exv10w26w3w7






Exhibit 10.26.3.7




			
	 	 	 
	Amerigroup Florida, Inc. 

d/b/a Amerigroup Community Care
	 	Medicaid HMO Contract






AHCA CONTRACT NO.
FA614

 AMENDMENT NO. 11




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




	1.	 	Effective February 1, 2009, Attachment I, Scope of Services, is hereby amended to
include Exhibit III-E, February 1, 2009 - August 31, 2009 Medicaid Non-Reform HMO
Capitation Rates, attached hereto and made a part of the Contract. All references in
the Contract to Exhibit III-D, September 1, 2008 - August 31, 2009 Medicaid Non-Reform
HMO Capitation Rates, shall hereinafter also refer to Exhibit III-E, February 1, 2009
- August 31, 2009 Medicaid Non-Reform HMO Capitation Rates, as appropriate.





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



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



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



     This Amendment cannot be executed unless all previous amendments to this Contract have been fully executed.



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



	 	 	 	 	 	 	 	 	 	 	 
	AMERIGROUP FLORIDA INC.

D/B/A AMERIGROUP COMMUNITY CARE	 	 	 	STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	SIGNED

	 	 	 	 	 	SIGNED	 	 	 	 
	BY:

	 	/s/ William L. McHugh 	 	 	 	BY:	 	/s/ Holly Benson	 	 
	 

	 	 

	 	 	 	 	 	 

	 	 
	NAME:

	 	William L. McHugh
	 	 	 	NAME:
	 	Holly Benson	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	TITLE:

	 	CEO
	 	 	 	TITLE:
	 	Secretary	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	DATE:

	 	 	 	 	 	DATE:	 	 	 	 
	 

	 	 

	 	 	 	 	 	 

	 	 





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




	 	 	 	 	 
	Specify	 	Letter/	 	 
	Type	 	Number	 	Description
	 
	Exhibit

	 	III-E
	 	February 1, 2009 - August 31,
2009 Medicaid Non-Reform HMO
Capitation Rates (5 pages)






AHCA Contract No. FA614, Amendment No. 11, Page 1 of 1




 









 









     



EXHIBIT III-E

February 1, 2009 - August 31, 2009 HMO RATES

(MEDICAID Non-Reform HMO CAPITATION RATES)

By Area, Age and Eligibility Category




TABLE 1


General Rates:




	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	TANF	 	SSI-N	 	SSI-B	 	SSI-AB
	Area	 	BTHMO+2MO	 	3MO-11MO	 	AGE (1-5)	 	AGE (6-13)	 	AGE (14-20)	 	AGE (21-54)	 	AGE (55+)	 	BTHMO+2MO	 	3MO-11MO	 	AGE (1-5)	 	AGE (6-13)	 	AGE (14-20)	 	AGE (21-54)	 	AGE (55+)	 	 	 	 	 	AGE (65-)	 	AGE (65+)
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Female	 	Male	 	Female	 	Male	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	01
	 	 	1,113.37	 	 	 	187.38	 	 	 	101.38	 	 	 	61.45	 	 	 	129.49	 	 	 	69.52	 	 	 	255.23	 	 	 	153.37	 	 	 	318.51	 	 	 	10,428.92	 	 	 	1,517.58	 	 	 	445.88	 	 	 	198.88	 	 	 	213.14	 	 	 	696.73	 	 	 	700.31	 	 	 	305.88	 	 	 	94.80	 	 	 	85.77	 
	02
	 	 	1,113.37	 	 	 	187.38	 	 	 	101.38	 	 	 	61.45	 	 	 	129.49	 	 	 	69.52	 	 	 	255.23	 	 	 	153.37	 	 	 	318.51	 	 	 	10,428.92	 	 	 	1,517.58	 	 	 	445.88	 	 	 	198.88	 	 	 	213.14	 	 	 	696.73	 	 	 	700.31	 	 	 	305.88	 	 	 	94.80	 	 	 	85.77	 
	03
	 	 	1,217.67	 	 	 	206.51	 	 	 	112.28	 	 	 	69.11	 	 	 	143.30	 	 	 	77.85	 	 	 	283.53	 	 	 	171.42	 	 	 	359.72	 	 	 	11,442.82	 	 	 	1,680.06	 	 	 	495.07	 	 	 	226.05	 	 	 	241.47	 	 	 	787.51	 	 	 	795.55	 	 	 	340.56	 	 	 	90.01	 	 	 	81.98	 
	04
	 	 	1,067.51	 	 	 	181.92	 	 	 	99.04	 	 	 	61.51	 	 	 	126.30	 	 	 	69.23	 	 	 	250.83	 	 	 	152.26	 	 	 	321.21	 	 	 	10,972.58	 	 	 	1,615.28	 	 	 	476.38	 	 	 	218.79	 	 	 	233.36	 	 	 	761.37	 	 	 	770.55	 	 	 	297.82	 	 	 	90.35	 	 	 	82.40	 
	05
	 	 	1,214.96	 	 	 	206.53	 	 	 	112.30	 	 	 	69.38	 	 	 	143.25	 	 	 	78.21	 	 	 	284.08	 	 	 	172.12	 	 	 	361.87	 	 	 	12,248.94	 	 	 	1,796.88	 	 	 	528.79	 	 	 	240.95	 	 	 	256.93	 	 	 	840.31	 	 	 	849.11	 	 	 	225.19	 	 	 	81.19	 	 	 	75.29	 
	06
	 	 	1,056.56	 	 	 	181.19	 	 	 	98.87	 	 	 	61.99	 	 	 	126.18	 	 	 	69.68	 	 	 	251.35	 	 	 	153.20	 	 	 	325.45	 	 	 	11,162.18	 	 	 	1,645.44	 	 	 	485.06	 	 	 	223.95	 	 	 	237.92	 	 	 	777.94	 	 	 	788.05	 	 	 	274.94	 	 	 	79.31	 	 	 	72.63	 
	07
	 	 	1,092.94	 	 	 	186.84	 	 	 	101.87	 	 	 	63.49	 	 	 	129.77	 	 	 	71.35	 	 	 	258.27	 	 	 	157.02	 	 	 	332.09	 	 	 	11,810.40	 	 	 	1,744.81	 	 	 	514.41	 	 	 	238.57	 	 	 	254.24	 	 	 	828.77	 	 	 	840.70	 	 	 	373.98	 	 	 	84.56	 	 	 	77.61	 
	08
	 	 	1,033.51	 	 	 	177.08	 	 	 	96.67	 	 	 	60.37	 	 	 	123.15	 	 	 	68.03	 	 	 	245.23	 	 	 	149.29	 	 	 	316.91	 	 	 	10,525.98	 	 	 	1,550.30	 	 	 	457.03	 	 	 	210.03	 	 	 	224.35	 	 	 	731.36	 	 	 	740.14	 	 	 	256.24	 	 	 	78.77	 	 	 	72.23	 
	09
	 	 	1,067.78	 	 	 	181.58	 	 	 	98.82	 	 	 	61.05	 	 	 	126.06	 	 	 	68.67	 	 	 	249.80	 	 	 	151.41	 	 	 	318.38	 	 	 	11,078.29	 	 	 	1,635.46	 	 	 	482.13	 	 	 	223.68	 	 	 	237.34	 	 	 	775.59	 	 	 	785.85	 	 	 	219.29	 	 	 	84.42	 	 	 	77.20	 
	10
	 	 	1,083.46	 	 	 	186.09	 	 	 	101.73	 	 	 	63.88	 	 	 	129.70	 	 	 	71.87	 	 	 	258.53	 	 	 	157.78	 	 	 	335.92	 	 	 	14,344.29	 	 	 	2,132.34	 	 	 	629.36	 	 	 	297.17	 	 	 	314.18	 	 	 	1,027.07	 	 	 	1,044.85	 	 	 	322.21	 	 	 	94.02	 	 	 	86.21	 
	11
	 	 	1,372.19	 	 	 	232.59	 	 	 	126.24	 	 	 	77.54	 	 	 	161.30	 	 	 	87.46	 	 	 	319.10	 	 	 	192.88	 	 	 	404.23	 	 	 	14,488.14	 	 	 	2,131.88	 	 	 	628.05	 	 	 	289.19	 	 	 	307.93	 	 	 	1,004.54	 	 	 	1,015.98	 	 	 	370.49	 	 	 	140.27	 	 	 	126.63	 
	6B*
	 	 	1,056.42	 	 	 	181.17	 	 	 	98.86	 	 	 	61.98	 	 	 	126.16	 	 	 	69.67	 	 	 	251.32	 	 	 	153.18	 	 	 	325.40	 	 	 	11,161.68	 	 	 	1,645.35	 	 	 	485.04	 	 	 	223.94	 	 	 	237.91	 	 	 	777.89	 	 	 	788.02	 	 	 	274.94	 	 	 	79.31	 	 	 	72.63	 






