Document:

WCG-Ex10.8_XT220Amendment1

    
	
			
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	Exhibit 10.8

	AMENDMENT 001
	Contract No. XT220
	Amendment Page 1

This AMENDMENT, entered into by the State of Florida, Department of Elder Affairs, (Department) and WellCare of Florida Inc., dba HealthEase (Contractor), amends contract XT220.
The purpose of this amendment is to: (1) revise and replace the Standard Contract; (2) introduce Attachment F, DOEA Cost Analysis; (3) revise and replace the Index to Attachments; (4) amend Attachment I; (5) revise Exhibit H; (6) revise Appendices 3 and 5; and (7) revise and replace Attachment G, Background Screening.
The purpose of this amendment is to amend the following contract section (Paragraphs and Attachments):
STANDARD CONTRACT:
Revise and replace the Standard Contract with an updated version which incorporates the following changes:
(a) Amend section 5;
(b) Introduce section 6.6;
(c) Introduce section 7.6;
(d) Amend section 8; and
(d) Introduce section 32.3.

REVISE AND REPLACE THE INDEX TO ATTACHMENTS

ATTACHMENT I
(a) Introduce section 1.1.2;
(b) Amend section 1.2;
(c) Amend section 2.4.4;
(d) Amend 2.5.3.4;
(e) Introduce 2.6(6), and renumber accordingly;
(f) Introduce section 2.8.1(7), and renumber accordingly;
(g) Introduce section 2.12.4(7); and
(h) Amend section 3.2.5.

CONTRACT ATTACHMENTS:
(a) Introduce Attachment F, DOEA Cost Analysis for Non-Competitively Procured Contracts In Excess of Category II; and
(b) Revise and replace Attachment G, Background Screening Affidavit of Compliance.

AMEND EXHIBIT
Revise and replace Exhibit H. 

AMEND APPENDICES
Revise and replace Appendices 3 and 5.

    
	
			
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	Exhibit 10.8

	AMENDMENT 001
	Contract No. XT220
	Amendment Page 2

_____________________________  Line denotes completion of above summary  ____________
STANDARD CONTRACT:

(a) Section 5 of the Standard Contract is hereby amended to read:
		
	5.
	Renewals

By mutual agreement of the Parties, in accordance with s. 287.058(1)(g), F.S., the Department may renew the contract for a period not to exceed three years, or the term of the original contract, whichever is longer. The renewal price, or method for determining a renewal price, is set forth in the bid, proposal, or reply. No other costs for the renewal may be charged. Any renewal is subject to the same terms and conditions as the original contract and contingent upon satisfactory performance evaluations by the Department and the availability of funds.
(b) Section 6.6 of the Standard Contract is hereby introduced to read:
		
	6.6
	To comply with Presidential Executive Order 12989 and State of Florida Executive Order Number 11-116, Contractor agrees to utilize the U.S. Department of Homeland Security's E-verify system to verify the employment of all new employees hired by Contractor during the contract term. Contractor shall include in related subcontracts a requirement that subcontractors performing work or providing services pursuant to the state contract utilize the E-verify system to verify employment of all new employees hired by the subcontractor during the contract term. Contractors meeting the terms and conditions of the E-Verify System are deemed to be in compliance with this provision.

(c) Section 7.6 of the Standard Contract is hereby introduced to read:
		
	7.6
	In accordance with s. 287.135 F.S., any contractor on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List (Lists), created pursuant to s. 215.473 F.S., is ineligible to enter into or renew a contract with the Department for goods or services of $1 million or more. Pursuant to s. 287.135 F.S., the Department may terminate this contract if the Contractor is found to have submitted a false certification of its status on the Lists or has been placed on the Lists. Further, the Contractor is subject to civil penalties, attorney’s fees and costs and any costs for investigations that led to the finding of false certification. If this contract contains $1 million or more, the Contractor shall complete and sign ATTACHMENT H, Certification Regarding Scrutinized Companies Lists, prior to the execution of this contract.

(d) Section 8 of the Standard Contract is hereby amended to read as follows:
		
	8.
	Background Screening

The Contractor shall ensure that the requirements of s. 430.0402 and ch. 435, F.S., as amended, are met regarding background screening for all persons who meet the definition of a direct service provider and who are not excepted, from the Department’s level 2 background screening pursuant to s. 430.0402(2)-(3), F.S. The Contractor must also comply with any applicable rules promulgated by the Department and the Agency for Health Care Administration regarding implementation of s. 430.0402 and ch. 435, F.S. Further information concerning the procedures for background screening are found at http://elderaffairs.state.fl.us/doea/backgroundscreening.php.
(e) Section 32.3 of the Standard Contract is hereby introduced to read:
		
	32.3
	The Contractor may purchase articles that are the subject of, or required to carry out, this contract from a nonprofit agency for the Blind or for the Severely Handicapped that is qualified pursuant to Chapter 413, F.S., in the same manner and under the same procedures set forth in s. 413.036(1) and (2), F.S. For purposes of this contract, the Contractor shall be deemed to be substituted for the Department insofar as dealings with such qualified nonprofit agency are concerned. Additional information about the designated nonprofit agency and the products it offers is available at http://www.respectofflorida.org. This clause is not applicable to subcontractors unless otherwise required by law.

    
	
			
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	Exhibit 10.8

	AMENDMENT 001
	Contract No. XT220
	Amendment Page 3

INDEX CONTRACT ATTACHMENTS
The Index to Contract Attachments is hereby replaced with the revised Index to Contract Attachments and attached hereto.
ATTACHMENT I
(a) Section 1.1.2 is hereby introduced to read as follows:
Payment Discrepancy - Where the Contractor provided services under this contract to an eligible enrollee and requested payment, but has not received said funds; or conversely where the Contractor did not provide services to an individual under this contract but received payment. A payment discrepancy also includes any situation where the Contractor was paid an incorrect capitation amount for an enrollee.
(b) Section 1.2 is hereby amended to read as follows:
		
	1.2
	DEPARTMENT MISSION STATEMENT

To foster an environment that promotes well-being for Florida’s elders and enables them to remain in their homes and communities. The Department’s vision is of all Floridians aging with dignity, purpose, and independence. Area agencies, lead agencies and local service providers as partners and stakeholders in Florida’s aging services network are expected to support the Department’s mission, vision, and program priorities.
(c) Section 2.4.4 is hereby amended to read as follows:
		
	2.4.4
	Performance Measures

The Contractor shall collect, calculate, and report Department-selected performance measures as specified by the Department. The Contractor shall submit such performance measures to the Department and the Agency contracted EQRO according to the following schedule: 1st quarter (January 1-March 31) and 2nd quarter (April 1- June 30) rates should be submitted to the EQRO prior to the performance measure site visit; 3rd quarter (July1- September 30), 4th quarter (October 1 – December 31) and annual roll-up rates shall be submitted by February 13 of the contract year. The Contractor shall collect the performance measures based on the previous calendar year (January 1 through December 31) unless otherwise specified. The Contractor is required to participate with the EQRO on all performance measure validation activities, including a site visit and submission of requested documentation. The Department may add, modify or remove reporting requirements with thirty (30) days advance notice. See EXHIBIT M for definitions and due dates.
(d) Section 2.5.3.4 is hereby amended to read as follows:
		
	2.5.3.4
	Requirements

When handling grievances and appeals, the Contractor shall take the following actions:
		
	(1) 
	Provide the enrollee a reasonable opportunity to present evidence and allegations of fact or law in person as well as in writing;

		
	(2) 
	Ensure the enrollee understands any time limits that may apply;

		
	(3) 
	Provide opportunity before and during the process for the enrollee or an authorized representative to examine the case file, including medical records, and any other material to be considered during the process; and

    
	
			
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	Exhibit 10.8

	AMENDMENT 001
	Contract No. XT220
	Amendment Page 4

		
	(4) 
	Consider as parties to the appeal the enrollee or an authorized representative or, if the enrollee is deceased, the legal representative of the estate.

(e) Section 2.6(6) is hereby introduced and renumbered to read as follows:
		
	2.6
	MEDICAID FAIR HEARINGS

		
	(1) 
	The Medicaid Fair Hearing policy and process is detailed in Department of Children and Families Rule 65-2.042 – 2.069, F.A.C. Fair Hearings may be requested verbally or in writing. No specific form is required.

		
	(2) 
	An enrollee may seek a Medicaid Fair Hearing without having first exhausted the Contractor’s grievance and appeal process.

a.  An enrollee who chooses to exhaust the Contractor’s grievance and appeal process may still file for a Medicaid Fair Hearing within ninety (90) calendar days of receipt of the Contractor’s notice of resolution.
b. An enrollee who chooses to seek a Medicaid Fair Hearing without pursuing the Contractor’s grievance and appeal process must do so within ninety (90) calendar days of receipt of the Contractor’s notice of action.
		
	(3) 
	In accordance with 42 CFR 438.400, the Contractor is required to inform an individual of his/her right to a Medicaid Fair Hearing when the Contractor takes action to deny, reduce, suspend, limit or terminate previously authorized services. This includes services requested by the enrollee and those determined to be unnecessary by the Contractor’s routine review of the care plans.

		
	(4) 
	Enrollees may request a Medicaid Fair Hearing pursuant to 42 CFR 431.200 - 431.250 if they are denied the choice of home and community-based waiver services as an alternative to institutional level of care specified for in this waiver; or if their services are denied, reduced, suspended or terminated.

		
	(5) 
	Parties to the Medicaid Fair Hearing include the Contractor, the enrollee or the enrollee’s authorized representative.

		
	(6) 
	To continue disputed services during a pending fair hearing, the enrollee must request a fair hearing within 20 days of receipt of notification of his or her fair hearing rights. Pursuant to 42 CFR 438.424(b), the MCO or the State must pay for disputed services, in accordance with State policy and regulations, if the MCO or the State Fair Hearing officer reverses a decision to deny authorization of services, and the enrollee received the disputed services while the appeal was pending.

