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WCG-EX10.12_GAFamilies0654Amendment14

	
			
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	Exhibit 10.12

AMENDMENT #14
TO CONTRACT NO. 0654 BETWEEN 
GEORGIA DEPARTMENT OF COMMUNITY HEALTH AND
WELLCARE OF GEORGIA, INC.

This Amendment is between the Georgia Department of Community Health (hereinafter referred to as “DCH” or the “Department”) and WellCare of Georgia, Inc. (hereinafter referred to as “Contractor”) and is made effective on July 31, 2012 or the date signed by the DCH Commissioner, whichever occurs first (hereinafter referred to as the “Effective Date”). Other than the changes, modifications and additions specifically articulated in this Amendment #14 to Contract #0654, the Contract as previously amended shall remain in effect and binding on and against DCH and Contractor. Unless expressly modified or added in this Amendment #14, the terms and conditions of the Contract and its previous amendments are expressly incorporated into this Amendment #14 as if completely restated herein.

WHEREAS, DCH and Contractor executed a contract for the provision of services to members of the Georgia Families Program; and,  

WHEREAS, pursuant to Section 32.0,  Amendment in Writing, DCH and Contractor desire to amend the above-referenced Contract as set forth below.

NOW THEREFORE, for and in consideration of the mutual promises of the Parties, the terms, provisions and conditions of this Amendment and other good and valuable consideration, the sufficiency of which is hereby acknowledged, DCH and Contractor hereby agree as follows: 

		
	I.
	Upon DCH’s receipt of written notice from CMS indicating that agency’s approval of this Amendment, the parties shall delete Section 26.0, Payment Bond & Irrevocable Letter of Credit, in its entirety and replace it with the following:

		
	26.0 
	IRREVOCABLE LETTER OF CREDIT  

		
	26.1 
	Within five (5) Business Days of Contract Execution, Contractor shall obtain and maintain in force and effect an irrevocable letter of credit in the amount representing one half of one month’s Net Capitation Payment associated with the actual GF lives in the Atlanta and Central Service Regions enrolled in Contractor’s plan. For SFY 2007-2012, on or before July 2 each year, Contractor shall modify the amount of the irrevocable letter of credit currently in force and effect to equal one-half of the average of the Net Capitation Payments paid to the Contractor for the months of January, February and March.

For SFY 2013, Contractor shall modify the amount of the irrevocable letter of credit in force and effect as of June 30, 2012 to equal 12.5% of the average of the Net Capitation Payments paid to the Contractor for the months of January, February, and March of 2012. Contractor shall submit the SFY 2013 irrevocable letter of credit to the Department on or before August 1, 2012 and such instrument shall be in effect until June 30, 2013.

Amendment #14
Contract #0654
WellCare of Georgia, Inc.

	
			
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For SFY 2014 and thereafter, on or before July 2 each following year, Contractor shall modify the amount of the irrevocable letter of credit in force and effect as of June 30 to equal 37.5% of the average of the incurred Capitation Payments calculated by the Department for the Contractor for the months of January, February and March. For each fiscal year, the irrevocable letter of credit shall be in effect for the duration of that fiscal year.

		
	26.2 
	If at any time during the year, the actual GF lives enrolled in Contractor’s plan increases or decreases by more than twenty-five percent, DCH, at its sole discretion, may increase or decrease the amount required for the irrevocable letter of credit.

		
	26.3 
	With regard to the irrevocable letter of credit, DCH may recoup payments from the Contractor for liabilities or obligations arising from any act, event, omission or condition which occurred or existed subsequent to the effective date of the Contract and which is identified in a survey, review, or audit conducted or assigned by DCH.

		
	26.4 
	DCH may also, at its discretion, redeem Contractor’s irrevocable letter of credit in the amount(s) of actual damages suffered by DCH if DCH determines that the Contractor is (1) unable to perform any of the terms and conditions of the Contract or if (2) the Contract is terminated by default or bankruptcy or material breach that is not cured within the time specified by DCH, or under both conditions described at one (1) and two (2).

		
	II.
	DCH and Contractor agree that they have assumed an obligation to perform the covenants, agreements, duties and obligations of the Contract, as modified and amended herein, and agree to abide by all the provisions, terms and conditions contained in the Contract as modified and amended.

		
	III.
	This Amendment shall be binding and inure to the benefit of the parties hereto, their heirs, representatives, successors and assigns. Whenever the provisions of this Amendment and the Contract are in conflict, the provisions of this Amendment shall take precedence and control.

		
	IV.
	It is understood by the Parties hereto that, if any part, term, or provision of this Amendment or this entire Amendment is held to be illegal or in conflict with any law of this State, then DCH, at its sole option, may enforce the remaining unaffected portions or provisions of this Amendment or of the Contract and the rights and obligations of the parties shall be construed and enforced as if the Contract or Amendment did not contain the particular part, term or provision held to be invalid.

		
	V.
	This Amendment shall become effective as stated herein and shall remain effective for so long as the Contract is in effect.

Amendment #14
Contract #0654
WellCare of Georgia, Inc.

	
			
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	VI.
	This Amendment shall be construed in accordance with the laws of the State of Georgia.