TABLE 2



General + Mental Health Rates:







	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	TANF	 	SSI-N	 	SSI-B	 	SSI-AB
	Area	 	BTHMO+2MO	 	3MO-11MO	 	AGE (1-5)	 	AGE (6-13)	 	AGE (14-20)	 	AGE (21-54)	 	AGE (55+)	 	BTHMO+2MO	 	3MO-11MO	 	AGE (1-5)	 	AGE (6-13)	 	AGE (14-20)	 	AGE (21-54)	 	AGE (55+)	 	 	 	 	 	AGE (65-)	 	AGE (65+)
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Female	 	Male	 	Female	 	Male	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	01
	 	 	1,113.39	 	 	 	187.40	 	 	 	103.02	 	 	 	73.14	 	 	 	140.42	 	 	 	80.45	 	 	 	259.67	 	 	 	157.81	 	 	 	322.25	 	 	 	10,429.00	 	 	 	1,517.66	 	 	 	453.32	 	 	 	246.93	 	 	 	257.13	 	 	 	778.13	 	 	 	731.29	 	 	 	306.09	 	 	 	106.45	 	 	 	97.42	 
	02
	 	 	1,113.40	 	 	 	187.41	 	 	 	104.29	 	 	 	81.71	 	 	 	142.91	 	 	 	82.94	 	 	 	258.64	 	 	 	156.78	 	 	 	321.46	 	 	 	10,429.08	 	 	 	1,517.74	 	 	 	459.67	 	 	 	277.70	 	 	 	258.36	 	 	 	749.41	 	 	 	725.19	 	 	 	326.08	 	 	 	109.81	 	 	 	100.78	 
	03
	 	 	1,217.58	 	 	 	206.52	 	 	 	113.60	 	 	 	78.29	 	 	 	149.38	 	 	 	83.93	 	 	 	285.07	 	 	 	172.96	 	 	 	361.06	 	 	 	11,442.89	 	 	 	1,680.13	 	 	 	501.33	 	 	 	261.81	 	 	 	261.99	 	 	 	811.41	 	 	 	806.83	 	 	 	347.41	 	 	 	98.99	 	 	 	90.96	 
	04
	 	 	1,067.52	 	 	 	181.93	 	 	 	100.42	 	 	 	71.07	 	 	 	132.64	 	 	 	75.57	 	 	 	252.44	 	 	 	153.87	 	 	 	322.61	 	 	 	10,972.69	 	 	 	1,615.39	 	 	 	486.14	 	 	 	274.53	 	 	 	265.34	 	 	 	798.63	 	 	 	788.14	 	 	 	322.37	 	 	 	107.12	 	 	 	99.17	 
	05
	 	 	1,214.97	 	 	 	206.54	 	 	 	113.51	 	 	 	78.06	 	 	 	151.36	 	 	 	85.32	 	 	 	287.37	 	 	 	175.41	 	 	 	364.65	 	 	 	12,248.99	 	 	 	1,796.93	 	 	 	533.81	 	 	 	273.37	 	 	 	286.61	 	 	 	895.23	 	 	 	870.01	 	 	 	227.92	 	 	 	94.01	 	 	 	88.11	 
	06
	 	 	1,056.58	 	 	 	181.21	 	 	 	100.72	 	 	 	75.24	 	 	 	138.56	 	 	 	82.06	 	 	 	256.38	 	 	 	158.23	 	 	 	329.70	 	 	 	11,162.25	 	 	 	1,645.51	 	 	 	491.58	 	 	 	266.06	 	 	 	276.46	 	 	 	849.27	 	 	 	815.20	 	 	 	276.25	 	 	 	83.20	 	 	 	76.52	 
	07
	 	 	1,092.96	 	 	 	186.86	 	 	 	103.65	 	 	 	76.18	 	 	 	141.63	 	 	 	83.21	 	 	 	263.09	 	 	 	161.84	 	 	 	336.16	 	 	 	11,810.46	 	 	 	1,744.87	 	 	 	520.53	 	 	 	278.08	 	 	 	290.41	 	 	 	895.70	 	 	 	866.18	 	 	 	376.57	 	 	 	95.08	 	 	 	88.13	 
	08
	 	 	1,033.52	 	 	 	177.09	 	 	 	97.93	 	 	 	69.15	 	 	 	128.97	 	 	 	73.85	 	 	 	246.72	 	 	 	150.78	 	 	 	318.20	 	 	 	10,526.05	 	 	 	1,560.37	 	 	 	463.03	 	 	 	244.31	 	 	 	244.03	 	 	 	754.27	 	 	 	750.96	 	 	 	263.09	 	 	 	91.99	 	 	 	85.45	 
	09
	 	 	1,067.80	 	 	 	181.60	 	 	 	100.37	 	 	 	71.86	 	 	 	133.22	 	 	 	75.83	 	 	 	251.62	 	 	 	153.23	 	 	 	319.95	 	 	 	11,078.36	 	 	 	1,635.53	 	 	 	488.46	 	 	 	259.82	 	 	 	258.08	 	 	 	799.75	 	 	 	797.26	 	 	 	226.14	 	 	 	94.01	 	 	 	86.79	 
	10
	 	 	1,083.48	 	 	 	186.11	 	 	 	103.65	 	 	 	77.24	 	 	 	138.55	 	 	 	80.72	 	 	 	260.78	 	 	 	160.03	 	 	 	337.87	 	 	 	14,344.39	 	 	 	2,132.44	 	 	 	637.71	 	 	 	344.88	 	 	 	341.56	 	 	 	1,058.95	 	 	 	1,059.91	 	 	 	329.06	 	 	 	102.08	 	 	 	94.27	 
	11
	 	 	1,372.21	 	 	 	232.61	 	 	 	127.86	 	 	 	88.83	 	 	 	168.79	 	 	 	94.95	 	 	 	321.01	 	 	 	194.79	 	 	 	405.88	 	 	 	14,488.22	 	 	 	2,131.96	 	 	 	635.02	 	 	 	328.99	 	 	 	330.76	 	 	 	1,031.14	 	 	 	1,028.54	 	 	 	377.72	 	 	 	148.33	 	 	 	134.69	 
	6B*
	 	 	1,056.44	 	 	 	181.19	 	 	 	100.61	 	 	 	74.50	 	 	 	137.86	 	 	 	81.37	 	 	 	256.07	 	 	 	157.93	 	 	 	329.41	 	 	 	11,161.75	 	 	 	1,645.42	 	 	 	491.54	 	 	 	265.93	 	 	 	276.34	 	 	 	849.01	 	 	 	815.09	 	 	 	276.25	 	 	 	83.20	 	 	 	76.52	 