		
	(7) 
	The notice of Fair Hearing rights must contain the following language: “If you disagree with this decision, you have a right to file an appeal with our Plan or to request a State Fair Hearing. You do not need to file an appeal before you request a Fair Hearing. If you would like to request a Fair Hearing you must do so no later than ninety (90) days from the date of this letter. If you want to have services continued, you must request a Fair Hearing within ten (10) days from the date of this letter. You may have to pay for services that you get if the decision is to uphold the action the Plan has taken.”

		
	(8) 
	The notice must also contain the address and phone number for information and assistance filing a Fair Hearing. The address is as follows:

Department of Children and Families
Office of Public Assistance Appeal Hearings
1317 Winewood Blvd.
Building 5, Room 203
Tallahassee, Florida 32399-0700
(850) 488-1429

    
	
			
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	Exhibit 10.8

	AMENDMENT 001
	Contract No. XT220
	Amendment Page 5

		
	(9) 
	To assist enrollees who wish to file a Medicaid Fair Hearing for financial or medical eligibility determinations, the Contractor must direct the enrollee to contact the Department of Children & Families and provide the appropriate contact information.

		
	(10) 
	The Contractor must provide information pertaining to the Medicaid Fair Hearing process and procedure in the member handbook and it must be shared with members upon enrollment and annually.

(f) Section 2.8.1(7) is hereby replaced by new language and renumbered accordingly.
		
	(7) 
	Pursuant to 42 CFR 438.102(a)(1)(i-iv)’s anti-gag clause, the MCO may not prohibit, or otherwise restrict, a health care professional acting within the lawful scope of practice, from advising or advocating on behalf of an enrollee who is his or her patient:

a. For the enrollee's health status, medical care, or treatment options, including any alternative treatment that may be self-administered.
b. For any information the enrollee needs in order to decide among all relevant treatment options.
c. For the risks, benefits, and consequences of treatment or non-treatment.
d. For the enrollee's right to participate in decisions regarding his or her health care, including the right to refuse treatment, and to express preferences about future treatment decisions.
		
	(8) 
	Pursuant to 42 CFR 438.608, the Contractor shall maintain a mandatory compliance plan that is designed to guard against fraud and abuse.

a. The Contractor shall develop and maintain written policies, procedures and standards of conduct that states the Contractor’s commitment to comply with all applicable federal and state standards.
b. The Contractor shall designate a compliance officer and a compliance committee that is accountable to senior management.
c. The Contractor shall ensure effective training and education for the compliance officer and the Contractor’s employees.
d. The Contractor shall ensure there are effective lines of communication between the compliance officer and the Contractor’s employees.
e. The Contractor shall enforce standards through well-published disciplinary guidelines.
f. The Contractor shall have a provision for internal monitoring and auditing.
g. The Contractor shall have a provision for prompt response to detected offenses, and for development of corrective action initiatives relating to this contract.
(g) Section 2.12.4(7) is hereby introduced and reads as follows:
		
	(7) 
	Pursuant to 42 CFR 431.55(h) and 42 CFR 438.808, FFP is not available for amounts expended for providers excluded by Medicare, Medicaid, or CHIP, except for emergency services.

(h) Section 3.2.5 is hereby amended to read as follows:
		
	3.2.5
	Payment Discrepancies

(1) The Contractor shall prepare all reports and monthly payment requests for submission to the Department. If after an enrollment and disenrollment submission to the fiscal agent or receipt of the fiscal agent remittance voucher a 

    
	
			
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	Exhibit 10.8

	AMENDMENT 001
	Contract No. XT220
	Amendment Page 6

payment discrepancy is discovered, the Contractor must submit detailed information on the Reconciliation Form (EXHIBIT H) to the Department within the following time frames:
(i) The Contractor has 30 calendar days to review and address any payment discrepancies before submitting them to the Department on the next Reconciliation Form. Detailed information regarding the discrepancy must be included on the following Reconciliation Form which is due to the Department on the 5th day of each month. If a discrepancy is resolved during the month between the discovery date and Reconciliation Form due date, the Contractor is not required to include it on the Reconciliation Form. 
(ii) If the payment discrepancy was discovered by the Department, the Contractor has 30 calendar days to review and address the discrepancy before submitting it on the next Reconciliation Form. Detailed information regarding the discrepancy must be included on the following Reconciliation Form, which is due to the Department on the 5th day of each month.
(2) Failure to submit a discovered payment discrepancy to the Department within the time frames listed above shall result in a loss of any money requested by the Contractor for such errors.
(3) For the purposes of this section, detailed information is defined as a description of the payment discrepancy that includes, at a minimum, whether the payment discrepancy is a situation where the plan is requesting payment, one where the plan is requesting a recoupment of payment(s) made, or one where an incorrect capitation rate was paid.
(4) Pursuant to the timeframes established in 42 CFR 447.45(d), regardless of the date the payment discrepancy is discovered, the Contractor must submit all payment discrepancies on the Reconciliation Form (EXHIBIT H) to the Department no later than 12 months from the date of services. Failure to report a payment discrepancy within this time frame will result in a loss of any money requested by the Contractor for such errors. For the purposes of this section, the "12 months from the date of service" will begin on the first day of the month following the month of service for which payment is requested. This time limit does not apply to payment discrepancies where the Contractor received payment in excess, as determined by the Department and/or Agency. For months of service during which the enrollee was designated Medicaid Pending, the 12 months will begin on the first day of the month following the month in which the enrollee’s Medicaid eligibility was determined.
CONTRACT ATTACHMENTS:
(a) Attachment F, DOEA Cost Analysis for Non-Competitively Procured Contracts in Excess of Category II is hereby introduced and attached hereto; and
(b) Attachment G, Background Screening Affidavit of Compliance is hereby replaced with the revised Attachment G, Background Screening Affidavit of Compliance.
AMENDED EXHIBIT
Exhibit H, Long-Term Care Community Diversion Pilot Project Reconciliation Report is hereby replaced with the revised Exhibit H, Long-Term Care Community Diversion Pilot Project Reconciliation Report and attached hereto.
APPENDIX 3, Programmatic Reports is hereby replaced with the revised Appendix 3, Programmatic Reports and attached hereto.

    
	
			
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	Exhibit 10.8

	AMENDMENT 001
	Contract No. XT220
	Amendment Page 7

APPENDIX 5, Enrollee Roster Template and Instructions is hereby replaced with the revised Appendix 5, Enrollee Roster Template and Instructions and attached hereto.

This amendment shall be effective on the last date that the amendment has been signed by both Parties.
All provisions in the agreement and any attachments thereto in conflict with this amendment shall be and are hereby changed to conform to 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 agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
IN WITNESS WHEREOF, the Parties hereto have caused this 18 page amendment to be executed by their officials there unto duly authorized.

Contractor: WELLCARE OF FLORIDA INC., dba    STATE OF FLORIDA,
HEALTHEASE    DEPARTMENT OF ELDER AFFAIRS

SIGNED BY: /s/ Christina Cooper        SIGNED BY:/s/ Charles T. Corley    
NAME:   Christina Cooper        NAME: CHARLES T. CORLEY
TITLE:  President FL & HI Division         TITLE: SECRETARY
DATE:   7/31/12         DATE:     8/2/12    
Federal Tax ID: 592583622
Fiscal Year Ending Date: 12/31

    
	
			
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	Exhibit 10.8

	AMENDMENT 001
	Contract No. XT220
	Amendment Page 8

Table of Contents
          ATTACHMENT I
	
				
	SECTION I
	SERVICES TO BE PROVIDED.......................................................................
	17
	

	1.1
	DEFINITIONS OF TERMS AND ACRONYMS......................................................
	17
	

	1.1.1
	CONTRACT ACRONYMS..............................................................................
	17
	

	1.1.2
	PROGRAM SPECIFIC TERMS.........................................................................
	17
	

	1.2
	DEPARTMENT MISSION STATEMENT............................................................
	21
	

	1.3
	GENERAL DESCRIPTION..............................................................................
	22
	

	1.3.1
	General Statement..........................................................................................
	22
	

	1.3.2
	Authority.....................................................................................................
	22
	

	1.3.2.1
	Incorporation of Reference Memoranda................................................................
	22
	

	1.3.3
	Contract Terms and Conditions...........................................................................
	22
	

	1.3.3.1
	Required Long-Term Care Services......................................................................
	22
	

	1.3.3.2
	Case Management Services...............................................................................
	25
	

	1.3.3.3
	Acute-Care Services.......................................................................................
	25
	

	1.3.3.3.1
	Acute-Care Provider Qualifications.....................................................................
	26
	

	1.3.3.4
	Expanded Services..........................................................................................
	27
	

	1.4
	INDIVIDUALS TO BE SERVED.......................................................................
	27
	

	1.4.1
	Eligibility for Program....................................................................................
	27
	

	1.4.2
	Ineligibility for the Program..............................................................................
	27
	

	1.4.3
	“Medicaid Pending”.......................................................................................
	27
	

	SECTION II
	MANNER OF SERVICE PROVISION..............................................................
	28
	

	2.1
	SERVICE TASKS..........................................................................................
	28
	

	2.1.1
	ENROLLMENT AND DISENROLLMENT...........................................................
	28
	

	2.1.1.1
	Enrollment Process........................................................................................
	28
	

	2.1.1.2
	Optional State Supplementation (OSS).................................................................
	29
	

	2.1.1.3
	Changes in Eligibility and Reenrollment...............................................................
	29
	

	2.1.1.4
	Effective Date of Enrollment.............................................................................
	29
	

	2.1.1.5
	Transition Care Planning..................................................................................
	29
	

	2.1.1.6
	Orientation..................................................................................................
	30
	

	2.1.1.7
	Enrollee Handbook........................................................................................
	30
	

	2.1.1.8
	Provider Directory.........................................................................................
	32
	

	2.1.1.9
	Plan ID Card................................................................................................
	32
	

	2.1.1.10
	Annual Notification........................................................................................
	32
	

