Document:

ahca-fa905amendment5.htm

 Back to Form 10-Q

Exhibit 10.10

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

AHCA CONTRACT NO. FA905

AMENDMENT NO. 5

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," or “Health Plan,” is hereby amended as follows:

	
1.

	
Standard Contract, Section III., Item E., Name, Mailing and Street Address of Payee, sub-items 1. and 2., are hereby deleted and replaced as follows:

 

	
  

	
1.

	
The name (Vendor name as shown on Page 1 of this Contract) and mailing address of the official payee to whom the payment shall be made:

 

Healthease of Florida, Inc.

P.O. Box 31379

Tampa, FL 33634

 

	
  

	
2.

	
The name of the contact person and street address where financial and administrative records are maintained:

 

Thomas Tran

Healthease of Florida, Inc.

8735 Henderson Road

Tampa, FL 33634

 

	
2.

	
Attachment II, Core Contract Provisions, Section I, Definitions and Acronyms, Item A., Definitions, the following definitions are hereby included or amended to now read as follows:

Avatar — In relation to Section XI, Information Management Systems, Item K., Social Networking:  A small graphic or pseudonym used on a website that identifies the person logging in.

Blog (Web Blog) — In relation to Section XI, Information Management Systems, Item K., Social Networking: A type of website, usually maintained by an individual with regular entries of commentary, descriptions of events, or other material such as graphics or video.  Entries are commonly displayed in reverse-chronological order.

Broadcast — In relation to Section XI, Information Management Systems, Item K., Social Networking: Video, audio, text, or email messages transmitted through an internet, cellular or wireless network for display on any device.

Direct Submitter (FFS PSNs Only) — A Medicaid fee-for-service provider that has been authorized by the fee-for-service Health Plan to submit electronic claims directly to the Agency’s Medicaid fiscal agent for payment without requiring such claims to be submitted by the provider to the Health Plan for individual authorization and subsequent submission by that FFS Health Plan to the Medicaid fiscal agent.  The FFS Health Plan must submit direct submitter authorization requests, in writing, to its Health Systems Development contract manager in order for such providers to be processed by the Medicaid fiscal agent for direct submitter inclusion.  The payment reconciliation process specified in Attachment II, Section XIII, Method of Payment, includes claims submitted by direct submitters.

AHCA Contract No. FA905, Amendment No. 5, Page 1 of 45

  

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

Excluded Parties List System (EPLS) — The Excluded Parties List System (EPLS) is a federal database containing information regarding entities debarred, suspended, proposed for debarment, excluded or disqualified under the nonprocurement common rule, or otherwise declared ineligible from receiving federal contracts, certain subcontracts, and certain federal assistance and benefits.

Friends/Followers — In relation to Section XI, Information Management Systems, Item K., Social Networking: Persons that choose to interact through online social networks by creating accounts or pages and proactively connecting with others.

Interactions — In relation to Section XI, Information Management Systems, Item K., Social Networking: Conversational exchange of messages.

Overpayment — Overpayment defined in accordance with s. 409.913, F.S., includes any amount that is not authorized to be paid by the Medicaid program whether paid as a result of inaccurate or improper cost reporting, improper claiming, unacceptable practices, fraud, abuse, or mistake.

Protected Health Information (PHI) — For purposes of this Attachment, protected health information shall have the same meaning and effect as defined in 45 CFR 160 and 164, limited to the information created, received, maintained or transmitted by the Health Plan from, or on behalf of the Agency.

Social Networking Applications — In relation to Section XI, Information Management Systems, Item K., Social Networking: Web-based services (excluding the Health Plan’s State-mandated website content, member portal, and provider portal) that provide a variety of ways for users to interact, such as email, comment posting, image sharing, invitation and instant messaging services.

Static Content — In relation to Section XI, Information Management Systems, Item K., Social Networking: Copy written by the Health Plan or taken from an outside authoritative source for web posting, for any period of time, shall be defined as Static Content and considered member materials under Attachment II, Section IV, Enrollee Services, Community Outreach and Marketing, Item A., Enrollee Services, of this Contract.  Static content does not include individualized emails or status messages.

Tags/Tagging — In relation to Section XI, Information Management Systems, Item K., Social Networking: Placing personal identification information within a picture or video.  Tags generally are presented as hovering links to additional information about the individual identified.

Username — In relation to Section XI, Information Management Systems, Item K., Social Networking: An identifying pseudonym associating the author to messages or content generated.

AHCA Contract No. FA905, Amendment No. 5, Page 2 of 45

  

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
3.

	
Attachment II, Core Contract Provisions, Section II, General Overview, Item D., General Responsibilities of the Health Plan, sub-item 4.a. is hereby amended to now read as follows:

   

	
  

	
a.

	
The Health Plan shall provide written materials for Agency review as follows unless specified elsewhere in the Contract:

	
  

	
(1)

	
Third party administrator subcontracts for FFS PSNs to BMHC at least ninety (90) calendar days before the effective date of the subcontract or change;

 

	
  

	
(2)

	
Managed Behavioral Health Organization subcontracts to BMHC at least forty-five (45) calendar days before the effective date of the subcontract or change; and

 

	
  

	
(3)

	
Other written materials to BMHC at least forty-five (45) calendar days before the effective date of the material or change.

 

	
4.

	
Attachment II, Core Contract Provisions, Section III, Eligibility and Enrollment, Item C., Disenrollment, sub-item 4., Involuntary Disenrollment Requests, is hereby amended to include sub-item a.(3) as follows:

 

	
  

	
(3)

	
Falsification of prescriptions by an enrollee.  In such cases the Health Plan shall report the event to MPI.

	
5.

	
Attachment II, Core Contract Provisions, Section IV, Enrollee Services, Community Outreach and Marketing, Item A., Enrollee Services, sub-item 6.a.(12) is hereby amended to change the telephone number to (850) 412-4502.

	
6.

	
Attachment II, Core Contract Provisions, Section IV, Enrollee Services, Community Outreach and Marketing, Item A., Enrollee Services, sub-item 6.a.(23) is hereby amended to now read as follows:

	
  

	
(23)

	
Procedures for reporting fraud, abuse and overpayment that includes the following specific language:

	
  

	
(a)

	
To report suspected fraud and/or abuse in Florida Medicaid, call the Consumer Complaint Hotline toll-free at 1-888-419-3456 or complete a Medicaid Fraud and Abuse Complaint Form, which is available online at: https://apps.ahca.myflorida.com/InspectorGeneral/fraud_complaintform.aspx;

	
  

	
(b)

	
If you report suspected fraud and your report results in a fine, penalty, or forfeiture of property from a doctor or other health care provider, you may be eligible for a reward through the Attorney General’s Fraud Rewards Program (toll-free 1-866-966-7226 or 850-414-3990).  The reward may be up to twenty-five percent (25%) of the amount recovered, or a maximum of $500,000 per case (Florida Statutes Chapter 409.9203). You can talk to the Attorney General’s Office about keeping your identity confidential and protected.

AHCA Contract No. FA905, Amendment No. 5, Page 3 of 45

  

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

	
7.

	
Attachment II, Core Contract Provisions, Section V, Covered Services, Item H., Coverage Provisions, sub-item 2.e. is hereby amended to now read as follows:

	
  

	
e.

	
The Health Plan shall cover fluoride treatment by a physician or a dentist for children/adolescents even if the Health Plan does not provide dental coverage.  Fluoride varnish application in a physician’s office is limited to children up to three and one half (3 1⁄2) years (42 months) of age.

	
8.

	
Attachment II, Core Contract Provisions, Section V, Covered Services, Item H., Coverage Provisions, sub-item 8., Out of Plan Use of Non-Emergency Services, the third sentence is hereby amended to now read as follows:

Written follow-up documentation of the approval must be provided to the out-of-network provider within one (1) business day after the approval.

	
9.

	
Attachment II, Core Contract Provisions, Section V, Covered Services, Item H., Coverage Provisions, sub-item 16.j. is hereby amended to now read as follows:

	
  

	
j.

	
Capitated Health Plans shall submit behavioral health pharmacy encounter data if behavioral health is a Health Plan covered service, to the BMHC secure file transfer protocol site in a format supplied by the Agency on an on-going quarterly schedule, as specified in Attachment II, Section XII, Reporting Requirements and the Health Plan Report Guide.

	
10.

	
Attachment II, Core Contract Provisions, Section V, Covered Services, Item H., Coverage Provisions, is hereby amended to include sub-item 16.I. as follows:

	
  

	
I.

	
Capitated health plans may have a pharmacy lock-in program that conforms to the requirements in the Medicaid Prescribed Drug Services Coverage, Limitations and Reimbursement Handbook, provided it is submitted in writing to BMHC and approved by the Agency in advance of implementation.

	
11.

	
Attachment II, Core Contract Provisions, Section VII, Provider Network, Item B., Network Standards, sub-item 3.c. is hereby amended to include the following:

The Health Plan shall not deny claims for services delivered by these providers solely based on the period between the date of service and the date of clean claim submission, unless that period exceeds three-hundred and sixty-five (365) calendar days, and shall be reimbursed by the Health Plan at the rate negotiated between the Health Plan and the public provider or the applicable Medicaid fee-for-service rate.  The Medicaid FFS rate is the standard Medicaid fee schedule rate or the CHD cost-based rate as specified by the County Health Department Clinic Services Coverage and Limitations Handbook for applicable rates.

	
12.

	
Attachment II, Core Contract Provisions, Section VII, Provider Network, Item H., Credentialing and Recredentialing, sub-item 2.c.(2) is hereby amended to now read as follows:

 

	
  

	
(2)

	
The Health Plan shall not contract with any provider who has a record of illegal conduct; i.e., found guilty of, regardless of adjudication, or who entered a plea of nolo contendere or guilty to any of the offenses listed in s. 435.04, F.S.;

 

AHCA Contract No. FA905, Amendment No. 5, Page 4 of 45

  

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
13.

	
Attachment II, Core Contract Provisions, Section VII, Provider Network, Item H., Credentialing and Recredentialing, is hereby amended to now include sub-item 8. as follows:

	
  

	
8.

	
The Health Plan shall submit disclosures and notifications to the federal Department of Health and Human Services (DHHS) Office of the Inspector General (OIG) and to MPI in accordance with s. 1128, s. 1156, and s. 1892, of the Social Security Act, 42 CFR 455.106, 42 CFR 1002.3, and 42 CFR 1001.1, as described in Section X, E.,11., Fraud and Abuse Prevention, of this Contract.