AHCA Contract No. FA614, Exhibit III-E, 1 of 5




 









 








     



EXHIBIT III-E

February 1, 2009 -August 31, 2009 HMO RATES

(MEDICAID Non-Reform HMO CAPITATION RATES)

By Area, Age and Eligibility Category




TABLE 3




General + MH + Dental Rates:




	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	TANF	 	SSI-N	 	SSI-B	 	SSI-AB
	Area	 	BTHMO+2MO	 	3MO-11MO	 	AGE (1-5)	 	AGE (6-13)	 	AGE (14-20)	 	AGE (21-54)	 	AGE (55+)	 	BTHMO+2MO	 	3MO-11MO	 	AGE (1-5)	 	AGE (6-13)	 	AGE (14-20)	 	AGE (21-54)	 	AGE (55+)	 	 	 	 	 	AGE (65-)	 	AGE (65+)
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Female	 	Male	 	Female	 	Male	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	01
	 	 	1,113.39	 	 	 	187.41	 	 	 	104.70	 	 	 	76.25	 	 	 	143.60	 	 	 	83.14	 	 	 	260.89	 	 	 	159.07	 	 	 	325.04	 	 	 	10,429.00	 	 	 	1,517.66	 	 	 	454.94	 	 	 	249.33	 	 	 	259.19	 	 	 	779.46	 	 	 	733.15	 	 	 	306.54	 	 	 	107.57	 	 	 	98.28	 
	02
	 	 	1,113.40	 	 	 	187.42	 	 	 	105.97	 	 	 	84.82	 	 	 	146.09	 	 	 	85.63	 	 	 	259.86	 	 	 	158.04	 	 	 	324.25	 	 	 	10,429.08	 	 	 	1,517.74	 	 	 	461.29	 	 	 	280.10	 	 	 	260.42	 	 	 	750.74	 	 	 	727.05	 	 	 	326.53	 	 	 	110.93	 	 	 	101.64	 
	03
	 	 	1,217.59	 	 	 	206.54	 	 	 	116.65	 	 	 	83.95	 	 	 	155.15	 	 	 	88.81	 	 	 	286.81	 	 	 	174.74	 	 	 	365.03	 	 	 	11,442.89	 	 	 	1,680.14	 	 	 	504.46	 	 	 	266.45	 	 	 	265.98	 	 	 	813.29	 	 	 	809.48	 	 	 	348.44	 	 	 	100.64	 	 	 	92.22	 
	04
	 	 	1,067.53	 	 	 	181.94	 	 	 	102.26	 	 	 	74.49	 	 	 	136.14	 	 	 	78.52	 	 	 	254.11	 	 	 	155.59	 	 	 	326.43	 	 	 	10,972.69	 	 	 	1,615.39	 	 	 	487.92	 	 	 	277.17	 	 	 	267.61	 	 	 	800.51	 	 	 	790.78	 	 	 	324.55	 	 	 	108.71	 	 	 	100.38	 
	05
	 	 	1,214.98	 	 	 	206.56	 	 	 	116.92	 	 	 	84.39	 	 	 	157.83	 	 	 	91.79	 	 	 	290.78	 	 	 	178.92	 	 	 	372.44	 	 	 	12,249.00	 	 	 	1,796.94	 	 	 	538.03	 	 	 	279.64	 	 	 	291.99	 	 	 	898.93	 	 	 	875.21	 	 	 	231.58	 	 	 	97.80	 	 	 	91.00	 
	06
	 	 	1,056.59	 	 	 	181.22	 	 	 	103.39	 	 	 	80.20	 	 	 	143.62	 	 	 	86.34	 	 	 	258.26	 	 	 	160.17	 	 	 	334.00	 	 	 	11,162.25	 	 	 	1,645.52	 	 	 	494.62	 	 	 	270.56	 	 	 	280.33	 	 	 	851.77	 	 	 	818.71	 	 	 	278.01	 	 	 	85.45	 	 	 	78.23	 
	07
	 	 	1,092.97	 	 	 	186.87	 	 	 	106.05	 	 	 	80.63	 	 	 	146.17	 	 	 	87.05	 	 	 	264.42	 	 	 	163.20	 	 	 	339.20	 	 	 	11,810.46	 	 	 	1,744.88	 	 	 	523.53	 	 	 	282.52	 	 	 	294.23	 	 	 	897.25	 	 	 	868.36	 	 	 	377.05	 	 	 	96.60	 	 	 	89.29	 
	08
	 	 	1,033.53	 	 	 	177.11	 	 	 	101.57	 	 	 	75.90	 	 	 	135.86	 	 	 	79.68	 	 	 	248.74	 	 	 	152.85	 	 	 	322.80	 	 	 	10,526.05	 	 	 	1,550.38	 	 	 	466.45	 	 	 	249.39	 	 	 	248.39	 	 	 	756.55	 	 	 	754.16	 	 	 	264.63	 	 	 	93.66	 	 	 	86.72	 
	09
	 	 	1,067.81	 	 	 	181.62	 	 	 	103.30	 	 	 	77.30	 	 	 	138.78	 	 	 	80.53	 	 	 	252.58	 	 	 	154.21	 	 	 	322.14	 	 	 	11,078.36	 	 	 	1,635.54	 	 	 	491.05	 	 	 	263.67	 	 	 	261.39	 	 	 	800.93	 	 	 	798.91	 	 	 	227.97	 	 	 	95.08	 	 	 	87.60	 
	10
	 	 	1,083.49	 	 	 	186.12	 	 	 	106.08	 	 	 	81.75	 	 	 	143.16	 	 	 	84.62	 	 	 	261.51	 	 	 	160.78	 	 	 	339.53	 	 	 	14,344.39	 	 	 	2,132.45	 	 	 	640.50	 	 	 	349.02	 	 	 	345.12	 	 	 	1,059.90	 	 	 	1,061.24	 	 	 	329.88	 	 	 	103.38	 	 	 	95.25	 
	11
	 	 	1,372.22	 	 	 	232.62	 	 	 	131.59	 	 	 	96.51	 	 	 	176.76	 	 	 	101.67	 	 	 	321.87	 	 	 	195.67	 	 	 	407.84	 	 	 	14,488.23	 	 	 	2,131.98	 	 	 	639.29	 	 	 	336.38	 	 	 	337.23	 	 	 	1,032.92	 	 	 	1,031.04	 	 	 	381.06	 	 	 	150.49	 	 	 	136.34	 
	6B*
	 	 	1,056.45	 	 	 	181.20	 	 	 	103.28	 	 	 	79.48	 	 	 	142.92	 	 	 	85.65	 	 	 	256.07	 	 	 	157.93	 	 	 	329.41	 	 	 	11,161.75	 	 	 	1,645.43	 	 	 	494.58	 	 	 	270.43	 	 	 	280.21	 	 	 	849.01	 	 	 	815.09	 	 	 	278.01	 	 	 	85.45	 	 	 	78.23	 