	2.1.1.11
	Care Plan and Service Delivery Requirements.........................................................
	32
	

	2.1.1.12
	Initial Care Plan Distribution.............................................................................
	33
	

	2.1.1.13
	Care Plan Review..........................................................................................
	34
	

	2.1.1.14
	Coordination and Continuity of Care....................................................................
	34
	

	2.1.1.15
	Assessments and Reassessments.........................................................................
	35
	

	2.1.1.16
	Level of Care................................................................................................
	35
	

	2.1.1.17
	Disenrollment Requested by the Enrollee...............................................................
	35
	

	2.1.1.18
	Disenrollment Requested by the Contractor..........................................................
	36
	

	2.1.1.19
	Disenrollment Requests...................................................................................
	36
	

	2.1.1.20
	Cancellations ...............................................................................................
	36
	

	2.2
	RECORDS MANAGEMENT AND HEALTH INFORMATION SYSTEMS...................
	37
	

    
	
			
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	Exhibit 10.8

	AMENDMENT 001
	Contract No. XT220
	Amendment Page 9

	
				
	2.2.1
	Background Screening Affidavit of Compliance
	38
	

	2.3
	UTILIZATION MANAGEMENT......................................................................
	38
	

	2.4
	QUALITY ASSURANCE................................................................................
	39
	

	2.4.1
	Quality Assurance Program...............................................................................
	39
	

	2.4.2
	Quality Assurance Committee............................................................................
	39
	

	2.4.3
	Quality Improvement and Performance Measures.....................................................
	40
	

	2.4.4
	Performance Measures....................................................................................
	41
	

	2.4.5
	Incident Reporting..........................................................................................
	41
	

	2.5
	GRIEVANCES AND APPEALS.........................................................................
	41
	

	2.5.1
	General Requirements.....................................................................................
	41
	

	2.5.2
	Categories of Challenges..................................................................................
	42
	

	2.5.3
	Filing Grievances and Appeals...........................................................................
	42
	

	2.5.3.1
	Time Limits.................................................................................................
	42
	

	2.5.3.2
	Expedited Appeals..........................................................................................
	43
	

	2.5.3.3
	Assistance...................................................................................................
	43
	

	2.5.3.4
	Requirements................................................................................................
	43
	

	2.5.4
	Notification of Action.....................................................................................
	43
	

	2.5.5
	Resolution and Notification...............................................................................
	44
	

	2.6
	MEDICAID FAIR HEARINGS..........................................................................
	44
	

	2.6.1
	Continuation of Benefits...................................................................................
	45
	

	2.7
	STAFFING REQUIREMENTS..........................................................................
	46
	

	2.7.1
	Staffing Levels..............................................................................................
	46
	

	2.7.2
	Positions Required..........................................................................................
	46
	

	2.7.3
	Staff Training................................................................................................
	46
	

	2.7.4
	Staffing Changes............................................................................................
	47
	

	2.8
	SERVICE PROVISIONS.................................................................................
	47
	

	2.8.1
	General Provisions.........................................................................................
	47
	

	2.8.2
	Availability/Accessibility of Services..................................................................
	48
	

	2.8.3
	Adult Protective Services.................................................................................
	49
	

	2.8.4
	Network Expansion........................................................................................
	50
	

	2.8.5
	Access to Services..........................................................................................
	50
	

	2.9
	CONTRACTOR’S FINANCIAL OBLIGATIONS...................................................
	50
	

	2.9.1
	Insolvency Protection......................................................................................
	50
	

	2.9.2
	Surplus Requirements......................................................................................
	51
	

	2.9.3
	Insurance....................................................................................................
	51
	

	2.9.4
	Interest and Savings........................................................................................
	51
	

	2.9.5
	Third Party Resources.....................................................................................
	52
	

	2.10
	FINANCIAL REPORTING..............................................................................
	52
	

	2.10.1
	Enrollee Payment Liability Protection..................................................................
	52
	

	2.10.2
	Audited Financial Statements.............................................................................
	52
	

	2.10.3
	Unaudited Quarterly Financial Statements..............................................................
	52
	

	2.11
	CONTRACT MANAGEMENT..........................................................................
	53
	

	2.11.1
	Independent Medical Review.............................................................................
	53
	

	2.12
	CONTRACTOR RESPONSIBILITIES.................................................................
	53
	

	2.12.1
	Contractor Qualifications..................................................................................
	53
	

	2.12.2
	Contractor Tasks...........................................................................................
	53
	

    
	
			
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	Exhibit 10.8

	AMENDMENT 001
	Contract No. XT220
	Amendment Page 10

	
				
	2.12.3
	Reporting....................................................................................................
	55
	

	2.12.4
	Provider Relations and Subcontracts.....................................................................
	56
	

	2.12.4.1
	Credentialing................................................................................................
	57
	

	2.12.4.2
	Re-Credentialing...........................................................................................
	58
	

	2.12.4.3
	Delegated Credentialing...................................................................................
	58
	

	2.12.4.4
	Identification of Conditions and Method of Payment.................................................
	58
	

	2.12.5
	Provisions for Monitoring and Inspections.............................................................
	58
	

	2.12.6
	Subcontractor Termination................................................................................
	58
	

	2.12.7
	Ownership and Management Disclosure................................................................
	58
	

	2.12.8
	Damages from Federal Disallowance....................................................................
	59
	

	2.12.9
	Legal Action Notification.................................................................................
	59
	

	2.12.10
	Conflict......................................................................................................
	59
	

	2.12.11
	Prospective Enrollee Materials...........................................................................
	59
	

	2.12.12
	Prohibited Activities.......................................................................................
	59
	

	2.12.13
	Sanctions....................................................................................................
	60
	

	2.12.14
	Assignment of Contract...................................................................................
	61
	

	2.12.15
	Contract Termination......................................................................................
	61
	

	SECTION III
	METHOD OF PAYMENT..............................................................................
	62
	

	3.1
	REQUEST FOR PAYMENT.............................................................................
	62
	

	3.2
	METHOD OF PAYMENT...............................................................................
	62
	

	3.2.1
	Capitation Rates............................................................................................
	62
	

	3.2.2
	834 Transactions...........................................................................................
	62
	

	3.2.3
	Payment in Full.............................................................................................
	63
	

	3.2.4
	Capitation Payments.......................................................................................
	63
	

	3.2.5
	Payment Discrepancies....................................................................................
	63
	

	
							
	ATTACHMENTS
	II – X, B, D, F – H and J

	 

	ATTACHMENT II
	CERTIFICATION REGARDING LOBBYING.............................................
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND AGREEMENTS
	64
	 

	ATTACHMENT III
	FINANCIAL AND COMPLIANCE AUDIT
	65
	 

	ATTACHMENT IV
	CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR AGREEMENTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS
	70
	 

	ATTACHMENT V
	CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
	71
	 

	ATTACHMENT VI
	ASSURANCES—NON-CONSTRUCTION PROGRAMS
	72
	 

	ATTACHMENT VII
	DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
	74
	 

	ATTACHMENT VIII
	PUBLIC ENTITY CRIMES
	77
	 

	ATTACHMENT IX
	MULTIPLE SIGNATURE VERIFICATION
	79
	 

	ATTACHMENT X
	AGREEMENT TO PROVIDE SERVICES TO INDIVIDUALS IDENTIFIED AS MEDICAID PENDING
	81
	 

	ATTACHMENT B
	CIVIL RIGHTS COMPLIANCE CHECKLIST
	82
	 

	ATTACHMENT D
	PROVIDER’S STATE CONTRACTS LIST
	86
	 

	ATTACHMENT F

ATTACHMENT G
	DOEA COST ANAYLSIS FOR NON-COMPETITIVELY PROCURED CONTRACTS
BACKGROUND SCREENING AFFIDAVIT OF COMPLIANCE
	87

88
	 

    
	
			
	Back to 10-Q
	 
	Exhibit 10.8

	AMENDMENT 001
	Contract No. XT220
	Amendment Page 11

	
							
	ATTACHMENT H
	CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS
	89
	 

	ATTACHMENT J
	VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION
	90
	 

	 
	 
	 
	 
	 

	EXHIBITS
	A - M
	 
	 
	 

	EXHIBIT A
	CAPITATION RATES
	91
	 
	 

	EXHIBIT B
	DISENROLLMENT SUMMARY REPORT
	92
	 
	 

	EXHIBIT C
	ENCOUNTER DATA REPORT
	93
	 
	 

	EXHIBIT D
	REPORT OF GRIEVANCES AND APPEALS
	98
	 
	 

	EXHIBIT E
	PROVIDER NETWORK AND STAFFING REPORT
	99
	 
	 

	EXHIBIT F
	ENROLLEE SATISFACTION SURVEY
	102
	 
	 

	EXHIBIT G
	SUBCONTRACTOR CONFORMATION
	105
	 
	 

	EXHIBIT H
	RECONCILIATION REPORT
	106
	 
	 

	EXHIBIT I
	REQUEST FOR DISENROLLMENT
	107
	 
	 

	EXHIBIT J
	SUBCONTRACTOR TRAINING ATTESTATION REPORT
	109
	 
	 

	EXHIBIT K
	FINANCIAL REPORTING PACKAGE
	110
	 
	 

	EXHIBIT L
	LEVEL OF CARE (LOC) REDERTERMINATION FORM
	128
	 
	 

	EXHIBIT M
	QUALITY IMPROVEMENT
	129
	 
	 

	 
	 
	 
	 
	 

	APPENDICES
	1 – 6
	 
	 
	 

	 
	 
	 
	 
	 

	APPENDIX 1
	ADDITIONAL SUB-CONTRACT REQUIREMENTS
	130
	 
	 

	APPENDIX 2
	ADDITIONAL OWNERSHIP AND MANAGEMENT REQUIREMENTS
	132
	 
	 

	APPENDIX 3
	PROGRAMMATIC REPORTS
	133
	 
	 

	APPENDIX 4
	SERVICE PROVIDER QUALIFICATIONS
	135
	 
	 

	APPENDIX 5
	ENROLLEE ROSTER REPORT
	140
	 
	 

	APPENDIX 6
	INCIDENT REPORTING LOG
	142
	 
	 

    
	
			
	Back to 10-Q
	 
	Exhibit 10.8

	AMENDMENT 001
	Contract No. XT220
	Amendment Page 12

EXHIBIT H

Long-Term Care Community Diversion Pilot Project
Reconciliation Report
For (Contractor name)  (Month/Year)

TAB 1
	
								
	Recipient Medicaid ID
	Recipient
Last Name
	Recipient
First Name
	Provider ID
	Enrollment Span
	Plan Comments
	DOEA Comments from LAST month
	DOEA Comments from THIS month

	 
	 
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 
	 

	
	
	Items on this tab of the report (Tab 1) include those which fall into the following categories:
 - New items that have never been submitted on the Reconciliation Form before.
 - Items AHCA is in the process of updating.
 - Items the Contractor has resolved with DCF/SSA that are ready for AHCA to update.
 - Items for which the Contractor has submitted the documents requested by DOEA.
 - Items the Contractor was told to resubmit via 834 on the last Reconciliation Form, but which rejected again for unknown reason(s).