	
14.

	
Attachment II, Core Contract Provisions, Section VIII, Quality Management, Item A., Quality Improvement, sub-item 3.a.(7) is hereby deleted in its entirety and replaced with the following:

	
  

	
(7)

	
PIP Documentation

 

	
  

	
(a)

	
PIP Proposal

 

	
  

	
(i)

	
Within ninety (90) calendar days after initial Contract execution, the Health Plan shall submit to the BMHC, in writing, a proposal for each planned PIP.

 

	
  

	
(ii)

	
Each PIP proposal shall be submitted using the most recent version of the EQRO PIP validation form.  The EQRO PIP validation form may be obtained from the following website: www.myfloridaeqro.com/. Instructions for using the form to submit PIP proposals and updates may be obtained from the BMHC.

 

	
  

	
(iii)

	
Activities 1 through 6 of the EQRO PIP validation form must be addressed in the PIP proposal.

 

	
  

	
(iv)

	
In the event the Health Plan elects to modify a portion of the PIP proposal after initial Agency approval, a written request to do so must be submitted to the BMHC.

 

	
  

	
(b)

	
Annual PIP Submission

 

	
  

	
(i)

	
The Health Plan shall submit on-going PIPs annually by August 1st to the BMHC for review and approval.

 

	
  

	
(ii)

	
The Health Plan shall update the EQRO PIP validation form in its annual submission to reflect the Health Plan’s progress. The Health Plan is not required to transfer on-going PIPs to a new, updated EQRO form.

 

	
  

	
(iii)

	
The Health Plan shall submit the BMHC-approved EQRO PIP validation form to the EQRO upon its request for validation.  The Health Plan shall not make changes to the BMHC-approved PIP being submitted to the EQRO unless expressly permitted by the BMHC in writing.

 

	
15.

	
Attachment II, Core Contract Provisions, Section VIII, Quality Management, Item A., Quality Improvement, sub-item 4.a., Cultural Competency Plan, the third sentence is hereby amended to now read as follows:

The CCP shall be updated annually and submitted to BMHC by June 1st for approval for implementation by September 1st of each Contract year.

 

AHCA Contract No. FA905, Amendment No. 5, Page 5 of 45

  

  

  

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

	
16.

	
Attachment II, Core Contract Provisions, Section IX, Grievance System, Item A., General Requirements, sub-item 8. is hereby amended to now read as follows:

	
  

	
8.

	
The Health Plan shall keep a log of complaints that do not become grievances, including date, complainant and enrollee name(s), nature of complaint, description of resolution and final disposition. The Health Plan shall submit this report upon request of the Agency.

	
17.

	
Attachment II, Core Contract Provisions, Section IX, Grievance System, Item E., Resolution and Notification, sub-item 7.c.(4) is hereby amended to change the telephone number to (850) 412-4502.

	
18.

	
Attachment II, Core Contract Provisions, Section X, Administration and Management, Item B., Staffing, is hereby amended to include sub-item 2.m. as follows:

	
  

	
m.

	
Social Networking Administrator:  If the Health Plan elects to use social networking, the Health Plan shall have a Social Networking Administrator, who may hold another position, but is ultimately responsible for policy development, implementation and oversight of all social networking activities.

	
19.

	
Attachment II, Core Contract Provisions, Section X, Administration and Management, Item E., Fraud and Abuse Prevention, is hereby deleted and replaced in its entirety as follows:

 

                E.     Fraud and Abuse Prevention

	
  

	
1.

	
The Health Plan shall establish functions and activities governing program integrity in order to reduce the incidence of fraud and abuse and shall comply with all state and federal program integrity requirements, including but not limited to the applicable provisions of the Social Security Act, ss. 1128, 1902, 1903, and 1932; 42 CFR 431, 433, 434, 435, 438, 441, 447, 455; 45 CFR Part 74; Chapters 409, 414, 458, 459, 460, 461, 626, 641 and 932, F.S., and 59A-12.0073, 59G and 69D-2, FAC.

	
  

	
2.

	
The Health Plan’s compliance officer as described in Attachment II, Section X, Administration and Management, Item B., Staffing, sub-item 2.j., shall have unrestricted access to the Health Plan’s governing body for compliance reporting, including fraud and abuse and overpayment.

	
  

	
3.

	
The Health Plan shall have adequate staffing and resources to enable the compliance officer to investigate unusual incidents and develop and implement corrective action plans relating to fraud and abuse and overpayment.

 

	
  

	
a.

	
The Health Plan shall establish and maintain a fraud investigative unit to investigate possible acts of fraud, abuse or overpayment, or may subcontract such functions.

	
  

	
b.

	
If a Health Plan subcontracts for the investigation of fraudulent claims and other types of program abuse by enrollees or service providers, the Health Plan shall file the following with the Bureau of Medicaid Program Integrity (MPI) for approval at least sixty (60) calendar days before subcontract execution:

	
  

	
(1)

	
The names, addresses, telephone numbers, e-mail addresses, and fax numbers of the principals of the entity with which the Health Plan wishes to subcontract;

 

AHCA Contract No. FA905, Amendment No. 5, Page 6 of 45

  

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  

	
(2)

	
A description of the qualifications of the principals of the entity with which the Health Plan wishes to subcontract; and

 

	
  

	
(3)

	
The proposed subcontract.

 

	
  

	
c.

	
The Health Plan shall submit to MPI such executed subcontracts, attachments, exhibits, addendums or amendments thereto, within thirty (30) calendar days after execution.

 

	
  

	
d.

	
The Health plan shall notify MPI and provide a copy of any corporate integrity or corporate compliance agreements within thirty (30) calendar days after execution of such agreements.

 

	
  

	
e.

	
The Health Plan shall notify MPI and provide a copy of any corrective action plans required by the Department of Financial Services (DFS) and/or federal governmental entities, excluding AHCA, within thirty (30) calendar days after execution of such plans.

	
  

	
4.

	
The Health Plan’s written fraud and abuse prevention program shall have internal controls and policies and procedures in place that are designed to prevent, reduce, detect, correct and report known or suspected fraud and abuse activities.

	
  

	
5.

	
The Health Plan shall submit its compliance plan, anti-fraud plan, and its fraud and abuse policies and procedures, or any changes to these items, to MPI for written approval at least forty-five (45) calendar days before those plans and procedures are implemented.

a.     At a minimum the compliance plan shall include:

	
  

	
(1)

	
Written policies, procedures and standards of conduct that articulate the Health Plan’s commitment to comply with all applicable federal and state standards;

 

	
  

	
(2)

	
The designation of a compliance officer and a compliance committee accountable to senior management;

	
  

	
(3)

	
Effective training and education of the compliance officer and the Health Plan’s employees

	
  

	
(4)

	
Effective lines of communication between the compliance officer and the Health Plan’s employees;

	
  

	
(5)

	
Enforcement of standards through well-publicized disciplinary guidelines;

	
  

	
(6)

	
Provision for internal monitoring and auditing; and

	
  

	
(7)

	
Provisions for prompt response to detected offenses and for development of corrective action initiatives.

 

AHCA Contract No. FA905, Amendment No. 5, Page 7 of 45

  

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
 

  

	
b.

	
At a minimum, the Health Plan shall submit its anti-fraud plan to MPI annually on July 1st.  The anti-fraud plan shall comply with s. 409.91212, F.S., and, at a minimum, shall include:

	
  

	
(1)

	
A written description or chart outlining the organizational arrangement of the Health Plan’s personnel who are responsible for the investigation and reporting of possible overpayment, abuse, or fraud;

	
  

	
(2)

	
A description of the Health Plan’s procedures for detecting and investigating possible acts of fraud, abuse, and overpayment;

	
  

	
(3)

	
A description of the Health Plan’s procedures for the mandatory reporting of possible overpayment, abuse, or fraud to MPI;

	
  

	
(4)

	
A description of the Health Plan’s program and procedures for educating and training personnel on how to detect and prevent fraud, abuse, and overpayment;

	
  

	
(a)

	
At a minimum, training shall be conducted within thirty (30) calendar days of new hire and annually thereafter;

	
  

	
(b)

	
The Health Plan shall have a methodology to verify training occurs as required; and

	
  

	
(c)

	
The Health Plan shall also include deficit reduction act requirements in the training curriculum.

	
  

	
(5)

	
The name, address, telephone number, e-mail address, and fax number of the individual responsible for carrying out the anti-fraud plan; and

 

	
  

	
(6)

	
A summary of the results of the investigations of fraud, abuse, or overpayment which were conducted during the previous year by the Health Plan’s fraud investigative unit.

 

	
  

	
c.

	
At a minimum, the Health Plan’s compliance plan, anti-fraud plan, and fraud and abuse policies and procedures shall comply with s. 409.91212, F.S., and with the following:

	
  

	
(1)

	
Ensure that all officers, directors, managers and employees know and understand the provisions;

	
  

	
(2)

	
Include procedures designed to prevent and detect potential or suspected fraud and abuse in the administration and delivery of services under this Contract.  Nothing in this Contract shall require that the Health Plan assure that non-participating providers are compliant with this Contract, but the Health Plan is responsible for reporting suspected fraud and abuse by non-participating providers when detected;

	
  

	
(3)

	
Describe the Health Plan’s organizational arrangement of anti-fraud personnel, their roles and responsibilities, including a description of the internal investigational methodology and reporting protocols;

 

AHCA Contract No. FA905, Amendment No. 5, Page 8 of 45

  

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  

	
(4)

	
Incorporate a description of the specific controls in place for prevention and detection of potential or suspected fraud and abuse, including, but not limited to:

	
  

	
(a)

	
Claims edits;

	
  

	
(b)

	
Post-processing review of claims;

	
  

	
(c)

	
Provider profiling, credentialing, and recredentialing, including a review process for claims and encounters that shall include providers and non-participating providers:

	
  

	
(i)

	
Who demonstrate a pattern of submitting falsified encounter data or service reports;

	
  

	
(ii)

	
Who demonstrate a pattern of overstated reports or up-coded levels of service;

	
  

	
(iii)

	
Who alter, falsify or destroy clinical record documentation;

	
  

	
(iv)

	
Who make false statements relating to credentials;

	
  

	
(v)

	
Who misrepresent medical information to justify enrollee referrals;

	
  

	
(vi)

	
Who fail to render medically necessary covered services they are obligated to provide according to their provider contracts;

 

	
  

	
(vii) Who charge enrollees for covered services; and

	
  

