Document:

EX-10.1

Exhibit 10.1

WELL CARE HMO, INC. D/B/A STAYWELL Medicaid HMO Contract

HEALTH PLAN OF FLORIDA

AHCA CONTRACT NO. FA522

AMENDMENT NO. 8

THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE
ADMINISTRATION, hereinafter referred to as the “Agency” and WELLCARE HMO, INC., d/b/a STAYWELL
HEALTHE PLAN OF FLORIDA, hereinafter referred to as the “Vendor” is hereby amended as follows:

	 	1.	 	Section III, C.1. of the Standard Contract is hereby amended to now read:

The Agency’s Contract Manager’s name address and telephone number for this Contract is as follows:

G. Douglas Harper

Agency for Health Care Administration

Building #3, Mail Stop #50

2727 Mahan Drive

Tallahassee, Florida 32308

Telephone – (850) 488-9287

Facsimile – (850) 410-1676

	 	2.	 	Attachment I, section 90.0, Payment and Authorized enrollment Levels, Table 2 is hereby
deleted in its entirety and replaced with the following:

	 	90.0	 	PAYMENT AND AUTHORIZATION ENROLLMENT LEVELS

	 	a.	 	The Agency assigns the Plan an authorization maximum enrollment level for each
operational county, and the Agency shall pay the Plan capitation payments for each
Agency operational area, in accordance with the following table. The Agency shall pay
the Plan capitation payments based on the Agency operation area (or rate zone) age
group, and gender, in accordance with Table 2. Where the Plan has implemented
behavioral health care, the Agency shall pay the Plan in accordance with Table 3.

	 	b.	 	The authorized maximum enrollment level is in effect as of July 1, 2005, or
upon Contract execution, whichever is later. The Agency must approve in writing any
such increase in the Plan’s maximum enrollment level for each operational county. Such
approval shall not be unreasonably withheld, and shall be based on the Plan’s
satisfactory performance of terms of the Contract and approval of the Plan’s
administrative and service resources, as specified in this Contract, in support of each
enrollment level.

	 	c.	 	The Agency has developed estimated rates, for examination and evaluation by its
actuary, Milliman and Co., to be paid to the Plan for services provided in Fiscal Year
2005 – 2006. These estimated rates represent the Agency’s best efforts to develop
accurate rates. They are included as Attachment VIII; entitled “ESTIMATED 2005 – 2006
HMO RATES; NOT FOR USE UNLESS APPROVED BY CMS.” The Agency may use or may amend and
use, these estimated rates only after certification by its actuary and approval by the
Centers for Medicare and Medicaid Services, and by notice in a contract amendment to
the Plan. Inclusion of these estimated rates is not intended to convey or imply any
rights, duties or obligations of either party, nor is it intended to restrict, restrain
or control the rights of either party that may have existed independently of this
section of the Contract. By signature of this document, the parties explicitly agree
that this section shall not independently convey any inherent rights, responsibilities
or obligations of either party, relative to these rates, and shall not itself be the
basis for any cause of administrative, legal or equitable action brought by either
party.

	 	d.	 	In the event the rates certified by the actuary and approved by CMS are
different from the Agency’s estimated rates, the Contractor agrees to accept a
reconciliation performed by the Agency to bring payments to the Contractor in line with
the approved rates.

	 	e.	 	Upon receipt of CMS approval of 2005 – 2006 capitation rates, the Agency shall
amend this Contract to reflect accepted capitation rates effective July 1, 2005.

	 	f.	 	Table 1 provides the Plan’s Contract enrollment levels.

	 	g.	 	Table 2 provides capitation rates for all Agency areas except for areas where
behavioral health care has been implemented.

	 	h.	 	Table 3 provides capitation rates for Agency areas where behavioral health care
has been implemented, including community mental health and mental health targeted case
management.

Table 1

Enrollment Levels

	 	 	 	 	 
	County
	 	Maximum Enrollment Level

	 
	 	 	 	 
	BREVARD
	 	 	14,000	 
	 
	 	 	 	 
	BROWARD
	 	 	25,500	 
	 
	 	 	 	 
	CHARLOTTE
	 	 	0	 
	 
	 	 	 	 
	CITRUS
	 	 	0	 
	 
	 	 	 	 
	DADE
	 	 	25,000	 
	 
	 	 	 	 
	DUVAL
	 	 	0	 
	 
	 	 	 	 
	ESCAMBIA
	 	 	0	 
	 
	 	 	 	 
	HERNANDO
	 	 	9,500	 
	 
	 	 	 	 
	HIGHLANDS
	 	 	0	 
	 
	 	 	 	 
	HILLSBOUROUGH
	 	 	28,000	 
	 
	 	 	 	 
	LEE
	 	 	10,000	 
	 
	 	 	 	 
	MANATEE
	 	 	12,000	 
	 
	 	 	 	 
	MARION
	 	 	0	 
	 
	 	 	 	 
	ORANGE
	 	 	38,000	 
	 
	 	 	 	 
	OSCEOLA
	 	 	12,000	 
	 
	 	 	 	 
	PALM BEACH
	 	 	15,000	 
	 
	 	 	 	 
	PASCO
	 	 	7,000	 
	 
	 	 	 	 
	PINELLAS
	 	 	15,000	 
	 
	 	 	 	 
	POLK
	 	 	25,000	 
	 
	 	 	 	 
	SANTA ROSA
	 	 	0	 
	 
	 	 	 	 
	SARASOTA
	 	 	4,500	 
	 
	 	 	 	 
	SEMINOLE
	 	 	5,000	 
	 
	 	 	 	 
	VOLUSIA
	 	 	0	 
	 
	 	 	 	 

1

Table 2.

Area wide Age-banded Capitation Rates for All Agency Areas of the State other than Areas 3, 5,6, 7
(Orange, Osceola, and Seminole counties) and 8.

Area 07 General Rates Plan  —  015016913 (BREVARD)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	337.19	 	 	 	75.53	 	 	 	47.77	 	 	 	52.81	 	 	 	108.40	 	 	 	134.29	 	 	 	204.16	 	 	 	286.57	 	 	 	286.57	 
	SSI/No Medicare
	 	 	3217.89	 	 	 	389.79	 	 	 	203.90	 	 	 	213.35	 	 	 	213.35	 	 	 	610.58	 	 	 	610.58	 	 	 	589.11	 	 	 	589.11	 
	SSI/Part B
	 	 	265.77	 	 	 	265.77	 	 	 	265.77	 	 	 	265.77	 	 	 	265.77	 	 	 	265.77	 	 	 	265.77	 	 	 	265.77	 	 	 	265.77	 
	SSI/Part A & B
	 	 	283.96	 	 	 	283.96	 	 	 	283.96	 	 	 	283.96	 	 	 	283.96	 	 	 	283.96	 	 	 	283.96	 	 	 	283.96	 	 	 	198.62	 

Area 09 General Rates Plan  —  015016910 (PALM BEACH)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	316.78	 	 	 	70.74	 	 	 	44.52	 	 	 	49.17	 	 	 	101.48	 	 	 	125.24	 	 	 	190.60	 	 	 	266.97	 	 	 	266.97	 
	SSI/No Medicare
	 	 	3344.05	 	 	 	405.22	 	 	 	211.12	 	 	 	221.15	 	 	 	221.15	 	 	 	633.22	 	 	 	633.22	 	 	 	610.93	 	 	 	610.93	 
	SSI/Part B
	 	 	267.20	 	 	 	267.20	 	 	 	267.20	 	 	 	267.20	 	 	 	267.20	 	 	 	267.20	 	 	 	267.20	 	 	 	267.20	 	 	 	267.20	 
	SSI/Part A & B
	 	 	320.32	 	 	 	320.32	 	 	 	320.32	 	 	 	320.32	 	 	 	320.32	 	 	 	320.32	 	 	 	320.32	 	 	 	320.32	 	 	 	224.19	 

Area 10 General Rates Plan  —  015016900 (BROWARD)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	328.74	 	 	 	73.77	 	 	 	46.68	 	 	 	51.61	 	 	 	105.94	 	 	 	131.31	 	 	 	199.49	 	 	 	280.33	 	 	 	280.33	 
	SSI/No Medicare
	 	 	4151.82	 	 	 	503.54	 	 	 	263.75	 	 	 	275.32	 	 	 	275.32	 	 	 	788.23	 	 	 	788.23	 	 	 	761.08	 	 	 	761.08	 
	SSI/Part B
	 	 	287.04	 	 	 	287.04	 	 	 	287.04	 	 	 	287.04	 	 	 	287.04	 	 	 	287.04	 	 	 	287.04	 	 	 	287.04	 	 	 	287.04	 
	SSI/Part A & B
	 	 	351.55	 	 	 	351.55	 	 	 	351.55	 	 	 	351.55	 	 	 	351.55	 	 	 	351.55	 	 	 	351.55	 	 	 	351.55	 	 	 	245.95	 

Area 11 General Rates Plan  —  015016909 (DADE)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	409.89	 	 	 	91.51	 	 	 	57.28	 	 	 	63.45	 	 	 	131.27	 	 	 	161.21	 	 	 	245.94	 	 	 	343.29	 	 	 	343.29	 
	SSI/No Medicare
	 	 	4561.77	 	 	 	556.46	 	 	 	288.69	 	 	 	302.80	 	 	 	302.80	 	 	 	869.67	 	 	 	869.67	 	 	 	836.38	 	 	 	836.38	 
	SSI/Part B
	 	 	453.72	 	 	 	453.72	 	 	 	453.72	 	 	 	453.72	 	 	 	453.72	 	 	 	453.72	 	 	 	453.72	 	 	 	453.72	 	 	 	453.72	 
	SSI/Part A & B
	 	 	429.61	 	 	 	429.61	 	 	 	429.61	 	 	 	429.61	 	 	 	429.61	 	 	 	429.61	 	 	 	429.61	 	 	 	429.61	 	 	 	297.22	 

Table 3

Age-banded Capitation Rates, Including Community Mental Health and Mental Health Targeted Case
Management

Area 03 General Rates plus Mental Health Plan  —  015016901 (HERNANDO)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	350.93	 	 	 	79.08	 	 	 	55.35	 	 	 	58.65	 	 	 	116.64	 	 	 	139.68	 	 	 	212.08	 	 	 	294.58	 	 	 	294.58	 
	SSI/No Medicare
	 	 	3231.66	 	 	 	408.26	 	 	 	247.79	 	 	 	236.33	 	 	 	236.33	 	 	 	626.37	 	 	 	626.37	 	 	 	591.60	 	 	 	591.60	 
	SSI/Part B
	 	 	302.32	 	 	 	302.32	 	 	 	302.32	 	 	 	302.32	 	 	 	302.32	 	 	 	302.32	 	 	 	302.32	 	 	 	302.32	 	 	 	302.32	 
	SSI/Part A & B
	 	 	295.89	 	 	 	295.89	 	 	 	295.89	 	 	 	295.89	 	 	 	295.89	 	 	 	295.89	 	 	 	295.89	 	 	 	295.89	 	 	 	209.16	 

Area 05 General Rates plus Mental Health Plan  —  015016903 (PASCO) 015016904 (PINELLAS)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	345.77	 	 	 	79.28	 	 	 	51.94	 	 	 	57.32	 	 	 	114.37	 	 	 	139.01	 	 	 	210.44	 	 	 	291.84	 	 	 	291.84	 
	SSI/No Medicare
	 	 	3265.63	 	 	 	429.24	 	 	 	240.86	 	 	 	235.59	 	 	 	235.59	 	 	 	628.37	 	 	 	628.37	 	 	 	594.95	 	 	 	594.95	 
	SSI/Part B
	 	 	266.87	 	 	 	266.87	 	 	 	266.87	 	 	 	266.87	 	 	 	266.87	 	 	 	266.87	 	 	 	266.87	 	 	 	266.87	 	 	 	266.87	 
	SSI/Part A & B
	 	 	318.72	 	 	 	318.72	 	 	 	318.72	 	 	 	318.72	 	 	 	318.72	 	 	 	318.72	 	 	 	318.72	 	 	 	318.72	 	 	 	225.77	 

