Document:

exhibit45awardagreement

Exhibit 4.5 
RESTRICTED STOCK UNIT AWARD AGREEMENT 
UNDER THE BORDERFREE, INC. 
2015 STOCK OPTION INDUCEMENT PLAN

	
			
	 
	 
	 

	Name of Grantee:
	 
	 

	 
	 
	 

	No. of Stock Restricted Units:
	 
	 

	 
	 
	 

	Grant Date:
	 
	 

Pursuant to the Borderfree, Inc. 2015 Stock Option Inducement Plan as amended through the date hereof (the “Plan”), Borderfree, Inc. (the “Company”) hereby grants an award of the number of Restricted Stock Units listed above (an “Award”) to the Grantee named above.  Each Restricted Stock Unit shall relate to one share of Common Stock, par value $0.01 per share (the “Stock”) of the Company.

		
	1.
	Restrictions on Transfer of Award.  This Award may not be sold, transferred, pledged, assigned or otherwise encumbered or disposed of by the Grantee, and any shares of Stock issuable with respect to the Award may not be sold, transferred, pledged, assigned or otherwise encumbered or disposed of until (i) the Restricted Stock Units have vested as provided in Paragraph 2 of this Agreement and (ii) shares of Stock have been issued to the Grantee in accordance with the terms of the Plan and this Agreement.

		
	2.
	Vesting of Restricted Stock Units.  The restrictions and conditions of Paragraph 1 of this Agreement shall lapse on the Vesting Date or Dates specified in the following schedule so long as the Grantee remains an employee of the Company or a Subsidiary on such Dates.  If a series of Vesting Dates is specified, then the restrictions and conditions in Paragraph 1 shall lapse only with respect to the number of Restricted Stock Units specified as vested on such date. The vesting of the Restricted Stock Units shall commence on ___________ (the "Closing Date").

	
				
	Incremental Number of Restricted Stock Units Vested
	 
	Vesting Date

	 
	 
	 
	 

	 
	(33.3)%
	 
	1st anniversary of the Closing Date

	 
	(33.3)%
	 
	2nd anniversary of the Closing Date

	 
	(33.4)%
	 
	3rd anniversary of the Closing Date

The Administrator may at any time accelerate the vesting schedule specified in this Paragraph 2.
		
	3.
	Termination of Employment.  If the Grantee’s employment with the Company and its Subsidiaries terminates for any reason (including death or disability) prior to the satisfaction of the vesting conditions set forth in Paragraph 2 above, any Restricted Stock Units that have not vested as of such date shall automatically and without notice terminate and be forfeited, and neither the Grantee nor any of his or her successors, heirs, assigns, or personal representatives will thereafter have any further rights or interests in such unvested Restricted Stock Units.

		
	4.
	Issuance of Shares of Stock.  As soon as practicable following each Vesting Date (but in no event later than two and one-half months after the end of the year in which the Vesting Date occurs), the Company shall issue to the Grantee the number of shares of Stock equal to the aggregate number of Restricted Stock Units that have vested pursuant to Paragraph 2 of this Agreement on such date and the Grantee shall thereafter have all the rights of a stockholder of the Company with respect to such shares.

		
	5.
	Incorporation of Plan.  Notwithstanding anything herein to the contrary, this Agreement shall be subject to and governed by all the terms and conditions of the Plan, including the powers of the Administrator set forth in Section 2(b) of the Plan.  Capitalized terms in this Agreement shall have the meaning specified in the Plan, unless a different meaning is specified herein.

		
	6.
	Tax Obligations.   

		
	a.
	Withholding.  In the event that the Company determines that it or any Subsidiary is required to account to HM Revenue & Customs for a Tax Liability and any Secondary NIC Liability or to withhold any other tax as a result of the exercise of this Award, the Grantee, as a condition to the issue of Stock under this Award, shall make arrangements satisfactory to the Company to enable it or any Subsidiary to satisfy all withholding liabilities. The Grantee shall also make arrangements satisfactory to the Company to enable it to satisfy any withholding requirements that may arise in connection with the vesting or disposition of Stock acquired under this Award.

		
	b.
	Tax Consultation.  The Grantee understands that he or she may suffer adverse tax consequences as a result of the Grantee’s purchase or disposition of the Stock. The Grantee represents that he or she will consult with any tax advisors the Grantee deems appropriate in connection with the purchase or disposition of the Stock and that the Grantee is not relying on the Company or any Affiliate for any tax advice.

