healtheaseamendment6.htm


    
      Back to Form 8-K

      Exhibit 10.2

       

      HealthEase
of Florida,
Inc.                                                                                                 

       Medicaid
HMO Contract

    

    
      


       

      AHCA
CONTRACT NO. FA619 

      AMENDMENT
NO. 6

    

    
      


       

      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
      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.

    

    
                                                                                               

    

    
      	 HEALTHEASE OF FLORIDA,
      INC.        	
              STATE OF FLORIDA, AGENCY
      FOR

              HEALTH
      CARE ADMINISTRATION

               

               

            
	
              SIGNED

              BY: /s/
      Heath
      Schiesser                    
      

            	
              SIGNED

              BY:
      /s/ Name
      Illegible                          
      

            
	
              NAME:
      Heath
      Schiesser                  
      

            	
              NAME:
      for Holly
      Benson                
         

            
	
              TITLE:
      President and
      CEO             
        

            	
              TITLE:
      Secretary                             
           

            
	
              DATE: 2-17-09                                   
      

            	
              DATE:
      2/19/09                                      

            
	 
      	 
      


    

    
      


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

    

    
       

    

    
      	
              
                Specify

              

              
                Type

              

            	
              
                Letter/

              

              
                Number

              

            	
              
                 

                Description

              

            
	
              
                Exhibit

              

            	
              
                III-E

              

            	
              
                February
      1, 2009 - August 31, 2009 Medicaid Non-Reform HMO

              

              
                Capitation
      Rates (5 pages)

              

            


    

    
      


       

      AHCA
Contract No. FA619, Amendment No. 6, Page 1 of 1

    

    
      AHCA Form
2100-0002 (Rev. NOV03)

    

    


    
      
        
           


        

        
           


          
            

          

        

        
           


        

      

    

     

    
      
        	
                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

              	
                1,217.57

              	
                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

              	
                86.32

              	
                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

              	
                69.16

              	
                128.97

              	
                73.85

              	
                246.72

              	
                150.78

              	
                318.20

              	
                10,526.05

              	
                1,550.37

              	
                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. FA619, 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
      + MIH + Dental Rates:

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	
                TANF

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	
                SSI-N

              	
                 
      

              	 
      	 
      	 
      	 
      	
                SSI-B

              	
                SSI-AB

              	 
      
	
                Area

              	
                BTHMG+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

              	
                79.46

              	
                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
      + MIH + 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

              	
                325.76

              	
                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

              	
                255.26

              	
                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. FA619, 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

              	
                795.77

              	
                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

              	
                SSS-AB

              
	
                Area

              	
                BTHMO+2MO

              	
                  3MO-11MO

              	
                AGE
      (1-5)

              	
                AGE
      (6-13)

              	
                   
      AGE (14-20)

              	
                   AG
      E (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

              	
                341.59

              	
                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

              	
                175.63

              	
                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

              	
                1,645.45

              	
                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. FA619, Exhibit III-E, 3 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
      7

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                General
      + Dental + Transportation Rates:

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	
                TANF

              	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	
                SSI-N

              	 
      	 
      	 
      	 
      	 
      	
                SSI-B

              	
                SSI-AB

              
	
                Area

              	
                BTHMO+2MO

              	
                3MO-11MO

              	
                AGE
      (1-5)

              	
                AGE
      (6-13)

              	
                  
          AGE (14-20)

              	
                      AG
      E (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

              	
                188.76

              	
                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

              	
                107.78

              	
                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

              	
                75.19

              	
                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

                	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	
                  SSI-N

                	 
      	 
      	 
      	 
      	 
      	
                  SSI-B

                	
                  SSE-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

                	
                  188.78

                	
                  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. FA619, 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 Ross, 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, Hamilton, Hernando,
      Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee,
    Union

              
	
                 

                Ares
      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

              
	
                 

                Ares
      10

              	
                 

                Broward

              
	
                 

                Area
      11

              	
                 

                Dade,
      Monroe

              


      

      
        


         

        AHCA
Contract No. FA619, Exhibit III-E, 5 of 5