Area 06 General Rates plus Mental Health Plan  —  015016902 (HILLSBOROUGH) 015016905 (POLK)
015016912 (MANATEE)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	330.07	 	 	 	75.91	 	 	 	61.92	 	 	 	67.67	 	 	 	122.23	 	 	 	135.83	 	 	 	204.29	 	 	 	282.98	 	 	 	282.98	 
	SSI/No Medicare
	 	 	3017.05	 	 	 	371.69	 	 	 	265.72	 	 	 	243.82	 	 	 	243.82	 	 	 	647.81	 	 	 	647.81	 	 	 	587.26	 	 	 	587.26	 
	SSI/Part B
	 	 	242.29	 	 	 	242.29	 	 	 	242.29	 	 	 	242.29	 	 	 	242.29	 	 	 	242.29	 	 	 	242.29	 	 	 	242.29	 	 	 	242.29	 
	SSI/Part A & B
	 	 	288.09	 	 	 	288.09	 	 	 	288.09	 	 	 	288.09	 	 	 	288.09	 	 	 	288.09	 	 	 	288.09	 	 	 	288.09	 	 	 	202.64	 

Area 07 General Rates plus Mental Health Plan  —  015016906 (ORANGE) 015016907 (OSCEOLA)
015016908 (SEMINOLE)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	337.20	 	 	 	76.92	 	 	 	58.07	 	 	 	59.10	 	 	 	114.69	 	 	 	136.45	 	 	 	206.32	 	 	 	287.87	 	 	 	287.87	 
	SSI/No Medicare
	 	 	3217.90	 	 	 	406.84	 	 	 	260.45	 	 	 	239.73	 	 	 	239.73	 	 	 	628.24	 	 	 	628.24	 	 	 	594.96	 	 	 	594.96	 
	SSI/Part B
	 	 	266.03	 	 	 	266.03	 	 	 	266.03	 	 	 	266.03	 	 	 	266.03	 	 	 	266.03	 	 	 	266.03	 	 	 	266.03	 	 	 	266.03	 
	SSI/Part A & B
	 	 	293.59	 	 	 	293.59	 	 	 	293.59	 	 	 	293.59	 	 	 	293.59	 	 	 	293.59	 	 	 	293.59	 	 	 	293.59	 	 	 	208.25	 

Area 08 General Rates plus Mental Health Plan  —  015016911 (LEE) 015016914 (SARASOTA)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	296.69	 	 	 	67.77	 	 	 	46.25	 	 	 	49.88	 	 	 	98.88	 	 	 	119.48	 	 	 	180.88	 	 	 	251.72	 	 	 	251.72	 
	SSI/No Medicare
	 	 	3079.31	 	 	 	393.43	 	 	 	223.95	 	 	 	221.50	 	 	 	221.50	 	 	 	594.93	 	 	 	594.93	 	 	 	563.76	 	 	 	563.76	 
	SSI/Part B
	 	 	243.57	 	 	 	243.57	 	 	 	243.57	 	 	 	243.57	 	 	 	243.57	 	 	 	243.57	 	 	 	243.57	 	 	 	243.57	 	 	 	243.57	 
	SSI/Part A & B
	 	 	292.10	 	 	 	292.10	 	 	 	292.10	 	 	 	292.10	 	 	 	292.10	 	 	 	292.10	 	 	 	292.10	 	 	 	292.10	 	 	 	206.49	 

	 	i.	 	For Plans participating in the frail/elderly program, the community rate shall be
paid for all members in each eligibility category except for those SSI members
determined by the Comprehensive Assessment and Review for Long Term Care (CARES) unit
to be at risk of nursing home institutionalization. Evidence of such assessments shall
be provided to the Agency by the Plan prior to authorization by the Agency of payment
of the institutional rates. Payment of institutional rates for any eligible Enrollee
shall continue only so long as the Enrollee meets the level of care requirements for
institutionalization, otherwise, the community capitation rate applies.

	 	j.	 	Notwithstanding the payment amounts which may be computed with the above rate
table, the sum of total capitation payments under this Contract shall not exceed the
total Contract amount of $657,268,872.00 as expressed in this Contract.

	 	3.	 	This amendment shall begin on June 1, 2005, or the date on which the amendment has been
signed by both parties, whichever is later.

All provisions in the Contract and any attachments thereto in conflict with this amendment shall be
and are hereby changed to conform with this amendment.

All provisions not in conflict with this amendment are still in effect and are to be performed
at the level specified in the Contract.

This amendment and all its attachments are hereby made a part of the Contract.

This amendment cannot be executed unless all previous amendments to this Contract have been
fully executed.

IN WITNESS WHEREOF, the parties hereto have caused this 6 page amendment (including all
attachments) to be executed by their officials thereunto duly authorized.

	 	 	 
	WELLCARE HMO, INC.	 	STATE OF FLORIDA, AGENCY FOR
	D/B/A STAYWELL HEALTH	 	HEALTH CARE ADMINISTRATION
	PLAN OF FLORIDA	 	 
	SIGNED

	 	SIGNED
	 
	 	 
	BY: /s/ Todd S. Farha__________________BY: /s/ [illegible] ______________________

	 
	 	 
	 

	 
	 	 
	NAME: Todd S. Farha

	 	NAME: Alan Levine
	 

	 	 
	TITLE: President and CEO

	 	TITLE: Secretary
	 

	 	 
	DATE:      

	 	DATE: 7/6/05      
	
 
	 	 

List of attachments included as part of this Amendment

	 	 	 	 	 
	Specify

Type

	 	

Number
	 	

Description
	 

	 	 
	 	 

Attachment VIII ESTIMATED 2005 – 2006 HMO RATES; NOT FOR USE UNLESS APPROVED BY CMS (2 pages)

THE REMAINDER OF THIS PAGE LEFT BLANK INTENTIONALLY

2

ATTACHMENT VIII

ESTIMATED 2005 – 2006 HMO RATES;

NOT FOR USE UNLESS APPROVED BY CMS

	 	 	 	 	 
	STAYWELL

July 1, 2005 through December 31, 2005

	 	MEDICAID HMO CONTRACT

contract Number
	 	

: FA522

Table 2

Area wide Age-banded Capitation Rates for All Agency Areas of the State Other than Those Areas in
Which Behavioral Health has not been Implemented

Area 07 General Rates Plan  —  015016913 (BREVARD)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	894.04	 	 	 	178.56	 	 	 	87.80	 	 	 	56.33	 	 	 	122.97	 	 	 	63.04	 	 	 	238.18	 	 	 	154.51	 	 	 	322.34	 	 	 	322.34	 
	SSI/No Medicare
	 	 	8976.51	 	 	 	1573.97	 	 	 	404.51	 	 	 	212.74	 	 	 	232.25	 	 	 	232.25	 	 	 	701.12	 	 	 	701.12	 	 	 	661.11	 	 	 	661.11	 
	SSI/Part B
	 	 	308.90	 	 	 	308.90	 	 	 	308.90	 	 	 	308.90	 	 	 	308.90	 	 	 	308.90	 	 	 	308.90	 	 	 	308.90	 	 	 	308.90	 	 	 	308.90	 
	SSI/Part A & B
	 	 	284.51	 	 	 	284.51	 	 	 	284.51	 	 	 	284.51	 	 	 	284.51	 	 	 	284.51	 	 	 	284.51	 	 	 	284.51	 	 	 	284.51	 	 	 	198.54	 

Area 09 General Rates Plan  —  015016910 (PALM BEACH)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	850.65	 	 	 	169.56	 	 	 	83.32	 	 	 	53.28	 	 	 	116.63	 	 	 	59.62	 	 	 	225.69	 	 	 	146.30	 	 	 	304.86	 	 	 	304.86	 
	SSI/No Medicare
	 	 	9123.67	 	 	 	1599.06	 	 	 	410.92	 	 	 	216.11	 	 	 	235.92	 	 	 	235.92	 	 	 	711.70	 	 	 	711.70	 	 	 	670.95	 	 	 	670.95	 
	SSI/Part B
	 	 	288.69	 	 	 	288.69	 	 	 	288.69	 	 	 	288.69	 	 	 	288.69	 	 	 	288.69	 	 	 	288.69	 	 	 	288.69	 	 	 	288.69	 	 	 	288.69	 
	SSI/Part A & B
	 	 	317.25	 	 	 	317.25	 	 	 	317.25	 	 	 	317.25	 	 	 	317.25	 	 	 	317.25	 	 	 	317.25	 	 	 	317.25	 	 	 	317.25	 	 	 	221.58	 

Area 10 General Rates Plan  —  015016900 (BROWARD)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	854.17	 	 	 	170.86	 	 	 	84.11	 	 	 	54.07	 	 	 	117.82	 	 	 	60.56	 	 	 	228.53	 	 	 	148.48	 	 	 	309.80	 	 	 	309.80	 
	SSI/No Medicare
	 	 	11134.67	 	 	 	1955.18	 	 	 	502.14	 	 	 	264.85	 	 	 	289.15	 	 	 	289.15	 	 	 	873.08	 	 	 	873.08	 	 	 	823.33	 	 	 	823.33	 
	SSI/Part B
	 	 	316.19	 	 	 	316.19	 	 	 	316.19	 	 	 	316.19	 	 	 	316.19	 	 	 	316.19	 	 	 	316.19	 	 	 	316.19	 	 	 	316.19	 	 	 	316.19	 
	SSI/Part A & B
	 	 	341.03	 	 	 	341.03	 	 	 	341.03	 	 	 	341.03	 	 	 	341.03	 	 	 	341.03	 	 	 	341.03	 	 	 	341.03	 	 	 	341.03	 	 	 	238.55	 

Area 11 General Rates plus Transportation Plan  —  015016909 (DADE)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	1112.08	 	 	 	221.47	 	 	 	108.96	 	 	 	69.38	 	 	 	152.49	 	 	 	77.84	 	 	 	294.30	 	 	 	190.48	 	 	 	396.50	 	 	 	396.50	 
	SSI/No Medicare
	 	 	12145.44	 	 	 	2131.38	 	 	 	551.08	 	 	 	286.49	 	 	 	314.89	 	 	 	314.89	 	 	 	952.30	 	 	 	952.30	 	 	 	894.10	 	 	 	894.10	 
	SSI/Part B
	 	 	455.34	 	 	 	455.34	 	 	 	455.34	 	 	 	455.34	 	 	 	455.34	 	 	 	455.34	 	 	 	455.34	 	 	 	455.34	 	 	 	455.34	 	 	 	455.34	 
	SSI/Part A & B
	 	 	433.96	 	 	 	433.96	 	 	 	433.96	 	 	 	433.96	 	 	 	433.96	 	 	 	433.96	 	 	 	433.96	 	 	 	433.96	 	 	 	433.96	 	 	 	433.96	 

Table 3

Area wide Age-banded Capitation Rates for All Agency Areas of the State Other than Those Areas in
Which Behavioral Health has not been Implemented

Area 03 General Rates plus Mental Health Plan  —  015016901 (HERNANDO)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	956.51	 	 	 	190.37	 	 	 	94.52	 	 	 	67.12	 	 	 	136.49	 	 	 	72.38	 	 	 	254.10	 	 	 	164.92	 	 	 	342.33	 	 	 	342.33	 
	SSI/No Medicare
	 	 	8796.56	 	 	 	1536.63	 	 	 	401.17	 	 	 	243.67	 	 	 	248.87	 	 	 	248.87	 	 	 	702.91	 	 	 	702.91	 	 	 	649.30	 	 	 	649.30	 
	SSI/Part B
	 	 	356.54	 	 	 	356.54	 	 	 	356.54	 	 	 	356.54	 	 	 	356.54	 	 	 	356.54	 	 	 	356.54	 	 	 	356.54	 	 	 	356.54	 	 	 	356.54	 
	SSI/Part A & B
	 	 	299.65	 	 	 	299.65	 	 	 	299.65	 	 	 	299.65	 	 	 	299.65	 	 	 	299.65	 	 	 	299.65	 	 	 	299.65	 	 	 	299.65	 	 	 	211.35	 