		
	VII.
	All other terms and conditions contained in the Contract and any amendment thereto, not amended by this Amendment, shall remain in full force and effect.

[SIGNATURES ON THE FOLLOWING PAGE]

Amendment #14
Contract #0654
WellCare of Georgia, Inc.

	
			
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SIGNATURE PAGE

IN WITNESS WHEREOF, DCH and Contractor, through their authorized officers and agents, have caused this Amendment to be executed on their behalf as of the date indicated.

GEORGIA DEPARTMENT OF COMMUNITY HEALTH

/s/ David A. Cook            8/3/12    
David A. Cook, Commissioner            Date

/s/ Jerry Dubberly               8/1/12    
Jerry Dubberly, Medicaid Division Chief        Date

WELLCARE OF GEORGIA, INC.

BY:    /s/ Jesse Thomas                    7-31-12    
Signature                            Date

_Jesse Thomas        
Print/Type Name 

President, South Division                
*TITLE

* Must be President, Vice President, CEO or Other Officer Authorized by Corporate Resolution to Execute on Behalf of and Bind the Corporation to a Contract

Amendment #14
Contract #0654
WellCare of Georgia, Inc.WCG-EX10.28_FLCOBDSNPAmendment3

	
			
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	Exhibit 10.28

AHCA AGREEMENT NO. AA051
AMENDMENT NO. 3
THIS COORDINATION OF BENEFITS AGREEMENT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the "Agency" and WELLCARE OF FLORIDA, INC., hereinafter referred to as the “Health Plan,” is hereby amended as follows:
		
	1.
	Section VII., Miscellaneous, Item E., Contact Information, the Agency contact person information is hereby amended to now read as follows:

The contact person for the Agency is as follows:
Frank Dichio
Agency for Health Care Administration
2727 Mahan Drive, MS# 19
Tallahassee, FL 32308
(850) 412-4137
Frankie.Dichio@ahca.myflorida.com
		
	2.
	Effective January 1, 2013, Exhibit B, Applicable Service Areas and Dual Eligible and Other Dual Eligible Categories, is hereby deleted in its entirety and replaced with Exhibit B-1, Revised Applicable Service Areas and Dual Eligible and Other Dual Eligible Categories, attached hereto and made part of the Agreement.  All references in the Agreement to Exhibit B shall hereinafter refer to Exhibit B-1.

		
	3.
	Effective January 1, 2013, Exhibit C, Florida Medicaid Benefits, is hereby deleted in its entirety and replaced with Exhibit C-1, Medicare Advantage Special Needs Plans Covered Services, attached hereto and made part of the Agreement.  All references in the Agreement to Exhibit C shall hereinafter refer to Exhibit C-1.

This amendment shall have an effective date of January 1, 2013, or the date on which both parties execute the amendment, whichever is later.
All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the Agreement.
This amendment and all its attachments are hereby made a part of the Agreement.
This amendment cannot be executed unless all previous amendments to this Agreement have been fully executed.

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Agreement No. AA051, Amendment No. 3, Page 1 of 2

	
			
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IN WITNESS WHEREOF, the parties hereto have caused this five (5) page amendment to be executed by their officials thereunto duly authorized. 

WELLCARE OF FLORIDA, INC.     STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION

SIGNED    SIGNED
BY:        /s/ Christina Cooper        BY:         /s/ Elizabeth Dudek    
    
NAME:    Christina Cooper        NAME:      Elizabeth Dudek    

TITLE:  President, Florida Division        TITLE:  Secretary    

DATE:   9/21/12        DATE:      9/21/12    

Specify    Letter/
Type    Number    Description    

		
	Exhibit
	B-1    Applicable Service Areas and Dual Eligible and Other Dual Eligible Categories (1 page)

		
	Exhibit
	C-1    Medicare Advantage Special Needs Plans Covered Services (2 pages)

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Agreement No. AA051, Amendment No. 3, Page 2 of 2

	
			
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EXHIBIT B-1
MA SNPS
APPLICABLE SERVICE AREAS AND
DUAL ELIGIBLE AND OTHER DUAL ELIGIBLE CATEGORIES
	
					
	MA SNP PLAN NAME
	H #
	SERVICE AREA BY COUNTY OR ZIP CODE
	CATEGORY OF SPECIAL NEEDS PLAN (Dual, Chronic, Institutional)
	APPLICABLE CATEGORY OF DUAL ELIGIBLE

	WELLCARE SELECT
	H1032061
	Brevard, Broward, Clay, Miami-Dade, Duval, Hernando, Highlands, Hillsborough, Indian River, Lake, Manatee, Marion, Martin, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Seminole, Sumter, St. Lucie, Volusia
	DUAL
	QDWI, QI, SLMB

	WELLCARE SELECT
	H1032101
	Bay, Alachua, Bradford, Calhoun, Charlotte, Citrus, DeSoto, Escambia, Franklin, Gadsden, Glades, Gulf, Hardee, Hendry, Holmes, Jefferson, Lee, Leon, Levy, Liberty, Madison, Okaloosa, Santa Rosa, Sarasota, Union, Wakulla, Walton, Washington
	DUAL
	QDWI, QI, SLMB