		
	c.
	Section 431 Election.  As a further condition of the issue of Stock under this Award, the Grantee shall have signed a Section 431 Election in the form set out in Appendix 1 or in such other form as may be determined by HM Revenue & Customs from time to time.

		
	d.
	Employer's National Insurance Charges.  As a further condition of the issue of Stock under this Award, the Grantee shall join with the Company or any other company or person who is or becomes a Secondary Contributor in making a Joint Election which has been approved by HM Revenue & Customs, for the transfer of the whole of any Secondary NIC Liability.

		
	e.
	Grantee's Tax Indemnity.

		
	i.
	Indemnity.  To the extent permitted by law, the Grantee hereby agrees to indemnify and keep indemnified the Company, and the Company as trustee for and on behalf of any related corporation, for any Tax Liability and Secondary NIC Liability.

		
	ii.
	No Obligation to Issue Stock.  The Company shall not be obliged to allot and issue any Stock or any interest in Stock pursuant to the exercise of this Award unless and until the Grantee has paid to the Company such sum as is, in the opinion of the Company, sufficient to indemnify the Company in full against the Tax Liability and the Secondary NIC Liability, or the Grantee has made such other arrangement as in the opinion of the Company will ensure that the full amount of any Tax Liability and any Secondary NIC Liability will be recovered from the Grantee within such period as the Company may then determine.

		
	iii.
	Right of Retention.  In the absence of any such other arrangement being made, the Company shall have the right to retain out of the aggregate number of shares of Stock to which the Grantee would have otherwise been entitled to under this Award, such number of shares of Stock as, in the opinion of the Company, will enable the Company to sell as agent for the Grantee (at the best price which can reasonably expect to be obtained at the time of the sale) and to pay over to the Company sufficient monies out of the net proceeds of sale, after deduction of all fees, commissions and expenses incurred in relation to such sale, to satisfy the Grantee's liability under such indemnity.

		
	7.
	No Obligation to Continue Employment.  Neither the Company nor any Subsidiary is obligated by or as a result of the Plan or this Agreement to continue the Grantee in employment and neither the Plan nor this Agreement shall interfere in any way with the right of the Company or any Subsidiary to terminate the employment of the Grantee at any time.

		
	8.
	Integration.  This Agreement constitutes the entire agreement between the parties with respect to this Award and supersedes all prior agreements and discussions between the parties concerning such subject matter.

		
	9.
	Data Privacy Consent.

		
	a.
	By entering into this Agreement, and as a condition of the grant of the Award, the Grantee consents to the collection, use, and transfer of personal data as described in this paragraph to the full extent permitted by and in full compliance with applicable laws. 

		
	b.
	The Grantee understands that the Company and its Subsidiaries hold Data about the Grantee for the purpose of managing and administering the Plan.  

		
	c.
	The Grantee further understands that the Company and/or its Subsidiaries will transfer Data among themselves as necessary for the purposes of implementation, administration, and management of the Grantee's participation in the Plan, and that the Company and/or its Subsidiary may each further transfer Data to any Data Recipients.  

		
	d.
	The Grantee understands that these Data Recipients may be located in the Grantee's country of residence or elsewhere, such as the United States.  The Grantee authorizes the Data Recipients to receive, possess, use, retain, and transfer Data in electronic or other form, for the purposes of implementing, administering, and managing the Grantee's participation in the Plan, including any transfer of such Data, as may be required for the administration of the Plan and/or the subsequent holding of Stock on the Grantee’s behalf, to a broker or third party with whom the Stock acquired on exercise may be deposited. Where the transfer is to be to a destination outside the European Economic Area, the Company shall take reasonable steps to ensure that the Grantee's personal data continues to be adequately protected and securely held.  

		
	e.
	The Grantee understands that the Grantee may, at any time, review the Data, request that any necessary amendments be made to it, or withdraw the Grantee's consent herein in writing by contacting the Company. The Grantee further understands that withdrawing consent may affect the Grantee's ability to participate in the Plan.

		
	10.
	Notices.  Notices hereunder shall be mailed or delivered to the Company at its principal place of business and shall be mailed or delivered to the Grantee at the address on file with the Company or, in either case, at such other address as one party may subsequently furnish to the other party in writing.

