nyschpamendno1.htm


    Back to Form
8-K

    Exhibit 10.2

    
 AMENDMENT
1

    
       

      APPENDIX
X

       

      
        	 Agency Code
      12000                           
                           	 Contract No.
      C022813                                                   
      
	 Period 1/1/08 -
      12/31/12                       
               	 Funding Amount
      for Period ____ no change ____


      

        

    

    
      This is
an AGREEMENT between THE STATE OF NEW YORK, acting by and through the New
York State Department of Health, having its principal office at Coming Tower,
Empire State Plaza, Room
1619, Albany, NY 12237, hereinafter referred to as the STATE), and Wellcare of New York,
Inc. (hereinafter referred to as the CONTRACTOR),
for modification of Contract Number C022813 as
amended in attached Appendix
C.

    

    
      


      All other
provisions of said AGREEMENT shall remain in full force and
effect.

    

    
       

      IN
WITNESS WHEREOF, the parties hereto have executed this AGREEMENT as of the dates
appearing under their signatures.

       

    

    
      
        	
                CONTRACTOR
      SIGNATURE

                 

              	
                 

              	 
      

                STATE
      AGENCY SIGANTURE

              
	
                By:     /s/ Heath
      Schiesser    

                         
       Heath
      Schiesser          
      

                          
      Printed Name

                 

              	
                 

              	
                 By: 
        /s/ Judith
      Arnold                        
          

                           Judith
      Arnold                      
               

                          
      Printed Name 

              
	
                Title:
       President
      and CEO     

              	
                 

              	
                Title:  Director,
      Division of Coverage and
      Enrollment

              
	
                 

                Date: 
      8/22/08                         

              	
                 

              	 
      

                Date:
      9/12/08                                           
      

              
	 
      	
                 

                 

                 

              	 
      

                State
      Agency Certification:

                “In
      addition to the acceptance of this contract, I also certify that original
      copies of this signature page will be attached to all exact copies of this
      contract.”

              


      

      
         

        
          
            
               


            

            
               


              
                

              

            

            
               


            

          

        

         

      

    

    
      
        	
                STATE
      OF FLORIDA

              	
                )

              
	 	)SS.:
	   
      County of Hillsborugh                 
      	)


      

    

    
      
On the
22nd day of August in the year  2008  before me, the
undersigned, personally appeared  Heath Schiesser, personally known to
me or proved to me

    

    
      on the
basis of satisfactory evidence to be the individual(s) whose name(s) is(are)
subscribed to the within instrument and acknowledged to me that he/she/they
executed the same in his/her/their/ capacity(ies), and that by his/her/their
signature(s) on the instrument, the individual(s), or the person upon behalf of
which the individual(s) acted, executed the instrument.

    

    
      


      _Cathleen
McGlynn                                                      
      

      (Signature
and office of the individual taking acknowledgement)

    

    
       

    

    
      	 
      	
              STATE
      COMPTROLLER'S SIGNATURE

            
	 
      	
              Title:

            
	 
      	
              Date:

            


    

    
       

      
        	 	 	
                 APPROVED

              	 
	 	 	
                 DEPT. OF AUDIT
      & CONTROL

              	 
	 	 	 	 
	 	 	
                 DEC 4
      2008

              	 
	 	 	 	 
	 	 	
                 /s/
      Name
      Illegible                                   
      

              	 
	 	 	 FOR THE STATE
      COMPTROLLER	 


      

       

      
        
          
             


          

          
             


            
              

            

          

          
             


          

        

      

      
APPENDIX
C 

      PROGRAM
SPECIFIC CLAUSES

    

    
       

      Sections
4.4, 4.5, 4.8 and 4.10 are revised to read as follows:

    

    
      


      4.4           Health
Insurance

    

    
       

                  
   The child must not have other health insurance coverage unless the
policy is one of the "Excepted Benefits" set forth in the federal Public Health
Service Act. These 

                      exceptions
are as
follows:

    

    
       