	WELLCARE ACCESS
	H1032175
	Alachua, Bay, Bradford, Brevard, Broward, Calhoun, Charlotte, Citrus, Clay, DeSoto, Duval, Escambia, Franklin, Gadsden, Glades, Gulf, Hardee, Hendry, Hernando, Highlands, Hillsborough, Holmes, Indian River, Jefferson, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Martin, Okaloosa, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Santa Rosa, Sarasota, Seminole, St. Lucie, Sumter, Union, Volusia, Wakulla, Walton, Washington
	DUAL
	FBDE, SLMB+

	WELLCARE ACCESS
	H1032176
	Miami-Dade
	DUAL
	FBDE, SLMB+

AHCA Agreement No. AA051, Exhibit B-1, Page 1 of 1

	
			
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	Exhibit 10.28

 EXHIBIT C-1
Medicare Advantage Special Needs Plans Covered Services

JANUARY 1, 2013 THROUGH DECEMBER 31, 2013

	
	
	

Medicaid Service

	HOSPITAL INPATIENT SERVICES

	HOSPITAL INPATIENT CROSSOVER

	HOSPITAL OUTPATIENT SERVICES

	HOSPTIAL OUTPATIENT CROSSOVER

	NURSING HOME CROSSOVER

	SKILLED NURSING HOME

	INTERMEDIATE CARE FACILITY (ICF) I SERVICES

	ICF II SERVICES

	MENTAL HEALTH HOSPITALS

	INTERMEDIATE CARE FACILITY FOR THE DEVELOPMENTALLY DISABLED (ICF/DD) SUNLAND

	ICF/DD SIXBED

	PHYSICIAN SERVICES

	PHYSICIAN SERVICES CROSSOVER

	PRESCRIBED MEDICINES
(E.G. BENZODIAZEPINES, BARBITURATES AND SOME OVER THE COUNTER PRODUCTS)

	LAB AND XRAY SERVICES

	LAB AND XRAY CROSSOVER

	PATIENT TRANSPORTATION

	PATIENT TRANSPORTATION CROSSOVER

	FAMILY PLANNING

	HOME HEALTH SERVICES

	HOME HEALTH CROSSOVER

	SCREENING SERVICES

	CHILD DENTAL SERVICES

	CHILD VISUAL SERVICES

	CHILD HEARING SERVICES

	ADULT DENTAL SERVICES

	ADULT VISION SERVICES

	ADULT HEARING SERVICES

	TARGETED CASE MANAGEMENT SERVICES

	NURSE PRACTITIONER

	REGISTERED PHYSICAL THERAPIST

	HOSPICE SERVICES

	COMMUNITY MENTAL HEALTH

	HOME AND COMMUNITY BASED AGING

	HOME AND COMMUNITY BASED DEVELOPMENTAL SERVICES

	AIDS WAIVER SERVICES

	BIRTHING CENTER SERVICES

AHCA Agreement No. AA051, Exhibit C-1, Page #PageNum# of 2

	
			
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	Exhibit 10.28

 EXHIBIT C-1
Medicare Advantage Special Needs Plans Covered Services

JANUARY 1, 2013 THROUGH DECEMBER 31, 2013

	
	
	

Medicaid Service

	RURAL HEALTH SERVICES

	RURAL HEALTH CROSSOVER

	PERSONAL CARE SERVICES

	PRIVATE DUTY NURSING SERVICES

	PHYSICAL THERAPY SERVICES

	SPEECH THERAPY SERVICES

	OCCUPATIONAL THERAPY SERVICES

	RESPIRATORY THERAPY SERVICES

	FEDERALLY QUALIFIED HEALTH CENTERS

	CLINIC SERVICES

	DEVELOPMENTAL SERVICES COMMUNITY SUPPORTED LIVING ARRANGEMENT (DS CSLA)

	MENTAL HEALTH CASE MANAGEMENT

	DEVELOPMENTAL EVALUATION AND INTERVENTION

	CHILD CASE MANAGEMENT SERVICES

	CHILD COMMNNITY MENTAL HEALTH SERVICES

	CHILD THERAPY SERVICES

	ADULT CONGREGATE LIVING FACILITY

	PHYSICIAN ASSISTANT SERVICES

	SCHOOL BASED SERVICES

	DIALYSIS CENTER

§ 422.101 Requirements relating to basic benefits.
* * * * *
(f)  Special needs plan model of care (1) MA organizations offering special needs plans must have a model of care plan specifying how the plan will coordinate and deliver care designed for the plan’s enrollees.  The model of care plan must provide for the following:
(i) Coordinate care for eligible beneficiaries.
(ii) Include a network of providers/services having relevant clinical expertise.
(iii) Target a special needs population.
(iv) Deliver care based on appropriate protocol for the target enrollees.
(v) Deliver care to frail/disabled enrollees.
(vi) Deliver care to enrollees who are at the end of life.
(vii) Apply performance measures to evaluate processes and outcomes of the model.

AHCA Agreement No. AA051, Exhibit C-1, Page #PageNum# of 2

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