The Contractor is responsible for moving any new items to Tab #2 if DOEA identifies them as one of the types of issues that go on that tab.

The Contractor is responsible for adding new items to Tab #1, and for removing any resolved items from Tab #1 before submitting the Reconciliation Form to DOEA each month.

	
							
	TAB 2

	Recipient Medicaid ID
	Recipient
Last Name
	Recipient
First Name
	Provider ID
	Enrollment Span
	Plan Comments
	DOEA Comments when moved to Tab 2

	 
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	
	
	Items on this tab of the report (Tab 2) include those which fall into the following categories:
 - DOEA has requested documentation, and the Contractor has not yet submitted it.
 - County of Residence discrepancies that DCF/SSA have not yet resolved.
 - Medicaid eligibility issues that DCF/SSA have not yet resolved.

DOEA Reviews these items every three (3) months to see if changes have been made. 

In the interim, it is the Contractor's responsibility to identify any items DOEA should review again and move the item to Tab #1. The items moved to Tab #1 should only be items the Contractor has good reason to believe have been fixed (received a NOCA, submitted the documents, etc.).

    
	
			
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	Exhibit 10.8

	AMENDMENT 001
	Contract No. XT220
	Amendment Page 13

APPENDIX 3

Programmatic Reports

All reports containing PHI will be password protected, zipped and encrypted using WinZip version 9.0 or higher. Use standard passwords for both the WinZip file as well as the report files. Unless otherwise indicated, electronic reports will be sent to DiversionReports@elderaffairs.org and a copy to the Contract Manager.

Level of Analysis:  The following levels of analysis will be used, as indicated, for the required reports:
		
	1.
	Individual Level - One report is required for each enrollee, e.g., one grievance record for each grievance, one record per long-term care service.

		
	2.
	Location Level - One report required for each nine-digit Medicaid provider number the Contractor has under contract.

		
	3.
	Contractor Level - One report is required for each seven-digit Medicaid provider number the Contractor has under contract.

	
							
	Report Name
	Level of Analysis
	Reporting Frequency
	Submission Method
	Reporting Location
	File Type
	File Name

	834 Transactions
	Individual
	Monthly the Wednesday preceding the second to last Saturday for enrollments and for disenrollments the prior day
	Secured Web site supplied by the fiscal agent, file upload and download
	Fiscal agent
	834 format Prescribed by the Fiscal Agent
	Prescribed by the Fiscal Agent

	Disenrollment Summary Report
	Location
	Monthly within 15 calendar days after the beginning of the reporting month
	Electronic Mail
	Department
	Excel (template in contract)
	Plan_Report Name_Date

	Encounter Data Report
	Individual
	Quarterly, within 3 months of the end of reporting calendar quarter
	FTP Site
	Department
	PDF/text file see contract
	Plan_Report Name_Quarter #_Year

	Grievance, Appeals, Complaints Report
	Individual
	Quarterly, within 5 calendar days of end or reporting calendar quarter
	Electronic Mail
	Department
	Excel (template in contract)
	Plan_Report Name_Quarter #_ Year

	Provider Network and Staff Listing
	Location
	Quarterly, within 5 calendar days of end of reporting calendar quarter
	Electronic Mail
	Department
	Excel (template in contract)
	Plan_Report Name_ Quarter #_ Year

	Emergency Management Plan
	Contractor
	Annually, April 30
	Electronic Mail
	Department
	Word/PDF
	Plan_Report Name_Date

    
	
			
	Back to 10-Q
	 
	Exhibit 10.8

	AMENDMENT 001
	Contract No. XT220
	Amendment Page 14

	
								
	 	Emergency Management Plan Verification
	Contractor
	Verification of plan within 30 days of execution of contract
	Electronic Mail
	Department
	Word/ PDF
	Plan_Report Name_Date

	 	Report Name
	Level of Analysis
	Reporting Frequency
	Submission Method
	Reporting Location
	File Type
	File Name

	 	Enrollee Satisfaction Survey
	Contractor
	Annually, May 15
	Electronic Mail
	Department
	Word/PDF (template in contract)
	Plan_Report Name_Date

	 	Reconciliation Report
	Individual
	Within 10 days of receipt of remittance vouchers
	Electronic Mail
	Department
	Excel
	Plan_Report Name_Date

	 	Insolvency Fund Statements
	Contractor
	Monthly Statements
	Electronic Mail or Hard Copy
	Department
	PDF copy
	Plan_Report Name_Date

	 	Audited Financial Statement
	Contractor
	Annually, within 120 days of end of Contractor’s fiscal year (4 months)
	Electronic Mail, Compact Disc or Hard Copy
	Department
	Word/PDF
	Plan_Report Name_Date

	 	Performance Measures
	Contractor
	Report to HSAG
	Electronic Mail to HSAG
	HSAG
	Format prescribed by HSAG
	Plan_Report Name_Date

	 
	 	Unaudited Financial Statements
	Contractor
	Quarterly, within 60 days of end of reporting quarter (2 months)
	Electronic Mail on Department supplied template
	Department
	Excel
	Plan_Report Name_Quarter#_Year

	 
	 	Performance Improvement Measures
	Contractor
	Report to HSAG
	Electronic Mail to HSAG
	HSAG
	Format prescribed by HSAG
	Plan_Report Name_Date

	 
	 	Staff Changes
	Individual
	As Needed
	Electronic Mail, hard copy or compact disk
	Department
	Word
	Plan_Report Name_Date

	 
	 	Subcontractor Training Attestation
	Subcontractor
	Annually, July 5
	Electronic Mail
	Department
	Excel
	Plan_Report Name_Date

	 	Enrollee Roster
	Contractor
	Monthly, the 8th of every month
	FTP Site
	Department
	Excel
	Plan_Report Name_Date

	
			
	Back to 10-Q
	 
	Exhibit 10.8

	AMENDMENT 001
	Contract No. XT219
	Amendment Page 15

 Appendix 5
Enrollee Roster Template and Instructions
	
										
	TAB 1

	PLAN NAME

	SUBMISSION MONTH

	Non-Medicaid Pending Enrollees

	Medicaid ID
	Social Security Number
	Last Name
	First Name
	Physical Address
	City
	Zip Code
	County
	Type of Facility
	Name of Facility

	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

Roster Tab (Tab 1):
This tab is for the basic enrollee roster. It consists of the basic enrollee demographic information, as well as the type and name of facility the enrollee is in, if applicable. For this tab, do NOT include Medicaid Pending individuals.
	
												
	TAB 2

	PLAN NAME

	SUBMISSION MONTH

	Medicaid Pending

	Medicaid ID
	Social Security Number
	Last Name
	First Name
	Physical Address
	City
	Zip Code
	County
	Type of Facility
	Name of Facility
	Date Application to DCF
	606 or 608?

	 
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

Medicaid Pending Tab (Tab 2):
This tab is for only those individuals that are Medicaid Pending. Please ensure that the date the application was sent to DCF is included for each individual. This list should be maintained in a chronological order, beginning with the earliest date, and ending with the most recent. Please ensure that this tab is updated prior to each submission to DOEA, removing any individuals that are no longer Medicaid Pending and adding those individuals to the Roster tab when appropriate.
	
							
	TAB 3

	PLAN NAME

	SUBMISSION MONTH

	Contracted Facilities

	Facility Name
	Facility Type
	Address
	City
	Zip Code
	County
	Number of Enrollees

	 
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

Network Tab (Tab 3):
This tab is a listing of all contracted facilities in the network. Please verify that the "Number of Enrollees" column is filled out and updated prior to each submission

      

	
			
	Back to 10-Q
	 
	Exhibit 10.8

	AMENDMENT 001
	Contract No. XT219
	Amendment Page 16

	
					
	PSA #
	 
	 
	 
	ATTACHMENT F

	Contract #
	 
	 
	 
	Exhibit 1

	 
	 
	 
	 
	 

	DOEA Cost Analysis For Non-Competitively Procured Contracts
In Excess Of Category II

	 
	 
	 
	 
	 

	Program:
	 
	

	Contract period:    
	 

	 
	 
	 
	 
	 

	TYPE OF SERVICE:
	 
	 

            
	
								
	1
	2
	Column 3
	Column 4
	Column 5
	6
	7
	8

	 
	 
	(to be completed by the Contractor)
	(to be completed by the DOEA ContractManager

	Budget
Category
	 
	Line Item
	Amount
	% Allocated to
this Agreement
	Allowable
	Reasonable
	Necessary

	Administration
	a.
	Salaries (List position titles and salaries below; add rows as necessary)
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	 
	Sub-total Salaries
	 
	#DIV/0!
	 
	 
	 

	b.
	Fringe Benefits
	 
	#DIV/0!
	 
	 
	 

	c.
	Equipment
	 
	#DIV/0!
	 