                      A.       Accident-only
coverage or disability income insurance;

                      B.        Coverage
issued as a supplement to liability insurance;

                      C.        Liability
insurance, including auto insurance;

                      D.       Workers'
compensation or similar insurance;

                     
E.        Automobile
medical payment insurance;

                      F.        Credit-only
insurance;

                      G.        Coverage
for on-site medical clinics;

                     
H.      
Dental-only, vision-only, or long term care insurance;

                      I.        
Specified disease coverage; 

                     
J.    
    Hospital indemnity or other fixed dollar indemnity
coverage; or 

                     
K.      
Medicare supplemental only or CHAMPUS supplemental coverage.

    

    
      


      Additional
exceptions for otherwise eligible children are:

    

    
       

      
        	
                 

              	 ▪	
                Participation in the Physically
      Handicapped Children's
Program;

              


      

    

    
       

      
        	
                 

              	 ▪	
                Health insurance by a
      non-custodial parent if the health plan's provider network is not
      geographically accessible to the child; or
  

              


      

    

    
       

    

    
      
        	
                 

              	 ▪	
                Enrollment in the Medicaid Family
      Planning Benefit
program.

              


      

    

    
      


                     
Children with other health insurance products are not eligible for CHPlus
including, but not limited to:

    

    
       

      
        	
                 

              	 ▪	
                A child with Medicare coverage;
      or

              


      

    

    
       

      
        	
                 

              	 ▪	
                A child insured with a college
      health insurance
policy.

              


      

    

    
       

      4.5           Public
Employees

    

    
       

      The
parent or guardian of the applicant child shall not be a public employee of the
State or a public agency with access to family health insurance coverage by a
state health benefits plan and the State or public agency pays all or part of
the cost of the family health insurance coverage. For a listing of other than
state agencies or state operated facilities, the CONTRACTOR may use the
following website to determine if the public agency has access to a state health
benefits plan:

    

    
       

      www.cs.state.ny.us/ebd/ebdonlinecenter/pamarket/directorv.cfm. If the CONTRACTOR is uncertain if a parent has access to
such coverage, the CONTRACTOR must contact the applicant's parent or guardian to find
out if the health insurance available to the family is that described in this
paragraph.

    


    
      
         


      

      
         


        
          

        

      

      
         


      

    

     

    
      4.8           Screen
for Eligibility

    

    
       

      The
CONTRACTOR shall follow the following steps to assure that children are screened
for Medicaid or CHPlus eligibility.

    

    
       

      New
Applications

    

    
       

      The
CONTRACTOR must screen all new applications for Medicaid eligibility using the
STATE developed eligibility screening worksheet. CONTRACTORS shall only enroll
children who appear eligible for Medicaid based on the screening worksheet in
CHPlus on a temporary basis, as described in section 8 of this Appendix and the
CHPlus manual.

    

    
      


      If the
screen indicates the child is not eligible for Medicaid, otherwise eligible
children residing in households with gross income at or below 250 percent of the
non-farm federal poverty level or, effective September 1, 2008, 400 percent of
the non-farm federal poverty level, are eligible for subsidized coverage under
CHPlus. If the CONTRACTOR determines a child to be eligible for CHPlus, the
child shall be enrolled in CHPlus for a period to begin on the first day of the
month an eligible child is enrolled, based on all required documentation, and
shall continue for twelve (12) months ending on the last day of the twelfth
month as specified in section 4.9 of this Appendix.

    

    
       

      Children
residing in households with gross income over 250 percent of the non-farm
federal poverty level or, effective September 1, 2008, over 400 percent of the
non-farm federal poverty level, are not eligible for subsidized coverage under
CHPlus but may be enrolled in CHPlus providing that they pay the full premium
amount for the health plan in which they are enrolled.

    

    
       

      4.10         Crowd-Out

    

    
       

      
      

       

      
        	 	
                1.       
        If the STATE determines that crowd-out is occurring in excess of a
      percentage specified in the State Child Health Plan established under
      Title XXI of the federal Social Security
      Act or as may be specified by the Secretary of the federal Department of
      Health and Human Services based on data collected pursuant to section 16.4
      of this Appendix, the
      following eligibility criterion shall be implemented for a child residing
      in a household with gross income at or below two hundred fifty percent of
      the non-farm
      federal poverty
      level.

