Document:

EX-10.1

Exhibit 10.1

AMENDMENT TO MEDICARE MANAGED CARE CONTRACT PURSUANT

TO SECTION 1860D-31 OF THE SOCIAL SECURITY ACT FOR THE 

OPERATION OF A MEDICARE-APPROVED PRESCRIPTION DRUG

DISCOUNT CARD

MUTUAL MODIFICATION AGREEMENT

Pursuant to 42 CFR § 403.820(e), the Centers for Medicare & Medicaid Services (CMS) and
WellCare of LA/WellCare HMO, Inc. (hereinafter referred to as the “Card Sponsor”) mutually
agree to modify the amendment to the contract D1903, D1032, and D3361 which governs the operation
of a Medicare-approved prescription drug discount card. The parties agree that Attachment B to the
amendment is deleted and replaced with the following:

“ATTACHMENT B

“Waivers and Modifications

	 	 	 	“1. Formulary – Generic Drugs: CMS grants the Card Sponsor a waiver of the provisions of 42 CFR
§403.806(c)(3) to offer at least one drug in each therapeutic category and/or to offer generic
drug in at least 55% of those therapeutic categories identified in Attachment 2 of the
Medicare-Approved Prescription Drug Discount Card and Transitional Assistance Program
Solicitation for Applications (for non-Medicare Managed Care Contractors). The Card Sponsor
agrees that it will offer its drug card enrollees access to its existing formulary used under
its drug benefit or drug discount program.

	 	 	 	“2. Manufacturer Rebates: CMS grants the Card Sponsor a waiver of the requirement that the Card
Sponsor obtain manufacturer rebates, discounts, or other price concessions as stated in 42 CFR
§403.806(c)(6).

	 	 	 	“3. Card Sponsor Reporting to CMS – Grievance and Customer Service Data: CMS grants the Card
Sponsor a waiver of the requirements related to reporting customer service and grievance data
as stated in 42 CFR §403.806(i)(l)(vii)and (vii).

	 	 	 	“4. Card Sponsor Reporting to CMS – Manufacturer Rebates: CMS grants the Card Sponsor a
modification of the savings reporting requirements described in 42 CFR §403.806(i)(l)(i) and
(ii) to delete references to savings from manufacturers.

	 	 	 	“5. Price Comparison: CMS grants the Card Sponsor a waiver of the requirement to display its
negotiated prices on a price comparison web site as stated in 42 CFR§§403.806(c)(5) and
403.806(i)(4)(v). Please remember: as stated in Section 2.10, Item 4 of the
Solicitation for Medicare Managed Care Organizations, Medicare managed care contractors are
required to submit pricing data, like all other drug card sponsors, for CMS’ use in monitoring
the drug card program. This data will not be reported publicly on the Price Comparison
website. Directions for submitting drug pricing data are located on
www.cms.hhs.gov/discountdrugs/ under “Related Links, B. Drug Pricing Data
Requirements.”

	 	 	 	“6. Years of Experience – CMS grants the Card Sponsor a waiver of the requirement that it have 3
years of private sector experience in the United States in pharmacy benefit management as
stated in 42 CFR§403.806(a)(2).

	 	 	 	“7. Eligibility/Enrollment Systems – CMS grants the Card Sponsor a waiver of the requirement
stated in Section 3.5.1 the Solicitation for Non-Medicare Managed Care Contractors that the
Card Sponsor demonstrate the capability to exchange data concerning beneficiary eligibility
for enrollment in the Card Sponsor’s drug card(s) and for transitional assistance.

	 	 	 	“8. Notice of Eligibility – CMS modifies the notice of eligibility requirements to require the
Card Sponsor to notify applying beneficiaries of their drug card eligibility within 7 days of
the Card Sponsor’s receipt of such information from CMS.

	 	 	 	“9. Distribution of Enrollment Materials – CMS modifies the timeframe for the distribution of
materials to new enrollees to require the Card Sponsor (a Medicare cost contractor) to provide
the materials within 14 and 30 days of the Card Sponsor’s receipt eligibility reply from CMS.