TABLE 4



General + MH + Transportation Rates:




	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	TANF	 	SSI-N	 	SSI-B	 	SSI-AB
	Area	 	BTHMO+2MO	 	3MO-11MO	 	AGE (1-5)	 	AGE (6-13)	 	AGE (14-20)	 	AGE (21-54)	 	AGE (55+)	 	BTHMO+2MO	 	3MO-11MO	 	AGE (1-5)	 	AGE (6-13)	 	AGE (14-20)	 	AGE (21-54)	 	AGE (55+)	 	 	 	 	 	AGE (65-)	 	AGE (65+)
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Female	 	Male	 	Female	 	Male	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	01
	 	 	1,118.74	 	 	 	188.77	 	 	 	103.85	 	 	 	73.64	 	 	 	142.45	 	 	 	81.79	 	 	 	262.97	 	 	 	160.32	 	 	 	325.75	 	 	 	10,468.09	 	 	 	1,543.33	 	 	 	458.61	 	 	 	249.36	 	 	 	263.26	 	 	 	798.19	 	 	 	748.22	 	 	 	313.56	 	 	 	120.17	 	 	 	106.26	 
	02
	 	 	1,118.75	 	 	 	188.78	 	 	 	105.12	 	 	 	82.21	 	 	 	144.94	 	 	 	84.28	 	 	 	261.94	 	 	 	159.29	 	 	 	324.97	 	 	 	10,468.17	 	 	 	1,543.41	 	 	 	464.96	 	 	 	280.13	 	 	 	264.49	 	 	 	769.47	 	 	 	742.12	 	 	 	333.55	 	 	 	123.53	 	 	 	109.62	 
	03
	 	 	1,224.01	 	 	 	208.18	 	 	 	114.60	 	 	 	78.89	 	 	 	151.82	 	 	 	85.54	 	 	 	289.04	 	 	 	175.98	 	 	 	365.28	 	 	 	11,492.20	 	 	 	1,712.51	 	 	 	508.01	 	 	 	264.88	 	 	 	269.71	 	 	 	836.72	 	 	 	828.19	 	 	 	356.12	 	 	 	118.76	 	 	 	103.70	 
	04
	 	 	1,072.09	 	 	 	183.11	 	 	 	101.13	 	 	 	71.50	 	 	 	134.38	 	 	 	76.72	 	 	 	256.26	 	 	 	156.01	 	 	 	325.61	 	 	 	11,011.02	 	 	 	1,640.55	 	 	 	491.32	 	 	 	276.91	 	 	 	271.34	 	 	 	818.29	 	 	 	804.74	 	 	 	329.55	 	 	 	122.97	 	 	 	109.39	 
	05
	 	 	1,218.84	 	 	 	207.54	 	 	 	114.11	 	 	 	78.42	 	 	 	152.83	 	 	 	87.29	 	 	 	289.75	 	 	 	177.22	 	 	 	367.18	 	 	 	12,280.81	 	 	 	1,817.81	 	 	 	538.12	 	 	 	275.35	 	 	 	291.59	 	 	 	911.55	 	 	 	883.79	 	 	 	234.47	 	 	 	108.09	 	 	 	97.18	 
	06
	 	 	1,060.38	 	 	 	182.19	 	 	 	101.31	 	 	 	75.60	 	 	 	140.00	 	 	 	83.01	 	 	 	258.73	 	 	 	160.02	 	 	 	332.19	 	 	 	11,193.75	 	 	 	1,666.20	 	 	 	495.85	 	 	 	268.01	 	 	 	281.39	 	 	 	865.43	 	 	 	828.84	 	 	 	281.96	 	 	 	94.76	 	 	 	83.97	 
	07
	 	 	1,096.99	 	 	 	187.89	 	 	 	104.28	 	 	 	76.56	 	 	 	143.16	 	 	 	84.23	 	 	 	265.58	 	 	 	163.74	 	 	 	338.80	 	 	 	11,845.21	 	 	 	1,767.68	 	 	 	525.23	 	 	 	280.23	 	 	 	295.85	 	 	 	913.53	 	 	 	881.23	 	 	 	381.95	 	 	 	107.21	 	 	 	95.94	 
	08
	 	 	1,038.81	 	 	 	178.45	 	 	 	98.76	 	 	 	69.66	 	 	 	130.99	 	 	 	75.18	 	 	 	249.98	 	 	 	153.26	 	 	 	321.67	 	 	 	10,564.27	 	 	 	1,575.46	 	 	 	468.20	 	 	 	246.69	 	 	 	250.01	 	 	 	773.87	 	 	 	767.52	 	 	 	269.02	 	 	 	106.78	 	 	 	94.97	 
	09
	 	 	1,072.91	 	 	 	182.92	 	 	 	101.17	 	 	 	72.34	 	 	 	135.16	 	 	 	77.11	 	 	 	254.77	 	 	 	155.63	 	 	 	323.30	 	 	 	11,117.70	 	 	 	1,661.37	 	 	 	493.79	 	 	 	262.27	 	 	 	264.24	 	 	 	819.93	 	 	 	814.30	 	 	 	232.70	 	 	 	109.81	 	 	 	96.97	 
	10
	 	 	1,086.47	 	 	 	186.89	 	 	 	104.12	 	 	 	77.52	 	 	 	139.69	 	 	 	81.47	 	 	 	262.62	 	 	 	161.43	 	 	 	339.83	 	 	 	14,370.64	 	 	 	2,149.68	 	 	 	641.26	 	 	 	346.51	 	 	 	345.67	 	 	 	1,072.41	 	 	 	1,071.28	 	 	 	334.36	 	 	 	114.42	 	 	 	102.22	 
	11
	 	 	1,375.30	 	 	 	233.40	 	 	 	128.34	 	 	 	89.12	 	 	 	169.97	 	 	 	95.73	 	 	 	322.92	 	 	 	196.24	 	 	 	407.91	 	 	 	14,515.60	 	 	 	2,149.93	 	 	 	638.72	 	 	 	330.69	 	 	 	335.05	 	 	 	1,045.18	 	 	 	1,040.40	 	 	 	382.84	 	 	 	160.77	 	 	 	142.70	 
	6B*
	 	 	1,060.24	 	 	 	182.17	 	 	 	101.20	 	 	 	74.86	 	 	 	139.30	 	 	 	82.32	 	 	 	258.42	 	 	 	159.72	 	 	 	331.90	 	 	 	11,193.25	 	 	 	1,666.11	 	 	 	495.81	 	 	 	267.88	 	 	 	281.27	 	 	 	865.17	 	 	 	828.73	 	 	 	281.96	 	 	 	94.76	 	 	 	83.97	 