		
	11.
	Additional terms

		
	a.
	The Grantee has no right to compensation or damages for any loss in respect of the Award where such loss arises (or is claimed to arise), in whole or in part, from the termination of the Grantee's employment; or notice to terminate employment given by or to the Grantee.  This exclusion of liability shall apply however termination of employment, or the giving of notice, is caused other than in a case where a competent tribunal or court, from which there can be no appeal (or which the relevant employing company has decided not to appeal), has found that the cessation of the Grantee's employment amounted to unfair or constructive dismissal of the Grantee and however compensation or damages may be claimed.

		
	b.
	The Grantee has no right to compensation or damages for any loss in respect of an Award where such loss arises (or is claimed to arise), in whole or in part, from any company ceasing to be a Subsidiary of the Company; or the transfer of any business from a Subsidiary of the Company to any person which is not a Subsidiary of the Company.  This exclusion of liability shall apply however the change of status of the relevant company, or the transfer of the relevant business, is caused, and however compensation or damages may be claimed.

	
		
	 
	BORDERFREE, INC.

	 
	 

	By:
	 

	 
	Title:

The foregoing Agreement is hereby accepted and the terms and conditions thereof hereby agreed to by the undersigned.  Electronic acceptance of this Agreement pursuant to the Company’s instructions to the Grantee (including through an online acceptance process) is acceptable.

	
					
	Dated:
	 
	 
	 
	 

	 
	 
	 
	Grantee's Signature
	 

	 
	 
	 
	 
	 

	 
	 
	 
	Grantee's name and address:FA971Amendment9forEDGARizing

Back to Form 8-k
Exhibit 10.1

AHCA CONTRACT NO. FA971
AMENDMENT NO. 9
THIS CONTRACT, entered into between the State of Florida, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the "Agency" and WELLCARE OF FLORIDA, INC., D/B/A STAYWELL HEALTH PLAN OF FLORIDA, hereinafter referred to as the "Vendor" or “Health Plan,” is hereby amended as follows:
		
	1.
	Standard Contract, Section I., Item C., Audit and Records, is hereby amended to include sub-item 6., as follows:

		
	6.
	To comply with public record laws as outlined in Section 119.0701, Florida Statutes.

		
	2.
	Standard Contract, Section I., Item M., Requirements of Section 287.058, Florida Statutes, sub-item 4., the second sentence is hereby revised to now read as follows:

This Contract shall begin September 1, 2012 and end January 31, 2015, inclusive.
		
	3.
	Attachment I, Scope of Services, Capitated Health Plan Section E., Method of Payment, Item 1., General, is hereby amended to include sub-item c. as follows:

		
	c.
	The Health Plan shall not accept any payment for services rendered after July 31, 2014.  Any payments due under the terms of this Contract may be withheld until the Agency receives from the Health Plan all written and properly executed documents as required by the written instructions of the Agency.

		
	4.
	Effective September 1, 2013, Attachment I, Scope of Services, Capitated Health Plans, Exhibit 2-R, Medicaid Reform HMO Capitation Rates, Effective September 1, 2013 – August 31, 2014, is hereby deleted in its entirety and replaced with Exhibit 2-R, Medicaid Reform HMO Capitation Rates, Effective September 1, 2013 – August 31, 2014, (90113) attached hereto and made a part of this Cotnract.

		
	5.
	Attachment II, Core Contract Provisions, Section XVI, Terms and Conditions, Q. Termination Procedures, is hereby revised to include Item 3. As follows:

		
	3.
	Upon termination or expiration of this Contract, in addition to any other Contract Provisions which extend beyond the termination date, the following provisions of this Contract shall survive:

	
				
	Contract Attachment
	Contract Attachment Section Cite
	Contract Cite Scope
	Cite End Date of Requirement or Date of Submission of Last Report

	II
	II.D.13.
	Ad Hoc Reporting (relative to Provisions under the Contract)
	8/31/15

	II
	II.D.14.
	Enhanced Benefits Program Data Reporting (Reform Only)
	10/10/14

	II
	II.D.20.a. and b.
	Medical Loss Ratio Reporting (Reform Capitated Plans Only)
	Annual – 1/30/15
Quarterly – 4/30/15

AHCA Contract No. FA971, Amendment No. 9, Page 1 of 7

	
				
	Contract Attachment
	Contract Attachment Section Cite
	Contract Cite Scope
	Cite End Date of Requirement or Date of Submission of Last Report