	 	 	 	“10. Provider Directory – CMS grants the Card Sponsor a waiver of the qualification stated in
Section 3.5.9 if the Solicitation requiring the Card Sponsor to provide its drug card
enrollees a directory of contracted network pharmacies.

	 	 	 	“11. Coordinate Drug Card and Medicare Managed Care Plan Enrollment Dates – CMS modifies the
requirement stated in Section 3.5.1 of the solicitation that the Card Sponsor make enrollments
in its drug card effective on the first day of the month immediately following the Card
Sponsor’s receipt of a complete enrollment application to allow the Card Sponsor to make
enrollments effective according to the same schedule as that which governs enrollment in the
Card Sponsor’s Medicare managed care plan.

	 	 	 	“12. Member Identification Cards – CMS grants the Card Sponsor a waiver of the requirement that
it issue each drug card enrollee an identification card in addition to the Card Sponsor’s
Medicare managed care plan identification card.

	 	 	 	“13. Member Handbook – CMS modifies the requirement that the Card Sponsor provide each drug card
enrollee with a member handbook to allow the Card Sponsor to provide such information as an
addendum to the Card Sponsor’s Medicare managed care plan member handbook.

	 	 	 	“14. Notice of Intent Deadline – CMS grants the Card Sponsor a waiver of the requirement stated
in Section 2.1 of the solicitation that applicants for Medicare approval must submit to CMS a
timely notice of intent to apply before CMS will consider the Card Sponsor’s application.

	 	 	 	“15. Distribution of Privacy Notice – CMS affirms that a Card Sponsor may comply with the
requirement that it provide new enrollees with a Notice of Privacy Practices through the
distribution of the Notice of Privacy Practices provided to enrollees in the Card Sponsor’s
Medicare managed care plan as long as such notice meets the requirements of the Privacy Rule
at 45 CFR§164.520.

“16. Group Enrollment/Streamlined Enrollment – CMS affirms that the Card Sponsor may comply
with 42 CFR § 403.814(b)(5)(ii) and 42 CFR § 403.811(a)(3) by allowing enrollees to opt out of
the approved card upon request and holding beneficiaries harmless for any enrollment fees
should he or she opt out of the drug card. Beneficiaries will be instructed that they can
disenroll by contacting the member services number or by not using their discount card. Such
instructions will include information about how to apply for transitional assistance. If the
card charges an annual enrollment fee, the Card Sponsor agrees not to charge the enrollee such
fee if s/he fails to use the card and/or indicates a desire to decline enrollment in the card.
In conducting group enrollment, the Card Sponsor must inform enrollees about the proper
procedures for declining enrollment in the card, and have a mechanism for ensuring that those
who decline enrollment are not charged or held liable for an annual enrollment fee.

	 	 	 	“17. Mandatory Use of Transitional Assistance – CMS grants the Card Sponsor a waiver of the
requirement that drug card enrollees be permitted to spend their transitional assistance at
their discretion. The Card Sponsor may require its drug card enrollees who receive
transitional assistance to apply such assistance to any co-payment that are the enrollee’s
obligation under the Card Sponsor’s drug plan and to any covered drugs purchased using the
Card Sponsor’s drug card.”

This agreement is effective May 1, 2004.

In witness whereof, the parties hereby execute this agreement.

FOR THE CARD SPONSOR;

	 	 	 
	Todd S. Farha

	 	President & CEO
	 

	 	 
	Printed Name

	 	Title
	 
	 	 
	/s/ TODD S. FARHA

	 	February 18, 2005
	 

	 	 
	Signature

	 	Date
	 
	 	 
	WellCare Health Plans, Inc.