AHCA Contract No. FA614, Exhibit III-E, 2 of 5





 












 





     



 EXHIBIT lll-E

February 1, 2009 - August 31, 2009 HMO RATES

(MEDICAID Non-Reform HMO CAPITATION RATES)

By Area, Age and Eligibility Category




 TABLE 5 




General
+ Transportation Rates:




	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 TANF 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 SSI-N 	 	 	 	 	 	 	 	 	 	 	 	 SSI-B 	 	 SSI-AB 
	 Area 	 	 BTHMO+2MO 	 	 3MO-11MO 	 	 AGE (1-5) 	 	 AGE (6-13) 	 	 AGE (14-20) 	 	 AGE (21-54) 	 	 AGE (55+) 	 	 BTHMO+2MO 	 	 3MO-11MO 	 	 AGE (1-5) 	 	 AGE (6-13) 	 	 AGE(14-20) 	 	 AGE (21-54) 	 	 AGE (55+) 	 	 	 	 AGE (65-) 	 	 AGE (65+) 
	 	 	 	 	 	 	 	 	 	 	 Female 	 	 Male 	 	 Female 	 	 Male 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 01
	 	 1,118.72
	 	 188.75
	 	 102.21
	 	 61.95
	 	 131.52
	 	 70.86
	 	 258.53
	 	 155.88
	 	 322.02
	 	 10,468.01
	 	 1,543.25
	 	 451.17
	 	 201.31
	 	 219.27
	 	 716.79
	 	 717.24
	 	 313.35
	 	 108.52
	 	 94.61 
	 02
	 	 1,118.72
	 	 188.75
	 	 102.21
	 	 61.95
	 	 131.52
	 	 70.86
	 	 258.53
	 	 155.88
	 	 322.02
	 	 10,468.01
	 	 1,543.25
	 	 451.17
	 	 201.31
	 	 219.27
	 	 716.79
	 	 717.24
	 	 313.35
	 	 108.52
	 	 94.61 
	 03
	 	 1,224.00
	 	 208.17
	 	 113.28
	 	 69.71
	 	 145.74
	 	 79.46
	 	 287.50
	 	 174.44
	 	 363.94
	 	 11,492.13
	 	 1,712.44
	 	 501.75
	 	 229.12
	 	 249.19
	 	 812.82
	 	 816.91
	 	 349.27
	 	 109.78
	 	 94.72 
	 04
	 	 1,072.08
	 	 183.10
	 	 99.75
	 	 61.94
	 	 128.04
	 	 70.38
	 	 253.65
	 	 154.40
	 	 324.21
	 	 11,010.91
	 	 1,640.44
	 	 481.56
	 	 221.17
	 	 239.36
	 	 781.03
	 	 787.15
	 	 305.00
	 	 106.20
	 	 92.62 
	 05
	 	 1,218.83
	 	 207.53
	 	 112.90
	 	 69.74
	 	 144.72
	 	 79.18
	 	 286.46
	 	 173.93
	 	 364.40
	 	 12,280.76
	 	 1,817.76
	 	 533.10
	 	 242.93
	 	 261.91
	 	 856.63
	 	 862.89
	 	 231.74
	 	 95.27
	 	 84.36 
	 06
	 	 1,060.36
	 	 182.17
	 	 99.46
	 	 62.35
	 	 127.62
	 	 70.63
	 	 253.70
	 	 154.99
	 	 327.94
	 	 11,193.68
	 	 1,666.13
	 	 489.33
	 	 225.90
	 	 242.85
	 	 794.10
	 	 801.69
	 	 280.65
	 	 90.87
	 	 80.08 
	 07
	 	 1,096.97
	 	 187.87
	 	 102.50
	 	 63.87
	 	 131.30
	 	 72.37
	 	 260.76
	 	 158.92
	 	 334.73
	 	 11,845.15
	 	 1,767.62
	 	 519.11
	 	 240.72
	 	 259.68
	 	 846.60
	 	 855.75
	 	 379.36
	 	 96.69
	 	 85.42 
	 08
	 	 1,038.80
	 	 178.44
	 	 97.50
	 	 60.87
	 	 125.17
	 	 69.36
	 	 248.49
	 	 151.77
	 	 320.38
	 	 10,564.20
	 	 1,575.39
	 	 462.20
	 	 212.41
	 	 230.33
	 	 750.96
	 	 756.70
	 	 262.17
	 	 93.56
	 	 81.75 
	 09
	 	 1,072.89
	 	 182.90
	 	 99.62
	 	 61.53
	 	 128.00
	 	 69.95
	 	 252.95
	 	 153.81
	 	 321.73
	 	 11,117.63
	 	 1,661.30
	 	 487.46
	 	 226.13
	 	 243.50
	 	 796.77
	 	 802.89
	 	 225.85
	 	 100.22
	 	 87.38 
	 10
	 	 1,086.45
	 	 186.87
	 	 102.20
	 	 64.16
	 	 130.84
	 	 72.62
	 	 260.37
	 	 159.18
	 	 337.88
	 	 14,370.54
	 	 2,149.58
	 	 632.91
	 	 298.80
	 	 318.29
	 	 1,040.53
	 	 1,056.22
	 	 327.51
	 	 106.36
	 	 94.16 
	 11
	 	 1,375.28
	 	 233.38
	 	 126.72
	 	 77.83
	 	 162.48
	 	 88.24
	 	 321.01
	 	 194.33
	 	 406.26
	 	 14,515.52
	 	 2,149.85
	 	 631.75
	 	 290.89
	 	 312.22
	 	 1,018.58
	 	 1,027.84
	 	 375.61
	 	 152.71
	 	 134.64 
	 6B*
	 	 1,060.22
	 	 182.15
	 	 99.45
	 	 62.34
	 	 127.60
	 	 70.62
	 	 253.67
	 	 154.97
	 	 327.89
	 	 11,193.18
	 	 1,666.04
	 	 489.31
	 	 225.89
	 	 242.84
	 	 794.05
	 	 801.66
	 	 280.65
	 	 90.87
	 	 80.08 