	 
	 

	d.
	Telephone & Utilities
	 
	#DIV/0!
	 
	 
	 

	e.
	Travel
	 
	#DIV/0!
	 
	 
	 

	f.
	Printing & Supplies
	 
	#DIV/0!
	 
	 
	 

	g.
	Building Space
	 
	#DIV/0!
	 
	 
	 

	h.
	Other (List below; add rows as necessary)
	 
	 
	 
	 
	 

	 
	 
	 
	#DIV/0!
	 
	 
	 

	 
	 
	#DIV/0!
	 
	 
	 

	 
	 
	#DIV/0!
	 
	 
	 

	 
	 
	#DIV/0!
	 
	 
	 

	 
	 
	#DIV/0!
	 
	 
	 

	 
	 
	#DIV/0!
	 
	 
	 

	 
	 
	#DIV/0!
	 
	 
	 

	 
	 
	#DIV/0!
	 
	 
	 

	 
	 
	#DIV/0!
	 
	 
	 

	 
	total administration
	 
	 
	 
	 
	 

	Services
	 
	Client Services (Attach details per instructions)
	 
	#DIV/0!
	 
	 
	 

	 
	TOTAL SERVICES
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	 
	 
	CONTRACT TOTAL
	 
	#DIV/0!
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 
	 

	CERTIFICATION (to be signed by DOEA Contract Manager)

	I certify that the cost for each line item has been evaluated and determined to be allowable, reasonable, and

	necessary as required by Section 216.3475, Florida Statutes.

	 
	 
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	Government Operations Consultant III
	 

	Name
	 
	Title
	 

	 
	 
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 
	 

	 
	 
	 
	 
	 
	 
	 

	Signature
	 
	Date
	 
	 

	 
	 
	 
	 
	 
	 
	 
	 

	
			
	Back to 10-Q
	 
	Exhibit 10.8

	AMENDMENT 001
	Contract No. XT219
	Amendment Page 17

	
					
	 
	 
	 
	 
	ATTACHMENT F

	 
	 
	 
	 
	Exhibit 2

INSTRUCTIONS:
Cost Analysis For Non-Competively Procured Contracts
In Excess Of Category II
	
	
	The purpose of the ATTACHMENT F, Exhibit 1, is to document that costs in non-competitively procured contracts in excess of $35,000 are allowable, reasonable and necessary.
Upon receipt of the form completed by the AAA, the DOEA contract manager will:
1.Evaluate each separate line item to determine whether the cost is allowable, reasonable and necessary.
a.To be allowable, a cost must be allowable pursuant to state and federal expenditure laws, rules and regulations and authorized by the agreement between the state and the contractor.
b.To be reasonable, a cost must be evaluated to determine that the amount does not exceed what a prudent person would incur given the specific circumstances.
c.To be necessary, a cost must be essential to the successful completion of the program.
2.Place the Cost Analysis for Non-Competitively Procured Agreements in Excess of Category II form in the official file for this contract at the Department of Elder Affairs. 

(1)    In accordance with the following instructions for the DOEA Cost Analysis For Non-Competitively Procured Contracts in Excess Of Category II worksheet (ATTACHMENT F, EXHIBIT 1), the contractor must complete COLUMNS 3 and 4 AND ensure COLUMN 5 calculates accurately.  This for is required for the original contract and for any amendment that affects the amount of compensation and/or the level of services provided.
(2)    Definition of Administrative Costs -

a.    Salaries/Wages:  The charges to directly hire someone and put them on payroll.
b.    Fringe Benefits:  The costs of health insurance, Social Security, Medicare, unemployment and other benefits paid on behalf of each employee.  If fringe benefits will be based on a specified percentage, rather than the actual cost of fringe benefits, then the calculation for the fringe benefits must also be shown.

c.    Equipment:  An article of expendable, tangible personal property generally having a useful life of more than one year and an acquisition cost that equals or exceeds the lesser of the established capitalization level of $5,000 (federal funds) or $1,000 or hardback bound books not circulated, with a value of $250.00 or more (state funds).
d.    Telephone and Utilities:  Expenses such as utilities and telephone service costs.
e.    Travel:  Expenses that are necessary, reasonable and allowable for carrying our the project.  Travel must be in accordance with Section 112.061, Florida Statutes, which includes submission of the claim on the approved State travel voucher or electronic means and at the authorized meal, per diem and state mileage reimbursement rates.
f.    Printing and Supplies:  Expenses such as office supplies, postage, and printing.

g.    Building Space:  Costs related to lease or mortgage payments.
h.    Other Costs:  Identify these by individual lien item and include their associated costs.
(3)    Client Service costs should be documented via Area Agency or Aging Area Plans, Unit Cost information input into WebDB, or some other form of documentation to support the cost analysis.
(4)    The allocation to the agreement will be calculated based on the cost by line item cost divided by the total agreement amount.

	
			
	Back to 10-Q
	 
	Exhibit 10.8

	AMENDMENT 001
	Contract No. XT219
	Amendment Page 18

	
		
	Department of

[logo]

ELDER AFFAIRS   State of Florida
	ATTACHMENT G

	 

	 

	BACKGROUND SCREENING

	 

	Affidavit of Compliance - Employer

	 

	 
	 

	 

	AUTHORITY:  This form is required annually of all employers to comply with the attestation requirements set forth in section 435.05(3), Florida Statutes.

		
	•
	The term “employer” means any person or entity required by law to conduct background screening, including but not limited to, Area Agencies on Aging, Aging Resource Centers, Aging and Disability Resource Centers, Lead Agencies, Long-Term Care Ombudsman Program, Serving Health Insurance Needs of Elders Program, Service Providers, Diversion Providers, and any other person or entity which hires employees or has volunteers in service who meet the definition of a direct service provider.  See §§ 435.02, 430.0402, Fla. Stat.

		
	•
	A direct service provider is “a person 18 years of age or older who, pursuant to a program to provide services to the elderly, has direct, face-to-face contact with a client while providing services to the client and has access to the client's living area, funds, personal property, or personal identification information as defined in s. 817.568.  The term includes coordinators, managers, and supervisors of residential facilities; and volunteers.”  § 430.0402(1)(b), Fla. Stat.

ATTESTATION:	
					
	As the duly authorized representative of  WellCare of Florida, Inc. dba HealthEase                    
	 

	located at 8735 Henderson Road,         Tampa,               Florida                     33634                   
	 

	Street Address
	City
	State
	Zip code
	 

	I, Christina Cooper                                               do hereby affirm under penalty of perjury
	 

	Name of Representative
	 
	 
	 
	 

	that the above names employer is in compliance with the provisions of Chapter 435 and section
	 

	430.0402, Florida Statutes, regarding level 2 background screening.
	 

	 
	 
	 
	 
	 

	/s/ Christina Cooper   7/31/12
	 
	 
	 

	Signature of Representative
	 
	Date

STATE OF FLORIDA, COUNTY OF HILLSBOROUGH    

Sworn to (or affirmed) and subscribed before me this 31st day of July       2012 , by

Christina Cooper                       Name of Representative) who is personally known 

to me or produced________________________as proof of identification:
	
					
	[NOTARY STAMP]
	 
	/s/ Emily A. Merlin
	 
	 

	Print, Type, or Stamp Commissioned Name of Notary Public
	Notary Public
	 
	 

            
	
					
	 

	DOEA Form 235, Affidavit of Compliance-Employer, Effective April 2012
	Section 435.05(3), F.S.

 Form available at:  http://elderaffairs.state.fl.us/english/backgroundscreening.phpWCG-Ex10.9_XT220Amendment2

	
			
	Back to 10-Q
	

	Exhibit 10.9

	AMENDMENT 002
	Contract No. XT220
	Amendment Page 1

This AMENDMENT, entered into by the State of Florida, Department of Elder Affairs (“Department”) and WellCare of Florida Inc., dba HealthEase (“Contractor”), amends contract XT220.
The purpose of this amendment is to renew the contract for an additional year and amend Appendix 4 to provide current capitulation rates. Additionally, this amendment (1) revises section 3 of the Standard contract, (2) revises certain paragraphs of Attachment I, (3) revises Attachment III, (4) replaces Appendix 3, (5) replaces Appendix 4 and (6) revises Exhibit A.
The purpose of this amendment is to amend the following contract sections (Paragraphs and Attachments):
STANDARD CONTRACT:
(1) Revises section 3 by amending the termination date.
ATTACHMENT I, STATEMENT OF WORK:
(1) Inserts section 1.4.3.1; and
(2) Revises section 2.1.1.11(3);
(3) Inserts section 2.1.1.14(2)(f);
(4) Revises section 2.6(6);
(5) Insert section 2.8.1.(9);
(6) Revises section 2.12.2(17);
(7) Revises section 2.12.15; and
(8) Revises section 3.1.1.
CONTRACT ATTACHMENTS:
(1) Revise Attachment III;
(2) Revise Appendix 3;
(3) Revise Appendix 4; and
(4) Revise Exhibit A.
_____________________________  Line denotes completion of above summary  ____________
STANDARD CONTRACT:
The Standard Contract is hereby revised as follows.
		
	(1)
	Section 3 is hereby revised to read:

This contract shall begin on June 1, 2012 or on the date on which the contract has been signed by the last party required to sign it, whichever is later. It shall end at midnight, local time in Tallahassee, Florida, on August 31, 2013.
ATTACHMENT I:
		
	(1)
	Section 1.4.3.1 is hereby introduced to read.

CARES will send the contractor the DOEA_CARES Form 602 (CARES to Case Management Referral Form) and the DOEA CARES Form 606 (Authorization to Assist) for the individual selecting to receive assistance with Medicaid financial eligibility only. In addition, CARES is responsible for submitting the Notification of Level of Care (DOEA-CARES 603), and the Certification of Enrollment Status (HCBS)(CF-AA 2515) documents for these individuals, to DCF. Contractors are required to send the 602 Form back to CARES within two (2) business days of a successful ACCESS application submission with comments that include the date the application was submitted and the DCF ACCESS Application Number for the individual.
		