              


      

                    


    

    
      The child
must not have been covered by a group health plan based upon a family member's
employment during the six (6) month period prior to the date of application
unless one of the following exceptions applies:

    

    
       

       a)          Loss
of employment is due to factors other than voluntary
separation;

    

    
       

      
        	
                 

              	b)	
                Death
      of the family member which results in termination of coverage under a
      group health plan under which the child is
  covered;

              


      

    

    
       

      
        	
                 

              	c)	
                Change
      to a new employer that does not provide an option for comprehensive health
      benefits coverage;

              


      

    

    
      


      
        
          
             


          

          
             


            
              

            

          

          
             


          

        

      

       

    

    
      
        	
                 

              	d)	
                Change
      of residence so that no employer-based comprehensive health benefits
      coverage is available;

              


      

    

    
       

      
        	
                 

              	e)	
                Discontinuation
      of comprehensive health benefits coverage to all employees of the
      applicant's employer;

              


      

    

    
       

      
        	
                 

              	f)	
                Expiration
      of the coverage periods established by COBRA or the provisions of sections
      3221(m), 4304(k) and 4305(e) of the Insurance
  Law;

              


      

    

    
       

                     
g)          Termination of
comprehensive health benefits coverage due to long-term
disability;

    

    
       

      
        	
                 

              	h)	
                Cost
      of employment-based health insurance is more than five percent of the
      family's income;

              


      

    

    
       

                     
i)           The child
applying for coverage is pregnant;

    

    
       

      
        	
                 

              	j)	
                The
      child applying for coverage under this title is at or below the age of
      five (5). Implementation of this exception is subject to federal approval
      of the State's child health plan setting forth such exception. The STATE
      shall notify the CONTRACTOR when such approval has been
      obtained.

              


      

    

    
      


      2.        
    Effective September 1, 2008, the waiting period set
forth in paragraph 1 of this section shall be
implemented for a child residing in a household with gross income between 251
and 400 percent of the non-farm federal poverty level, provided, however, the
exceptions set forth in subparagraphs (a)-(g) and (i) of paragraph 1 of this
section shall be the only exceptions applied to such child. The STATE shall
notify the CONTRACTOR if and when federal approval of the income expansion to
400 percent of the non-farm federal poverty level has been obtained at which
point, all the exceptions set forth in paragraph 1 of this section shall apply
to children residing in households with gross income between 251 and 400 percent
of the non-farm federal poverty level.

    


    
      
         


      

      
         


        
          

        

      

      
         


      

    


    
      Sections
5.2, 5.3 and 5.4 are revised to read as follows:

    

    
      


      5.2           New
York State Residency

       

      
      

       

      
        	 	
                Proof of
      residency must match the home address in Section A of the Growing up
      Healthy or Access New York Health Care application and must be dated
      within six (6) months of the application. Proof of residency shall be
      documented by the following: an identification card with address, a
      postmarked envelope or postcard with name and date (this cannot be used if
      sent to a P.O. Box), a driver's license, a utility bill (including oil,
      gas or electric, water, cable, or telephone) that includes the street
      address and zip code for the service (the city name is not required on the
      bill), letters/correspondence from a federal, state or local government
      agency, a letter or rent receipt containing the name and street of the
      tenant and the amount paid each month, as well as the name and address
      from the landlord and the landlord's signature, a valid lease that
      contains the applicant's name, address and amount of rent from the
      landlord, property tax records, a mortgage statement or a letter stating
      that an applying child or family member resides with a particular
      individual. 

              


      

       

    

    
      
      

       

      
        	 	The CONTRACTOR shall
      not accept cell-phone bills, magazine labels, bank statements, an envelope
      or postcard without a street address (just a P.O. Box), an envelope with a
      forwarding label from the Post Office, a window envelope or Federal or
      state tax returns.


      

       

    

    
      5.3           Other
Health Insurance Coverage

      
      

       

      
        	 	Other health
      insurance, if applicable, shall be documented by a copy of the insurance
      policy, a certificate of insurance, a copy of the insurance card or a copy
      of the Medicare card.


      

       

    

    
      
        	 	Documentation of
      health insurance is necessary for CHPlus to determine if a child's
      coverage or access to coverage makes them ineligible for the program.
      Documentation of other health insurance is necessary for Medicaid and
      Family Health Plus as a possible deduction when calculating eligibility
      and for coverage of future medical bills. If the applicant indicates
      he/she has other health insurance coverage, the health plan shall obtain
      documentation of such coverage at initial enrollment and if different than
      what was stated on the initial application, at
  recertification.