3

Area 05 General Rates plus Mental Health Plan  —  015016903 (PASCO) 015016904 (PINELLAS)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	919.98	 	 	 	183.43	 	 	 	91.15	 	 	 	64.87	 	 	 	131.62	 	 	 	69.93	 	 	 	245.33	 	 	 	159.49	 	 	 	331.03	 	 	 	331.03	 
	SSI/No Medicare
	 	 	9248.02	 	 	 	1615.41	 	 	 	420.86	 	 	 	252.27	 	 	 	258.55	 	 	 	258.55	 	 	 	735.80	 	 	 	735.80	 	 	 	681.19	 	 	 	681.19	 
	SSI/Part B
	 	 	332.63	 	 	 	332.63	 	 	 	332.63	 	 	 	332.63	 	 	 	332.63	 	 	 	332.63	 	 	 	332.63	 	 	 	332.63	 	 	 	332.63	 	 	 	332.63	 
	SSI/Part A & B
	 	 	321.24	 	 	 	321.24	 	 	 	321.24	 	 	 	321.24	 	 	 	321.24	 	 	 	321.24	 	 	 	321.24	 	 	 	321.24	 	 	 	321.24	 	 	 	227.10	 

Area 06 General Rates plus Mental Health Plan  —  015016902 (HILLSBOROUGH) 015016905 (POLK)
015016912 (MANATEE)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	839.91	 	 	 	168.14	 	 	 	84.80	 	 	 	67.94	 	 	 	131.59	 	 	 	75.16	 	 	 	230.12	 	 	 	151.25	 	 	 	309.66	 	 	 	309.66	 
	SSI/No Medicare
	 	 	8536.50	 	 	 	1494.29	 	 	 	393.28	 	 	 	262.75	 	 	 	284.04	 	 	 	284.04	 	 	 	746.59	 	 	 	746.59	 	 	 	653.76	 	 	 	653.76	 
	SSI/Part B
	 	 	319.38	 	 	 	319.38	 	 	 	319.38	 	 	 	319.38	 	 	 	319.38	 	 	 	319.38	 	 	 	319.38	 	 	 	319.38	 	 	 	319.38	 	 	 	319.38	 
	SSI/Part A & B
	 	 	288.23	 	 	 	288.23	 	 	 	288.23	 	 	 	288.23	 	 	 	288.23	 	 	 	288.23	 	 	 	288.23	 	 	 	288.23	 	 	 	288.23	 	 	 	202.46	 

Area 07 General Rates plus Mental Health Plan  —  015016906 (ORANGE) 015016907 (OSCEOLA)
015016907 (SEMINOLE)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	894.05	 	 	 	178.57	 	 	 	89.54	 	 	 	68.64	 	 	 	132.32	 	 	 	72.39	 	 	 	240.41	 	 	 	156.74	 	 	 	324.62	 	 	 	324.62	 
	SSI/No Medicare
	 	 	8976.52	 	 	 	1573.98	 	 	 	414.04	 	 	 	264.97	 	 	 	264.82	 	 	 	264.82	 	 	 	733.66	 	 	 	733.66	 	 	 	674.72	 	 	 	674.72	 
	SSI/Part B
	 	 	312.78	 	 	 	312.78	 	 	 	312.78	 	 	 	312.78	 	 	 	312.78	 	 	 	312.78	 	 	 	312.78	 	 	 	312.78	 	 	 	312.78	 	 	 	312.78	 
	SSI/Part A & B
	 	 	296.22	 	 	 	296.22	 	 	 	296.22	 	 	 	296.22	 	 	 	296.22	 	 	 	296.22	 	 	 	296.22	 	 	 	296.22	 	 	 	296.22	 	 	 	210.25	 

Area 08 General Rates plus Mental Health Plan  —  015016911 (LEE) 015016914 (SARASOTA)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	785.53	 	 	 	156.86	 	 	 	78.13	 	 	 	56.61	 	 	 	113.39	 	 	 	60.74	 	 	 	210.44	 	 	 	136.92	 	 	 	284.23	 	 	 	284.23	 
	SSI/No Medicare
	 	 	8247.94	 	 	 	1440.21	 	 	 	376.25	 	 	 	229.28	 	 	 	234.06	 	 	 	234.06	 	 	 	659.32	 	 	 	659.32	 	 	 	608.59	 	 	 	608.59	 
	SSI/Part B
	 	 	313.20	 	 	 	313.20	 	 	 	313.20	 	 	 	313.20	 	 	 	313.20	 	 	 	313.20	 	 	 	313.20	 	 	 	313.20	 	 	 	313.20	 	 	 	313.20	 
	SSI/Part A & B
	 	 	297.40	 	 	 	297.40	 	 	 	297.40	 	 	 	297.40	 	 	 	297.40	 	 	 	297.40	 	 	 	297.40	 	 	 	297.40	 	 	 	297.40	 	 	 	210.20	 

4

	 	 	 	 	 
	STAYWELL

January 1, 2006 through June 30, 2006

	 	MEDICAID HMO CONTRACT

contract Number
	 	

: FA522

Table 2

Area wide Age-banded Capitation Rates for All Agency Areas of the State Other than Those Areas in
Which Behavioral Health has not been Implemented

Area 07 General Rates Plan  —  015016913 (BREVARD)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	894.04	 	 	 	178.56	 	 	 	87.80	 	 	 	56.33	 	 	 	122.97	 	 	 	63.04	 	 	 	238.18	 	 	 	154.51	 	 	 	322.34	 	 	 	322.34	 
	SSI/No Medicare
	 	 	8976.51	 	 	 	1573.97	 	 	 	404.51	 	 	 	212.74	 	 	 	232.25	 	 	 	232.25	 	 	 	701.12	 	 	 	701.12	 	 	 	661.11	 	 	 	661.11	 
	SSI/Part B
	 	 	199.32	 	 	 	199.32	 	 	 	199.32	 	 	 	199.32	 	 	 	199.32	 	 	 	199.32	 	 	 	199.32	 	 	 	199.32	 	 	 	199.32	 	 	 	199.32	 
	SSI/Part A & B
	 	 	72.42	 	 	 	72.42	 	 	 	72.42	 	 	 	72.42	 	 	 	72.42	 	 	 	72.42	 	 	 	72.42	 	 	 	72.42	 	 	 	72.42	 	 	 	63.26	 

Area 09 General Rates Plan  —  015016910 (PALM BEACH)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	850.65	 	 	 	169.56	 	 	 	83.32	 	 	 	53.28	 	 	 	116.63	 	 	 	59.62	 	 	 	225.69	 	 	 	146.30	 	 	 	304.86	 	 	 	304.86	 
	SSI/No Medicare
	 	 	9123.67	 	 	 	1599.06	 	 	 	410.92	 	 	 	216.11	 	 	 	235.92	 	 	 	235.92	 	 	 	711.70	 	 	 	711.70	 	 	 	670.95	 	 	 	670.95	 
	SSI/Part B
	 	 	179.44	 	 	 	179.44	 	 	 	179.44	 	 	 	179.44	 	 	 	179.44	 	 	 	179.44	 	 	 	179.44	 	 	 	179.44	 	 	 	179.44	 	 	 	179.44	 
	SSI/Part A & B
	 	 	76.11	 	 	 	76.11	 	 	 	76.11	 	 	 	76.11	 	 	 	76.11	 	 	 	76.11	 	 	 	76.11	 	 	 	76.11	 	 	 	76.11	 	 	 	66.48	 

Area 10 General Rates Plan  —  015016900 (BROWARD)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	854.17	 	 	 	170.86	 	 	 	84.11	 	 	 	54.07	 	 	 	117.82	 	 	 	60.56	 	 	 	228.53	 	 	 	148.48	 	 	 	309.80	 	 	 	309.80	 
	SSI/No Medicare
	 	 	11134.67	 	 	 	1955.18	 	 	 	502.14	 	 	 	264.85	 	 	 	289.15	 	 	 	289.15	 	 	 	873.08	 	 	 	873.08	 	 	 	823.33	 	 	 	823.33	 
	SSI/Part B
	 	 	205.90	 	 	 	205.90	 	 	 	205.90	 	 	 	205.90	 	 	 	205.90	 	 	 	205.90	 	 	 	205.90	 	 	 	205.90	 	 	 	205.90	 	 	 	205.90	 
	SSI/Part A & B
	 	 	81.99	 	 	 	81.99	 	 	 	81.99	 	 	 	81.99	 	 	 	81.99	 	 	 	81.99	 	 	 	81.99	 	 	 	81.99	 	 	 	81.99	 	 	 	71.59	 

Area 11 General Rates plus Transportation Plan  —  015016909 (DADE)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	1112.08	 	 	 	221.47	 	 	 	108.96	 	 	 	69.38	 	 	 	152.49	 	 	 	77.84	 	 	 	294.30	 	 	 	190.48	 	 	 	396.50	 	 	 	396.50	 
	SSI/No Medicare
	 	 	12145.44	 	 	 	2131.38	 	 	 	551.08	 	 	 	286.49	 	 	 	314.89	 	 	 	314.89	 	 	 	952.30	 	 	 	952.30	 	 	 	894.10	 	 	 	894.10	 
	SSI/Part B
	 	 	273.91	 	 	 	273.91	 	 	 	273.91	 	 	 	273.91	 	 	 	273.91	 	 	 	273.91	 	 	 	273.91	 	 	 	273.91	 	 	 	273.91	 	 	 	273.91	 
	SSI/Part A & B
	 	 	125.66	 	 	 	125.66	 	 	 	125.66	 	 	 	125.66	 	 	 	125.66	 	 	 	125.66	 	 	 	125.66	 	 	 	125.66	 	 	 	125.66	 	 	 	103.75	 

Table 3

Area wide Age-banded Capitation Rates for All Agency Areas of the State Other than Those Areas in
Which Behavioral Health has not been Implemented

Area 03 General Rates plus Mental Health Plan  —  015016901 (HERNANDO)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	956.51	 	 	 	190.37	 	 	 	94.52	 	 	 	67.12	 	 	 	136.49	 	 	 	72.38	 	 	 	254.10	 	 	 	164.92	 	 	 	342.33	 	 	 	342.33	 
	SSI/No Medicare
	 	 	8796.56	 	 	 	1536.63	 	 	 	401.17	 	 	 	243.67	 	 	 	248.87	 	 	 	248.87	 	 	 	702.91	 	 	 	702.91	 	 	 	649.30	 	 	 	649.30	 
	SSI/Part B
	 	 	237.65	 	 	 	237.65	 	 	 	237.65	 	 	 	237.65	 	 	 	237.65	 	 	 	237.65	 	 	 	237.65	 	 	 	237.65	 	 	 	237.65	 	 	 	237.65	 
	SSI/Part A & B
	 	 	83.24	 	 	 	83.24	 	 	 	83.24	 	 	 	83.24	 	 	 	83.24	 	 	 	83.24	 	 	 	83.24	 	 	 	83.24	 	 	 	83.24	 	 	 	73.70	 