	
(viii) Who bill for services not rendered;

	
  

	
(d)

	
Prior authorization;

	
  

	
(e)

	
Utilization management;

	
  

	
(f)

	
Subcontract and provider contract provisions;

	
  

	
(g)

	
Provisions from the provider and the enrollee handbooks; and

	
  

	
(h)

	
Standards for a code of conduct;

	
  

	
(5)

	
Contain provisions pursuant to this section for the confidential reporting of Health Plan violations to MPI and other agencies as required by law;

	
  

	
(6)

	
Include provisions for the investigation and follow-up of any reports;

	
  

	
(7)

	
Ensure that the identities are protected for individuals reporting in good faith alleged acts of fraud and abuse;

	
  

	
(8)

	
Require all suspected or confirmed instances of internal and external fraud and abuse relating to the provision of, and payment for, Medicaid services including, but not limited to, Health Plan employees/management, providers, subcontractors, vendors, delegated entities, or enrollees under state and/or federal law be reported to MPI within fifteen (15) calendar days of detection.  Additionally, any final resolution reached by the Health Plan shall include a written statement that provides notice to the provider or enrollee that the resolution in no way binds the State of Florida nor precludes the State of Florida from taking further action for the circumstances that brought rise to the matter;

 

AHCA Contract No. FA905, Amendment No. 5, Page 9 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  

	
(9)

	
Ensure that the Health Plan and all providers and subcontractors, upon request and as required by state and/or federal law, shall:

	
  

	
(a)

	
Make available to all authorized federal and state oversight agencies and their agents, including but not limited to the Agency, the Florida Attorney General, and DFS any and all administrative, financial and medical records and data relating to the delivery of items or services for which Medicaid monies are expended; and

	
  

	
(b)

	
Allow access to all authorized federal and state oversight agencies and their agents, including but not limited to the Agency, the Florida Attorney General, and DFS to any place of business and all medical records and data, as required by state and/or federal law. Access shall be provided during normal business hours, except under special circumstances when the Agency, the Florida Attorney General, and DFS shall have after-hours admission.  The Agency and the Florida Attorney General shall determine the need for special circumstances;

	
  

	
(10)

	
Ensure that the Health Plan shall cooperate fully in any investigation by federal and state oversight agencies and any subsequent legal action that may result from such an investigation;

	
  

	
(11)

	
Ensure that the Health Plan does not retaliate against any individual who reports violations of the Health Plan’s fraud and abuse policies and procedures or suspected fraud and abuse;

	
  

	
(12)

	
Not knowingly have affiliations with individuals debarred or excluded by federal agencies under ss. 1128 and 1128A of the Social Security Act and 42 CFR 438.610;

	
  

	
(13)

	
Check monthly the federal List of Excluded Individuals and Entities (LEIE), or its equivalent, and the federal Excluded Parties List System (EPLS) to identify excluded parties during the process of engaging the services of new employees, subcontractors and providers and during renewal of agreements and recredentialing.  The Health Plan shall not engage the services of an entity that is in nonpayment status or is excluded from participation in federal health care programs under ss. 1128 and 1128A of the Social Security Act;

	
  

	
(14)

	
Provide details and educate employees, subcontractors and providers about the following as required by s. 6032 of the federal Deficit Reduction Act of 2005:

	
  

	
(a)

	
The False Claim Act;

 

AHCA Contract No. FA905, Amendment No. 5, Page 10 of 45

  

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  

	
(b)

	
The penalties for submitting false claims and statements;

	
  

	
(c)

	
Whistleblower protections;

	
  

	
(d)

	
The law’s role in preventing and detecting fraud, waste and abuse;

	
  

	
(e)

	
Each person’s responsibility relating to detection and prevention; and

	
  

	
(f)

	
The toll-free state telephone numbers for reporting fraud and abuse.

	
  

	
6.

	
The Health Plan shall query its potential non-provider subcontractors before contracting to determine whether the subcontractor has any existing or pending contract(s) 

	 	
with the Agency and, if any, notify MPI

                     

	
  

	
7.

	
In accordance with s. 6032 of the federal Deficit Reduction Act of 2005, the Health Plan shall make available written fraud and abuse policies to all employees.  If the Health Plan has an employee handbook, the Health Plan shall include specific information about s. 6032, the Health Plan’s policies, and the rights of employees to be protected as whistleblowers.

	
  

	
8.

	
The Health Plan shall comply with all reporting requirements as set forth below; and in s. 409.91212, F.S.; Attachment II, Section XII, Reporting Requirements; and the Health Plan Report Guide.

	
  

	
a.

	
The Health Plan shall report on a quarterly basis a comprehensive fraud and abuse prevention activity report regarding its investigative, preventive, and detective activity efforts.

	
  

	
b.

	
The Health Plan shall, by September 1st of each year, report to MPI its experience in implementing an anti-fraud plan, and, on conducting or subcontracting for investigations of possible fraudulent or abusive acts during the prior state fiscal year.  The report must include, at a minimum:

	
  

	
(1)

	
The dollar amount of health plan losses and recoveries attributable to overpayment, abuse and fraud; and

	
  

	
(2)

	
The number of health plan referrals to MPI.

	
  

	
9.

	
The Health Plan shall meet with the Agency periodically, at the Agency’s request, to discuss fraud, abuse, neglect and overpayment issues.

	
  

	
10.

	
Notwithstanding any other provisions related to the imposition of sanctions or fines in this Contract, including any attachments, exhibits, addendums or amendments hereto, if the Health Plan fails to comply with the requirements of s. 409.91212, F.S., the Agency shall impose those administrative fines set forth in s. 409.91212(5) and (6), F.S.

	
  

	
11.

	
The Health Plan shall notify DHHS OIG and MPI within ten (10) business days of discovery of individuals who have met the conditions giving rise to mandatory or permissive exclusions per s. 1128, s. 1156, and s.1892 of the Social Security Act, 42 CFR 455.106, 42 CFR 1002.3, and 42 CFR 1001.1.

 

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

AHCA Contract No. FA905, Amendment No. 5, Page 11 of 45

  

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  

	
a.

	
In accordance with 42 CFR 455.106, the Health Plan shall disclose to DHHS OIG, with a copy to MPI within ten (10) business days after discovery, the identity of any person who:

 

	
  

	
(1)

	
Has ownership or control interest in the Health Plan, or is an agent or managing employee of the Health Plan; and

 

	
  

	
(2)

	
Has been convicted of a criminal offense related to that person's involvement in any program under Medicare, Medicaid, or the Title XX services program since the inception of those programs.

 

	
  

	
b.

	
In addition to the disclosure required under 42 CFR 455.106, the Health Plan shall also disclose to DHHS OIG with a copy to MPI within ten (10)  business days after discovery, the identity of any person described in 42 CFR 1002.3 and 42 CFR 1001.1001(a)(1), and to the extent not already disclosed, to additionally disclose any person who:

          

	
  

	
(1)

	
Has ownership or control interest in a Health Plan network provider, or subcontractor, or is an agent or managing employee of a Health Plan network provider or subcontractor; and

 

	
  

	
(2)

	
Has been convicted of a crime as identified in s. 1128 of the Social Security Act and/or conviction of a crime related to that person's involvement in any program under Medicare, Medicaid, or the Title XX services program since the inception of those programs;

 

	
  

	
(3)

	
Has been denied initial entry into the Health Plan’s network for program integrity-related reasons; or

 

	
  

	
(4)

	
Is a provider against whom the Health Plan has taken any action to limit the ability of the provider to participate in the Health Plan’s provider network, regardless of what such an action is called.  This includes, but is not limited to, suspension actions, settlement agreements and situations where an individual or entity voluntarily withdraws from the program or Health Plan provider network to avoid a formal sanction.

 

	
  

	
c.

	
The Health Plan shall submit the written notification referenced above to DHHS OIG via email to:  floridaexclusions@oig.hhs.gov and copy MPI via email to:  mpifo@ahca.myflorida.com.  Document information examples include but are not limited to court records such as indictments, plea agreements, judgments, and conviction/sentencing documents.

 

	
  

	
d.

	
In lieu of an email notification, a hard copy notification is acceptable to DHHS OIG at:

 

Attention:  Florida Exclusions

Office of the Inspector General

Office of Investigations

7175 Security Boulevard, Suite 210

Baltimore, MD 21244

AHCA Contract No. FA905, Amendment No. 5, Page 12 of 45

  

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

With a copy to MPI at:

 

Attention:  Florida Exclusions

Office of the Inspector General

Medicaid Program Integrity

2727 Mahan Drive, M.S. #6

Tallahassee, FL 32308-5403

	
20.

	
Attachment II, Core Contract Provisions, Section XI, Information Management and Systems, is hereby amended to include Item K., Social Networking as follows:

 

                K.  Social Networking

This section provides requirements for policy development, permitted uses of applications and acceptable content for social networking.  If the Health Plan chooses to use social networking applications/tools in its Medicaid line of business, these contract requirements apply to it and all communications by the Health Plan or its subcontractors with enrollees, providers and website requirements, when conducted through social networking applications.

	
           1.

	
General Requirements

	
  

	
a.

	
The Health Plan shall establish a social networking administrator, who can hold another position, but is ultimately responsible for the Health Plan’s policy development, implementation and oversight of all social networking activities.

	
  

	
b.

	
The Health Plan shall develop and maintain written social networking policies and procedures and a social networking monitoring plan in accordance with this Contract.  The policies and procedures shall include a statement of purpose/general information stating how the Health Plan uses social networking; for example, customer service, community outreach or notifications to enrollees and/or providers.  The social networking monitoring plan shall be developed in accordance with sub-item 5., Monitoring, of this section.

	
  

	
(1)

	
The Health Plan shall submit these policies, procedures and monitoring plan, including the intended uses and all initial social networking site static, distributed or broadcast content to BMHC for approval sixty (60) calendar days prior to the launch of any new social networking application.

	
  

	
(a)

	
Changes in social networking usage and/or content must be submitted to BMHC for approval sixty (60) calendar days prior to the effective date of the change.

	
  

	
(b)

	
The Health Plan shall evaluate and annually submit these policies, procedures and monitoring plan, including social networking site content to BMHC each September 1st.  However, if the policies, procedures or monitoring plan have been approved by BMHC within six (6) months prior to the annual evaluation/submission above, and are unchanged from the previous Contract year, the Health Plan shall submit an attestation to BMHC that the prior year’s social networking policies, procedures and monitoring plan are still in place.