      

       

      
        	 	If the CONTRACTOR
      receives a paycheck stub as documentation of income that includes a
      deduction for health insurance, the CONTRACTOR must ask the applicant who
      is covered through the employer based policy and note the response on the
      stub. If the child is covered, in most cases, the child is not eligible
      for CHPlus. If only the parent is covered, the child is eligible for
      CHPlus


      

       

      
        	 	In most cases, if an
      applicant presents a State paycheck stub, the person will have access to
      the State health benefits plan and the child will be ineligible for
      CHPlus. If a person is employed by a local government or is a teacher,
      they may have access to the State health benefits plan also. The
      CONTRACTOR must determine if such coverage is through a State health
      benefits plan to determine if a child is eligible for CHPlus. For a
      listing of other
      than state agencies or state operated facilities, the CONTRACTOR may use
      the following
      website to determine if the public agency has access to a State health
      benefits plan:
      www.cs.state.nv.us/ebd/ebdonlinecenter/pamarket/directory.cfm. If the CONTRACTOR is uncertain,
      the CONTRACTOR shall call the applicant or the employer to determine if
      the child has access to the State health benefits
  program.


      

      

        
          
             


          

          
             


            
              

            

          

          
             


          

        

      

       

    

    
      5.4           Income

      
      

       

      
        	 	Income documentation
      must be provided for all household members listed in section B of the
      Growing up Healthy or Access New York Health Care application who have
      income. Income documentation must be provided for all categories listed
      below that apply. The CONTRACTOR must obtain documentation of the gross
      income for the four weeks preceding the application signature date for all
      individuals included in the household. Unearned income that varies from
      month to month (i.e. interest income) must also be documented for the four
      weeks prior to application. Documentation of unearned income which docs
      not vary on a month to month basis does not have to be dated within the
      four weeks prior the application as long as it reflects the current
      amount. Applicants may provide, at recertification, their social security
      number in lieu of income documentation. Income shall be documented by the
      following:


      

       

    

    
                     
a.          Wages and
Salary:

    

    
       

      
        	
                 

              	1.	
                Paycheck
      stubs for the four (4) consecutive weeks preceding the application
      signature date. Paychecks may only be used if they include all information
      typically contained on a pay stub, including net and gross income and
      deductions. Paycheck stubs must include the name of both the employer and
      employee. The CONTRACTOR shall accept a paycheck stub without the
      employee's name if the person provides their social security number on the
      application and the paycheck stub includes the social security
      number.

              


      

    

    
      
        	
                 

              	2. 	
                In
      cases where the CONTRACTOR receives three weeks of paycheck stubs and is
      missing one in between, the CONTRACTOR shall use the year to date income
      on the subsequent paycheck to calculate the amount of the missing paycheck
      stub. In this instance, the CONTRACTOR shall accept three paycheck stubs
      rather than four;

              


      

    

    
      
        	
                 

              	3. 	
                Letter
      from the employer on company letterhead which is signed and dated and
      includes the employer's name, address and phone number and the employee's
      name and gross income. If the applicant indicates their employer does not
      have letterhead, the CONTRACTOR shall accept a letter without it and note
      on the letter that according to the applicant, letterhead does not
      exist;

              


      

    

    
      
        	
                 

              	4. 	
                Signed
      and dated income tax return (Federal form 1040) if used for applications
      prior to April 1 of the following year; or

              
	 	5. 	Business/payroll
      records.


      

    

     

    
      The
following are not acceptable documentation of earned income: quarterly wage
statements, W-2s and 1099s.

    

    
      


      If a
person has recently begun a new job or receiving some regular income and
therefore cannot document income for the last four weeks, the CONTRACTOR shall
follow the instructions in section 7 of this Appendix, presumptive eligibility.
This will involve documenting only what they have and obtaining further
documentation when the income is received.

    


    
      
         


      

      
         


        
          

        

      

      
         


      

    


    
      A joint
tax return must be signed by both filers. If an electronic tax return is used,
the family may bring a signed copy of the tax return. If the return is filed
electronically, a copy of the acknowledgement form from the Internal Revenue
Service, which includes a DCN number that verifies that tax return was accepted
electronically is acceptable.