	II
	II.D.23.
	SMMC Transition
	12/31/14

	II
	III.B.3.
	Unborn Activations
	10/31/14

	II
	IV.A.17.g.
	Medicaid Redetermination Notice Summary Reporting (Health Plan Participating in Medicaid Redetermination Notices Pursuant to Contract Attachment I)
	11/14/14

	II
	IV.B.6.a.
	Community Outreach Representative Reporting
	11/14/14

	II
	V.H.2.h. and i.
	CHCUP Reporting
	1/15/15 for unaudited
9/30/15 for audited

	II
	V.H.7.
	Emergency Services Claims Processing
	8/31/15

	II
	V.H.10.
	Hospital Services – Inpatient Claims Processing
	8/31/15

	II
	V.H.12.
	Hospital Services – Ancillary Services Processing
	8/31/15

	II
	V.H.14.
	Immunization Claims Processing
	8/31/15

	II
	V.H.16.
	Prescribed Drug Services Claims Processing Rebate Issue Resolution Requirements
	8/31/15

	II
	V.H.16.l
	Prescribed Drug Services Rebate Issue Resolution Requirements
	8/31/15

	II
	V.H.16.f.(1)
	Hernandez Settlement Agreement Ombudsman Log
	10/15/14

	II
	V.H.16.f.(3)(e)
	Hernandez Settlement Agreement Survey Reporting
	8/01/14

	II
	V.H.18.
	Emergency Shelter/Foster Care Program Physical Screening Claims Processing
	8/31/15

	II
	V.H.23.
	Affordable Care Act Primary Care Services Fee Increase Claims Processing
	8/31/15 or earlier if attestation received stating all claims have been settled.

	II
	VI.C.1.
	Behavioral Health Inpatient Hospital Services Claims Processing
	8/31/15

	II
	VI.C.3.
	Emergency Behavioral Health Services Claims Processing
	8/31/15

AHCA Contract No. FA971, Amendment No. 9, Page 2 of 7

	
				
	Contract Attachment
	Contract Attachment Section Cite
	Contract Cite Scope
	Cite End Date of Requirement or Date of Submission of Last Report

	II
	VI.D.6.
	Behavioral Health Transition Plan Claims Processing
	8/31/15

	II
	VI.O.
	Behavioral Health Annual 80/20 Expenditure Report
(Non-Reform)
	Annual – 4/01/15

	II
	VII.B.3.
	Public Health Provider Claims Processing
	8/31/15

	II
	VII.I.4.e.
	Provider Call Center Automated System – Relative to Claims Processing
	8/31/15

	II
	VIII.A.7.
	Critical Incident Report and Code 15 Reporting
	8/15/14

	II
	VIII.A.7.
	Critical Incident Report Summary
	8/15/14

	II
	VIII.B.1.
	Utilization Management Relative to Claims Processing
	8/31/15

	II
	IX
	Grievance and Appeal Processing for Grievances and Appeals Submitted for Dates of Service While the Recipient Was Enrolled with the Health Plan
	8/31/15 or until no outstanding grievances and appeals exist, whichever comes first

	II
	IX.A.7.
	Grievance and Appeal Reporting
	8/31/15 or until no outstanding grievances and appeals exist, whichever comes first

	II
	X.A.4.
	Encounter Data Staffing
	9/30/15

	II
	X.B.2.a.
	Minimum Staffing Requirements Related to Contract Manager, Data Processing and Data Reporting Coordinator, Compliance Officer and Claims/Encounter Manager
	8/31/15; however, full-time requirement and exclusivity requirements do not apply

	II
	X.C.
	Claims Processing
	8/31/15

	II
	X.C.7.
	Claims Aging Report
	9/14/15 or earlier – if attestation received stating that all claims have been settled.

	II
	X.D.
	Encounter Data Processing
	9/30/15

	II
	X.E.5.b. & 8.b.
	Fraud and Abuse Anti-Fraud Plan
	9/01/14

	II
	X.E.8.a.
	Quarterly Fraud and Abuse Activity Report
	10/15/14

AHCA Contract No. FA971, Amendment No. 9, Page 3 of 7

	
				
	Contract Attachment
	Contract Attachment Section Cite
	Contract Cite Scope
	Cite End Date of Requirement or Date of Submission of Last Report

	II
	X.E.10.
	Annual Fraud and Abuse Activity Report
	9/01/14

	II
	X.E.11.
	Notification to the Department of Health and Human Services Office of the Inspector General and to MPI of Persons Meeting Specified Contract Criteria
	Notify DHHS OIG and MPI within ten (10) business days of discovery

	II
	XII.B.1. Table 1
	Audited Annual and Unaudited Quarterly Financial Reports
	Annual – 4/01/15
Quarterly – through 11/14/15 or earlier – if attestation received stating that all claims have been settled.

