 



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


 

	 	 
	
Specify


Type

	
 Letter/


Number

	 	
 Description


	Attachment I	Exhibit 1-C	 	Revised Maximum Enrollment Levels (4 Pages)





 


 


REMAINDER OF PAGE INTENTIONALLY LEFT BLANK


 


 




 






	
AHCA Contract No. FA905, Amendment No. 9, Page 1 of 1














  





  











  




	
 


















 




	HealthEase of Florida, Inc.	 	Medicaid HMO Non-Reform Contract
	 	 	 
	 	ATTACHMENT I	 
	 	EXHIBIT 1-C	 
	 	REVISED MAXIMUM ENROLLMENT LEVELS 	 





 




 


Maximum enrollment levels and Health Plan provider numbers associated with the counties and populations served. Exhibit 2-NR-C provide the capitation rate tables respective to the areas of operation listed below.


 


A.    Non-Reform


 


See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates


 


            Area 1 Counties: Escambia, Santa Rosa


 



	
Effective Date: 11/01/11 Escambia, 08/01/11 Santa Rosa


	County	Enrollment Level	Provider Number
	    Escambia	67,500	015019344
	    Santa Rosa	31,500	015019343





 


 


See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates


 


Area 2 Counties: Bay, Calhoun, Gadsden, Jefferson, Leon, Liberty, Madison, Wakulla


 



	Effective Date: 03/01/12 Bay, 09/01/09 all other counties
	 County	 Enrollment Level	 Provider Number
	 Bay	 16,900	 TBD
	 Calhoun	 800	015019340
	 Gadsden	 3,500	015019315
	 Jefferson	 1,000	015019318
	 Leon	 7,000	015019320
	 Liberty	 400	015019342
	 Madison	 1,500	015019322
	 Wakulla	 1,000	015019336 





 


 


 


REMAINDER OF PAGE INTENTIONALLY LEFT BLANK


 


 










	
AHCA Contract No. FA905, Attachment I, Exhibit 1-C, Page 1 of 4










  










 



	 	 	 
	HealthEase of Florida, Inc.	 	Medicaid HMO Non-Reform Contract
	 





   


    See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates 




 


Area 3 Counties: Citrus, Lake, Marion, Putnam


 



	
Effective Date: 09/01/09


	
County

	
Enrollment Level

	
Provider Number


	
Citrus

	
7,500

	
015019309


	
Lake

	
7,000

	
015019319


	
Marion

	
20,000

	
015019323


	
Putnam

	
6,000

	
015019329












 



	
  

	
See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates







 


                Area 4 Counties: Duval, Volusia


 



	
Effective Date: 09/01/09


	
County

	
Enrollment Level

	
Provider Number


	
Duval

	
55,000

	
015019313


	
Volusia

	
15,000

	
015019335












 



	
  

	
See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates







 


                Area 5 Counties: Pasco, Pinellas


 



	
Effective Date: 09/01/09


	
County

	
Enrollment Level

	
Provider Number


	
Pasco

	
6,000

	
015019302


	
Pinellas

	
9,000

	
015019303







 


REMAINDER OF PAGE INTENTIONALLY LEFT BLANK


 


 




 





AHCA Contract No. FA905, Attachment I, Exhibit 1-C, Page 2 of 4







  










 




	 	 	 
	HealthEase of Florida, Inc.	 	Medicaid HMO Non-Reform Contract
	 





   




 


                See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates 




Area 6 Counties: Highlands, Hillsborough, Manatee, Polk


 



	
Effective Date: 09/01/09


	
County

	
Enrollment Level

	
Provider Number


	
Highlands

	
3,000

	
015019317


	
Hillsborough

	
18,000

	
015019300


	
Manatee

	
6,000

	
015019301


	
Polk

	
10,000

	
015019304












 



	
  

	
See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates Area 7 Counties: Brevard, Orange, Osceola, Seminole







 



	
Effective Date: 09/01/09


	
County

	
Enrollment Level

	
Provider Number


	
Brevard

	
14,000

	
015019308


	
Orange

	
25,000

	
015019327


	
Osceola

	
8,000

	
015019328


	
Seminole

	
4,000

	
015019333












 



	
  

	
See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates Area 8 County: Sarasota







 



	
Effective Date: 09/01/09


	
County

	
Enrollment Level

	
Provider Number


	
Sarasota

	
3,000

	
015019332







 


REMAINDER OF PAGE INTENTIONALLY LEFT BLANK


 


 


 


 




 






AHCA Contract No. FA905, Attachment I, Exhibit 1-C, Page 3 of 4









  











  






 




	 	 	 
	HealthEase of Florida, Inc.	 	Medicaid HMO Non-Reform Contract
	 





 





	
  

	
See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates 







                Area 9 Counties: Martin, Palm Beach


 



	
Effective Date: 09/01/09


	
County

	
Enrollment Level

	
Provider Number


	
Martin

	
5,000

	
015019324


	
Palm Beach

	
10,500

	
015019339












 



	
  

	
See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates Area 10 County: Broward







 



	
Effective Date: 09/01/09


	
County

	
Enrollment Level

	
Provider Number


	
Broward

	
13,500

	
015019337













	
  

	
See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates Area 11 County: Miami-Dade







 



	
Effective Date: 09/01/09


	
County

	
Enrollment Level

	
Provider Number


	
Miami-Dade

	
25,000

	
015019338







 


 


REMAINDER OF PAGE INTENTIONALLY LEFT BLANK