Area 05 General Rates plus Mental Health Plan  —  015016903 (PASCO) 015016904 (PINELLAS)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	919.98	 	 	 	183.43	 	 	 	91.15	 	 	 	64.87	 	 	 	131.62	 	 	 	69.93	 	 	 	245.33	 	 	 	159.49	 	 	 	331.03	 	 	 	331.03	 
	SSI/No Medicare
	 	 	9248.02	 	 	 	1615.41	 	 	 	420.86	 	 	 	252.27	 	 	 	258.55	 	 	 	258.55	 	 	 	735.80	 	 	 	735.80	 	 	 	681.19	 	 	 	681.19	 
	SSI/Part B
	 	 	214.59	 	 	 	214.59	 	 	 	214.59	 	 	 	214.59	 	 	 	214.59	 	 	 	214.59	 	 	 	214.59	 	 	 	214.59	 	 	 	214.59	 	 	 	214.59	 
	SSI/Part A & B
	 	 	83.91	 	 	 	83.91	 	 	 	83.91	 	 	 	83.91	 	 	 	83.91	 	 	 	83.91	 	 	 	83.91	 	 	 	83.91	 	 	 	83.91	 	 	 	74.53	 

Area 06 General Rates plus Mental Health Plan  —  015016902 (HILLSBOROUGH) 015016912 (MANATEE)
015016905 (POLK)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	839.91	 	 	 	168.14	 	 	 	84.80	 	 	 	67.94	 	 	 	131.59	 	 	 	75.16	 	 	 	230.12	 	 	 	151.25	 	 	 	309.66	 	 	 	309.66	 
	SSI/No Medicare
	 	 	8536.50	 	 	 	1494.29	 	 	 	393.28	 	 	 	262.75	 	 	 	284.04	 	 	 	284.04	 	 	 	746.59	 	 	 	746.59	 	 	 	653.76	 	 	 	653.76	 
	SSI/Part B
	 	 	201.26	 	 	 	201.26	 	 	 	201.26	 	 	 	201.26	 	 	 	201.26	 	 	 	201.26	 	 	 	201.26	 	 	 	201.26	 	 	 	201.26	 	 	 	201.26	 
	SSI/Part A & B
	 	 	73.23	 	 	 	73.23	 	 	 	73.23	 	 	 	73.23	 	 	 	73.23	 	 	 	73.23	 	 	 	73.23	 	 	 	73.23	 	 	 	73.23	 	 	 	64.45	 

Area 07 General Rates plus Mental Health Plan  —  015016906 (ORANGE) 015016907 (OSCEOLA)
015016908 (SEMINOLE)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	894.05	 	 	 	178.57	 	 	 	89.54	 	 	 	68.64	 	 	 	132.32	 	 	 	72.39	 	 	 	240.41	 	 	 	156.74	 	 	 	324.62	 	 	 	324.62	 
	SSI/No Medicare
	 	 	8976.52	 	 	 	1573.98	 	 	 	414.04	 	 	 	264.97	 	 	 	264.82	 	 	 	264.82	 	 	 	733.66	 	 	 	733.66	 	 	 	674.72	 	 	 	674.72	 
	SSI/Part B
	 	 	203.20	 	 	 	203.20	 	 	 	203.20	 	 	 	203.20	 	 	 	203.20	 	 	 	203.20	 	 	 	203.20	 	 	 	203.20	 	 	 	203.20	 	 	 	203.20	 
	SSI/Part A & B
	 	 	84.13	 	 	 	84.13	 	 	 	84.13	 	 	 	84.13	 	 	 	84.13	 	 	 	84.13	 	 	 	84.13	 	 	 	84.13	 	 	 	84.13	 	 	 	74.97	 

Area 08 General Rates plus Mental Health Plan  —  01506911 (LEE) 015016914 (SARASOTA)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	785.53	 	 	 	156.86	 	 	 	78.13	 	 	 	56.61	 	 	 	113.39	 	 	 	60.74	 	 	 	210.44	 	 	 	136.92	 	 	 	284.23	 	 	 	284.23	 
	SSI/No Medicare
	 	 	8247.94	 	 	 	1440.21	 	 	 	376.25	 	 	 	229.28	 	 	 	234.06	 	 	 	234.06	 	 	 	659.32	 	 	 	659.32	 	 	 	608.59	 	 	 	608.59	 
	SSI/Part B
	 	 	191.91	 	 	 	191.91	 	 	 	191.91	 	 	 	191.91	 	 	 	191.91	 	 	 	191.91	 	 	 	191.91	 	 	 	191.91	 	 	 	191.91	 	 	 	191.91	 
	SSI/Part A & B
	 	 	77.95	 	 	 	77.95	 	 	 	77.95	 	 	 	77.95	 	 	 	77.95	 	 	 	77.95	 	 	 	77.95	 	 	 	77.95	 	 	 	77.95	 	 	 	69.13	 

5EX-10.2

Exhibit 10.2

HEALTHEASE OF FLORIDA, INC. Medicaid HMO Contract

AHCA CONTRACT NO. FA521

AMENDMENT NO. 7

THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE
ADMINISTRATION, hereinafter referred to as the “Agency” and HEALTHEASE OF FLORIDA, INC.,
hereinafter referred to as the “Vendor” is hereby amended as follows:

	 	1.	 	Section III, C.1. of the Standard Contract is hereby amended to now read:

The Agency’s Contract Manager’s name address and telephone number for this Contract is as follows:

G. Douglas Harper

Agency for Health Care Administration

Building #3, Mail Stop #50

2727 Mahan Drive

Tallahassee, Florida 32308

Telephone – (850) 488-9287

Facsimile – (850) 410-1676

	 	2.	 	Attachment I, section 90.0, Payment and Authorized enrollment Levels, Table 2 is hereby
deleted in its entirety and replaced with the following:

	 	90.0	 	PAYMENT AND AUTHORIZATION ENROLLMENT LEVELS

	 	a.	 	The Agency assigns the Plan an authorization maximum enrollment level for each
operational county, and the Agency shall pay the Plan capitation payments for each
Agency operational area, in accordance with the following table. The Agency shall pay
the Plan capitation payments based on the Agency operation area (or rate zone) age
group, and gender, in accordance with Table 2. Where the Plan has implemented
behavioral health care, the Agency shall pay the Plan in accordance with Table 3.

	 	b.	 	The authorized maximum enrollment level is in effect as of July 1, 2005, or
upon Contract execution, whichever is later. The Agency must approve in writing any
such increase in the Plan’s maximum enrollment level for each operational county. Such
approval shall not be unreasonably withheld, and shall be based on the Plan’s
satisfactory performance of terms of the Contract and approval of the Plan’s
administrative and service resources, as specified in this Contract, in support of each
enrollment level.

	 	c.	 	The Agency has developed estimated rates, for examination and evaluation by its
actuary, Milliman and Co., to be paid to the Plan for services provided in Fiscal Year
2005 – 2006. These estimated rates represent the Agency’s best efforts to develop
accurate rates. They are included as Attachment VIII; entitled “ESTIMATED 2005 – 2006
HMO RATES; NOT FOR USE UNLESS APPROVED BY CMS.” The Agency may use or may amend and
use, these estimated rates only after certification by its actuary and approval by the
Centers for Medicare and Medicaid Services, and by notice in a contract amendment to
the Plan. Inclusion of these estimated rates is not intended to convey or imply any
rights, duties or obligations of either party, nor is it intended to restrict, restrain
or control the rights of either party that may have existed independently of this
section of the Contract. By signature of this document, the parties explicitly agree
that this section shall not independently convey any inherent rights, responsibilities
or obligations of either party, relative to these rates, and shall not itself be the
basis for any cause of administrative, legal or equitable action brought by either
party.

	 	d.	 	In the event the rates certified by the actuary and approved by CMS are
different from the Agency’s estimated rates, the Contractor agrees to accept a
reconciliation performed by the Agency to bring payments to the Contractor in line with
the approved rates.

	 	e.	 	Upon receipt of CMS approval of 2005 – 2006 capitation rates, the Agency shall
amend this Contract to reflect accepted capitation rates effective July 1, 2005.

	 	f.	 	Table 1 provides the Plan’s Contract enrollment levels.

	 	g.	 	Table 2 provides capitation rates for all Agency areas except for areas where
behavioral health care has been implemented.

	 	h.	 	Table 3 provides capitation rates for Agency areas where behavioral health care
has been implemented, including community mental health and mental health targeted case
management.

Table 1.

Enrollment Levels

	 	 	 	 	 
	County
	 	Maximum Enrollment Level

	 
	 	 	 	 
	BREVARD
	 	 	14,000	 
	 
	 	 	 	 
	BROWARD
	 	 	13,500	 
	 
	 	 	 	 
	CALHOUN
	 	 	800	 
	 
	 	 	 	 
	CITRUS
	 	 	5,000	 
	 
	 	 	 	 
	DUVAL
	 	 	55,000	 
	 
	 	 	 	 
	ESCAMBIA
	 	 	18,000	 
	 
	 	 	 	 
	GADSDEN
	 	 	3,500	 
	 
	 	 	 	 
	HIGHLANDS
	 	 	3,000	 
	 
	 	 	 	 
	HILLSBOUROUGH
	 	 	18,000	 
	 
	 	 	 	 
	JEFFERSON
	 	 	1,000	 
	 
	 	 	 	 
	LAKE
	 	 	6,000	 
	 
	 	 	 	 
	LEON
	 	 	6,000	 
	 
	 	 	 	 
	LIBERTY
	 	 	400	 
	 
	 	 	 	 
	MADISON
	 	 	1,000	 
	 
	 	 	 	 
	MANATEE
	 	 	6,000	 
	 
	 	 	 	 
	MARION
	 	 	20,000	 
	 
	 	 	 	 
	MARTIN
	 	 	5,000	 
	 
	 	 	 	 
	MIAMI-DADE
	 	 	25,000	 
	 
	 	 	 	 
	ORANGE
	 	 	25,000	 
	 
	 	 	 	 
	OSCEOLA
	 	 	8,000	 
	 
	 	 	 	 
	PALM BEACH
	 	 	9,000	 
	 
	 	 	 	 
	PASCO
	 	 	6,000	 
	 
	 	 	 	 
	PINELLAS
	 	 	9,000	 
	 
	 	 	 	 
	POLK
	 	 	10,000	 
	 
	 	 	 	 
	PUTNAM
	 	 	6,000	 
	 
	 	 	 	 
	SANTA ROSA
	 	 	4,000	 
	 
	 	 	 	 
	SARASOTA
	 	 	3,000	 
	 
	 	 	 	 
	SEMINOLE
	 	 	4,000	 
	 
	 	 	 	 
	VOLUSIA
	 	 	15,000	 
	 
	 	 	 	 
	WAKULLA
	 	 	1,000	 
	 
	 	 	 	 

Table 2.

Area wide Age-banded Capitation Rates for All Agency Areas of the State.