 

AHCA Contract No. FA905, Amendment No. 5, Page 13 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  

	
(2)

	
The policies and procedures must include the requirement that, when using social networking applications, the protection of PHI and all HIPAA Privacy Rule-related information must be maintained and monitored.  The Health Plan shall ensure that social networking records are maintained in accordance with this Contract, for the purposes of monitoring of this requirement.

	
  

	
(3)

	
The social networking policies and procedures shall identify management resources, internal teams, external management resources (subcontractors) and human resources needed or used to monitor usage, analyze information trends and prepare responses for the public or private individuals/organizations.

	
  

	
(4)

	
The social networking policies and procedures shall specify record retention requirements in accordance with this Contract, and include those records kept of each update and who is responsible for the update as it occurs, updates, communications or messages posted, with identifying handle or representative code in order to specify which Health Plan employee has issued the communication.

	
  

	
c.

	
The Health Plan shall develop and maintain a social networking matrix that identifies staff and subcontractors participating in social networking activities on behalf of the Health Plan.  The Health Plan shall provide the Agency with unrestricted access to this matrix upon request.  This matrix shall be updated within one (1) business day of any change and include the following information for each person:

	
  

	
(1)

	
The social networking application name; for example, MySpace, Twitter, Facebook, Nixle.com, etc.;

	
  

	
(2)

	
First and last name of the individual;

	
  

	
(3)

	
Username (if applicable);

	
  

	
(4)

	
Email address;

	
  

	
(5)

	
Password; and

	
  

	
(6)

	
Description of the social networking role, responsibility usage and control.

	
  

	
d.

	
The Health Plan shall provide to its employees instruction and training on this Contract and the Health Plan’s social networking policies and procedures before using social networking applications on behalf of the Health Plan.

	
  

	
e.

	
The Health Plan is vicariously liable for any social networking violations of its employees, agents, vendors or subcontractors.

	
  

	
(1)

	
In addition to any other sanctions available in Attachment II, Section XIV, Sanctions, any violations of this section shall subject the Health Plan to administrative action by the Agency as determined by the Agency. The Health Plan may dispute any such administrative action pursuant to Attachment II, Section XVI, Terms and Conditions, Item I., Disputes.

AHCA Contract No. FA905, Amendment No. 5, Page 14 of 45

  

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  

	
(2)

	
The Health Plan shall report to BMHC any Health Plan staff who violates any requirements of the social networking policies and procedures or of this Contract within fifteen (15) calendar days of knowledge of such violation.

    

	
  

	
f.

	
The Health Plan shall comply with copyright and intellectual property law and shall reference or cite sources appropriately on all social networking sites.

	
  

	
g.

	
In addition to all other review and monitoring aspects of this Contract, the Agency reserves the right to monitor or review the Health Plan’s monitoring of all social networking activity without notice.

	
  

	
h.

	
The Health Plan shall ensure its social networking applications and sites comply with the community outreach and marketing requirements specified in Attachment II, Section IV, Enrollee Services, Community Outreach and Marketing, Item B., Community Outreach and Marketing, of this Contract.

	
           2.

	
Social Networking Applications

	
  

	
a.

	
The following social networking applications or media communications are permitted by the Agency upon its written approval:

	
  

	
(1)

	
Micro-blogging/Presence applications: Twitter, Plurk, Tumblr, Jaiku, fmylife;

	
  

	
(2)

	
Social networking: Bebo, Facebook, LinkedIn, MySpace, Orkut, Skyrock, Hi5, Ning, Elgg;

	
  

	
(3)

	
Social Network aggregation: NutshellMail, FriendFeed; and

	
  

	
(4)

	
Events: Upcoming, Eventful, Meetup.com.

	
  

	
b.

	
Unless listed in a. above, the following Health Plan social networking sites or media are prohibited.  Examples of prohibited social networking sites or media include but are not limited to:

	
  

	
(1)

	
Collaboration

	
  

	
(a)

	
Wikis:  Wikipedia, PBwiki, wetpaint;

	
  

	
(b)

	
Social bookmarking (or social tagging): Delicious, StumbleUpon, Google Reader, CiteULike;

	
  

	
(c)

	
Social news:  Digg, Mixx, Reddit, NowPublic; and

	
  

	
(d)

	
Opinion sites: epinions, Yelp.

	
  

	
(2)

	
Multimedia

	
  

	
(a)

	
Photo sharing:  Flickr, Zooomr, Photobucket, SmugMug, Picasa;

 

	
  

	
(b)

	
Video sharing:  YouTube, Vimeo, sevenload;

	
  

	
(c)

	
Livecasting: Ustream.tv, Justin.tv, Stickam; and

 

AHCA Contract No. FA905, Amendment No. 5, Page 15 of 45

  

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  

	
(d)

	
Audio and Music sharing:  imeem, The Hype Machine, Last.fm, ccMixter.

	
  

	
(3)

	
Reviews and Opinions

	
  

	
(a)

	
Product Reviews:  epinions.com, MouthShut.com; and

	
  

	
(b)

	
Community Q&A:  Yahoo! Answers, WikiAnswers, Askville, Google Answers.

	
  

	
(4)

	
Entertainment

	
  

	
(a)

	
Media and Entertainment Platforms:  Cisco Eos;

	
  

	
(b)

	
Virtual worlds:  Second Life, The Sims Online, Forterra; and

	
  

	
(c)

	
Game sharing:  Miniclip, Kongregate.

	
  

	
(5)

	
Other

(a)      Information aggregators:  Netvibes, Twine (website);

(b)      Platform providers:  Huzu; and

(c)      Blogs:  Blogger, LiveJournal, Open Diary, TypePad, WordPress, Vox, Expresssion Engine.

	
  

	
c.

	
In any invitation, link or information about third party social networking applications or sites presented by the Health Plan that requires a user to have a membership, the Health Plan shall clearly advise users of the following:

	
  

	
(1)

	
That participation will require the user to become a member of the third party host;

	
  

	
(2)

	
Disclaim the Health Plan’s responsibility for the third party membership; and

	
  

	
(3)

	
That the third party controls the membership, privacy, and data exchanged, and may use information for its own marketing purposes (or sell it.)

	
           3.

	
User Requirements

             

	
                   a.

	
The Health Plan’s presence on such social networking sites shall include an avatar and/or a username that clearly indicates the Health Plan that is being represented and cannot use any Agency logo or State of Florida seal.  When registering for social networking applications, the Health Plan shall use its email address.  If the application requires a username, the following syntax shall be used: http://twitter.com/<Healthplan_identifier><username>

	
  

	
b.

	
The Health Plan shall personalize its interactions to include an identifying handle or representative code in order to specify which Health Plan employee has issued the communication.  The Health Plan shall keep social networking records in accordance with social networking record retention requirements specified in Attachment II, Core Contract Provisions, Section XI, Information Management Systems, Item K., Social Networking, sub-item 1.b.(4).

 

AHCA Contract No. FA905, Amendment No. 5, Page 16 of 45

  

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  

	
c.

	
All Social Networking connections must be initiated by the external user and not the Health Plan.

	
  

	
d.

	
The Health Plan’s social networking interactions with the public must either be general broadcast messages of information availability or responses to inquiry that contain only referral to authoritative resources such as the Health Plan or appropriate state or federal agency websites (including emergency public health advisories).  The Health Plan shall not reference, cite, or publish information, views or ideas of any third party without the third party’s written consent and only as permitted by the Agency for the purpose of conducting business in accordance with this Contract.

	
  

	
e.

	
The Health Plan may distribute updates, messages and reminders only to registered friends/followers who have chosen to receive these types of communication whether actively or passively (through a subscription initiated by the external user).  Any subscription must be initiated by an opt-in from a user.  Any communication resulting from such a subscription shall include a link/method to opt-out of the subscription.

	
  

	
f.

	
The Health Plan shall not conduct business relating to this Contract that involves the communication of personal identifying, confidential or sensitive information on a Health Plan social network application.

	
  

	
g.

	
The Health Plan shall place photographs on pages that are hosted on the site and not linked from outside web pages.  The Health Plan shall not post information, photos, links/URLs or other items online that would reflect negatively on any individual(s), its enrollees, the Agency or the state.

	
  

	
h.

	
The Health Plan shall not place/embed video on its social networking sites.

	
  

	
i.

	
The Health Plan shall not tag photographic or video content and must remove all tags placed by others upon discovery.

	
  

	
j.

	
The Health Plan shall not allow advertising, whether targeted or general, on its social networking sites.

 

	
  

	
k.

	
The Health Plan shall not use affiliate/referral links or banners on its social networking sites.  This includes links to other non-Medicaid lines of business in which the Health Plan or a parent company is engaged.  The Health Plan shall ensure the following:

 

	
  

	
(1)

	
Any site that automatically generates such linkage, recommendation, or endorsement on side bars or pop-ups must contain a message prominently displayed in the area under the Health Plan’s control that such items, resources, and companies are NOT endorsed by the Health Plan or the Agency; and

	
  

	
(2)

	
Any external links on any websites controlled by the Health Plan must be clearly identified as external links and must pop up a warning dialog when clicked on informing the user that they are leaving the Health Plan site.

 

AHCA Contract No. FA905, Amendment No. 5, Page 17 of 45

  

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
           4.

	
Functionalities

	
  

	
a.

	
The following functionalities are permitted:

	
  

	
(1)

	
Search – Finding information through keyword search;

	
  

	
(2)

	
Links – Guides to other related information; and

	
  

	
(3)

	
Signals – The use of syndication technology such as RSS to notify users of content changes.

	
  

	
b.

	
The following functionalities are prohibited:

	
  

	
(1)

	
Authoring – The ability to create and update content leads to the collaborative work of many rather than just a few web authors.  In wikis, users may extend, undo and redo each other’s work.  In blogs, posts and the comments of individuals build up over time;

	
  

	
(2)

	
Tags – Categorization of content by users adding one-word descriptions to facilitate searching, without dependence on pre-made categories;

	
  

	
(3)

	
Extensions – Software that makes the Web and application platform as well as a document server; and

	
  

	
(4)

	
Forums – Sites hosted by  a company that allow users to create topics (threads) and post comments, questions, etc., that are available for public conversation among all members in the forum.

	
           5.

	
Monitoring

 The Health Plan shall include the following social networking areas in its monitoring:

	
  

	
a.

	
Social networking matrix of users as specified in Section K.1.c. of this section;

 

	
  

	
b.