	(2)
	Section 2.1.1.11(3) is hereby revised as follows.

(3)Any month of enrollment for which the Contractor receives capitation and during which an enrollee receives case management as the only long-term care service provided pursuant to this contract shall be submitted to the Department on the Reconciliation Report (Exhibit H) for recoupment. Exceptions to this provision are limited to the following:
a. If a Contractor's enrollee is hospitalized or in a nursing facility for rehabilitation, then the Contractor is responsible for their Medicare crossover claims in addition to case management, and may receive capitation for said month(s).

	
			
	Back to 10-Q
	

	Exhibit 10.9

	AMENDMENT 002
	Contract No. XT220
	Amendment Page 2

b. If an enrollee leaves the service area temporarily for thirty (30) calendar days or fewer, then the Contractor may receive capitation for said month.
Failure to report any other situations where services were suspended for a month or more and capitation was requested by and paid to the Contractor may indicate Medicaid fraud and may be reported to Medicaid Program Integrity for further investigation.
		
	(3)
	Section 2.1.1.14(2)(f) is hereby introduced to read.

Upon the request of the Department, each Contractor shall provide to its contract manager a detailed transition plan related to the Statewide Medicaid Managed Care Long-Term Care Program. All contractors must comply with any additional requests for information from the Department regarding coordination between this contract and the Statewide Medicaid Managed Care Long-Term Care Program contract. Prior to submission, the Department will provide to Contractors a list of required elements that must be included in the submissions and a timeframe for submission.
		
	(4)
	Section 2.6(6) is hereby revised as follows.

To continue disputed services during a pending fair hearing, the enrollee must request a fair hearing within 10 days of receipt of notification of his or her fair hearing rights. Pursuant to 42 CFR 438.424(b), the MCO or the State must pay for disputed services, in accordance with State policy and regulations, if the MCO or the State Fair Hearing officer reverses a decision to deny authorization of services, and the enrollee received the disputed services while the appeal was pending.
		
	(5)
	Section 2.8.1(9) is hereby introduced to read as follows.

The Contractor shall comply with all federal waiver requirements including any changes not explicitly listed in contract.
		
	(6)
	Section 2.2.12(17) is hereby revised as follows.

The Contractor shall provide to the Department encounter data that is recipient-specific service utilization data in the electronic format as specified in EXHIBIT C, and will additionally provide encounter data as specified in section 2.12.2(17)(b). The service utilization data reported represents the comprehensive array of services that might be necessary to maintain a member at home while avoiding nursing home placement, including acute and long-term care services.
a. Before submitting encounter data to the Department, Contractors shall validate the data collected for long-term care and acute care services.
b. 837 Encounter Data

		
	1.
	Encounter data collection and submission are required from all Contractors for all services rendered to their enrollees pursuant to this Contract. The Contractor shall submit encounter data that meets established Agency data quality standards as defined herein. These standards are defined by the Agency to ensure receipt of complete and accurate data for program administration and are closely monitored and enforced. The Department will give sixty (60) calendar days’ advance notice to the Contractor to ensure continuous quality improvement in the event that the Department or the Agency revises or amends these standards. The Contractor shall make changes or corrections to any systems, processes or data transmission formats as needed to comply with Agency data quality standards as originally defined or subsequently amended.

		
	2.
	The Contractor must be capable of sending and receiving any claims information directly to the Agency in standards and timeframes specified by the Agency or Department within sixty (60) days notice.

		
	3.
	The Contractor must submit a Check Run Summary File for each provider payment adjudication cycle no later than seven (7) calendar days following each respective adjudication cycle and in a format specified by the Agency or Department. The Contractor must begin submitting the Check Run Summary File upon notification from the Agency or Department.

		
	4.
	The Contractor must submit a Check Run Summary File reporting how total provider payment amounts reconcile with the encounter data submissions for each provider payment adjudication cycle. The Check Run Summary File must be submitted along with the encounter claims data submissions. The Check 

	
			
	Back to 10-Q
	

	Exhibit 10.9

	AMENDMENT 002
	Contract No. XT220
	Amendment Page 3

Run Summary File must be submitted in a format and in timeframes specified by the Agency or Department.
		
	5.
	For data acceptance purposes the Contractor must ensure the provider information it supplies to the Agency is sufficient to ensure providers are recognized in the Medicaid system (FMMIS) as either actively enrolled Medicaid providers or as Managed Care Plan registered providers. The Contractor is responsible for ensuring information is sufficient for accurate identification of participating network providers and non-participating providers who render services to the Contractor’s enrollees.

		
	6.
	The encounter data submission standards required to support encounter data collection and submission are defined by the Agency in the Medicaid Companion Guides and this section. In addition, the Agency will post encounter data reporting requirements on the following website: http://ahca.myflorida.com/Medicaid/meds/.

		
	7.
	The Contractor shall adhere to the following requirements for the encounter data submission process:

		
	a.
	For all non-pharmacy typical and atypical services, the Contractor shall submit encounters to the Agency for all typical and atypical services with Contractor paid dates on or after July 1, 2012 on an ongoing basis within sixty (60) calendar days following the end of the month in which the Contractor paid the claims for services.

		
	b.
	For all encounters submitted, if the Agency or its fiscal agent notifies the Contractor of encounters failing X12 (EDI) edits or compliance edits, the Contractor shall remediate all such encounters within sixty (60) calendar days after such notice.

		
	c.
	The Contractor shall retain submitted historical encounter data for a period not less than six (6) years as specified in the Standard Contract, Section 10.2.

		
	8.
	The Contractor shall have a comprehensive automated and integrated encounter data system capable of meeting the requirements below:

		
	a.
	All Contractor encounters shall be submitted to the Agency in the standard HIPAA transaction formats, namely the ANSI X12N 837 transaction formats (P – Professional; I - Institutional; D - Dental), and, for pharmacy services, if applicable, in the National Council for Prescription Drug Programs (NCPDP) format. Encounters must include the Contractor’s paid amounts and shall be submitted for all providers (capitated and non-capitated).

		
	b.
	The Contractor shall collect and submit encounter data to the Agency’s fiscal agent. The Contractor shall be held responsible for errors or noncompliance resulting from their own actions or the actions of an agent authorized to act on their behalf.

		
	c.
	The Contractor shall convert all information that enters its claims system via hard copy paper claims or other proprietary formats to encounter data to be submitted in the appropriate HIPAA-compliant formats.

		
	d.
	The Contractor shall provide complete and accurate encounters to the Agency as defined below. The Contractor shall implement review procedures to validate encounter data submitted by providers.

		
	1.
	Complete: A Contractor submitting at least ninety-five (95%) of its encounter data. The Contractor shall strive to achieve a one-hundred percent (100%) complete submission rate.

		
	2.
	Accurate (X12): Ninety-five percent (95%) of the records in a Contractor’s encounter batch submission pass X12 EDI compliance edits as specified by the Agency.

		
	3.
	Accurate (NCPDP): Ninety-five percent (95%) of the records in a Contractor’s encounter batch submission pass NCPDP edits and the pharmacy benefits system edits specified by the Agency. The NCPDP edits are described in the National Council for Prescription Drug Programs Telecommunications Standard Guides.

		
	4.
	The Contractor is responsible for correcting previously submitted X12 and NCPDP encounter data transactions to reflect the most current and accurate payment adjustment or reversal that results in a recoupment or additional payment within thirty (30) days of the respective action.

		
	9.
	The Contractor shall designate sufficient IT and staffing resources to perform these encounter functions as determined by generally accepted best industry practices.

	
			
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	Exhibit 10.9

	AMENDMENT 002
	Contract No. XT220
	Amendment Page 4

		
	10.
	Where a Contractor has entered into capitation reimbursement arrangements with providers, the Contractor shall comply with item 8 of this section, above. The Contractor shall require timely submissions from its providers as a condition of the capitation payment.

		
	11.
	The Contractor shall participate in Agency-sponsored workgroups directed at continuous improvements in encounter data quality and operations.

		
	12.
	If the Department determines that the Contractor has failed to comply with the encounter data reporting requirements of this Contract, the Department shall require the Contractor to submit a corrective action plan (CAP). In addition to a CAP, the Department may apply sanctions in accordance with the Contract.

		
	(7)
	Section 2.12.15 is hereby revised as follows.

2.12.15.1 Termination by the Contractor
(1) The contractor agrees to extend the thirty (30) calendar days’ notice found in the Standard Contract, Section 49.1, to one-hundred and twenty (120) calendar days’ notice for terminations initiated by the Contractor.
(2) The Contractor shall render written notice of termination to the Department by certified mail, return receipt requested, or in person with proof of delivery, or by facsimile or email letter followed by certified mail, return receipt requested. The notice of termination shall specify the date on which such termination shall become effective.
(3) The Contractor will work with the Department to create a transition plan, including the orderly and reasonable transfer of enrollee care. The transition plan must be approved in writing by the Department. Depending on the volume of Contractor enrollees affected, the Department may require an extension of the termination date.
(4) In the event of a notice of termination and unless a written waiver is executed by the Department, the Contractor must take the following actions:
a. Continue performance under the terms of the contract until the termination effective date.
b. Cease enrollment of new enrollees under the contract.
c. Perform the duties specified in the approved transition plan.
d. Terminate all activities listed in Section 2.12.11.
e. Take such action as may be necessary, or as the Department, in consultation with the Agency may direct, for the protection of property related to the contract that is in the possession of the provider and in which the Department and Agency have or may acquire an interest.
f. Not accept any payment submitted by the Department, after the termination date, unless the payment is for services actually delivered prior to the date of termination. Any payments due under the terms of the contract may be withheld until the Department receives from the Contractor all written and properly executed documents as required by the written instructions of the Department.
g. Upon notification of approval from the Department and at least 60 calendar days prior to the effective date of the termination, provide written notification to all enrollees of the date on which the Contractor will no longer participate in the Program and instructions on how to contact the Department’s CARES office for information on their long-term care options.
h. In the event the contract has been terminated in only one or more counties of the state, complete the performance of this contract in all other areas in which the Contractor’s duties have not been terminated.