Area 04 General Rates Plan  —  015019335 (VOLUSIA)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	316.95	 	 	 	71.10	 	 	 	44.92	 	 	 	49.61	 	 	 	101.93	 	 	 	126.35	 	 	 	191.96	 	 	 	269.58	 	 	 	269.58	 
	SSI/No Medicare
	 	 	3103.82	 	 	 	374.05	 	 	 	193.41	 	 	 	202.51	 	 	 	202.51	 	 	 	580.16	 	 	 	580.16	 	 	 	559.62	 	 	 	559.62	 
	SSI/Part B
	 	 	273.15	 	 	 	273.15	 	 	 	273.15	 	 	 	273.15	 	 	 	273.15	 	 	 	273.15	 	 	 	273.15	 	 	 	273.15	 	 	 	273.15	 
	SSI/Part A & B
	 	 	292.54	 	 	 	292.54	 	 	 	292.54	 	 	 	292.54	 	 	 	292.54	 	 	 	292.54	 	 	 	292.54	 	 	 	292.54	 	 	 	204.72	 

Area 07 General Rates Plan  —  015019308 (BREVARD)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	337.19	 	 	 	75.53	 	 	 	47.77	 	 	 	52.81	 	 	 	108.40	 	 	 	134.29	 	 	 	204.16	 	 	 	286.57	 	 	 	286.57	 
	SSI/No Medicare
	 	 	3217.89	 	 	 	389.79	 	 	 	203.90	 	 	 	213.35	 	 	 	213.35	 	 	 	610.58	 	 	 	610.58	 	 	 	589.11	 	 	 	589.11	 
	SSI/Part B
	 	 	265.77	 	 	 	265.77	 	 	 	265.77	 	 	 	265.77	 	 	 	265.77	 	 	 	265.77	 	 	 	265.77	 	 	 	265.77	 	 	 	265.77	 
	SSI/Part A & B
	 	 	283.96	 	 	 	283.96	 	 	 	283.96	 	 	 	283.96	 	 	 	283.96	 	 	 	283.96	 	 	 	283.96	 	 	 	283.96	 	 	 	198.62	 

Area 09 General Rates Plan  —  015019324 (MARTIN) 015019339 (PALM BEACH)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	316.78	 	 	 	70.74	 	 	 	44.52	 	 	 	49.17	 	 	 	101.48	 	 	 	125.24	 	 	 	190.60	 	 	 	266.97	 	 	 	266.97	 
	SSI/No Medicare
	 	 	3344.05	 	 	 	405.22	 	 	 	211.12	 	 	 	221.15	 	 	 	221.15	 	 	 	633.22	 	 	 	633.22	 	 	 	610.93	 	 	 	610.93	 
	SSI/Part B
	 	 	267.20	 	 	 	267.20	 	 	 	267.20	 	 	 	267.20	 	 	 	267.20	 	 	 	267.20	 	 	 	267.20	 	 	 	267.20	 	 	 	267.20	 
	SSI/Part A & B
	 	 	320.32	 	 	 	320.32	 	 	 	320.32	 	 	 	320.32	 	 	 	320.32	 	 	 	320.32	 	 	 	320.32	 	 	 	320.32	 	 	 	224.19	 

Area 10 General Rates Plan  —  015019337 (BROWARD)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	328.74	 	 	 	73.77	 	 	 	46.68	 	 	 	51.61	 	 	 	105.94	 	 	 	131.31	 	 	 	199.49	 	 	 	280.33	 	 	 	280.33	 
	SSI/No Medicare
	 	 	4151.82	 	 	 	503.54	 	 	 	263.75	 	 	 	275.32	 	 	 	275.32	 	 	 	788.23	 	 	 	788.23	 	 	 	761.08	 	 	 	761.08	 
	SSI/Part B
	 	 	287.04	 	 	 	287.04	 	 	 	287.04	 	 	 	287.04	 	 	 	287.04	 	 	 	287.04	 	 	 	287.04	 	 	 	287.04	 	 	 	287.04	 
	SSI/Part A & B
	 	 	351.55	 	 	 	351.55	 	 	 	351.55	 	 	 	351.55	 	 	 	351.55	 	 	 	351.55	 	 	 	351.55	 	 	 	351.55	 	 	 	245.95	 

Area 11 General Rates plus Transportation Plan  —  015019338 (DADE)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	409.89	 	 	 	91.51	 	 	 	57.28	 	 	 	63.45	 	 	 	131.27	 	 	 	161.21	 	 	 	245.94	 	 	 	343.29	 	 	 	343.29	 
	SSI/No Medicare
	 	 	4561.77	 	 	 	556.46	 	 	 	288.69	 	 	 	302.80	 	 	 	302.80	 	 	 	869.67	 	 	 	869.67	 	 	 	836.38	 	 	 	836.38	 
	SSI/Part B
	 	 	453.72	 	 	 	453.72	 	 	 	453.72	 	 	 	453.72	 	 	 	453.72	 	 	 	453.72	 	 	 	453.72	 	 	 	453.72	 	 	 	453.72	 
	SSI/Part A & B
	 	 	429.61	 	 	 	429.61	 	 	 	429.61	 	 	 	429.61	 	 	 	429.61	 	 	 	429.61	 	 	 	429.61	 	 	 	429.61	 	 	 	297.22	 

Table 3

Age-banded Capitation Rates, Including Community Mental Health and Mental Health Targeted Case
Management

Area 01 General Rates plus Mental Health Plan  —  015019314 (ESCAMBIA) 015019331 (SANTA ROSA)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	308.58	 	 	 	69.00	 	 	 	49.05	 	 	 	52.61	 	 	 	103.52	 	 	 	121.46	 	 	 	184.66	 	 	 	257.30	 	 	 	257.30	 
	SSI/No Medicare
	 	 	3048.46	 	 	 	371.81	 	 	 	243.40	 	 	 	238.17	 	 	 	238.17	 	 	 	607.82	 	 	 	607.82	 	 	 	569.75	 	 	 	569.75	 
	SSI/Part B
	 	 	330.18	 	 	 	330.18	 	 	 	330.18	 	 	 	330.18	 	 	 	330.18	 	 	 	330.18	 	 	 	330.18	 	 	 	330.18	 	 	 	330.18	 
	SSI/Part A & B
	 	 	328.66	 	 	 	328.66	 	 	 	328.66	 	 	 	328.66	 	 	 	328.66	 	 	 	328.66	 	 	 	328.66	 	 	 	328.66	 	 	 	234.66	 

1

Area 02 General Rates plus Mental Health Plan  —  015019340 (CALHOUN) 015019315 (GADSDEN)
015019318 (JEFFERSON) 015019320 (LEON) 015019322 (MADISON) 015019336 (WAKULLA) 015019342
(LIBERTY)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	308.58	 	 	 	69.19	 	 	 	60.98	 	 	 	55.90	 	 	 	106.81	 	 	 	120.89	 	 	 	184.09	 	 	 	253.06	 	 	 	253.06	 
	SSI/No Medicare
	 	 	3048.46	 	 	 	372.48	 	 	 	300.12	 	 	 	242.56	 	 	 	242.56	 	 	 	591.95	 	 	 	591.95	 	 	 	562.93	 	 	 	562.93	 
	SSI/Part B
	 	 	334.32	 	 	 	334.32	 	 	 	334.32	 	 	 	334.32	 	 	 	334.32	 	 	 	334.32	 	 	 	334.32	 	 	 	334.32	 	 	 	334.32	 
	SSI/Part A & B
	 	 	327.20	 	 	 	327.20	 	 	 	327.20	 	 	 	327.20	 	 	 	327.20	 	 	 	327.20	 	 	 	327.20	 	 	 	327.20	 	 	 	233.20	 

Area 03 General Rates plus Mental Health Plan  —  015019309 (CITRUS) 015019319 (LAKE) 015019323
(MARION)

015019329 (PUTNAM)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	350.93	 	 	 	79.08	 	 	 	55.35	 	 	 	58.65	 	 	 	116.64	 	 	 	139.68	 	 	 	212.08	 	 	 	294.58	 	 	 	294.58	 
	SSI/No Medicare
	 	 	3231.66	 	 	 	408.26	 	 	 	247.79	 	 	 	236.33	 	 	 	236.33	 	 	 	626.37	 	 	 	626.37	 	 	 	591.60	 	 	 	591.60	 
	SSI/Part B
	 	 	302.32	 	 	 	302.32	 	 	 	302.32	 	 	 	302.32	 	 	 	302.32	 	 	 	302.32	 	 	 	302.32	 	 	 	302.32	 	 	 	302.32	 
	SSI/Part A & B
	 	 	295.89	 	 	 	295.89	 	 	 	295.89	 	 	 	295.89	 	 	 	295.89	 	 	 	295.89	 	 	 	295.89	 	 	 	295.89	 	 	 	209.16	 

Area 04 General Rates plus Mental Health Plan  —  015019313 (DUVAL)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	316.96	 	 	 	72.59	 	 	 	53.19	 	 	 	54.51	 	 	 	106.83	 	 	 	128.19	 	 	 	193.80	 	 	 	270.44	 	 	 	270.44	 
	SSI/No Medicare
	 	 	3103.85	 	 	 	383.49	 	 	 	248.61	 	 	 	232.79	 	 	 	232.79	 	 	 	607.27	 	 	 	607.27	 	 	 	571.05	 	 	 	571.05	 
	SSI/Part B
	 	 	277.60	 	 	 	277.60	 	 	 	277.60	 	 	 	277.60	 	 	 	277.60	 	 	 	277.60	 	 	 	277.60	 	 	 	277.60	 	 	 	277.60	 
	SSI/Part A & B
	 	 	312.33	 	 	 	312.33	 	 	 	312.33	 	 	 	312.33	 	 	 	312.33	 	 	 	312.33	 	 	 	312.33	 	 	 	312.33	 	 	 	224.51	 

Area 05 General Rates plus Mental Health Plan  —  015019302 (PASCO) 015019303 (PINELLAS)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	345.77	 	 	 	79.28	 	 	 	51.94	 	 	 	57.32	 	 	 	114.37	 	 	 	139.01	 	 	 	210.44	 	 	 	291.84	 	 	 	291.84	 
	SSI/No Medicare
	 	 	3265.63	 	 	 	429.24	 	 	 	240.86	 	 	 	235.59	 	 	 	235.59	 	 	 	628.37	 	 	 	628.37	 	 	 	594.95	 	 	 	594.95	 
	SSI/Part B
	 	 	266.87	 	 	 	266.87	 	 	 	266.87	 	 	 	266.87	 	 	 	266.87	 	 	 	266.87	 	 	 	266.87	 	 	 	266.87	 	 	 	266.87	 
	SSI/Part A & B
	 	 	318.72	 	 	 	318.72	 	 	 	318.72	 	 	 	318.72	 	 	 	318.72	 	 	 	318.72	 	 	 	318.72	 	 	 	318.72	 	 	 	225.77	 

Area 06 General Rates plus Mental Health Plan  —  015019300 (HILLSBOROUGH) 015019301 (MANATEE)
015019304 (POLK)

015019317 (HIGHLANDS)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	330.07	 	 	 	75.91	 	 	 	61.92	 	 	 	67.67	 	 	 	122.23	 	 	 	135.83	 	 	 	204.29	 	 	 	282.98	 	 	 	282.98	 
	SSI/No Medicare
	 	 	3017.05	 	 	 	371.69	 	 	 	265.72	 	 	 	243.82	 	 	 	243.82	 	 	 	647.81	 	 	 	647.81	 	 	 	587.26	 	 	 	587.26	 
	SSI/Part B
	 	 	242.29	 	 	 	242.29	 	 	 	242.29	 	 	 	242.29	 	 	 	242.29	 	 	 	242.29	 	 	 	242.29	 	 	 	242.29	 	 	 	242.29	 
	SSI/Part A & B
	 	 	288.09	 	 	 	288.09	 	 	 	288.09	 	 	 	288.09	 	 	 	288.09	 	 	 	288.09	 	 	 	288.09	 	 	 	288.09	 	 	 	202.64	 

Area 07 General Rates plus Mental Health Plan  —  015019327 (ORANGE) 015019328 (OSCEOLA)
015019333 (SEMINOLE)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	337.20	 	 	 	76.92	 	 	 	58.07	 	 	 	59.10	 	 	 	114.69	 	 	 	136.45	 	 	 	206.32	 	 	 	287.87	 	 	 	287.87	 
	SSI/No Medicare
	 	 	3217.90	 	 	 	406.84	 	 	 	260.45	 	 	 	239.73	 	 	 	239.73	 	 	 	628.24	 	 	 	628.24	 	 	 	594.96	 	 	 	594.96	 
	SSI/Part B
	 	 	266.03	 	 	 	266.03	 	 	 	266.03	 	 	 	266.03	 	 	 	266.03	 	 	 	266.03	 	 	 	266.03	 	 	 	266.03	 	 	 	266.03	 
	SSI/Part A & B
	 	 	293.59	 	 	 	293.59	 	 	 	293.59	 	 	 	293.59	 	 	 	293.59	 	 	 	293.59	 	 	 	293.59	 	 	 	293.59	 	 	 	208.25	 