	II
	XII.B.1. Table 1
	Behavioral Health Annual 80/20 Expenditure Report
(non-Reform)
	Annual – 4/01/15
Reconciled IBNR report (Non-Reform Health Plans, if applicable,) should be filed on 2/1/2015 for CY 2013 and 2/1/2016 for CY 2014.

	II
	XII.B.1. Table 1
	CHCUP (CMS-416) & FL 60% Screening (Child Health Check Up report)
	1/15/15 for unaudited
9/30/15 audited

	II
	XII.B.1. Table 1
	Claims Aging Report & Supplemental Filing Report
	Quarterly – 9/14/15 or earlier – if attestation received stating that all claims have been settled.

	II
	XII.B.1. Table 1
	Code 15 – Critical Incident Report
	8/15/14

	II
	XII.B.1. Table 1
	Complaints, Grievance, and Appeals Report
	Quarterly – 8/31/15 or earlier – if attestation received stating that all outstanding grievances and appeals have been processed

	II
	XII.B.1. Table 1
	Critical Incident Report
	8/15/14

	II
	XII.B.1. Table 1
	Critical Incident Report Summary
	8/15/14

	II
	XII.B.1. Table 1
	Hernandez Settlement Agreement Ombudsman Log
	10/15/14

	II
	XII.B.1. Table 1
	Hernandez Settlement Agreement Survey
	8/01/14

	II
	XII.B.1. Table 1
	Insolvency Protection Multiple Signatures Agreement Form
	If there is a change in signatories

AHCA Contract No. FA971, Amendment No. 9, Page 4 of 7

	
				
	Contract Attachment
	Contract Attachment Section Cite
	Contract Cite Scope
	Cite End Date of Requirement or Date of Submission of Last Report

	II
	XII.B.1. Table 1
	MPI – Annual Fraud & Abuse Activity Report
	9/01/14

	II
	XII.B.1. Table 1
	MPI – Quarterly Fraud & Abuse Activity Report
	10/15/14

	II
	XII.B.1. Table 1
	MPI – Suspected/Confirmed Fraud & Abuse Reporting
	Within fifteen (15) calendar days of detection

	II
	XII.B.1. Table 1
	Performance Measures
	7/01/14

	II
	XII.B.1. Table 1
	Quarterly and Annual Medical Loss Ratio Reports
(Reform Only)
	Annual – 1/30/15
Quarterly – 4/30/15

	II
	XII.B.1. Table 1
	Subcontractors and Affiliates Report
	10/15/14

	II
	XII.B.1. Table 1
	ACA Physician Fee Increase Quarterly Report (third and fourth quarter 2013 and each quarter of 2014)
	8/31/15 or earlier if attestation received stating all claims have been settled

	II
	XIV.
	Sanctions
	8/31/15

	II
	XV.H.
	Third Party Creditable Coverage Notice to Agency’s Third Party Liability Vendor
	9/14/15 or earlier – if attestation received stating that all claims have been settled.

	II
	XV.J.
	Financial Reporting
	Annual – 4/01/15
Quarterly – 11/14/15 or earlier – if attestation received stating that all claims have been settled.

	II
	XVI.H.
	Damages for Failure to Meet Contract Requirements
	8/31/15

	II
	XVI.Q.
	Encounter Data Submission
	9/30/15

	II
	XVI.V.1., 2. and 3.
	Ownership and Management Disclosure
	8/31/15

	II
	XVII.
	Liquidated Damages
	8/31/15

	II Exhibits
	III.B.
	Newborn Enrollment (FFS PSNs Only)
	10/31/14

	II Exhibits
	IV.A.15.
	Enhanced Benefit Program (Reform Only)
	10/10/14

	II Exhibits
	X.C.
	Claims Payment (Capitated Health Plans Only)
	8/31/15

AHCA Contract No. FA971, Amendment No. 9, Page 5 of 7

	
				
	Contract Attachment
	Contract Attachment Section Cite
	Contract Cite Scope
	Cite End Date of Requirement or Date of Submission of Last Report

	II Exhibits
	X.C.
	Claims Payment (FFS Health Plans Only)
	8/31/15

	II Exhibits
	X.C.
	Claims Aging Reporting (FFS PSNs Capitated for Behavioral Health Services and/or Approved to Subcapitate for Services)
	Quarterly – 9/15/15 or earlier – if attestation received stating that all claims have been settled.