 TABLE 6 




General + Dental Rates:




	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 TANF 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 SSI-N 	 	 	 	 	 	 	 	 	 	 	 	 SSI-B 	 	 SSI-AB 
	 Area 	 	 BTHMO+2MO 	 	 3MO-11MO 	 	 AGE (1-5) 	 	 AGE (6-13) 	 	 AGE (14-20) 	 	 AGE (21-54) 	 	 AGE (55+) 	 	 BTHMO+2MO 	 	 3MO-11MO 	 	 AGE (1-5) 	 	 AGE (6-13) 	 	 AGE (14-20) 	 	 AGE (21-54) 	 	 AGE (55+) 	 	 	 	 AGE (65-) 	 	 AGE (65+) 
	 	 	 	 	 	 	 	 	 	 	 Female 	 	 Male 	 	 Female 	 	 Male 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 01
	 	 1,113.37
	 	 187.39
	 	 103.06
	 	 64.56
	 	 132.67
	 	 72.21
	 	 256.45
	 	 154.63
	 	 321.30
	 	 10,428.92
	 	 1,517.58
	 	 447.50
	 	 201.28
	 	 215.20
	 	 698.06
	 	 702.17
	 	 306.33
	 	 95.92
	 	 86.63 
	 02
	 	 1,113.37
	 	 187.39
	 	 103.06
	 	 64.56
	 	 132.67
	 	 72.21
	 	 256.45
	 	 154.63
	 	 321.30
	 	 10,428.92
	 	 1,517.58
	 	 447.50
	 	 201.28
	 	 215.20
	 	 698.06
	 	 702.17
	 	 306.33
	 	 95.92
	 	 86.63 
	 03
	 	 1,217.58
	 	 206.53
	 	 115.33
	 	 74.77
	 	 149.07
	 	 82.73
	 	 285.27
	 	 173.20
	 	 363.69
	 	 11,442.82
	 	 1,680.07
	 	 498.20
	 	 230.69
	 	 245.46
	 	 789.39
	 	 798.20
	 	 341.69
	 	 91.66
	 	 83.24 
	 04
	 	 1,067.52
	 	 181.93
	 	 100.88
	 	 64.93
	 	 129.80
	 	 72.18
	 	 252.50
	 	 153.98
	 	 325.03
	 	 10,972.58
	 	 1,615.28
	 	 478.16
	 	 221.43
	 	 235.63
	 	 763.25
	 	 773.19
	 	 300.00
	 	 91.94
	 	 83.61 
	 05
	 	 1,214.97
	 	 206.55
	 	 115.71
	 	 75.71
	 	 149.72
	 	 83.68
	 	 287.49
	 	 176.63
	 	 369.66
	 	 12,248.95
	 	 1,796.89
	 	 533.01
	 	 247.22
	 	 262.31
	 	 844.01
	 	 854.31
	 	 228.85
	 	 84.98
	 	 78.18 
	 06
	 	 1,056.57
	 	 181.20
	 	 101.54
	 	 66.95
	 	 131.24
	 	 73.96
	 	 253.23
	 	 155.14
	 	 329.75
	 	 11,162.18
	 	 1,845.45
	 	 488.10
	 	 228.45
	 	 241.79
	 	 780.44
	 	 791.56
	 	 276.70
	 	 81.56
	 	 74.34 
	 07
	 	 1,092.95
	 	 186.85
	 	 104.27
	 	 67.94
	 	 134.31
	 	 75.19
	 	 259.60
	 	 158.38
	 	 335.13
	 	 11,810.40
	 	 1,744.82
	 	 517.41
	 	 243.01
	 	 258.06
	 	 830.32
	 	 842.88
	 	 374.46
	 	 86.08
	 	 78.77 
	 08
	 	 1,033.52
	 	 177.10
	 	 100.31
	 	 67.11
	 	 130.04
	 	 73.86
	 	 247.25
	 	 151.36
	 	 321.51
	 	 10,525.98
	 	 1,550.31
	 	 460.45
	 	 215.11
	 	 228.71
	 	 733.64
	 	 743.34
	 	 257.78
	 	 80.44
	 	 73.50 
	 09
	 	 1,067.79
	 	 181.60
	 	 101.75
	 	 66.49
	 	 131.62
	 	 73.37
	 	 250.76
	 	 152.39
	 	 320.57
	 	 11,078.29
	 	 1,635.47
	 	 484.72
	 	 227.53
	 	 240.65
	 	 776.77
	 	 787.50
	 	 221.12
	 	 85.49
	 	 78.01 
	 10
	 	 1,083.47
	 	 186.10
	 	 104.16
	 	 68.39
	 	 134.31
	 	 75.77
	 	 259.26
	 	 158.53
	 	 337.58
	 	 14,344.29
	 	 2,132.35
	 	 632.15
	 	 301.31
	 	 317.74
	 	 1,028.02
	 	 1,046.18
	 	 323.03
	 	 95.32
	 	 87.19 
	 11
	 	 1,372.20
	 	 232.60
	 	 129.97
	 	 85.22
	 	 169.27
	 	 94.18
	 	 319.96
	 	 193.76
	 	 406.19
	 	 14,488.15
	 	 2,131.90
	 	 632.32
	 	 296.58
	 	 314.40
	 	 1,006.32
	 	 1,018.48
	 	 373.83
	 	 142.43
	 	 128.28 
	 6B*
	 	 1,056.43
	 	 181.18
	 	 101.53
	 	 66.94
	 	 131.22
	 	 73.95
	 	 251.32
	 	 153.18
	 	 325.40
	 	 11,161.68
	 	 1,645.36
	 	 488.08
	 	 228.44
	 	 241.78
	 	 777.89
	 	 788.02
	 	 276.70
	 	 81.56
	 	 74.34 






 AHCA
Contract No. FA614, Exhibit III-E, 3 of 5


















 





     



EXHIBIT III-E

February 1, 2009 - August 31, 2009 HMO RATES

(MED1CAID Non-Reform HMO CAPITATION RATES)

By Area, Age and Eligibility Category




TABLE 7




General + Dental+Transportation Rates:




	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	TANF	 	 	 	 	 	 	 	 	 	 	 	 	 	AGE (14-20)	 	AGE (21-54)	 	 	 	 	 	 	 	 	 	SSI-N	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-AB
	Area	 	BTHMO+2MO	 	3MO-11MO	 	AGE (1-5)	 	AGE (6-13)	 	Female	 	Male	 	Female	 	Male	 	AGE (55+)	 	BTHMO+2MO	 	3MO-11MO	 	AGE (1-5)	 	AGE (6-13)	 	AGE (14-20)	 	AGE (21-54)	 	AGE (55+)	 	SSI-B	 	AGE (65-)	 	AGE (65+)
	01

	 	 	1,118.72	 	 	 	188.76	 	 	 	103.89	 	 	 	65.06	 	 	 	134.70	 	 	 	73.55	 	 	 	259.75	 	 	 	157.14	 	 	 	324.81	 	 	 	10,468.01	 	 	 	1,543.25	 	 	 	452.79	 	 	 	203.71	 	 	 	221.33	 	 	 	718.12	 	 	 	719.10	 	 	 	313.80	 	 	 	109.64	 	 	 	95.47	 
	02