Area 08 General Rates plus Mental Health Plan  —  015019332 (SARASOTA)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	<1 year	 	 	1-5	 	 	 	6-13	 	 	14-20 Male	 	14-20 Female	 	21-54 Male	 	21-54 Female	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	296.69	 	 	 	67.77	 	 	 	46.25	 	 	 	49.88	 	 	 	98.88	 	 	 	119.48	 	 	 	180.88	 	 	 	251.72	 	 	 	251.72	 
	SSI/No Medicare
	 	 	3079.31	 	 	 	393.43	 	 	 	223.95	 	 	 	221.50	 	 	 	221.50	 	 	 	594.93	 	 	 	594.93	 	 	 	563.76	 	 	 	563.76	 
	SSI/Part B
	 	 	243.57	 	 	 	243.57	 	 	 	243.57	 	 	 	243.57	 	 	 	243.57	 	 	 	243.57	 	 	 	243.57	 	 	 	243.57	 	 	 	243.57	 
	SSI/Part A & B
	 	 	292.10	 	 	 	292.10	 	 	 	292.10	 	 	 	292.10	 	 	 	292.10	 	 	 	292.10	 	 	 	292.10	 	 	 	292.10	 	 	 	206.49	 

	 	i.	 	For Plans participating in the frail/elderly program, the community rate shall be
paid for all members in each eligibility category except for those SSI members
determined by the Comprehensive Assessment and Review for Long Term Care (CARES) unit
to be at risk of nursing home institutionalization. Evidence of such assessments shall
be provided to the Agency by the Plan prior to authorization by the Agency of payment
of the institutional rates. Payment of institutional rates for any eligible Enrollee
shall continue only so long as the Enrollee meets the level of care requirements for
institutionalization, otherwise, the community capitation rate applies.

	 	j.	 	Notwithstanding the payment amounts which may be computed with the above rate
table, the sum of total capitation payments under this Contract shall not exceed the
total Contract amount of $820,932,336.00 as expressed in this Contract.

	 	3.	 	This amendment shall begin on July 1, 2005, or the date on which the amendment has been
signed by both parties, whichever is later.

All provisions in the Contract and any attachments thereto in conflict with this amendment
shall be and are hereby changed to conform with this amendment.

All provisions not in conflict with this amendment are still in effect and are to be performed
at the level specified in the Contract.

This amendment and all its attachments are hereby made a part of the Contract.

This amendment cannot be executed unless all previous amendments to this Contract have been
fully executed.

THE REMAINDER OF THIS PAGE LEFT BLANK INTENTIONALLY

2

IN WITNESS WHEREOF, the parties hereto have caused this 9 page amendment (including all
attachments) to be executed by their officials thereunto duly authorized.

	 	 	 	 	 
	HEALTHEASE OF FLORIDA, INC.	 	 	 	STATE OF FLORIDA, AGENCY FOR
	 	 	 	 	HEALTH CARE ADMINISTRATION
	SIGNED

BY: /s/Todd S. Farha

	 	     
	 	SIGNED

BY: _[Illegible]      
	 

	 	 	 	 
	NAME: Todd S. Farha

	 	 	 	NAME: Alan Levine
	 
	 	 	 	 
	 
	 	 
	 
	 	 	 	 
	TITLE: President and CEO

	 	 	 	TITLE: Secretary
	 
	 	 	 	 
	 
	 	 
	 
	 	 	 	 
	DATE:      

	 	 	 	DATE: 7-6-05      
	
 
	 	 	 	 
	 
	 	 	 	 
	List of attachments included as part of this Amendment
	 	 
	 
	 	 	 	 
	Specify

Type

	 	

Number
	 	

Description
	 

	 	 
	 	 

Attachment VIII ESTIMATED 2005 – 2006 HMO RATES; NOT FOR USE UNLESS APPROVED BY CMS (4 pages)

THE REMAINDER OF THIS PAGE LEFT BLANK INTENTIONALLY

3

ATTACHMENT VIII

ESTIMATED 2005 – 2006 HMO RATES;

NOT FOR USE UNLESS APPROVED BY CMS

	 	 	 	 	 
	HEALTHEASE

July 1, 2005 through December 31, 2005

	 	MEDICAID HMO CONTRACT

contract Number
	 	

: FA521

Table 2

Area wide Age-banded Capitation Rates for All Agency Areas of the State Other than Those Areas in
Which Behavioral Health has not been Implemented

Area 04 General Rates Plan  —  015019335 (VOLUSIA)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	877.98	 	 	 	175.54	 	 	 	86.37	 	 	 	55.47	 	 	 	120.97	 	 	 	62.05	 	 	 	234.40	 	 	 	152.22	 	 	 	317.36	 	 	 	317.36	 
	SSI/No Medicare
	 	 	8571.85	 	 	 	1495.58	 	 	 	383.99	 	 	 	199.57	 	 	 	218.39	 	 	 	218.39	 	 	 	659.82	 	 	 	659.82	 	 	 	620.93	 	 	 	620.93	 
	SSI/Part B
	 	 	333.59	 	 	 	333.59	 	 	 	333.59	 	 	 	333.59	 	 	 	333.59	 	 	 	333.59	 	 	 	333.59	 	 	 	333.59	 	 	 	333.59	 	 	 	333.59	 
	SSI/Part A & B
	 	 	294.49	 	 	 	294.49	 	 	 	294.49	 	 	 	294.49	 	 	 	294.49	 	 	 	294.49	 	 	 	294.49	 	 	 	294.49	 	 	 	294.49	 	 	 	205.57	 

Area 07 General Rates Plan  —  015019308 (BREVARD)

Area 09 General Rates Plan  —  015019324 (MARTIN) 015019339 (PALM BEACH)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	850.65	 	 	 	169.56	 	 	 	83.32	 	 	 	53.28	 	 	 	116.63	 	 	 	59.62	 	 	 	225.69	 	 	 	146.30	 	 	 	304.86	 	 	 	304.86	 
	SSI/No Medicare
	 	 	9123.67	 	 	 	1599.06	 	 	 	410.92	 	 	 	216.11	 	 	 	235.92	 	 	 	235.92	 	 	 	711.70	 	 	 	711.70	 	 	 	670.95	 	 	 	670.95	 
	SSI/Part B
	 	 	288.69	 	 	 	288.69	 	 	 	288.69	 	 	 	288.69	 	 	 	288.69	 	 	 	288.69	 	 	 	288.69	 	 	 	288.69	 	 	 	288.69	 	 	 	288.69	 
	SSI/Part A & B
	 	 	317.25	 	 	 	317.25	 	 	 	317.25	 	 	 	317.25	 	 	 	317.25	 	 	 	317.25	 	 	 	317.25	 	 	 	317.25	 	 	 	317.25	 	 	 	221.58	 

Area 10 General Rates Plan  —  015019337 (BROWARD)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	854.17	 	 	 	170.86	 	 	 	84.11	 	 	 	54.07	 	 	 	117.82	 	 	 	60.56	 	 	 	228.53	 	 	 	148.48	 	 	 	309.80	 	 	 	309.80	 
	SSI/No Medicare
	 	 	11134.67	 	 	 	1955.18	 	 	 	502.14	 	 	 	264.85	 	 	 	289.15	 	 	 	289.15	 	 	 	873.08	 	 	 	873.08	 	 	 	823.33	 	 	 	823.33	 
	SSI/Part B
	 	 	316.19	 	 	 	316.19	 	 	 	316.19	 	 	 	316.19	 	 	 	316.19	 	 	 	316.19	 	 	 	316.19	 	 	 	316.19	 	 	 	316.19	 	 	 	316.19	 
	SSI/Part A & B
	 	 	341.03	 	 	 	341.03	 	 	 	341.03	 	 	 	341.03	 	 	 	341.03	 	 	 	341.03	 	 	 	341.03	 	 	 	341.03	 	 	 	341.03	 	 	 	238.55	 

Area 11 General Rates plus Transportation Plan  —  015019338 (DADE)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	1112.08	 	 	 	221.47	 	 	 	108.96	 	 	 	69.38	 	 	 	152.49	 	 	 	77.84	 	 	 	294.30	 	 	 	190.48	 	 	 	396.50	 	 	 	396.50	 
	SSI/No Medicare
	 	 	12145.44	 	 	 	2131.38	 	 	 	551.08	 	 	 	286.49	 	 	 	314.89	 	 	 	314.89	 	 	 	952.30	 	 	 	952.30	 	 	 	894.10	 	 	 	894.10	 
	SSI/Part B
	 	 	455.34	 	 	 	455.34	 	 	 	455.34	 	 	 	455.34	 	 	 	455.34	 	 	 	455.34	 	 	 	455.34	 	 	 	455.34	 	 	 	455.34	 	 	 	455.34	 
	SSI/Part A & B
	 	 	433.96	 	 	 	433.96	 	 	 	433.96	 	 	 	433.96	 	 	 	433.96	 	 	 	433.96	 	 	 	433.96	 	 	 	433.96	 	 	 	433.96	 	 	 	299.72	 

4

	 	 	 	 	 
	HEALTHEASE

July 1, 2005 through December 31, 2005

	 	MEDICAID HMO CONTRACT

contract Number
	 	

: FA521

Table 3

Area wide Age-banded Capitation Rates for All Agency Areas of the State Other than Those Areas in
Which Behavioral Health has not been Implemented

Area 01 General Rates plus Mental Health Plan  —  015019314 (ESCAMBIA) 015019331 (SANTA
ROSA)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	856.86	 	 	 	169.64	 	 	 	84.58.	 	 	 	64.23	 	 	 	128.66	 	 	 	71.38	 	 	 	227.66	 	 	 	148.26	 	 	 	303.38	 	 	 	303.38	 
	SSI/No Medicare
	 	 	8379.21	 	 	 	1456.20	 	 	 	384.40	 	 	 	263.28	 	 	 	284.40	 	 	 	284.40	 	 	 	732.06	 	 	 	732.06	 	 	 	631.82	 	 	 	631.82	 
	SSI/Part B
	 	 	367.49	 	 	 	367.49	 	 	 	367.49	 	 	 	367.49	 	 	 	367.49	 	 	 	367.49	 	 	 	367.49	 	 	 	367.49	 	 	 	367.49	 	 	 	367.49	 
	SSI/Part A & B
	 	 	331.54	 	 	 	331.54	 	 	 	331.54	 	 	 	331.54	 	 	 	331.54	 	 	 	331.54	 	 	 	331.54	 	 	 	331.54	 	 	 	331.54	 	 	 	236.11	 

Area 02 General Rates plus Mental Health Plan  —  015019315 (GADSDEN) 015019318 (JEFFERSON)
015019320 (LEON) 015019322 (MADISON) 015019336 (WAKULLA) 015019340 (CALHOUN) 015019342
(LIBERTY)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	856.87	 	 	 	169.65	 	 	 	85.36	 	 	 	69.25	 	 	 	128.93	 	 	 	71.65	 	 	 	226.56	 	 	 	147.16	 	 	 	302.78	 	 	 	302.78	 
	SSI/No Medicare
	 	 	8379.20	 	 	 	1456.19	 	 	 	388.93	 	 	 	278.27	 	 	 	264.36	 	 	 	264.36	 	 	 	690.25	 	 	 	690.25	 	 	 	621.15	 	 	 	621.15	 
	SSI/Part B
	 	 	380.79	 	 	 	380.79	 	 	 	380.79	 	 	 	380.79	 	 	 	380.79	 	 	 	380.79	 	 	 	380.79	 	 	 	380.79	 	 	 	380.79	 	 	 	380.79	 
	SSI/Part A & B
	 	 	328.39	 	 	 	328.39	 	 	 	328.39	 	 	 	328.39	 	 	 	328.39	 	 	 	328.39	 	 	 	328.39	 	 	 	328.39	 	 	 	328.39	 	 	 	232.96	 