    

    
       

      The
CONTRACTOR shall not accept a letter from an employer that states an
"approximate" or "average" income.

    

    
       

                 
     b.         Self-Employment
Income:

    

    
       

      
        	
                 

              	1.	
                
                  Signed
      and dated income tax return and all schedules including Schedule C for
      sole owners of a business, Schedule E for rental real estate, partnerships
      and S corporations or Schedule F for farmers, Schedule K-l (Form 1065) and
      Form 1065 for Partnerships, and Schedule K-1 (Form 1120S) and Form 1120S
      for S Corporations; (See paragraph above on electronic returns);
      or

                

              


        
          
            	
                     

                  	2. 	
                    
                      Records
      of earnings and expenses/business records. The three month
      "Self-Employment worksheet" used by many local social services districts
      may be used as acceptable proof as long as it is consistent with other
      information on the application and appears internally
      consistent.

                    

                  


          

        

        
          
            	
                     

                  	3. 	
                    
                      If
      no other form of documentation is available, a self-declaration of
      income.

                    

                  


          

        

        
          
          

        

      

       

                
      c.         Unemployment
Benefits:

    

    
       

      
        
          
            	 	1.	Award
      letter or certificate;
	
                     

                  	2. 	
                    
                      A
      monthly benefit statement from the New York State Department of
      Labor;

                    

                  


          

        

        
          
            	
                     

                  	3. 	
                    
                      A
      printout of the recipient's account information from the New York State
      Department of Labor's website (www.labor.state.ny.us);

                    

                  


          

        

        
          
            	
                     

                  	4. 	
                    Correspondence
      from the New York State Department of Labor; or

                  
	 	5. 	A
      copy of the direct payment card with
printout.


          

        

      

       

    

    
      The
CONTRACTOR shall not accept the monetary determination letter as documentation
of unemployment as it is not necessarily what the person will receive in income.
If the applicant does not have any of the above, the CONTRACTOR shall enroll the
child presumptively in accordance with section 7 of this Appendix and follow-up
accordingly.

    

    
      


    

    
                  
    d.         Private
Pensions/Annuities:

    

    
       

                                  
1.           Statement from
pension/annuity.

    

     

    
                  
    e.          Social
Security Retirement/Survivors/Disability Insurance:

    

    
       

                                  
1.           Award
letter/certificate;

    

    
                                  
2.           Benefit
check stub; or

    

    
                                  
3.           Correspondence
from the Social Security Administration.

    


    
      
         


      

      
         


        
          

        

      

      
         


      

    


    
      The
CONTRACTOR shall not accept bank statements as documentation of this amount
since they show only net income.

    

    
       

                     
f.           Child
Support/Alimony

    

    
       

      
        	
                 

              	1. 	
                Letter
      from person providing support which includes the name and address of the
      person providing the support, the amount of the support being provided,
      the name of the person receiving the support and who the support is for.
      The letter must be signed and dated;

              
	 	2. 	Letter
      from court;
	 	3. 	
                Child
      support/alimony check stub. If the same amount of support is received each
      time and it is consistent with the child support order, it is not
      necessary to obtain four weeks of check stubs. If there is any dispute or
      discrepancy, and the child support is not received on a consistent basis
      from week to week, four weeks worth of check stubs must be submitted and
      averaged;

              
	 	4. 	
                Monthly
      bank statement for those recipients that choose direct deposit for their
      child support;

              
	 	5. 	
                A copy
      of their child support account information from the following website:
      www.newyorkchildsupport.com;
      or

              
	 	6. 	A
      copy of the New York Eppicard with
printout.


      

       

    

    
                     
g.          Worker's
Compensation

    

    
       

      
        
          	 	1.	Award letter;
      or
	 	2. 	Check
  stub.
	 	 	 


        

         

      

                      h.       
  Veteran's Benefits

    

    
       

      
        	
                 

              	
                1.

              	Award
      letter;


      

    

    
      
        	
                 

              	
                2.

              	Benefit
      check stub; or
	 	3. 	Correspondence
      from the Veteran's Administration.


      

    

    
       

                      
i.          Military
Pay

    

    
       

      
        
          
            	
                     

                  	
                    1.

                  	Award
      letter; or    
	 	2. 	Check
      stub.