	
Social networking content updates and posting;

	
  

	
c.

	
Social networking records retention; and

	
  

	
d.

	
Social networking permitted and prohibited activities and functionalities.

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

 

 

 

 

AHCA Contract No. FA905, Amendment No. 5, Page 18 of 45

  

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
21.

	
Attachment II, Core Contract Provisions, Section XII, Reporting Requirements, Item A., Health Plan Reporting Requirements, Table 1-A, Revised Summary of Reporting Requirements, is hereby deleted in its entirety and replaced with Table 1-B, Revised Summary of Reporting Requirements, as follows.  All references in the Contract to Table 1-A shall hereinafter refer to Table 1-B.

 

TABLE 1-B

REVISED SUMMARY OF REPORTING REQUIREMENTS

	
  Contract 

Section

	
Report Name

	
Plan Type

	
Frequency

	
Submit To

	
Section II and Exhibit 2

	
Benefit Maximum Report

	
Ref HMO;

Ref FFS PSN;

Ref Cap PSN;

CCC

 

	
Monthly, fifteen (15) calendar days after the end of the reporting month in which claims reach $450,000 in enrollee costs

	
HSD Contract Manager once $450,000 is reached, and to BMHC that initial month and monthly thereafter through the end of the Contract year

	
Section III and Exhibit 3

	
Newborn Enrollment Report

	
NR FFS PSN;

Ref FFS PSN;

CCC

	
Weekly, on Wednesday

	
Medicaid Area Office

	
Section III and Exhibit 3

	
Involuntary Disenrollment Report

	
Ref HMO;

Ref FFS PSN;

Ref Cap PSN;

CCC;

HIV/AIDS

	
Monthly, first Thursday of month

	
Choice Counseling Vendor

	
Section IV

	
Medicaid Redetermination Notice Summary Report

	
All Plans that participate per Attachment I

	
Quarterly, forty-five (45) calendar days after end of reporting quarter

	
BMHC

	
Section IV

	
Community Outreach Health Fairs/Public Events Notification

	
All Plans

	
Monthly, no later than 20th calendar day of month before event month; amendments two (2) weeks before event

	
BMHC

 

AHCA Contract No. FA905, Amendment No. 5, Page 19 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract

Section

	
Report Name

	
Plan Type

	
Frequency

	
Submit To

	
Section IV

	
Community Outreach Representative Report

	
All Plans

	
Two (2) weeks before activity

 

Quarterly, forty-five (45) calendar days after end of reporting quarter

	
BMHC

	
Section V and Exhibit 4

	
Enhanced Benefits Report

	
Ref HMO;

Ref FFS PSN;

Ref Cap PSN;

CCC;

HIV/AIDS

	
Monthly, ten (10) calendar days after end of reporting month

	
BMHC

	
Section V, Exhibit 5

	
Customized Benefit Notifications Report

	
Ref HMO;

Ref Cap PSN

	
Monthly, fifteen (15) calendar days after end of reporting month

	
BMHC

	
Section V

	
CHCUP (CMS-416) & FL 60% Screening (Child Health Check Up report)

	
All Plans

	
Annually, unaudited by January 15th for prior federal fiscal year;

Annually, audited report by October 1st

	
BMHC

	
Section V

	
Inpatient Discharge Report

	
NR Ref HMO;

NR Cap PSN;

Ref HMO;

Ref Cap PSN;

HIV/AIDS

	
Quarterly, thirty (30) calendar days after end of reporting quarter

	
BMHC

 

AHCA Contract No. FA905, Amendment No. 5, Page 20 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract

Section

	
Report Name

	
Plan Type

	
Frequency

	
Submit To

	
Section V

	
Hernandez Settlement Ombudsman Log

	
NR HMO;

NR FFS PSN*;

NR Cap PSN;

Ref HMO;

Ref FFS PSN*;

Ref Cap PSN;

CCC*;

HIV/AIDS

 

* If the FFS Health Plan has authorization requirements for prescribed dru  services

	
Quarterly, fifteen (15) calendar days after end of reporting quarter

	
BMHC

	
Section V

	
Hernandez Settlement Agreement Survey

	
NR HMO;

NR FFS PSN*;

NR Cap PSN;

Ref HMO;

Ref FFS PSN*;

Ref Cap PSN;

CCC*;

HIV/AIDS

 

* If the FFS Health Plan has authorization requirements for prescribed drug services

	
Annually, on August 1st

	
BMHC

	
Section V and Exhibit 6

	
Behavioral Health – Pharmacy Encounter Data Report

	
NR HMO;

Ref HMO;

Ref Cap PSN;

HIV/AIDS

	
Quarterly, forty-five (45) calendar days after end of

Reporting quarter

	
BMHC

	
Section V

	
Pharmacy Navigator Report

	
Ref HMO;

Ref Cap PSN;

HIV/AIDS

	
Annually, by December 1st

	
Choice Counseling Vendor

 

AHCA Contract No. FA905, Amendment No. 5, Page 21 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract

Section

	
Report Name

	
Plan Type

	
Frequency

	
Submit To

	
Section VI, Exhibit 6

	
Behavioral Health Annual 80/20 Expenditure Report

 

	
NR HMO

	
Annually, by April 1st;

 

Supplemental file due February 1st of the following year for plans that reported IBNR

	
BMHC

	
Section VI, Exhibit 6

	
Behavioral Health Critical Incident Report - Individual

	
NR HMO;

Ref-HMO;

Ref. FFS PSN; Ref Cap. PSN;

CCC;

HIV/AIDS

	
Immediately, no later than twenty-four (24) hours after occurrence or knowledge of incident

	
BMHC

	
Section VI, Exhibit 6

	
Behavioral Health Critical Incident Report - Summary

	
NR HMO;

Ref HMO;

Ref FFS PSN;

Ref Cap PSN;

CCC;

HIV/AIDS

	
Monthly, by the 15th

	
BMHC

	
Section VI, Exhibit 6

	
Behavioral Health - Required Staff/Providers Report

	
NR HMO;

Ref HMO;

Ref FFS PSN;

Ref Cap PSN;

CCC;

HIV/AIDS

	
Quarterly, forty-five (45) calendar days after end of reporting quarter for Health Plans operating less than one (1) year;

 

Annually, by August 15th, for all other Health Plans

	
BMHC

	
Section VI, Exhibit 6

	
Behavioral Health - FARS/CFARS

	
NR HMO

Ref HMO;

Ref FFS PSN;

Ref Cap PSN;

CCC;

HIV/AIDS

	
Semi-Annually, August 15th and February 15th

	
BMHC

	
Section VI, Exhibit 6

	
Behavioral Health - Enrollee Satisfaction Survey Summary

	
NR HMO;

Ref HMO;

Ref FFS PSN;

Ref Cap PSN;

CCC;

HIV/AIDS

	
Annually by March 1st

	
BMHC behavioral health analyst

 

AHCA Contract No. FA905, Amendment No.  5, Page 22 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract

Section

	
Report Name

	
Plan Type

	
Frequency

	
Submit To

	
Section VI, Exhibit 6

	
Behavioral Health - Stakeholders’ Satisfaction Survey  Summary

	
NR HMO;

Ref HMO;

Ref FFS PSN;

Ref Cap PSN;

CCC;

HIV/AIDS

	
Annually, by March 1st

	
BMHC

	
Section VI, Exhibit 6

	
Behavioral Health - Encounter Data Report

	
NR HMO;

Ref HMO;

Ref Cap PSN;

HIV/AIDS

	
Quarterly, forty-five (45) calendar days after end of reporting quarter

	
BMHC

	
Section VII

	
Provider Network File

	
All Plans

	
Monthly, first Thursday of month (optional weekly submissions each Thursday for remainder of month)

	
AHCA Choice Counseling

Vendor and Medicaid fiscal agent for Reform;

 

For non-Reform, to Medicaid fiscal agent and BMHC

	
Section VII

	
Provider Termination and New Provider Notification Report

	
All Plans

	
Summary of new and terminated providers due monthly, by the fifteenth (15th) calendar day of the month following the reporting month

	
BMHC

	
Section VII

	
PCP Wait Times Report

	
All Plans

	
Annually, by February 1st

	
BMHC

	
Section VIII

	
Cultural Competency Plan (and Annual Evaluation)

	
All Plans

	
Annually, June 1st

	
BMHC

	
Section VIII and Exhibit 5

	
Performance Measures

	
All Plans

	
Annually, on July 1st

	
BMQM

	
Section IX

	
Complaints, Grievance, and Appeals Report

	
All Plans

	
Quarterly, fifteen (15) calendar days after end of quarter

	
BMHC

 

AHCA Contract No. FA905, Amendment No. 5, Page 23 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract

Section

	
Report Name

	
Plan Type

	
Frequency

	
Submit To

	
Section X

	
MPI – Quarterly Fraud & Abuse Activity Report

	
All Plans

	
Quarterly, fifteen (15) calendar days after the end of reporting quarter

	
MPI

	
Section X

	
MPI – Annual Fraud & Abuse Activity  Report

	
All Plans

	
Annually by September 1st.

	
MPI

	
Section X

	
MPI - Suspected/Confirmed Fraud & Abuse Reporting

	
All Plans

	
Within fifteen (15) calendar days of detection

	
MPI

	
Section X

	
Claims Aging Report & Supplemental Filing Report

	
All Plans

	
Quarterly, forty-five (45) calendar days after end of reporting quarter;

 

Capitated Plans, optional supplemental filing – one-hundred and five (105) calendar days after end of reporting quarter

	
BMHC

	
Section XIII, Exhibit 13

	
Medicaid Reform Supplemental HIV/AIDS Report

	
Ref HMO;

Ref FFS PSN;

Ref Cap PSN;

CCC;

HIV/AIDS

	
Monthly, by second Thursday of month

	
BMHC

	
Section XIII, Exhibit 13

	
Catastrophic Component Threshold Report

	
Ref HMO;

Ref FFS PSN;

Ref Cap PSN; CCC per Attachment I

	
Monthly, fifteen (15) calendar days after end of reporting month

	
BMHC

	
Section XV, Exhibit 15

	
Insolvency Protection Multiple Signatures Agreement Form

	
NR HMO;

NR Cap PSN;

Ref HMO;

Ref Cap PSN;

HIV/AIDS

	
Annually, by April 1st;

 

Thirty (30) calendar days after any change

	
BMHC

 

AHCA Contract No. FA905, Amendment No. 5, Page 24 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract

Section

	
Report Name

	
Plan Type

	
Frequency

	
Submit To

	
Section XV

	
Audited Annual and Unaudited Quarterly Financial Reports

	
All Plans except CCC

	
Audited - Annually by April 1st for calendar year;

 

Unaudited – Quarterly, forty-five (45) calendar days after end of reporting quarter

	
BMHC

NR HMO = Non-Reform health maintenance organization, includes Health Plans covering Frail/Elderly Program services as specified in Attachment I

Ref HMO = Reform health maintenance organization

Ref Cap PSN = Reform capitated provider service network

Ref FFS PSN = Reform Fee-for-Service Provider Service Network

NR Cap PSN = Non-Reform Capitated Provider Service Network

NR FFS PSN = Non-Reform Fee-for-Service Provider Service Network

CCC = Specialty plan for children with chronic conditions

HIV/AIDS = Specialty plan for recipients living with HIV/AIDS

	
22.