	 	 	1,118.72	 	 	 	188.76	 	 	 	103.89	 	 	 	65.06	 	 	 	134.70	 	 	 	73.55	 	 	 	259.75	 	 	 	157.14	 	 	 	324.81	 	 	 	10,468.01	 	 	 	1,543.25	 	 	 	452.79	 	 	 	203.71	 	 	 	221.33	 	 	 	718.12	 	 	 	719.10	 	 	 	313.80	 	 	 	109.64	 	 	 	95.47	 
	03

	 	 	1,224.01	 	 	 	208.19	 	 	 	116.33	 	 	 	75.37	 	 	 	151.51	 	 	 	84.34	 	 	 	289.24	 	 	 	176.22	 	 	 	367.91	 	 	 	11,492.13	 	 	 	1,712.45	 	 	 	504.88	 	 	 	233.76	 	 	 	253.18	 	 	 	814.70	 	 	 	819.56	 	 	 	350.30	 	 	 	111.43	 	 	 	95.98	 
	04

	 	 	1,072.09	 	 	 	183.11	 	 	 	101.59	 	 	 	65.36	 	 	 	131.54	 	 	 	73.33	 	 	 	255.32	 	 	 	156.12	 	 	 	328.03	 	 	 	11,010.91	 	 	 	1,640.44	 	 	 	483.34	 	 	 	223.81	 	 	 	241.63	 	 	 	782.91	 	 	 	789.79	 	 	 	307.18	 	 	 	107.79	 	 	 	93.83	 
	05

	 	 	1,218.84	 	 	 	207.55	 	 	 	116.31	 	 	 	76.07	 	 	 	151.19	 	 	 	84.65	 	 	 	289.87	 	 	 	177.44	 	 	 	372.19	 	 	 	12,280.77	 	 	 	1,817.77	 	 	 	537.32	 	 	 	249.20	 	 	 	267.29	 	 	 	860.33	 	 	 	868.09	 	 	 	235.40	 	 	 	99.06	 	 	 	87.25	 
	06

	 	 	1,060.37	 	 	 	182.18	 	 	 	102.13	 	 	 	67.31	 	 	 	132.68	 	 	 	74.91	 	 	 	255.58	 	 	 	156.93	 	 	 	332.24	 	 	 	11,193.68	 	 	 	1,666.14	 	 	 	492.37	 	 	 	230.40	 	 	 	246.72	 	 	 	796.60	 	 	 	805.20	 	 	 	282.41	 	 	 	93.12	 	 	 	81.79	 
	07

	 	 	1,096.98	 	 	 	187.88	 	 	 	104.90	 	 	 	68.32	 	 	 	135.84	 	 	 	76.21	 	 	 	262.09	 	 	 	160.28	 	 	 	337.77	 	 	 	11,845.15	 	 	 	1,767.63	 	 	 	522.11	 	 	 	245.16	 	 	 	263.50	 	 	 	848.15	 	 	 	857.93	 	 	 	379.84	 	 	 	98.21	 	 	 	86.58	 
	08

	 	 	1,038.81	 	 	 	178.46	 	 	 	101.14	 	 	 	67.61	 	 	 	132.06	 	 	 	76.19	 	 	 	250.51	 	 	 	153.84	 	 	 	324.98	 	 	 	10,564.20	 	 	 	1,575.40	 	 	 	465.62	 	 	 	217.49	 	 	 	234.69	 	 	 	753.24	 	 	 	759.90	 	 	 	263.71	 	 	 	95.23	 	 	 	83.02	 
	09

	 	 	1,072.90	 	 	 	182.92	 	 	 	102.55	 	 	 	66.97	 	 	 	133.56	 	 	 	74.65	 	 	 	253.91	 	 	 	154.79	 	 	 	323.92	 	 	 	11,117.63	 	 	 	1,661.31	 	 	 	490.05	 	 	 	229.98	 	 	 	246.81	 	 	 	796.95	 	 	 	804.54	 	 	 	227.68	 	 	 	101.29	 	 	 	88.19	 
	10

	 	 	1,086.46	 	 	 	186.88	 	 	 	104.63	 	 	 	68.67	 	 	 	135.45	 	 	 	76.52	 	 	 	261.10	 	 	 	159.93	 	 	 	339.54	 	 	 	14,370.54	 	 	 	2,149.59	 	 	 	635.70	 	 	 	302.94	 	 	 	321.85	 	 	 	1,041.48	 	 	 	1,057.55	 	 	 	328.33	 	 	 	107.66	 	 	 	95.14	 
	11

	 	 	1,375.29	 	 	 	233.39	 	 	 	130.45	 	 	 	85.51	 	 	 	170.45	 	 	 	94.96	 	 	 	321.87	 	 	 	195.21	 	 	 	408.22	 	 	 	14,515.53	 	 	 	2,149.87	 	 	 	636.02	 	 	 	298.28	 	 	 	318.69	 	 	 	1,020.36	 	 	 	1,030.34	 	 	 	378.95	 	 	 	154.87	 	 	 	136.29	 
	6B*

	 	 	1,060.23	 	 	 	182.16	 	 	 	102.12	 	 	 	67.30	 	 	 	132.66	 	 	 	74.90	 	 	 	253.67	 	 	 	154.97	 	 	 	327.89	 	 	 	11,193.18	 	 	 	1,666.05	 	 	 	492.35	 	 	 	230.39	 	 	 	246.71	 	 	 	794.05	 	 	 	801.66	 	 	 	282.41	 	 	 	93.12	 	 	 	81.79	 






Table 8




General+ Mental Health + Dental + Transportation Rates:




	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	TANF	 	 	 	 	 	 	 	 	 	 	 	 	 	AGE (14-20)	 	AGE (21-54)	 	 	 	 	 	 	 	 	 	SSI-N	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	SSI-AB
	Area	 	BTHMO+2MO	 	3MO-11MO	 	AGE (1-5)	 	AGE (6-13)	 	Female	 	Male	 	Female	 	Male	 	AGE (55+)	 	BTHMO+2MO	 	3MO-11MO	 	AGE (1-5)	 	AGE (6-13)	 	AGE (14-20)	 	AGE (21-54)	 	AGE (55+)	 	SSI-B	 	AGE (65-)	 	AGE (65+)
	01

	 	 	1,118.74	 	 	 	188.78	 	 	 	105.53	 	 	 	76.75	 	 	 	145.63	 	 	 	84.48	 	 	 	264.19	 	 	 	161.58	 	 	 	328.55	 	 	 	10,468.09	 	 	 	1,543.33	 	 	 	460.23	 	 	 	251.76	 	 	 	265.32	 	 	 	799.52	 	 	 	750.08	 	 	 	314.01	 	 	 	121.29	 	 	 	107.12	 
	02