	 	8735 Henderson Road, Tampa, FL 33634
	 

	 	 
	Organization

	 	Address

FOR THE CENTERS FOR MEDICARE & MEDICAID SERVICES

	 	 	 
	/s/ CYNTHIA MORENO

	 	3/4/05
	 

	 	 
	Cynthia Moreno

	 	Date

Acting Director

Medicare Plan Accountability Group

Center for Beneficiary ChoicesEX-10.2

Exhibit 10.2

APPENDIX X

	 	 	 
	Agency Code: 12000

	 	Contract Number: C-014386

Period: October 1, 1997 through June 30, 2005

Funding Amount for Period: $76,710,771

This is an AGREEMENT between THE STATE OF NEW YORK, acting by and through the Department of
Health, having its principal office at Corning Tower, Empire State Plaza, Albany, NY,
(hereinafter referred to as the STATE), and WellCare of New York (hereinafter referred to as the
CONTRACTOR), for modification of Contract Number C-014386 as reflected in the attached provisions
to Section I.B.1 of the Agreement and Appendices E and L, and to extend the period of the contract
through June 30, 2005.

CONTRACTOR acknowledges that the STATE is currently developing a replacement contract document to
govern services provided to Child Health Plus enrollees. If that replacement contract between the
CONTRACTOR and the STATE is in place prior to June 30, 2005, this CONTRACT will be cancelled upon
approval of the replacement contract. Any extension to this CONTRACT beyond June 30, 2005 must be
done via written amendment approved by the Office of the State comptroller.

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

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

	 	 	 	 	 
	CONTRACTOR SIGNATURE

By: /s/ TODD S. FARHA

	 	 	 	STATE AGENCY SIGNATURE

By: /s/ JUDITH ARNOLD
	 
	 	 	 	 
	 
	 	 
	 
	 	 	 	 
	Todd S. Farha

	 	 	 	Judith Arnold
	 
	 	 	 	 
	 
	 	 
	 
	 	 	 	 
	Printed Name

	 	 	 	Printed Name
	 
	 	 	 	 
	Title: President and CEO
	 	Title: Deputy Commissioner
	 
	 	 	 	 
	 
	 	 
	 
	 	 	 	 
	Date:

	 	12/3/04
	 	Date: 12/8/04
	
 
	 	 
	 	 

	 	 	 	State Agency Certification;

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

     

	 	 	 	 	 
	STATE OF FLORIDA
	 	 	)	 
	County of Hillsborough
	 	 	)	 

On the 3rd day of December 2004, before me personally appeared Todd S. Farha, to me
known, who being duly sworn, did depose and say that he resides at Tampa, Florida, that he is the
President and CEO of the WellCare of New York, Inc., the corporation described herein which
executed the foregoing instrument; and that he signed his name thereto by order of the board of
directors of said corporation.

	 	 	 
	(Notary) /s/ Kathleen R. Casey

	 	STATE COMPTROLLER SIGNATURE
	 

	 	

	Kathleen R. Casey

Notary Public – State of Florida

	 	

Title: Patricia M. O’Donnell
	
 
	 	 
	My Commission Expires Apr 22, 2008

	 	Date: 3/8/05
	
 
	 	 

Commission #DD305227

Bonded By National Notary Assoc.

1

STATE OF NEW YORK

AGREEMENT

Section I.B.1 is revised to read as follows:

I. Conditions of Agreement

B.1 This AGREEMENT is extended through June 30, 2005 or until the start date of a new contract
between the STATE and the CONTRACTOR governing services provided to Child Health Plus enrollees,
whichever date occurs first.

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APPENDIX E

Financial Information

Section A is revised to read as follows:

A. Wellcare of New York shall receive, for the period January 1, 2005 through June 30, 2005, an
amount up to, but not to exceed, $5,700,000 to provide and administer a Child Health Plus program
for uninsured children in the counties identified in Appendix A-2, Section II.B.1 of this AGREEMENT
or as modified by the STATE. Payment of this amount is based on the CONTRACTOR meeting the
responsibilities provided in this AGREEMENT.

Additional Premium Information:

For Downstate region serving Bronx, Kings, New York and Queen county(ies):

The total monthly premium shall be $120.84

The State share of the total monthly premium shall be $120.84 or the total monthly premium for
children in families with gross household income less than 160% of the federal poverty level and
children who are American Indians or Alaskan Natives (AI/AN).