          

        

      

      
         

      

    

    
       j.          Interest/Dividends/Royalties

    

    
       

      
        
          
            	
                     

                  	
                    1.

                  	Recent
      statement from bank, credit union or financial
    institution;
	 	2. 	Letter
      from broker;
	 	3. 	Letter
      from Agent; or
	 	4. 	A
      1099 or tax return if no other documentation is
  available.


          

        

      

    

    
       

                       k.          Income
from Rent or Room/Board

       

      
        	
              	1. 	
                Letter
      from roomer, boarder or tenant including the name and address of the
      tenant, roomer/boarder, the name of the landlord and the amount paid. The
      letter must be signed and dated; or

              
	 	2. 	Check
      stub.


      

      

        
          
             


          

          
             


            
              

            

          

          
             


          

        

      

       

    

    
                     
l.           Support from
other Family members

    

    
       

                            
      
1.          Signed statement
or letter from family member.

    

    
      


                      m.     
   Self Declaration of Income


    

    
       

      
        	
                 

              	
                1.

              	CONTRACTOR
      shall accept a Self-Declaration of Income form found in Attachment A of
      this section if the applicant has no other way to document his/her income.
      The form must be completed in full and may only be accepted if no other
      income documentation is
available.


      

    

    
      


                      n.          Student
Stipends

    

    
       

      
        	
                 

              	 	
                1.

              	A
      letter from the school/organization providing the stipend which must
      include the amount being given and any restrictions on the use of the
      money, if any.


      

    

    
       

      o.       
  Non-Monetary Compensation

    

    
       

      
        	
                 

              	1. 	
                A
      letter from the person providing non-monetary compensation, in lieu of
      wages, including the name of the person providing the service, what
      service is being provided, the type of compensation being provided (i.e.
      rent), the value of the compensation on the open market and the name,
      signature and date of the person providing the
    compensation.

              


      

    

    
      


                      p.       
  No income

    

    
       

      
        	
                 

              	1. 	
                
                  A
      statement on the application or on the Declaration of No Income form found
      in Attachment B of this section indicating how the person is supporting
      him/herself with no income. 

                

              
	 	2. 	This
      form should only be used when a household has no income. It is not to be
      used if one person in the household has income and one person in the
      household does not.


      

      

        
          
             


          

          
             


            
              

            

          

          
             


          

        

The
following provision 9.15 is added:

    

    
       

      9.15         Early
Recertification Application

      
      

       

      
        	 	If the CONTRACTOR
      receives a recertification application early (not a complete Growing up
      Healthy or Access New York Health Care application at any other point in
      the year), the child shall be recertified at the end of the coverage
      period. Any changes in premium contribution shall not begin until the
      first day of the month following the 12 month enrollment period. If the
      child appears eligible for Medicaid, the CONTRACTOR shall immediately
      inform the family that they must apply for Medicaid. The CONTRACTOR shall
      not begin the temporary enrollment period until the first day of the month
      following the 12 month enrollment period. If a child is presumptively
      recertified, the CONTRACTOR shall immediately inform the family of the
      missing documentation. The CONTRACTOR shall not begin the presumptive
      recertification period until the first day of the month following the 12
      month period.


      

      

        
          
             


          

          
             


            
              

            

          

          
             


          

        

      

       

    

    
      Section
10.1 is revised to read as follows:

    

    
       

      10.1         Family
Premium Contribution

      
      

       

      
        	 	
                The
      CONTRACTOR shall collect from subscribers any required family premium
      contribution.   There is no family premium contribution for
      children whose gross household income is less than 160 percent of the
      non-farm federal poverty level or for children who are American Indians or
      Alaskan Natives (AI/AN) whose gross household income is less than 250
      percent of the non-farm federal poverty level.

                 

              
	 	
                 The
      family premium contribution for children whose gross household income is
      between 160 percent and 222 percent of the non-farm federal poverty level
      is $9 per child, with a family maximum of $27 per month.

                 

              
	 	
                 The
      family premium contribution for children whose gross household income is
      between 223 percent and 250 percent of the non-farm federal poverty level
      is $15 per child, with a family maximum of $45 per month.

                 

              
	 	
                The
      following provisions are effective for September 1, 2008
      enrollment:

                 

              
	 	
                The
      family premium contribution for children whose gross household income is
      between 251 percent and 300 percent of the non-farm federal poverty level
      is $20 per child, with a family maximum of $60 per month.