	
Attachment II, Core Contract Provisions, Section XII, Reporting Requirements, Item A., Health Plan Reporting Requirements, Table 2-B, Revised Summary of Submission Requirements, is hereby deleted in its entirety and replaced with Table 2-C, Revised Summary of Submission Requirements, as follows.  All references in the Contract to Table 2-B shall hereinafter refer to Table 2-C.

TABLE 2-C

REVISED SUMMARY OF SUBMISSION REQUIREMENTS

	
  Contract 

Section

	
Submission

	
Plan Type

	
Frequency

	
Submit To

	
Attachment I, Section B., Item3.a.

	
Increase in enrollment levels

	
Capitated Health Plans;

FFS PSNs;

CCC

	
Before increases occur

	
BMHC and HSD

	
Attachment I, Section D., Item 3.b.

	
Changes to optional or expanded services

	
FFS PSNs;

CCC

	
Annually, by June 15th

	
HSD

	
Attachment I, Section D., Item 3.c.

	
Changes to optional or expanded services

	
Capitated Health Plans

	
Annually, by June 15th

	
HSD

	
 

i.Subsequent references are to Attachment II and its Exhibits

 

AHCA Contract No. FA905, Amendment No. 5, Page 25 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract 

Section

	
Submission

	
Plan Type

	
Frequency

	
Submit To

	
Section II, Item D.4.

	
Policies, procedures, model provider agreements & amendments, subcontracts, All materials related to Contract for distribution to enrollees, providers, public

	
All

	
Before beginning use; whenever changes occur

	
BMHC

	
Section II, Item D.4.a.

	
Written materials

	
All

	
Forty-five (45) calendar days before effective date

	
BMHC

	
Section II, Item D.4.b

	
Written notice of change to enrollees

	
All

	
Thirty (30) calendar days before effective date

	
Enrollees affected

	
Section II, Item D.6.

	
Enrollee materials, PDL, provider & enrollee handbooks

	
All

	
Available on Health Plan’s website without log-in

	
Plan website

	
Section III, Item B.3.c.(1)

	
Enrollee pregnancy

	
All

	
Upon confirmation

	
DCF & MPI

	
Section III, Item B.3.c.(3)

	
Unborn activation notice

	
All

	
Presentation for delivery

	
DCF & MPI

	
Section III, Item B.3.d.

	
Birth information if no unborn activation

	
All

	
Upon delivery

	
DCF

	
Section III, Item C.4.b.

	
Involuntary disenrollment request

	
All

	
Forty-five (45) calendar days before effective date

	
BMHC

	
Section III, Item C.4.e.

	
Notice that Health Plan is requesting disenrollment in next Contract month

	
All

	
Before effective date

	
Enrollees affected

 

AHCA Contract No. FA905, Amendment No. 5, Page 26 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract 

Section

	
Submission

	
Plan Type

	
Frequency

	
Submit To

	
Section IV, Item A.1.e.

	
Notice of reinstatement

	
All

	
By 1st calendar day of month after learning of reinstatement or within five (5) calendar days from receipt of enrollment file, whichever is later

	
Enrollee affected

	
Section IV, Item A.2.a. and Item A. 6.a.(17); Section VIII, Item A.4.

	
How to get Health Plan information in alternative formats

	
All

	
Include in cultural competency plan and enrollee handbook, and upon request

	
Enrollees & potential enrollees

	
Section IV, Item A.2.c.

	
Right to get information about Health Plan

	
All

	
Annually

	
Enrollees

	
Section IV, Item A.7.c.

	
Provider directory online file

	
All

	
Update monthly & submit attestation

	
BMHC

	
Section IV, Item A.9.a.

	
Enrollee assessments

	
All

	
Within thirty (30) calendar days of enrollment notify about pregnancy screening

	
Enrollees

	
Section IV, Item A.9.c.

	
Enrollees more than 2 months behind in periodicity screening

	
All

	
Contact twice, if needed

	
Enrollees who meet criteria

	
Section IV, Item A.11.f.

	
Toll-free help line performance standards

	
All

	
Get approval before beginning operation

	
BMHC

	
Section IV, Item A.12. and Item A.,6.a.(17); Section VIII, Item A.4.

	
How to access translation services

	
All

	
Include in cultural competence plan and enrollee handbook

	
Enrollees

	
Section IV, Item A.14.a.

	
Incentive program

	
All

	
Get approval before offering

	
BMHC

	
Section IV, Item A.14.g.

	
Pre-natal care programs

	
All

	
Before implementation

	
BMHC

 

AHCA Contract No. FA905, Amendment No. 5, Page 27 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract 

Section

	
Submission

	
Plan Type

	
Frequency

	
Submit To

	
Section IV, Item A.17.c.

	
Notice of change in participation in redetermination notices

	
All

	
Annually, by June 1st, if change in plan participation

	
BMHC

	
Section IV, Item A.17.c.(1)

	
Redetermination policies & procedures

	
All

	
When Health Plan agrees to participate

	
BMHC

	
Section IV, Item A.17.c.(1)(a)

	
Notice in writing to discontinue  Medicaid redetermination date data use

	
All

	
Thirty (30) calendar days before stopping

	
BMHC

	
Section IV, Item B.3.c.

	
Member services phone script responding to community outreach calls and outreach materials

	
All

	
Before use

	
BMHC

	
Section IV, Item B.4.c.

	
In case of force majeure, notice of participation in health fair or other public event

	
All

	
By day of event

	
BMHC

	
Section IV, Item B.6.f.

	
Report of staff or community outreach rep. violations

	
All

	
Within fifteen (15) calendar days of knowledge

	
BMHC

	
Section V, Item C.1.

	
Written details of expanded services

	
All

	
Before implementation

	
HSD

	
Section V, Item F.

	
Decision to not offer a service on moral/religious grounds

	
All

	
One-hundred and twenty (120) calendar days before implementation

 

Thirty (30) calendar days before implementation

	
BMHC

 

 

 

 

Enrollees

 

AHCA Contract No. FA905, Amendment No. 5, Page 28 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract 

Section

	
Submission

	
Plan Type

	
Frequency

	
Submit To

	
Section V, Item H.10.b.2.

	
UNOS form & disenrollment request for specified transplants

	
All

	
When enrollee listed

	
BMHC

	
Section V, Item H.14.e.

	
Attestation that the Health Plan has advised providers to enroll in VFC program

	
All

	
Annually, by October 1st

	
BMHC

	
Section V, Item H.16.a.(4)

	
PDL update

	
All

	
Annually, by October 1st.

Thirty (30) calendar days written notice of change.

	
BMHC and Bureau of Medicaid Pharmacy Services

	
Section VII, Item A.2.

	
Capacity to provide covered services

	
All

	
Before taking enrollment

	
BMHC

	
Section VII, Item C.1.

	
Request for initial or expansion review

	
All

	
When requesting initial enrollment or expansion into a county.

	
BMHC and HSD

	
Section VII, Item C.2.

	
Compliance with access requirements following significant changes in service area or new populations

	
All

	
Before expansion

	
BMHC and HSD

	
Section VII, Item C.3.

	
Significant network changes

	
All

	
Within seven (7) business days

	
BMHC

	
Section VII, Item C.5.

	
When PCP leaves network

	
All

	
Within fifteen (15) calendar days of knowledge.

A copy of the enrollee notice for terminated providers is due no more than fifteen (15) calendar days after receipt of the PCP termination notice.

	
BMHC & affected enrollees

 

AHCA Contract No. FA905, Amendment No. 5, Page 29 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract 

Section

	
Submission

	
Plan Type

	
Frequency

	
Submit To

	
Section VII, Item D.2.jj.

	
Waiver of provider agreement indemnifying clause

	
All

	
Approval before use

	
BMHC

	
Section VII, Item E.3.

	
Notice of terminated providers due to imminent danger/impairment

	
All

	
Immediate

	
BMHC and Provider

	
Section VII, Item E.4.

	
Termination or suspension of providers; for “for cause” terminations, include reasons for termination

	
All

	
Sixty (60) calendar days before termination effective date

	
BMHC, affected enrollees, & provider

	
Section VII, Item H.8.

 

 

	
Notice of individuals with conditions giving rise to permissive or mandatory exclusions

 

 

	
All

	
Within ten (10) business days of learning of the health care-related criminal conviction;

 

or

 

Denial of credentialing for program integrity related reasons, or  other required disclosure.

	
DHHS OIG

 

With a copy to

 

MPI

	
Section VIII, Item A.1.b.

	
Written Quality Improvement Plan

	
All

	
Within thirty (30) calendar days of initial Contract execution;

Thereafter, Annually by April 1st.

	
BMHC

	
Section VIII, Item A.3.a.(7)(a)

	
Proposal for each planned PIP

	
All

	
Ninety (90) calendar days after Contract execution.

 

	
BMHC

	
Section VIII, Item A.3.a.(7)(b)

	
Annual PIP proposal for each planned PIP

	
All

	
Thereafter, Annually by August 1

	
BMHC

 

AHCA Contract No. FA905, Amendment No. 5, Page 30 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract 

Section

	
Submission

	
Plan Type

	
Frequency

	
Submit To

	
Section VIII, Item A.3.c.(1)

	
Performance measure data and auditor certification

	
All

	
Annually by July 1st

	
BMQM

	
Section VIII, Item A.3.c.(4)

	
Performance measure action plan

	
All

	
Within thirty (30) calendar days of determination of unacceptable performance

	
BMQM

	
Section VIII, Item A.3.e.(7)

	
Written strategies for medical record review

	
All

	
Before use

	
BMHC

	
Section VIII, Item B.1.a.(4)(a)

	
Service authorization protocols & any changes

	
All

	
Before use

	
BMHC

	
Section VIII, Item B.4.