	
			
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	Exhibit 10.9

	AMENDMENT 002
	Contract No. XT220
	Amendment Page 5

2.12.15.2 Termination by the Department
(1) The Department shall render written notice of termination to the Contractor by certified mail, return receipt requested, or in person with proof of delivery, or by facsimile or email letter followed by certified mail, return receipt requested. The notice of termination shall specify the nature of termination, the extent to which performance of work under the Contract is terminated, and the date on which such termination shall become effective.
(2) In accordance with s. 1932(e)(4), Social Security Act, the Department shall provide the Contractor with an opportunity for a hearing prior to termination for cause. This does not preclude the Department from terminating without cause pursuant to Section 49.1 of the Standard Contract or from terminating due to unavailability of funds pursuant to Section 49.2 of the Standard Contract.
(3) The Contractor will work with the Department to create a transition plan, including the orderly and reasonable transfer of enrollee care. Depending on the volume of Contractor enrollees affected, the Department may require an extension of the termination date.
(4) In the event of a notice of termination, and unless a written waiver is executed by the Department, the Contractor must take the following actions:
a. Continue performance under the terms of the new contract until termination date.
b. Cease enrollment of new enrollees under the contract.
c. Perform the duties as specified in the approved transition plan.
d. Terminate all activities listed in Section 2.12.11.
e. Take such action as may be necessary, or as the Department, in consultation with the Agency, may direct, for the protection of property related to the contract that is in the possession of the provider and in which the Department and Agency have or may acquire an interest.
f. Not accept any payment submitted after the contract ends, unless the payment is for the time period covered under the contract. Any payments due under the terms of the contract may be withheld until the Department receives from the Contractor all written and properly executed documents as required by the written instructions of the Department.
g. At least 60 calendar days prior to the effective date of the termination, provide written notification to all enrollees of the date on which the Contractor will no longer participate in the Program and instructions on how to contact the Department’s CARES office for information on their long-term care options.
h. If the contract has been terminated in only one or more counties of the state, the Contractor must, with Department approval, complete the performance of this contract in all other areas in which the Contractor’s duties have not been terminated.
		
	(8)
	Section 3.1.1 is hereby revised as follows.

This section supersedes section 47 of the standard contract to the extent there is conflict. The Agency, through the Medicaid fiscal agent, will make a payment to the Contractor on a monthly basis for the Contractor’s satisfactory performance of its duties and responsibilities as set forth in this attachment. This Section III supersedes section 26 of the Standard Contract and related sections to the extent that they require the Contractor to submit bills or invoices directly to the Department. The final payment will be made at the beginning of the month of contract expiration, in August of 2013, and requires Contractor to provide the services set in this contract for all individuals enrolled with that Contractor through August 31, 2013.

	
			
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	Exhibit 10.9

	AMENDMENT 002
	Contract No. XT220
	Amendment Page 6

CONTRACT ATTACHMENTS:
		
	(1)
	Attachment III is hereby replaced with the revised Attachment III and attached hereto.

		
	(2)
	Appendix 3, Programmatic Reports is hereby revised to read.

Reporting Frequency: Monthly, by the 5th of each month. See Section 3.2.5.
		
	(3)
	Appendix 4 is hereby replaced with the revised Appendix 4 and attached hereto.

This amendment shall be effective on the last date that the amendment has been signed by both Parties.
All provisions in the agreement and any attachments thereto in conflict with this amendment shall be and are hereby changed to conform to 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 agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
IN WITNESS WHEREOF, the Parties hereto have caused this 6 page amendment to be executed by their officials there unto duly authorized.
Contractor: WellCare of Florida Inc., dba    STATE OF FLORIDA,
HealthEase    DEPARTMENT OF ELDER AFFAIRS

SIGNED BY:   /s/ Christina Cooper    SIGNED BY:  /s/ Charles T. Corley
NAME:  Christina Cooper    NAME: CHARLES T. CORLEY
TITLE:  President, FL & HI Division    TITLE: SECRETARY
DATE:   8/26/12    DATE:  8/29/12
FEDERAL ID NUMBER: 592583622
Fiscal Year End Date: 12/31

	
			
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	Exhibit 10.9

	AMENDMENT 002
	Contract No. XT220
	Amendment Page 7

ATTACHMENT III
EXHIBIT-1
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF THE FOLLOWING:
	
				
	PROGRAM TITLE
	FUNDING SOURCE
	CFDA
	AMOUNT

	Long Term Community Diversion Pilot Project
	CMS
	93.778
	$33,624,000.00

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	

TOTAL FEDERAL AWARD
	$33,624,000.00

COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS AGREEMENT ARE AS FOLLOWS:
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
	
				
	PROGRAM TITLE
	FUNDING SOURCE
	CFDA
	AMOUNT

	Long Term Community Diversion Pilot Project
	General Revenue-Match
	93.777
&
93.778
	$26,376,000.00

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	

TOTAL STATE AWARD
	$26,376,000.00

STATE FINANCIAL ASSISTANCE SUBJECT TO Sec. 215.97, F.S.
	
				
	PROGRAM TITLE
	FUNDING SOURCE
	CSFA
	AMOUNT

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	

TOTAL AWARD
	$0.00

COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS AGREEMENT ARE AS FOLLOWS:

	
			
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	Exhibit 10.9

	AMENDMENT 002
	Contract No. XT220
	Amendment Page 8

ATTACHMENT III
EXHIBIT-2
PART I: AUDIT RELATIONSHIP DETERMINATION
Providers who receive state or federal resources may or may not be subject to the audit requirements of OMB Circular A-133, as revised, and/or Section 215.97, Fla. Stat. Providers who are determined to be recipients or subrecipients of federal awards and/or state financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I and/or Part II of Exhibit 1 are met. Providers who have been determined to be vendors are not subject to the audit requirements of OMB Circular A- 133, as revised, and/or Section 215.97, Fla. Stat. Regardless of whether the audit requirements are met, providers who have been determined to be recipients or subrecipients of federal awards and/or state financial assistance, must comply with applicable programmatic and fiscal compliance requirements.
In accordance with Sec. 210 of OMB Circular A-133 and/or Rule 691-5.006, FAC, provider has been determined to be:
 Vendor or exempt entity and not subject to OMB Circular A-133 and/or Section 215.97, F.S.
   X     Recipient/subrecipient subject to OMB Circular A-133 and/or Section 215.97, F.S.
NOTE: If a provider is determined to be a recipient /subrecipient of federal and/or state financial assistance and has been approved by the Department to subcontract, they must comply with Section 215.97(7), F.S., and Rule 69I-.006(2), FAC [state financial assistance] and Section _ .400 OMB Circular A-133 [federal awards].
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive federal awards or state matching funds on Federal awards and who are determined to be a subrecipient, must comply with the following fiscal laws, rules and regulations:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR Part 225 Cost Principles for State, Local and Indian Tribal Governments (Formerly OMB Circular A-87)*
OMB Circular A-102 – Administrative Requirements
OMB Circular A-133 – Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
NON-PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR Part 230 Cost Principles for Non-Profit Organizations (Formerly OMB Circular A-122 – Cost Principles)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A-110 – Administrative Requirements)
Requirements)
OMB Circular A-133 – Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
EDUCATIONAL INSTITUTIONS (EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT) MUST FOLLOW:
2 CFR Part 220 Cost Principles for Educational Institutions OMB (Formerly Circular A-21 – Cost Principles)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A-110 – Administrative Requirements)
OMB Circular A-133 – Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
*Some federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the OMB Circular A-133 Compliance Supplement, Appendix 1.
STATE FINANCIAL ASSISTANCE. Providers who receive state financial assistance and who are determined to be a recipient/subrecipient, must comply with the following fiscal laws, rules and regulations:
Section 215.97, Fla. Stat.
Chapter 69I-5, Fla. Admin. Code
State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations

	
			
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	Exhibit 10.9

	AMENDMENT 002
	Contract XT220
	Amendment Page 9

Appendix 4
Service Provider Qualifications	
					
	Required Service
	Qualified Provider Types
	License Authority
	Certification
Authority
	Other Standards

	Adult Companion
	Home Health Agency
	Ch. 400, Part III, F.S.
	 
	Optional; must meet Federal Conditions of Participation under 42 CFR 484

	Homemaker/Companion Agency
	Ch. 400.509, F.S.
	 
	 

	Nurse Registry
	Ch. 400.506, F.S.
	 
	 

	CCE Provider
	Ch. 400.203 F.S.
	 
	As defined in Ch. 400.203, F.S.; registration in accordance with Ch. 400.509, F.S.

	 

	Adult Day Health Care
	Adult Day Care Center
	Ch. 409, Part III, F.S.
	 
	 

	Assisted Living Facility
	Ch. 429, Part I, F.S.
	 
	 

	 

	Assisted Living Services
	Assisted Living Facility
	Ch. 429, Part I, F.S.
	 
	 

	 

	Case Management
	Contractor ONLY
	 
	 
	Case managers must be qualified in one of the following ways: (a) have a Bachelor's Degree in Social Work, Sociology, Psychology, Gerontology or related field, (b) be a Registered Nurse, licensed to practice in the state, (c) have a Bachelor's Degree in an unrelated field and at least two (2) years of geriatric experience, or (d) be a Licensed Practical Nurse (LPN) with four (4) years of geriatric experience. All case managers must have at least 2 years of geriatric experience and 4 hours of in service training annually and the Abuse and Neglect Exploitation training (which shall be approved in advance by the Department).

	 

	Chore Services
	General Contractor
	Ch. 489.131, F.S.
	 
	 

	Pest Control Business
	Ch. 482.071, F.S.
	 
	 

	Commercial Cleaning Company*
	 
	 
	Applicable local business license or certificate required

	Home Health Agency
	Ch. 400, Part III, F.S.
	 