The State share of the total monthly premium shall be $111.84 or the total monthly premium minus $9
for children in families with gross household income between 160% and 222% of the federal poverty
level with a maximum of $27 per month per family. The State share is the total monthly premium
less $9 for each of the first three children. For additional children, the State share is the
total monthly premium.

The State share of the total monthly premium shall be $105.84 or the total monthly premium minus
$15 for children in families with gross household income between 223% and 250% of the federal
poverty level with a maximum of $45 per month per family. The State share is the total monthly
premium less $15 for each of the first three children. For additional children, the State share is
the total monthly premium.

For Northern Metro region serving Dutchess, Orange, Sullivan and Ulster couny(ies):

The total monthly premium shall be: $97.62.

The State share of the total monthly premium shall be $97.62 or the total monthly premium for
children in families with gross household income less than 160% of the federal poverty level and
children who are American Indians or Alaskan Natives (AI/AN).

The State share of the total monthly premium shall be $88.62 or the total monthly premium minus $9
for children in families with gross household income between 160% and 222% of the federal poverty
level with a maximum of $27 per month per family. The State share is the total monthly premium
less $9 for each of the first three children. For additional children, the State share is the
total monthly premium.

The State share of the total monthly premium shall be $82.62 or the total monthly premium minus $15
for children in families with gross household income between 223% and 250% of the federal poverty
level with a maximum of $45 per month per family. The State share is the total monthly premium
less $15 for each of the first three children. For additional children, the State share is the
total monthly premium.

For Upsate Other than Rensselear region serving Albany, Columbia, and Greene county(ies):

The total monthly premium shall be: $96.63.

The State share of the total monthly premium shall be $96.63 or the total monthly premium for
children in families with gross household income less than 160% of the federal poverty level and
children who are American Indians or Alaskan Natives (AI/AN).

The State share of the total monthly premium shall be $87.63 or the total monthly premium minus $9
for children in families with gross household income between 160% and 222% of the federal poverty
level with a maximum of $27 per month per family. The State share is the total monthly premium
less $9 for each of the first three children. For additional children, the State share is the
total monthly premium.

The State share of the total monthly premium shall be $81.63 or the total monthly premium minus $15
for children in families with gross household income between 223% and 250% of the federal poverty
level with a maximum of $45 per month per family. The State share is the total monthly premium
less $15 for each of the first three children. For additional children, the State share is the
total monthly premium.

For Rensselear county:

The total monthly premium shall be: $95.93.

The State share of the total monthly premium shall be $95.93 or the total monthly premium for
children in families with gross household income less than 60% of the federal poverty level and
children who are American Indians or Alaskan Natives (AI/AN).

The State share of the total monthly premium shall be $86.93 or the total monthly premium minus $9
for children in families with gross household income between 160% and 222% of the federal poverty
level with a maximum of $27 per month per family. The State share is the total monthly premium
less $9 for each of the first three children. For additional children, the State share is the
total monthly premium.

The State share of the total monthly premium shall be $80.93 or the total monthly premium minus $15
for children in families with gross household income between 223% and 250% of the federal poverty
level with a maximum of $45 per month per family. The State share is the total monthly premium
less $15 for each of the first three children. For additional children, the State share is the
total monthly premium.

In the absence of an approved premium modification by the Department of Health and State Insurance
Department, the premium above or subsequent premium approval (whichever is in effect) shall
continue as the State’s subsidy through June 30, 2005.

3

Appendix L

Privacy and Confidentiality

Section II is revised as follows:

II. Effective April 14, 2003, the CONTRACTOR shall comply with the following agreement:

Federal Health Insurance Portability and Accountability Act (HIPAA)

Business Associate Agreement (“Agreement”)

This Business Associate Agreement between the New York Department of Health and WellCare of New
York, hereinafter referred to as the Business Associate, is effective on April 14, 2003 to June 30,
2005.

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