	
Changes to UM component

	
All

	
Thirty (30) calendar days before effective date

	
BMHC

	
Section IX, Item A.8.

	
Complaint log

	
All

	
Upon request

	
BMHC

	
Section X, Item B.2.

	
Changes in staffing

	
All

	
Five (5) business days of any change

	
BMHC & HSD

	
Section X, Item B.2.b.

	
Full-Time Administrator

	
All

	
Before designating duties of any other position

	
BMHC

	
Section X, Item D.3.a.

	
Reform and non-Reform historical encounter data for all typical and atypical services

	
All

	
According to Agency-approved schedules and no later than 10/31/09

	
MEDS team & Agency Fiscal Agent

	
Section X, Item D.3.b.

	
Encounter data for all typical and atypical services

	
All

	
Within sixty (60) calendar days following end of month in which Health Plan paid claims for services, and as specified in MEDS Companion Guide

	
MEDS Team & Agency Fiscal Agent

	
Section X, Item E.3.b.

	
Subcontract for investigation of Fraud and Abuse

	
All

	
At least sixty (60) calendar days before anticipated subcontract execution date

	
MPI

 

AHCA Contract No. FA905, Amendment No. 5, Page 31 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract 

Section

	
Submission

	
Plan Type

	
Frequency

	
Submit To

	
Section X, Item E.3.c.

	
Executed Subcontract for investigation of Fraud and Abuse

	
All

	
Within thirty (30) calendar days after subcontract execution

	
MPI

	
Section X, Item E.3.d.

	
Corporate Integrity Agreements and/or Corporate Compliance Agreements

	
All

	
Within thirty (30) calendar days after execution

	
MPI

	
Section X, Item E.3.e.

	
Corrective Action Plans required by the Florida Department of Financial Services (DFS) and/or Federal governmental entities

	
All

	
Within thirty (30) calendar days after execution

	
MPI

	
Section X, Item E.5.

	
Compliance plan, anti-fraud plan, and related fraud and abuse policies & procedures

	
All

	
Within forty-five (45) calendar days after Agency contract execution;

 

Upon initial implementation or revision; or

 

As requested by MPI

	
MPI

	
Section X, Item E.5.b.

	
Anti-fraud plan annual submission

	
All

	
Annually on July 1st, upon revision, or as requested by MPI.

	
MPI

 

AHCA Contract No. FA905, Amendment No. 5, Page 32 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract 

Section

	
Submission

	
Plan Type

	
Frequency

	
Submit To

	
Section X, Item E.11.

	
Notice of individuals with conditions giving rise to permissive or mandatory exclusions

 

 

	
All

	
Within ten (10) business days of learning of the health care-related criminal conviction;

 

or

 

Denial of credentialing for program integrity related reasons, or  other required disclosure.

	
DHHS OIG

 

With a copy to

 

MPI

	
Section XI, Item D.4.a.

	
Any problem that threatens system performance

	
All

	
Within one (1) hour

	
Applicable Agency staff

	
Section XI, Item D.8.a.

 

	
Business Continuity-Disaster Recovery Plan

	
All

	
Before beginning operation.

Ten (10) business days before change.

 

Certification if plan is unchanged by April 30th, annually thereafter.

 

 

	
BMHC

	
Section XI, Item E.1.

	
System changes

	
All

	
Ninety (90) calendar days before change

	
HSD

 

AHCA Contract No. FA905, Amendment No. 5, Page 33 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract 

Section

	
Submission

	
Plan Type

	
Frequency

	
Submit To

	
Section XI, Item K.1.b.

	
Social Networking policies, procedures and monitoring plan

	
All

	
Sixty (60) calendar days before beginning any new social networking application;

 

Sixty (60) calendar days before change in policy, procedure or monitoring plan;

 

Attestation if policies, procedures and monitoring plan are unchanged by September 1 of each Contract year.

	
BMHC

	
Section XI, Item K.1.b.

	
Social networking content and intended use

	
All

	
Sixty (60) calendar days before launch of any new social networking application or policy, procedure or monitoring plan;

 

Sixty (60) calendar days before effective date of change in usage and/or content.

	
BMHC

	
Section XIV, Item A.1.(a)

	
Corrective action plan

	
All

	
Within ten (10) business days of notice of violation or non-compliance with Contract

	
Agency Bureau sending violation notice

	
Section XIV, Item A.1.(b)

	
Performance measure action plan

	
All

	
Within thirty (30) calendar days of notice of failure to meet a performance standard

	
BMQM

	
Section XV, Item C.

	
Proof of working capital

	
All

	
Before enrollment

	
BMHC

	
Section XV, Item G.2.

	
Physician incentive plan

	
All

	
Written description  before use

	
BMHC

	
Section XV, Item H.

	
Third party coverage identified

	
All

	
As soon as known

	
Medicaid Third Party Liability Vendor

 

AHCA Contract No. FA905, Amendment No. 5, Page 34 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract 

Section

	
Submission

	
Plan Type

	
Frequency

	
Submit To

	
Section XV, Item I.

	
Proof of fidelity bond coverage

	
All

	
Within sixty (60) calendar days of Contract execution & before delivering health care

	
HSD Contract manager

	
Section XVI, Item C.1.

	
Request for assignment or transfer of contract in approved merger/acquisition

	
All

	
Ninety (90) days before effective date

	
HSD

	
Section XVI, Item M.

	
Use of “Medicaid” or “AHCA”

	
All

	
Before use

	
BMHC

	
Section XVI, Item O.

	
All subcontracts for Agency approval

	
All

	
Before effective date

	
BMHC

	
Section XVI, Item O.1.f.

	
Subcontract monitoring schedule

	
All

	
Annually, by December 1st

	
BMHC

	
Section XVI, Item V.1.

	
Ownership & management disclosure forms

	
All

	
With initial application; and then annually by September 1st

	
HSD – for initial application;

BMHC & HSD for annual

	
Section XVI, Item V.1.

	
Changes in ownership & control

	
All

	
Within five (5) calendar days of knowledge & sixty (60) days before effective date

	
BMHC & HSD

	
Section XVI, Item V.4.a.

	
Fingerprints for principals

	
All

	
Before Contract execution.

 

	
HSD

	
Section XVI, Item V.4.c.

	
Fingerprints of newly hired principals

	
All except CCC

	
Within thirty (30) calendar days of hire date

	
HSD

	
Section XVI, Item V.5.

	
Information about offenses listed in 435.04

	
All

	
Within five (5) business days of knowledge

	
HSD

	
Section XVI, Item V.6.

	
Corrective action plan related to principals committing offenses under 435.04

	
All

	
As prescribed by the Agency

	
HSD

 

AHCA Contract No. FA905, Amendment No. 5, Page 35 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract 

Section

	
Submission

	
Plan Type

	
Frequency

	
Submit To

	
Section XVI, Item Y.

	
General insurance policy declaration pages

	
All except CCC

	
Annually upon renewal

	
BMHC

	
Section XVI, Item Z.

	
Workers’ compensation insurance declaration page

	
All except CCC

	
Annually upon renewal

	
BMHC

	
Section XVI, Item BB.

	
Emergency Management Plan

	
All

	
Before beginning operation and by May 31st annually thereafter

	
BMHC

	
Exhibit 2, Section II, Item D.4.c.

	
Policies & procedures for screening for clinical eligibility & any changes to them

	
CCC

	
Before implementation

	
BMHC

	
Exhibit 3, Section III, Item C.5.

	
Disenrollment notice

	
CCC

	
Get template approved before use

 

At least two (2) months before anticipated effective date of involuntary disenrollment

	
BMHC

 

 

Enrollee

	
Exhibit 5, Section V, Item A.6.

	
Letters about exhaustion of benefits under customized benefit package

	
Reform capitated Health Plans

	
Before use

	
BMHC

	
Exhibit 5, Section V, Item H.20.g.

	
Transportation subcontract

	
NR HMO offering transportation; Reform Health Plans

	
Before execution

	
BMHC

	
Exhibit 5, Section V, Item H.20.h.

	
Transportation policies & procedures

	
NR HMO offering transportation; Reform Health Plans

	
Before use

	
BMHC

 

AHCA Contract No. FA905, Amendment No. 5, Page 36 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract 

Section

	
Submission

	
Plan Type

	
Frequency

	
Submit To

	
Exhibit 5, Section V, Item H.20.i.

	
Transportation adverse incidents

	
NR HMO offering transportation; Reform Health Plans

	
Within two (2) business days of the occurrence

	
BMHC

	
Exhibit 5, Section V, Item H.20.i.

	
Transportation suspected fraud

	
NR HMO offering transportation; Reform Health Plans

	
Immediately upon identification

	
MPI

	
Exhibit 5, Section V, Item H.20.p.

	
Transportation performance measures

	
NR HMO offering transportation; Reform Health Plans

	
Annually report by July 1st

	
BMQM

	
Exhibit 5, Section V, Item H.20.q. & r.

	
Attestation that Health Plan complies with transportation policies & procedures & drivers pass background checks & meet qualifications

	
NR HMO offering transportation; Reform Health Plans

	
Annually by January 1st

	
BMHC

	
Exhibit 6, Item A.3.

	
Review & approval of behavioral health services staff & subcontractors for licensure compliance

	
Reform Health Plans & NR HMOs

	
Before providing services

	
BMHC

	
Exhibit 6, Item B.9.

	
Model agreement with community mental health centers

	
Reform Health Plans & NR HMOs

	
Before agreement is executed

	
BMHC

	
Exhibit 6, Item C.3.e.

	
Denied appeals from providers for emergency services claims

	
Plans covering behavioral health

	
Within ten (10) calendar days after Health Plan’s final denial

	
BMHC

 

AHCA Contract No. FA905, Amendment No. 5, Page 37 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract 

Section

	
Submission

	
Plan Type

	
Frequency

	
Submit To

	
Exhibit 6, Item C.5.a.(3)

	
Medical necessity criteria for community mental health services

	
Plans covering behavioral health

	
Before use and before changes implemented

	
BMHC

	
Exhibit 6, Item L.2.

	
MBHO staff psychiatrist and model contracts for each specialty type

	
Plans covering behavioral health

	
Before execution

	
BMHC

	
Exhibit 6, Item M.