	Optional; must meet Federal Conditions of Participation under 42 CFR 484

	CCE Provider
	Ch. 400.203 F.S.
	 
	As defined in Ch. 400.203, F.S.; registration in accordance with Ch. 400.509, F.S.

	 

	
			
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	AMENDMENT 002
	Contract XT220
	Amendment Page 10

	
					
	Consumable
Medical Supplies
	Home Health Agency
	Ch. 400, Part III, F.S.
	 
	Optional; must meet Federal Conditions of Participation under 42 CFR 484

	Home Medical Equipment Provider
	Ch. 400, Part X, F.S.
	 
	 

	Pharmacy
	 
	 
	 

	Prescription Drug Wholesale Distributor*
	 
	 
	Appropriate Department of Health Licensure Required or applicable local business license

	Assisted Living Facility*
	Ch. 429, Part I, F.S.
	 
	 

	 

	Environment
Accessibility/
Adaptation
	General Contractor
	Ch. 489.131, F.S.
	 
	 

	Independent Providers
	Licensed pursuant to state and local building codes or other licensure appropriate for task(s) performed. (Ch 205, F.S.)
	 
	 

	 

	Escort Service
	Home Health Agency
	Ch. 400, Part III, F.S.
	 
	Optional; must meet Federal Conditions of Participation under 42 CFR 484

	Nurse Registry*
	Ch. 400.506, F.S.
	 
	 

	CCE Provider
	Ch. 400.203 F.S.
	 
	As defined in Ch. 400.203, F.S.; registration in accordance with Ch. 400.509, F.S.

	 

	Family Training
	Clinical Social Worker, Mental Health Counselor
	Ch. 491, F.S.
	 
	 

	Registered Nurse, Licensed Practical Nurse
	Ch. 464, F.S.
	 
	 

	CCE Provider
	Ch. 400.203 F.S.
	 
	As defined in Ch. 400.203, F.S.; registration in accordance with Ch. 400.509, F.S.

	 

	
			
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	Exhibit 10.9

	AMENDMENT 002
	Contract XT220
	Amendment Page 11

	
					
	Financial
Assessment and
Risk Reduction
	Certified Public Accountant
	Ch. 437, F.S.
	 
	 

	Bank
	Ch. 658, F.S.
	 
	 

	Independent Contractor*
	 
	 
	Confirmed to be qualified to perform the service by training and experience. Independent contractors may include the following designations or occupations: Certified Financial Analyst, Certified Financial Planner, Certified Financial Advisor, Insurance Agent,
Individual with 4 yr degree in finance, accounting and/or 4 yr working experience within the finance or banking industry and Pass a Level II background screening

	CCE Provider
	Ch. 400.203 F.S.
	 
	As defined in Ch. 400.203, F.S.; registration in accordance with Ch. 400.509, F.S.

	 

	Homemaker
	Home Health Agency
	Ch. 400, Part III, F.S.
	 
	Optional; must meet Federal Conditions of Participation under 42 CFR 484

	Homemaker/Companion Agency
	Ch. 400.509, F.S.
	 
	 

	Nurse Registry
	Ch. 400.506, F.S.
	 
	 

	CCE Provider
	Ch. 400.203 F.S.
	 
	As defined in Ch. 400.203, F.S.; registration in accordance with Ch. 400.509, F.S.

	 

	Home-Delivered
Meals
	Food Service Establishment
	Ch. 509.241, F.S.
	 
	 

	Food Establishment
	 
	 
	Permit under Ch. 500.12, F.S.

	CCE Provider
	Ch. 400.203 F.S.
	 
	As defined in Ch. 400.203, F.S.; registration in accordance with Ch. 400.509, F.S.

	Older Americans Act Provider
	 
	 
	As defined in Ch 58A-1, Florida Administrative Code (FAC)

	 

	Nursing Facility
Service
	Nursing Facility
	Ch. 400, Part II, F.S.
	 
	 

	 

	
			
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	Exhibit 10.9

	AMENDMENT 002
	Contract XT220
	Amendment Page 12

	
					
	Nutritional
Assessment and
Risk Reduction
	Dietician/Nutritionist, Nutrition Counselor
	Ch. 468, Part X, F.S.
	 
	 

	Other Health Professionals
	 
	 
	Must practice within the legal scope of their practice.

	Nurse Registry*
	Ch. 400.506, F.S.
	 
	 

	CCE Provider
	Ch. 400.203 F.S.
	 
	As defined in Ch. 400.203, F.S.; registration in accordance with Ch. 400.509, F.S.

	 

	Occupational
Therapy
	Occupational Therapist
	Ch. 468, Part III, F.S.
	 
	 

	Occupational Therapist Assistant
	Ch. 468, Part III, F.S.
	 
	 

	Home Health Agency
	Ch. 400, Part III, F.S.
	 
	Must meet Federal Conditions of Participation under 42 CFR 484

	 

	Personal Care
	Home Health Agency
	Ch. 400, Part III, F.S.
	 
	Optional; must meet Federal Conditions of Participation under 42 CFR 484

	Nurse Registry
	Ch. 400.506, F.S.
	 
	 

	CCE Provider
	Ch. 400.203 F.S.
	 
	As defined in Ch. 400.203, F.S.; registration in accordance with Ch. 400.509, F.S.

	 

	Personal
Emergency
Response System
	Alarm System Contractor
	 
	Ch. 489, Part II, F.S.
	 

	Low Voltage Contractor and Electrical Contractor*
	 
	 
	Exempt from licensure in accordance with Section 489.503(15)(a-d) and Section 489.503(16), F.S

	 

	Physical Therapy
	Physical Therapist
	Ch. 486, F.S.
	 
	 

	Home Health Agency
	Ch. 400, Part III, F.S.
	 
	Must meet Federal Conditions of Participation under 42 CFR 484

	 

	Respiratory
Therapy
	Respiratory Therapist*
	Ch. 468, F.S.
	 
	 

	Home Health Agency
	Ch. 400, Part III, F.S.
	 
	Must meet Federal Conditions of Participation under 42 CFR 484

	 

	
			
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	Exhibit 10.9

	AMENDMENT 002
	Contract XT220
	Amendment Page 13

	
					
	Respite
	Adult Day Care Center
	Ch. 409, Part III, F.S.
	 
	 

	Assisted Living Facility
	Ch. 429, Part I, F.S.
	 
	 

	Home Health Agency
	Ch. 400, Part III, F.S.
	 
	Optional; must meet Federal Conditions of Participation under 42 CFR 484

	Homemaker/Companion Agency
	Ch. 400.509, F.S.
	 
	 

	Nursing Facility
	Ch. 400, Part II, F.S.
	 
	 

	Nurse Registry
	Ch. 400.506, F.S.
	 
	 

	CCE Provider
	Ch. 400.203 F.S.
	 
	As defined in Ch. 400.203, F.S.; registration in accordance with Ch. 400.509, F.S.

	 

	Speech Therapy
	Speech-language Pathologist
	Ch. 468, Part I, F.S.
	 
	 

	Home Health Agency
	Ch. 400, Part III, F.S.
	 
	Must meet Federal Conditions of Participation under 42 CFR 484

	
			
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	Contract No. 220
	Exhibit 10.9

	AMENDMENT 002
	 
	Amendment Page 14

EXHIBIT A
CAPITATION RATES
	
				
	Provider           ID
	Provider Name
	County Name
	9/1/2012-8/31/2013                        Diversion Capitation Rate

	005575802
	WELLCARE OF FLORIDA
	BAY
	$1,453.78

	005575803
	WELLCARE OF FLORIDA
	CALHOUN
	$1,453.78

	005575804
	WELLCARE OF FLORIDA
	COLUMBIA
	$1,331.52

	005575800
	WELLCARE OF FLORIDA
	ESCAMBIA
	$1,567.78

	005575805
	WELLCARE OF FLORIDA
	FRANKLIN
	$1,453.78

	005575806
	WELLCARE OF FLORIDA
	GADSDEN
	$1,453.78

	005575807
	WELLCARE OF FLORIDA
	GULF
	$1,453.78

	005575808
	WELLCARE OF FLORIDA
	HOLMES
	$1,453.78

	005575809
	WELLCARE OF FLORIDA
	JACKSON
	$1,453.78

	005575810
	WELLCARE OF FLORIDA
	JEFFERSON
	$1,453.78

	005575811
	WELLCARE OF FLORIDA
	LEON
	$1,453.78

	005575812
	WELLCARE OF FLORIDA
	LIBERTY
	$1,453.78

	005575813
	WELLCARE OF FLORIDA
	MADISON
	$1,453.78

	005575814
	WELLCARE OF FLORIDA
	OKALOOSA
	$1,567.78

	005575801
	WELLCARE OF FLORIDA
	SANTA ROSA
	$1,567.78

	005575815
	WELLCARE OF FLORIDA
	TAYLOR
	$1,453.78

	005575816
	WELLCARE OF FLORIDA
	WAKULLA
	$1,453.78

	005575817
	WELLCARE OF FLORIDA
	WALTON
	$1,567.78

	005575818
	WELLCARE OF FLORIDA
	WASHINGTON
	$1,453.78

The following table lists the initial rates for prospective expansions.
	
			
	PSA
	Counties
	9/1/2012-8/31/2012                     
Diversion Capitation Rate

	 
	 
	 

	1
	Escambia, Okaloosa Santa Rosa, and Walton
	$1,567.78

	2
	Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, and Washington
	$1,453.78

	3
	Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lake, Levy, Marion, Putman, Sumter, Suwannee, and Union
	$1,331.52

	4
	Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia
	$1,288.17

	5
	Pasco and Pinellas
	$1,408.77

	6
	Hardee, Highlands, Hillsborough, Manatee, and Polk
	$1,395.80

	7
	Brevard, Orange, Osceola, and Seminole
	$1,176.92

	8
	Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota
	$1,495.59

	9
	Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie
	$1,413.46

	10
	Broward
	$1,373.21

	11
	Miami-Dade and Monroe
	$1,562.85

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