Area 03 General Rates plus Mental Health Plan  —  015019309 (CITRUS) 015019319 (LAKE) 015019323
(MARION)

015019329 (PUTNAM)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	956.51	 	 	 	190.37	 	 	 	94.52	 	 	 	67.112	 	 	 	136.49	 	 	 	248.87	 	 	 	702.91	 	 	 	702.92	 	 	 	649.30	 	 	 	649.30	 
	SSI/No Medicare
	 	 	8796.56	 	 	 	1536.63	 	 	 	401.17	 	 	 	243.67	 	 	 	248.87	 	 	 	284.87	 	 	 	702.91	 	 	 	702.19	 	 	 	649.30	 	 	 	649.30	 
	SSI/Part B
	 	 	356.54	 	 	 	356.54	 	 	 	356.54	 	 	 	356.54	 	 	 	356.54	 	 	 	356.54	 	 	 	356.54	 	 	 	356.54	 	 	 	356.54	 	 	 	356.54	 
	SSI/Part A & B
	 	 	299.65	 	 	 	299.65	 	 	 	299.65	 	 	 	299.65	 	 	 	299.65	 	 	 	299.65	 	 	 	299.65	 	 	 	299.65	 	 	 	299.65	 	 	 	211.35	 

Area 04 General Rates plus Mental Health Plan  —  015019313 (DUVAL)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	877.99	 	 	 	175.55	 	 	 	87.56	 	 	 	63.92	 	 	 	127.39	 	 	 	68.47	 	 	 	235.93	 	 	 	153.75	 	 	 	318.93	 	 	 	318.93	 
	SSI/No Medicare
	 	 	8571.86	 	 	 	1495.59	 	 	 	394.00	 	 	 	254.46	 	 	 	252.62	 	 	 	252.62	 	 	 	694.02	 	 	 	694.02	 	 	 	635.24	 	 	 	635.24	 
	SSI/Part B
	 	 	342.17	 	 	 	342.17	 	 	 	342.17	 	 	 	342.17	 	 	 	342.17	 	 	 	342.17	 	 	 	342.17	 	 	 	342.17	 	 	 	342.17	 	 	 	342.17	 
	SSI/Part A & B
	 	 	311.96311.96	 	 	 	311.96	 	 	 	311.96	 	 	 	311.96	 	 	 	311.96	 	 	 	311.96	 	 	 	311.96	 	 	 	311.96	 	 	 	311.96	 	 	 	223.04	 

Area 05 General Rates plus Mental Health Plan  —  015019302 (PASCO) 015019303 (PINELLAS)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	919.98	 	 	 	183.43	 	 	 	91.15	 	 	 	64.87	 	 	 	131.62	 	 	 	69.93	 	 	 	245.33	 	 	 	159.49	 	 	 	331.03	 	 	 	331.03	 
	SSI/No Medicare
	 	 	9248.02	 	 	 	1615.41	 	 	 	420.86	 	 	 	252.27	 	 	 	258.55	 	 	 	258.55	 	 	 	735.80	 	 	 	735.80	 	 	 	681.19	 	 	 	681.19	 
	SSI/Part B
	 	 	332.63	 	 	 	332.63	 	 	 	332.63	 	 	 	332.63	 	 	 	332.63	 	 	 	332.63	 	 	 	332.63	 	 	 	332.63	 	 	 	332.63	 	 	 	332.63	 
	SSI/Part A & B
	 	 	321.24	 	 	 	321.24	 	 	 	321.24	 	 	 	321.24	 	 	 	321.24	 	 	 	321.24	 	 	 	321.24	 	 	 	321.24	 	 	 	321.24	 	 	 	227.10	 

Area 06 General Rates plus Mental Health Plan  —  015019300 (HILLSBOROUGH) 015019301 (MANATEE)
015019304 (POLK)

015019317 (HIGHLANDS)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	839.91	 	 	 	168.14	 	 	 	84.80	 	 	 	67.94	 	 	 	131.59	 	 	 	75.16	 	 	 	230.12	 	 	 	151.25	 	 	 	309.66	 	 	 	309.66	 
	SSI/No Medicare
	 	 	8536.50	 	 	 	1494.29	 	 	 	393.28	 	 	 	262.75	 	 	 	284.04	 	 	 	284.04	 	 	 	746.59	 	 	 	746.59	 	 	 	653.76	 	 	 	653.76	 
	SSI/Part B
	 	 	319.38	 	 	 	319.38	 	 	 	319.38	 	 	 	319.38	 	 	 	319.38	 	 	 	319.38	 	 	 	319.38	 	 	 	319.38	 	 	 	319.38	 	 	 	319.38	 
	SSI/Part A & B
	 	 	288.23	 	 	 	288.23	 	 	 	288.23	 	 	 	288.23	 	 	 	288.23	 	 	 	288.23	 	 	 	288.23	 	 	 	288.23	 	 	 	288.23	 	 	 	202.46	 

5

Area 07 General Rates plus Mental Health Plan  —  015019327 (ORANGE) 015019328 (OSCEOLA)
015019333 (SEMINOLE)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	894.05	 	 	 	178.57	 	 	 	89.54	 	 	 	68.64	 	 	 	132.32	 	 	 	72.39	 	 	 	240.41	 	 	 	156.74	 	 	 	324.62	 	 	 	324.62	 
	SSI/No Medicare
	 	 	8976.52	 	 	 	1573.98	 	 	 	414.04	 	 	 	264.97	 	 	 	264.82	 	 	 	264.82	 	 	 	733.66	 	 	 	733.66	 	 	 	674.72	 	 	 	674.72	 
	SSI/Part B
	 	 	312.78	 	 	 	312.78	 	 	 	312.78	 	 	 	312.78	 	 	 	312.78	 	 	 	312.78	 	 	 	312.78	 	 	 	312.78	 	 	 	312.78	 	 	 	312.78	 
	SSI/Part A & B
	 	 	296.22	 	 	 	296.22	 	 	 	296.22	 	 	 	296.22	 	 	 	296.22	 	 	 	296.22	 	 	 	296.22	 	 	 	296.22	 	 	 	296.22	 	 	 	210.25	 

Area 08 General Rates plus Mental Health Plan  —  015019332 (SARASOTA)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	785.53	 	 	 	156.86	 	 	 	78.13	 	 	 	56.61	 	 	 	113.39	 	 	 	60.74	 	 	 	210.44	 	 	 	136.92	 	 	 	284.23	 	 	 	284.23	 
	SSI/No Medicare
	 	 	8247.94	 	 	 	1440.21	 	 	 	376.25	 	 	 	229.28	 	 	 	234.06	 	 	 	234.06	 	 	 	659.32	 	 	 	659.32	 	 	 	608.59	 	 	 	608.59	 
	SSI/Part B
	 	 	313.20	 	 	 	313.20	 	 	 	313.20	 	 	 	313.20	 	 	 	313.20	 	 	 	313.20	 	 	 	313.20	 	 	 	313.20	 	 	 	313.20	 	 	 	313.20	 
	SSI/Part A & B
	 	 	297.40	 	 	 	297.40	 	 	 	297.40	 	 	 	297.40	 	 	 	297.40	 	 	 	297.40	 	 	 	297.40	 	 	 	297.40	 	 	 	297.40	 	 	 	210.20	 

6

	 	 	 	 	 
	HEALTHEASE

January 1, 2006 through June 30, 2006

	 	MEDICAID HMO CONTRACT

contract Number
	 	

: FA521

Table 2

Area wide Age-banded Capitation Rates for All Agency Areas of the State Other than Those Areas in
Which Behavioral Health has not been Implemented

Area 04 General Rates Plan  —  015019335 (VOLUSIA)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	877.98	 	 	 	175.54	 	 	 	86.37	 	 	 	55.47	 	 	 	120.97	 	 	 	62.05	 	 	 	234.40	 	 	 	152.22	 	 	 	317.36	 	 	 	317.36	 
	SSI/No Medicare
	 	 	8571.85	 	 	 	1495.58	 	 	 	383.99	 	 	 	199.57	 	 	 	218.39	 	 	 	218.39	 	 	 	659.82	 	 	 	659.82	 	 	 	620.93	 	 	 	620.93	 
	SSI/Part B
	 	 	207.10	 	 	 	207.10	 	 	 	207.10	 	 	 	207.10	 	 	 	207.10	 	 	 	207.10	 	 	 	207.10	 	 	 	207.10	 	 	 	207.10	 	 	 	207.10	 
	SSI/Part A & B
	 	 	77.20	 	 	 	77.20	 	 	 	77.20	 	 	 	77.20	 	 	 	77.20	 	 	 	77.20	 	 	 	77.20	 	 	 	77.20	 	 	 	77.20	 	 	 	67.39	 

Area 07 General Rates Plan  —  015019308 (BREVARD)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	894.04	 	 	 	178.56	 	 	 	87.80	 	 	 	56.33	 	 	 	122.97	 	 	 	63.04	 	 	 	238.18	 	 	 	154.51	 	 	 	322.34	 	 	 	322.34	 
	SSI/No Medicare
	 	 	8976.51	 	 	 	1573.97	 	 	 	404.51	 	 	 	212.74	 	 	 	232.25	 	 	 	232.25	 	 	 	701.12	 	 	 	701.12	 	 	 	661.11	 	 	 	661.11	 
	SSI/Part B
	 	 	199.32	 	 	 	199.32	 	 	 	199.32	 	 	 	199.32	 	 	 	199.32	 	 	 	199.32	 	 	 	199.32	 	 	 	199.32	 	 	 	199.32	 	 	 	199.32	 
	SSI/Part A & B
	 	 	72.42	 	 	 	72.42	 	 	 	72.42	 	 	 	72.42	 	 	 	72.42	 	 	 	72.42	 	 	 	72.42	 	 	 	72.42	 	 	 	72.42	 	 	 	66.48	 

Area 09 General Rates Plan  —  015019324 (MARTIN) 015019339 (PALM BEACH)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	850.65	 	 	 	169.56	 	 	 	83.32	 	 	 	53.28	 	 	 	116.63	 	 	 	59.62	 	 	 	225.69	 	 	 	146.30	 	 	 	304.86	 	 	 	304.86	 
	SSI/No Medicare
	 	 	9123.67	 	 	 	1599.06	 	 	 	410.92	 	 	 	216.11	 	 	 	235.92	 	 	 	235.92	 	 	 	711.70	 	 	 	711.70	 	 	 	670.95	 	 	 	670.95	 
	SSI/Part B
	 	 	179.44	 	 	 	179.44	 	 	 	179.44	 	 	 	179.44	 	 	 	179.44	 	 	 	179.44	 	 	 	179.44	 	 	 	179.44	 	 	 	179.44	 	 	 	179.44	 
	SSI/Part A & B
	 	 	76.11	 	 	 	76.11	 	 	 	76.11	 	 	 	76.11	 	 	 	76.11	 	 	 	76.11	 	 	 	76.11	 	 	 	76.11	 	 	 	76.11	 	 	 	66.48	 

Area 10 General Rates Plan  —  015019337 (BROWARD)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	854.17	 	 	 	170.86	 	 	 	84.11	 	 	 	54.07	 	 	 	117.82	 	 	 	60.56	 	 	 	228.53	 	 	 	148.48	 	 	 	309.80	 	 	 	309.80	 
	SSI/No Medicare
	 	 	11134.67	 	 	 	1955.18	 	 	 	502.14	 	 	 	264.85	 	 	 	289.15	 	 	 	289.15	 	 	 	873.08	 	 	 	873.08	 	 	 	823.33	 	 	 	823.33	 
	SSI/Part B
	 	 	205.90	 	 	 	205.90	 	 	 	205.90	 	 	 	205.90	 	 	 	205.90	 	 	 	205.90	 	 	 	205.90	 	 	 	205.90	 	 	 	205.90	 	 	 	205.90	 
	SSI/Part A & B
	 	 	81.99	 	 	 	81.99	 	 	 	81.99	 	 	 	81.99	 	 	 	81.99	 	 	 	81.99	 	 	 	81.99	 	 	 	81.99	 	 	 	81.99	 	 	 	71.59	 