	 	 	1,118.75	 	 	 	188.79	 	 	 	106.80	 	 	 	85.32	 	 	 	148.12	 	 	 	86.97	 	 	 	263.16	 	 	 	160.55	 	 	 	327.76	 	 	 	10,468.17	 	 	 	1,543.41	 	 	 	466.58	 	 	 	282.53	 	 	 	266.55	 	 	 	770.80	 	 	 	743.98	 	 	 	334.00	 	 	 	124.65	 	 	 	110.48	 
	03

	 	 	1,224.02	 	 	 	208.20	 	 	 	117.65	 	 	 	84.55	 	 	 	157.59	 	 	 	90.42	 	 	 	290.78	 	 	 	177.76	 	 	 	369.25	 	 	 	11,492.20	 	 	 	1,712.52	 	 	 	511.14	 	 	 	269.52	 	 	 	273.70	 	 	 	838.60	 	 	 	830.84	 	 	 	357.15	 	 	 	120.41	 	 	 	104.96	 
	04

	 	 	1,072.10	 	 	 	183.12	 	 	 	102.97	 	 	 	74.92	 	 	 	137.88	 	 	 	79.67	 	 	 	256.93	 	 	 	157.73	 	 	 	329.43	 	 	 	11,011.02	 	 	 	1,640.55	 	 	 	493.10	 	 	 	279.55	 	 	 	273.61	 	 	 	820.17	 	 	 	807.38	 	 	 	331.73	 	 	 	124.56	 	 	 	110.60	 
	05

	 	 	1,218.85	 	 	 	207.56	 	 	 	117.52	 	 	 	84.75	 	 	 	159.30	 	 	 	92.76	 	 	 	293.16	 	 	 	180.73	 	 	 	374.97	 	 	 	12,280.82	 	 	 	1,817.82	 	 	 	542.34	 	 	 	281.62	 	 	 	296.97	 	 	 	915.25	 	 	 	888.99	 	 	 	238.13	 	 	 	111.88	 	 	 	100.07	 
	06

	 	 	1,060,39	 	 	 	182.20	 	 	 	103.98	 	 	 	80.56	 	 	 	145.06	 	 	 	87.29	 	 	 	260.61	 	 	 	161.96	 	 	 	336.49	 	 	 	11,193.75	 	 	 	1,666.21	 	 	 	498.89	 	 	 	272.51	 	 	 	285.26	 	 	 	867.93	 	 	 	832.35	 	 	 	283.72	 	 	 	97.01	 	 	 	85.68	 
	07

	 	 	1,097.00	 	 	 	187.90	 	 	 	106.68	 	 	 	81.01	 	 	 	147.70	 	 	 	88.07	 	 	 	266.91	 	 	 	165.10	 	 	 	341.84	 	 	 	11,845.21	 	 	 	1,767.69	 	 	 	528.23	 	 	 	284.67	 	 	 	299.67	 	 	 	915.08	 	 	 	883.41	 	 	 	382.43	 	 	 	108.73	 	 	 	97.10	 
	08

	 	 	1,038.82	 	 	 	178.47	 	 	 	102.40	 	 	 	76.40	 	 	 	137.88	 	 	 	81.01	 	 	 	252.00	 	 	 	155.33	 	 	 	326.27	 	 	 	10,564.27	 	 	 	1,575.47	 	 	 	471.62	 	 	 	251.77	 	 	 	254.37	 	 	 	776.15	 	 	 	770.72	 	 	 	270.56	 	 	 	108.45	 	 	 	96.24	 
	09

	 	 	1,072.92	 	 	 	182.94	 	 	 	104.10	 	 	 	77.78	 	 	 	140.72	 	 	 	81.81	 	 	 	255.73	 	 	 	156.61	 	 	 	325.49	 	 	 	11,117.70	 	 	 	1,661.38	 	 	 	496.38	 	 	 	266.12	 	 	 	267.55	 	 	 	821.11	 	 	 	815.95	 	 	 	234.53	 	 	 	110.88	 	 	 	97.78	 
	10

	 	 	1,086.48	 	 	 	186.90	 	 	 	106.55	 	 	 	82.03	 	 	 	144.30	 	 	 	85.37	 	 	 	263.35	 	 	 	162.18	 	 	 	341.49	 	 	 	14,370.64	 	 	 	2,149.69	 	 	 	644.05	 	 	 	350.65	 	 	 	349.23	 	 	 	1,073.36	 	 	 	1,072.61	 	 	 	335.18	 	 	 	115.72	 	 	 	103.20	 
	11

	 	 	1,375.31	 	 	 	233.41	 	 	 	132.07	 	 	 	96.80	 	 	 	177.94	 	 	 	102.45	 	 	 	323.78	 	 	 	197.12	 	 	 	409.87	 	 	 	14,515.61	 	 	 	2,149.95	 	 	 	642.99	 	 	 	338.08	 	 	 	341.52	 	 	 	1,046.96	 	 	 	1,042.90	 	 	 	386.18	 	 	 	162.93	 	 	 	144.35	 
	6B*

	 	 	1,060.25	 	 	 	182.18	 	 	 	103.87	 	 	 	79.82	 	 	 	144.36	 	 	 	86.60	 	 	 	258.42	 	 	 	159.72	 	 	 	331.90	 	 	 	11,193.25	 	 	 	1,666.12	 	 	 	498.85	 	 	 	272.38	 	 	 	285.14	 	 	 	865.17	 	 	 	828.73	 	 	 	283.72	 	 	 	97.01	 	 	 	85.68	 






AHCA Contract No. FA614, Exhibit III-E, 4 of 5


















 





EXHIBIT
III-E

February 1, 2009 - August 31, 2009 HMO RATES

(MEDICAID Non-Reform HMO CAPITATION RATES)

By Area, Age and Eligibility Category




	 	 	 
	Area

	 	Corresponding Counties
	 
	 	 
	Area 1

	 	Escambia, Okaloosa, Santa Rosa, Walton
	Area 2

	 	Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Washington, Wakulla
	Area 3

	 	Alachua, Bradford, Citrus,
Columbia, Dixie, Gilchrist, Hamillton, Hemando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, Union
	Area 4

	 	Baker, Clay, Duval, Flagler,
Nassau, St Johns, Volusia
	Area 5

	 	Pasco, Pinellas
	Area 6

	 	Hardee, Highlands, Manatee, Polk
	Area 6B *

	 	Hillsborough
	Area 7

	 	Brevard, Orange, Osceola, Seminole
	Area 8

	 	Charlotte, Collier, De Soto, Glades, Hendry, Lee, Sarasota
	Area 9

	 	Indian River, Okeechobee, St. Lucie, Martin, Palm Beach
	Area 10

	 	Broward
	Area 11

	 	Dade, Monroe






AHCA
Contract No. FA614, Exhibit III-E, 5 of 5




 









 





EXHIBIT
III-E

February 1, 2009 - August 31, 2009 HMO RATES

(MEDICAID Non-Reform HMO CAPITATION RATES)

By Area, Age and Eligibility Category




AHCA
Contract No. FA614, Exhibit III-E, 6 of 5