	II Exhibits
	X.C.
	Claims Payment (FFS PSNs Approved to Subcapitate for Services)
	8/31/15

	II Exhibits
	XIII.C.
	Kick Payments (Reform Capitated Health Plans Only)
	8/31/15

	II Exhibits
	XIII.A. - F.
	Reconciliation (FFS Health Plans Only)
	12/01/15

	II Exhibits
	XIII.
	Reconciliation Refunds (FFS PSNs Approved to Subcapitate for Services)
	12/01/15

	II Exhibits
	XIII.
	Reconciliation Refunds (Safety-Net Hospital Based FFS PSNs Only)
	12/01/15

	II Exhibits
	XV.A.
	Insolvency Protection (Capitated Health Plans and FFS PSNs Approved to Subcapitate or Are Capitated for Behavioral Health Services)
	Until receipt of proof of satisfaction of all outstanding obligations incurred under the Contract

		
	5.
	Attachment II, Core Contract Provisions, Section XVI, Terms and Conditions, Item HH., Communications is hereby included as follows:

		
	HH.
	Notwithstanding any term or condition of this Contract to the contrary, the Health Plan bears sole responsibility for ensuring that its performance of this Contract (and that of its’ subcontractors related to this Contract) fully complies with all state and federal law governing the monitoring, interception, recording, use or disclosure of wire, oral or electronic communications, including but not limited to the Florida Security of Communications Act, §§ 934.01, et seq., F.S., and the Electronic Communications Privacy Act, 18 U.S.C. § 2510 et seq. (hereafter, collectively, “Communication Privacy Laws”).  Prior to intercepting, recording or monitoring any communications which are subject to Communication Privacy Laws, the Health Plan must:  (1) submit a plan which specifies in detail the manner in which the Health Plan (and its’ subcontractors related to this contract) will ensure that such actions are in full compliance with Communication Privacy Laws (the “Privacy Compliance Plan”); and (2) obtain written approval, signed and stamped by the Agency Contract Manager, approving the Privacy Compliance Plan.  No modifications to an approved Privacy Compliance Plan may be implemented by the Health Plan unless an amended Privacy Compliance Plan is submitted to the Agency, and written approval 

AHCA Contract No. FA971, Amendment No. 9, Page 6 of 7

of the amended Privacy Compliance Plan is signed and notarized by the Agency Contract Manager.  Agency approval of the Health Plan’s Privacy Compliance Plan in no way constitutes a representation by the Agency that the Compliance Plan is in full compliance with applicable Communication Privacy Laws, or otherwise shifts or diminishes the Health Plan’s sole burden to ensure full compliance with applicable Communication Privacy Laws in all aspects of the Health Plan’s performance of this Contract.  Violation of this term may result in sanctions to include termination of the contract and/or liquidated damages.
Unless otherwise stated, this Amendment shall be effective upon execution by both Parties.
All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in this Contract.
This Amendment and all its attachments are hereby made part of this Contract.
This Amendment cannot be executed unless all previous amendments to this Contract have been fully executed.
IN WITNESS WHEREOF, the Parties hereto have caused this ten (10) page Amendment (including all attachments) to be executed by their officials thereunto duly authorized.

	
					
	WELLCARE OF FLORIDA, INC., D/B/A
	 
	STATE OF FLORIDA, AGENCY FOR

	STAYWELL HEALTH PLAN OF FLORIDA
	 
	HEALTH CARE ADMINISTRATION

	 
	 
	 
	 
	 

	SIGNED
	 
	 
	SIGNED
	 

	BY:
	/s/ Gregg MacDonald
	 
	BY:
	/s/ Elizabeth Dudek

	 
	 
	 
	 
	 

	NAME:
	Gregg MacDonald
	 
	NAME:
	Elizabeth Dudek

	 
	 
	 
	 
	 

	TITLE:
	Region President
	 
	TITLE:
	Secretary

	 
	 
	 
	 
	 

	DATE:
	12-29-2014
	 
	DATE:
	1/8/15

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

	
					
	Specify
	 
	 
	 

	Type
	 
	Number
	Description
	 

	Attachment I
	 
	Exhibit 2-R
	Medicaid Reform HMO Capitation Rates, Effective
September 1, 2013 – August 31, 2014 (90113) (2 Pages)