Area 11 General Rates plus Transportation Plan  —  015019338 (DADE)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	1112.08	 	 	 	221.47	 	 	 	108.96	 	 	 	69.38	 	 	 	152.49	 	 	 	77.84	 	 	 	294.30	 	 	 	190.48	 	 	 	396.50	 	 	 	396.50	 
	SSI/No Medicare
	 	 	12145.44	 	 	 	2131.38	 	 	 	551.08	 	 	 	286.49	 	 	 	314.89	 	 	 	314.89	 	 	 	952.30	 	 	 	952.30	 	 	 	894.10	 	 	 	894.10	 
	SSI/Part B
	 	 	273.91	 	 	 	273.91	 	 	 	273.91	 	 	 	273.91	 	 	 	273.91	 	 	 	273.91	 	 	 	273.91	 	 	 	273.91	 	 	 	273.91	 	 	 	273.91	 
	SSI/Part A & B
	 	 	125.66	 	 	 	125.66	 	 	 	125.66	 	 	 	125.66	 	 	 	125.66	 	 	 	125.66	 	 	 	125.66	 	 	 	125.66	 	 	 	125.66	 	 	 	103.75	 

7

	 	 	 	 	 
	HEALTHEASE

January 1, 2006 through June 30, 2006

	 	MEDICAID HMO CONTRACT

contract Number
	 	

: FA521

Table 3

Area wide Age-banded Capitation Rates for All Agency Areas of the State Other than Those Areas in
Which Behavioral Health has not been Implemented

Area 01 General Rates plus Mental Health Plan  —  015019314 (ESCAMBIA) 015019331 (SANTA
ROSA)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	856.86	 	 	 	169.64	 	 	 	84.58	 	 	 	64.23	 	 	 	128.66	 	 	 	71.38	 	 	 	227.66	 	 	 	148.26	 	 	 	303.38	 	 	 	303.38	 
	SSI/No Medicare
	 	 	8379.21	 	 	 	1456.20	 	 	 	384.40	 	 	 	263.28	 	 	 	284.40	 	 	 	284.40	 	 	 	732.06	 	 	 	732.06	 	 	 	631.82	 	 	 	631.82	 
	SSI/Part B
	 	 	221.62	 	 	 	221.62	 	 	 	221.62	 	 	 	221.62	 	 	 	221.62	 	 	 	221.62	 	 	 	221.62	 	 	 	221.62	 	 	 	221.62	 	 	 	221.62	 
	SSI/Part A & B
	 	 	94.36	 	 	 	94.36	 	 	 	94.36	 	 	 	94.36	 	 	 	94.36	 	 	 	94.36	 	 	 	94.36	 	 	 	94.36	 	 	 	94.36	 	 	 	84.53	 

Area 02 General Rates plus Mental Health Plan  —  015019315 (GADSDEN) 015019318 (JEFFERSON)
015019320 (LEON) 015019322 (MADISON) 015019336 (WAKULLA) 015019340 (CALHOUN) 015019342
(LIBERTY)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	856.87	 	 	 	169.65	 	 	 	85.36	 	 	 	69.25	 	 	 	128.93	 	 	 	71.65	 	 	 	226.56	 	 	 	147.16	 	 	 	302.78	 	 	 	302.78	 
	SSI/No Medicare
	 	 	8379.20	 	 	 	1456.19	 	 	 	388.93	 	 	 	278.27	 	 	 	264.36	 	 	 	264.36	 	 	 	690.25	 	 	 	690.25	 	 	 	621.15	 	 	 	621.15	 
	SSI/Part B
	 	 	234.92	 	 	 	234.92	 	 	 	234.92	 	 	 	234.92	 	 	 	234.92	 	 	 	234.92	 	 	 	234.92	 	 	 	234.92	 	 	 	234.92	 	 	 	234.92	 
	SSI/Part A & B
	 	 	91.24	 	 	 	91.24	 	 	 	91.24	 	 	 	91.24	 	 	 	91.24	 	 	 	91.24	 	 	 	91.24	 	 	 	91.24	 	 	 	91.24	 	 	 	81.38	 

Area 03 General Rates plus Mental Health Plan  —  015019309 (CITRUS) 015019319 (LAKE) 015019323
(MARION)

015019329 (PUTNAM)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	956.51	 	 	 	190.37	 	 	 	94.52	 	 	 	67.21	 	 	 	136.49	 	 	 	72.38	 	 	 	254.10	 	 	 	164.92	 	 	 	342.33	 	 	 	342.33	 
	SSI/No Medicare
	 	 	8796.56	 	 	 	1536.63	 	 	 	401.17	 	 	 	243.67	 	 	 	248.87	 	 	 	248.87	 	 	 	702.91	 	 	 	702.91	 	 	 	649.30	 	 	 	649.30	 
	SSI/Part B
	 	 	237.65	 	 	 	237.65	 	 	 	237.65	 	 	 	237.65	 	 	 	237.65	 	 	 	237.65	 	 	 	237.65	 	 	 	237.65	 	 	 	237.65	 	 	 	237.65	 
	SSI/Part A & B
	 	 	83.24	 	 	 	83.24	 	 	 	83.24	 	 	 	83.24	 	 	 	83.24	 	 	 	83.24	 	 	 	83.24	 	 	 	83.24	 	 	 	83.24	 	 	 	73.70	 

Area 04 General Rates plus Mental Health Plan  —  015019313 (DUVAL)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	877.99	 	 	 	175.55	 	 	 	87.56	 	 	 	63.92	 	 	 	127.39	 	 	 	68.47	 	 	 	235.93	 	 	 	153.75	 	 	 	318.93	 	 	 	318.93	 
	SSI/No Medicare
	 	 	8571.86	 	 	 	1495.59	 	 	 	394.00	 	 	 	254.46	 	 	 	252.62	 	 	 	252.62	 	 	 	694.02	 	 	 	694.02	 	 	 	635.24	 	 	 	365.24	 
	SSI/Part B
	 	 	215.68	 	 	 	215.68	 	 	 	215.68	 	 	 	215.68	 	 	 	215.68	 	 	 	215.68	 	 	 	215.68	 	 	 	215.68	 	 	 	215.68	 	 	 	215.68	 
	SSI/Part A & B
	 	 	94.67	 	 	 	94.67	 	 	 	94.67	 	 	 	94.67	 	 	 	94.67	 	 	 	94.67	 	 	 	94.67	 	 	 	94.67	 	 	 	94.67	 	 	 	84.86	 

Area 05 General Rates plus Mental Health Plan  —  015019302 (PASCO) 015019303 (PINELLAS)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	919.98	 	 	 	183.43	 	 	 	91.15	 	 	 	64.87	 	 	 	131.62	 	 	 	69.93	 	 	 	245.33	 	 	 	159.49	 	 	 	331.03	 	 	 	331.03	 
	SSI/No Medicare
	 	 	9248.02	 	 	 	1615.41	 	 	 	420.86	 	 	 	252.27	 	 	 	258.55	 	 	 	258.55	 	 	 	735.80	 	 	 	735.80	 	 	 	681.19	 	 	 	681.19	 
	SSI/Part B
	 	 	214.59	 	 	 	214.59	 	 	 	214.59	 	 	 	214.59	 	 	 	214.59	 	 	 	214.59	 	 	 	214.59	 	 	 	214.59	 	 	 	214.59	 	 	 	214.59	 
	SSI/Part A & B
	 	 	83.91	 	 	 	83.91	 	 	 	83.91	 	 	 	83.91	 	 	 	83.91	 	 	 	83.91	 	 	 	83.91	 	 	 	83.91	 	 	 	83.91	 	 	 	74.53	 

Area 06 General Rates plus Mental Health Plan  —  015019300 (HILLSBOROUGH) 015019301 (MANATEE)
015019304 (POLK)

015019317 (HIGHLANDS)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	839.91	 	 	 	168.14	 	 	 	84.80	 	 	 	67.94	 	 	 	131.59	 	 	 	75.16	 	 	 	230.12	 	 	 	151.25	 	 	 	309.66	 	 	 	309.66	 
	SSI/No Medicare
	 	 	8536.50	 	 	 	1494.29	 	 	 	393.28	 	 	 	262.75	 	 	 	284.04	 	 	 	284.04	 	 	 	746.59	 	 	 	746.59	 	 	 	653.76	 	 	 	653.76	 
	SSI/Part B
	 	 	201.26	 	 	 	201.26	 	 	 	201.26	 	 	 	201.26	 	 	 	201.26	 	 	 	201.26	 	 	 	201.26	 	 	 	201.26	 	 	 	201.26	 	 	 	201.26	 
	SSI/Part A & B
	 	 	73.23	 	 	 	73.23	 	 	 	73.23	 	 	 	73.23	 	 	 	73.23	 	 	 	73.23	 	 	 	73.23	 	 	 	73.23	 	 	 	73.23	 	 	 	64.45	 

Area 07 General Rates plus Mental Health Plan  —  015019327 (ORANGE) 015019328 (OSCEOLA)
015019333 (SEMINOLE)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	894.05	 	 	 	178.57	 	 	 	89.54	 	 	 	68.64	 	 	 	132.32	 	 	 	72.39	 	 	 	240.41	 	 	 	156.74	 	 	 	324.62	 	 	 	324.62	 
	SSI/No Medicare
	 	 	8976.52	 	 	 	1573.98	 	 	 	414.04	 	 	 	264.97	 	 	 	264.82	 	 	 	264.82	 	 	 	733.66	 	 	 	733.66	 	 	 	674.72	 	 	 	674.72	 
	SSI/Part B
	 	 	203.20	 	 	 	203.20	 	 	 	203.20	 	 	 	203.20	 	 	 	203.20	 	 	 	203.20	 	 	 	203.20	 	 	 	203.20	 	 	 	203.20	 	 	 	203.20	 
	SSI/Part A & B
	 	 	84.13	 	 	 	84.13	 	 	 	84.13	 	 	 	84.13	 	 	 	84.13	 	 	 	84.13	 	 	 	84.13	 	 	 	84.13	 	 	 	84.13	 	 	 	74.97	 

Area 08 General Rates plus Mental Health Plan  —  015019332 (SARASOTA)

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	BTHMO+2MO
	 	3MO-11MO	 		1-5		 	 	6-13	 	 	 	14-20 	(M)	 	 	14-20 	(F)	 	 	21-54 	(M)	 	 	21-54 	(F)	 	 	55-64	 	 	 	65+	 
	TANF/FC/SOBRA
	 	 	785.53	 	 	 	156.86	 	 	 	78.13	 	 	 	56.61	 	 	 	113.39	 	 	 	60.74	 	 	 	210.44	 	 	 	136.92	 	 	 	284.23	 	 	 	284.23	 
	SSI/No Medicare
	 	 	8247.94	 	 	 	1440.21	 	 	 	376.25	 	 	 	229.28	 	 	 	234.06	 	 	 	234.06	 	 	 	659.32	 	 	 	659.32	 	 	 	608.59	 	 	 	608.59	 
	SSI/Part B
	 	 	191.91	 	 	 	191.91	 	 	 	191.91	 	 	 	191.91	 	 	 	191.91	 	 	 	191.91	 	 	 	191.91	 	 	 	191.91	 	 	 	191.91	 	 	 	191.91	 
	SSI/Part A & B
	 	 	77.95	 	 	 	77.95	 	 	 	77.95	 	 	 	77.95	 	 	 	77.95	 	 	 	77.95	 	 	 	77.95	 	 	 	77.95	 	 	 	77.95	 	 	 	69.13	 

8

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00092-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00092-of-00352.parquet"}]]