                 

              
	 	
                The
      family premium contribution for children whose gross household income is
      between 301 percent and 350 percent of the non-farm federal poverty level
      is $30 per child, with a family maximum of $90 per month.

                 

              
	 	The family premium
      contribution for children whose gross household income is between 351
      percent and 400 percent of the non-farm federal poverty level is $40 per
      child, with a family maximum of $120 per
month.


      

       

    

    
      
         


      

      
         


        
          

        

      

      
         


      

    


    
      The
following provision is added to Section 14.2:

    

    
       

      
        	
                 

              	
                ▪

              	 For Child Health Plus applicants
      listed as undocumented immigrants, the CONTRACTOR
      must review the application and the supporting documentation submitted by
      the parent to determine if the child is truly undocumented. The CONTRACTOR
      shall only assume a child is undocumented if the family indicates the
      child does not have any valid immigration documentation and no other
      information to the contrary has been provided. If the child's parent is
      legally employed (provides pay stubs, an income tax return or an employer
      letter) and has a social security number, the CONTRACTOR must assume that
      the parent has valid immigration paperwork and that the child is not
      undocumented. Such cases required additional follow up with the family
      prior to enrolling the
child.


      

    

    

      
        
           


        

        
           


          
            

          

        

        
           


        

      

    

     

    
      The
following provision in Section 16.2 is revised effective July 1, 2008 as
follows:

    

    
       

      Additional Reports for
Health Plans that Participate in the Facilitated Enrollment
Program:

    

    
       

      New Applications- On
a monthly basis, by the 1.0th
business day of the month following the end of the month when applications were
taken, the CONTRACTOR shall report, by county, the total number of new complete
and incomplete applications sent to a LDSS for an eligibility determination. The
CONTRACTOR shall report, by county, the number of new complete and incomplete
applications forwarded to a LDSS for adults only, children only and adults and
children and the total number of new applicants for Family Health Plus, adult
Medicaid and children's Medicaid.

    

    
       

      Number of
Facilitators - On a monthly basis by the 10th
business day of the month, the CONTRACTOR shall submit to the STATE'S Division
of Managed Care and Program Evaluation, the total number of facilitators
employed by the CONTRACTOR.

    


    
      
         


      

      
         


        
          

        

      

      
         


      

    


    
      Section
18.1 is revised to read as follows:

    

    
      


      18.1         Monthly
Premium Payment

       

      
        	 	
                The
      total monthly premium shall be the amount approved by the State Insurance
      Department in consultation with the STATE in effect at the time of
      enrollment.

                 

              
	 	
                The STATE
      shall pay the CONTRACTOR the total monthly premium for children in
      families with gross household income less than 160 percent of the non-farm
      federal poverty level (FPL) and children who are American Indians or
      Alaskan Natives (AI/AN) whose gross household income is less than 250
      percent of the FPL.

                 

              
	 	
                The STATE
      shall pay the CONTRACTOR the total monthly premium less $9 for each of the
      first three children in families with gross household income between 160
      percent and 222 percent of the FPL. The STATE shall pay the total monthly
      premium for each additional child.

                 

              
	 	
                The STATE
      shall pay the CONTRACTOR the total monthly premium less $15 for each of
      the first three children in families with gross household income between
      223 percent and 250 percent of the FPL. The STATE shall pay the total
      monthly premium for each additional child.

                 

              
	 	
                The
      following provisions are effective for September 1, 2008
      enrollment:

                 

              
	 	
                The STATE
      shall pay the CONTRACTOR the total monthly premium less $20 for each of
      the first three children in families with gross household income between
      251 percent and 300 percent of the FPL. The STATE shall pay the total
      monthly premium for each additional child.

                 

              
	 	
                The STATE
      shall pay the CONTRACTOR the total monthly premium less $30 for each of
      the first three children in families with gross household income between
      301 percent and 350 percent of the FPL. The STATE shall pay the total
      monthly premium for each additional child.

                 

              
	 	The
      STATE shall pay the CONTRACTOR the total monthly premium less $40 for each
      of the first three children in families with gross household income
      between 351 percent and 400 percent of the FPL. The STATE shall pay the
      total monthly premium for each additional
  child.