	 
	 
	 
	 

REMAINDER OF PAGE INTENTIONALLY BLANK

AHCA Contract No. FA971, Amendment No. 9, Page 7 of 7

EXHIBIT 2-R
September 1, 2013 – August 31, 2014 HMO RATES (90113)
(MEDICAID Reform HMO CAPITATION RATES)
By Area, Age and Eligibility Category

	
		
	TABLE 1:
	COMPREHENSIVE COMPONENT AND CATASTROPHIC COMPONENT CAPITATION RATES

Effective September 1, 2013 – August 31, 2014
ESTIMATED HEALTH PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS
	
			
	 
	AREA 4
	AREA 10

	Eligibility Category: Children and Families

	Month 0-2 All
	$1,254.43
	$1,290.08

	Month 3-11 All
	$202.78
	$208.54

	1-5 All
	$147.67
	$142.05

	6-13 All
	$147.67
	$142.05

	14-20 Female
	$147.67
	$142.05

	14-20 Male
	$147.67
	$142.05

	21-54 Female
	$147.67
	$142.05

	21-54 Male
	$147.67
	$142.05

	55+ All
	$147.67
	$142.05

	Eligibility Category: Aged and Disabled

	Month 0-2 All
	$25,030.37
	$25,626.47

	Month 3-11 All
	$3,918.32
	$4,011.64

	1-5 All
	$891.10
	$945.83

	6-13 All
	$891.10
	$945.83

	14-20 All
	$891.10
	$945.83

	21-54 All
	$891.10
	$945.83

	55+ All
	$891.10
	$945.83

	Eligibility Category: Aged and Disabled with Medicare Parts A & B

	Under Age 65
	$175.41
	$152.49

	Age 65 and Over
	$124.04
	$107.83

	Eligibility Category: Aged and Disabled with Medicare Part B Only

	All Ages
	$372.25
	$372.66

	Population: HIV/AIDS Specialty Population

	No Medicare HIV
	$2,181.02
	$3,317.61

	No Medicare AIDS
	$3,005.04
	$3,825.06

	Medicare HIV
	$228.70
	$235.50

	Medicare AIDS
	$194.36
	$199.91

AHCA Contract No. FA971, Attachment I, Exhibit 2-R (90113), Page 1 of 2

	
		
	TABLE 2:
	KICK PAYMENT AMOUNTS FOR COVERED OBSTETRICAL DELIVERY SERVICES

Effective September 1, 2013 – August 31, 2014
	
								
	CPT Code
	Obstetrical Delivery CPT Code Description
	Area 4
	Area 10

	59409
	Vaginal delivery only
	

	$4,125.39
	

	

	$4,071.76
	

	59410
	Vaginal delivery including postpartum care

	59515
	Cesarean delivery including postpartum care

	59612
	Vaginal delivery only, after previous cesarean delivery

	59614
	Vaginal delivery only, after previous cesarean delivery including postpartum care

	59622
	Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery inc postpartum care

	
		
	TABLE 3:
	KICK PAYMENT AMOUNTS FOR COVERED TRANSPLANT SERVICES

Effective September 1, 2013 – August 31, 2014
	
				
	CPT Code
	Transplant CPT Code Description
	Children/Adolescents or Adult
	All Areas

	32851
	Lung single, without bypass
	Children/Adolescents
	$320,800.00

	32851
	Lung single, without bypass
	Adult
	$238,000.00

	32852
	Lung single, with bypass
	Children/Adolescents
	$320,800.00

	32852
	Lung single, with bypass
	Adult
	$238,000.00

	32853
	Lung double, without bypass
	Children/Adolescents
	$320,800.00

	32853
	Lung double, without bypass
	Adult
	$238,000.00

	32854
	Lung double, with bypass
	Children/Adolescents
	$320,800.00

	32854
	Lung double, with bypass
	Adult
	$238,000.00

	33945
	Heart transplant with or without recipient cardiectomy
	All Age Groups
	$162,000.00

	47135
	Liver, allotransplation, orthotopic, partial or whole from cadaver or living donor
	All Age Groups
	$122,600.00

	47136
	Liver, heterotopic, partial or whole from cadaver or living donor any age
	All Age Groups
	$122,600.00

AHCA Contract No. FA971, Attachment I, Exhibit 2-R (90113), Page 2 of 2

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