	
Optional services

	
Plans covering behavioral health

	
Before offering

	
BMHC

	
Exhibit 6, Item R.3.a.

	
Schedule for administrative and program monitoring and clinical record review

	
Plans covering behavioral health

	
Annually by July 1st

	
BMHC

	
Exhibit 8, Section VIII, Item B.5.

	
Substitute disease management initiatives

	
CCC

	
Within sixty (60) calendar days of Contract execution

	
BMHC

	
Exhibit 8, Section VIII, Item A.3.f.

	
Provider satisfaction survey plan & questions

	
All Reform Health Plans

	
By end of 8th month of Contract for approval

	
BMHC

	
Exhibit 8, Section VIII, Item A.3.f.

	
Provider satisfaction survey results

	
All Reform Health Plans

	
Four (4) months after the beginning of the 2nd year of Contract

	
BMHC

	
Exhibit 8, Section VIII, Item B.5.b.

	
Policies and procedures and program descriptions for each disease management program

	
All Reform Health Plans

	
Annually, by April 1st

	
BMHC

	
Exhibit 8, Section VIII, Item B.1.e. (5)

	
Caseload maximums for case managers

	
HIV/AIDS specialty plan

	
Before providing services

	
BMHC

	
Exhibit 10, Section X, Item C.5.a.

	
Discrepancies in ERV

	
FFS Health Plans;

CCC

	
Within ten (10) business days of discovery

	
HSD analyst

 

AHCA Contract No. FA905, Amendment No. 5, Page 38 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  Contract 

Section

	
Submission

	
Plan Type

	
Frequency

	
Submit To

	
Exhibit 15, Section XV, Item A.1.a.

	
Conversion application to capitated Health Plan

	
FFS PSNs;

CCC

	
By September 1, 2012

	
HSD

	
Exhibit 15, Section XV, Item I.

	
Proof of coverage for any non-government subcontractor

	
CCC

	
Within sixty (60) calendar days of execution and before delivery of care

	
BMHC

	
Exhibit 16, Section XVI, Item V.4.c.

	
Fingerprints of newly hired principals

	
CCC

	
Within thirty (30) calendar days of hire date

	
Letter to HSD contract manager with list of hires and FDLE screening results

NR HMO = Non-Reform health maintenance organization, includes Health Plans covering Frail/Elderly Program services as specified in Attachment I

Ref HMO = Reform health maintenance organization

Ref Cap PSN = Reform capitated provider service network

Ref FFS PSN = Reform Fee-for-Service Provider Service Network

NR Cap PSN = Non-Reform Capitated Provider Service Network

NR FFS PSN = Non-Reform Fee-for-Service Provider Service Network

CCC = Specialty plan for children with chronic conditions

HIV/AIDS = Specialty plan for recipients living with HIV/AIDS

	
23.

	
Attachment II, Core Contract Provisions, Section XIV, Sanctions, Item A., General Provisions, sub-item 1.(b) is hereby amended to now read as follows:

	
  

	
(b)

	
If the Agency determines that the Health Plan has not met its performance standards, the Health Plan shall submit to the Bureau of Medicaid Quality Management (BMQM) a performance measure action plan (PMAP) within thirty (30) calendar days of receiving notice from the Agency.

	
24.

	
Attachment II, Core Contract Provisions, Section XIV, Sanctions, Item E., Civil Monetary Penalties, is hereby amended to include sub-item 5. as follows:

	
  

	
5.

	
Notwithstanding the provisions of this Section, the Health Plan is subject to the fines set forth in s. 409.91212, F. S.  See Attachment II, Section X, Administration and Management, Item E., Fraud and Abuse Prevention, of this Contract.

 

25.           Attachment II, Core Contract Provisions, Section XVI, Terms and Conditions, Item C., Assignment, is hereby amended to include sub-item 5. as follows:

	
  

	
5.

	
The entity requesting the assignment or transfer and the acquiring/merging entity must work with the Agency to develop and implement an Agency-approved transition plan, to include a timeline and appropriate notices to all enrollees and all providers as required by the Agency and to ensure a seamless transition for enrollees, particularly those requiring care coordination/case management.

 

AHCA Contract No. FA905, Amendment No. 5, Page 39 of 45

  

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
26.

	
Attachment II, Core Contract Provisions, Section XVI, Terms and Conditions, Item O., Subcontracts, sub-item 1.c. is hereby amended to now read as follows:

	
  

	
c.

	
The Agency encourages use of minority business enterprise subcontractors.  See Attachment II, Section VII, Provider Network, Item D., Provider Contract Requirements, for provisions and requirements specific to provider contracts.  See Attachment II, Section XVI, Terms and Conditions, Item W., Minority Recruitment and Retention Plan, for other minority recruitment and retention plan requirements.

	
27.

	
Attachment II, Core Contract Provisions, Section XVI, Terms and Conditions, Item V., Ownership and Management Disclosure, sub-items 4., 5. and 6. are hereby deleted in their entirety and replaced as follows:

	
  

	
4.

	
By September 1st of each Contract Year, the Health Plan shall conduct an annual background check with the Florida Department of Law Enforcement on all persons with five percent (5%) or more ownership interest in the Health Plan, or who have executive management responsibility for the Health Plan, or have the ability to exercise effective control of the Health Plan (see ss. 409.912 and 435.04, F.S.).

	
  

	
a.

	
The Health Plan shall submit, prior to execution of this Contract, complete sets of fingerprints of principals of the Health Plan to HSD for the purpose of conducting a criminal history record check (see s. 409.907, F.S.).

	
  

	
b.

	
Principals of the Health Plan shall be as defined in s. 409.907, F.S.

	
  

	
c.

	
The Health Plan shall submit to the Agency Contract Manager complete sets of fingerprints of newly hired principals (officers, directors, agents, and managing employees) within thirty (30) calendar days of the hire date.

	
  

	
5.

	
The Health Plan shall submit to the Agency, within five (5) business days, any information on any officer, director, agent, managing employee, or owner of stock or beneficial interest in excess of five percent (5%) of the Health Plan who has been found guilty of, regardless of adjudication, or who entered a plea of nolo contendere or guilty to, any of the offenses listed in s. 435.04, F.S.  The Health Plan shall submit information to HSD for such persons who have a record of illegal conduct according to the background check.  The Health Plan shall keep a record of all background checks to be available for Agency review upon request.

	
  

	
6.

	
The Agency shall not contract with a Health Plan that has an officer, director, agent, managing employee, or owner of stock or beneficial interest in excess of five percent (5%) of the Health Plan, who has committed any of the above listed offenses (see ss. 409.912 and 435.04, F.S.).  In order to avoid termination, the Health Plan shall submit a corrective action plan, acceptable to the Agency, which ensures that such person is divested of all interest and/or control and has no role in the operation and/or management of the Health Plan.

 

	
28.

	
Attachment II, Core Contract Provisions, Section XVI, Terms and Conditions, Item W., Minority Recruitment and Retention Plan, the header row is hereby amended to now read as follows:

W.            Minority Recruitment and Retention Plan

AHCA Contract No. FA905, Amendment No. 5, Page 40 of 45

  

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

	
29.

	
Attachment II, Core Contract Provisions, Section XVI, Terms and Conditions, is hereby amended to include Items DD. through FF. as follows:

DD.  Authority to Act

Any person executing this Contract or any documents, instruments or assurances, created, presented or reasonably necessary or appropriate to carry out the full intent and purpose of this Contract, in a representative capacity, hereby warrants to the Agency that it has implied, express or delegated authority to enter into, execute, attest or certify this Contract or aforementioned documents on behalf of such party which it represents.  The Health Plan shall not raise the fact that a person executing a document, instrument or assurance as set forth herein lacks authority to bind the Health Plan for which it is representing as a defense to the enforcement of this Contract or other document executed in connection with this Contract.

EE.  Proof of Execution by Electronic Copy or Facsimile.

For purposes of executing this Contract or any documents, instruments and assurances created, presented or reasonably necessary or appropriate to carry out the full intent and purpose of this Contract, a document signed or electronically signed and transmitted by facsimile, e-mail or other form of electronic transmission is to be treated as an original document.  The signature or electronic signature of any party thereon, for purposes hereof, is to be considered as an original signature, and the document transmitted is to be considered to have the same binding effect as an original signature on an original document.  At the request of the Agency, any document transmitted by facsimile, telecopy, e-mail or other form of electronic transmission is to be executed in original form by the Health Plan.  The Health Plan shall not raise the fact that any signature was transmitted through the use of a facsimile, e-mail or other form of electronic transmission as a defense to the enforcement of this Contract or other document executed in connection with this Contract.

FF.  Remedies Cumulative

Except as otherwise expressly provided herein, all rights, powers and privileges conferred hereunder upon the Health Plan are cumulative and not restrictive of those given by law.  No remedy herein conferred is exclusive of any other available remedy; but each and every such remedy is cumulative and is in addition to every other remedy given by Contract or now or hereafter existing at law, in equity or by statute.

	
30.

	
Attachment II, Core Contract Provisions, Exhibit 5, Covered Services, Item 2., Non-Reform Health Plans covering dental as an optional service and Reform Health Plans, Section V, Covered Services, Item H., Coverage Provisions, sub-item 3., Dental Services, is hereby deleted in its entirety and replaced with the following:

Dental services are defined in the Medicaid Dental Services Coverage and Limitations Handbook.

	
  

	
a.

	
For enrollees under age 21, the Health Plan shall cover diagnostic services, preventive treatment, CHCUP dental screening (including a direct referral to a dentist for enrollees beginning at three (3) years of age or earlier as indicated); restorative treatment, endodontic treatment, periodontal treatment, surgical procedures and/or extractions, orthodontic treatment, complete and partial dentures, complete and partial denture relines and repairs, and adjunctive and emergency services.  Fluoride varnish application in a physician’s office under CHCUP is limited to children up to three and one half (3 1⁄2) years (42 months) of age.  The Health Plan shall ensure the following for active orthodontia:

 

AHCA Contract No. FA905, Amendment No. 5, Page 41 of 45

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  

	
(1)

	
The Health Plan shall ensure continuity of care for active orthodontia until completion of care, regardless of provider network affiliation;

	
  

	
(2)

	
The Health Plan shall ensure reimbursement to providers for active orthodontia until completion of care, regardless of provider network affiliation;

	
  

	
(3)

	
The Health Plan shall ensure maintenance of written case management continuity of care protocol(s) that include the following minimum functions:

	
  

	
(a)

	
Appropriate referral of and scheduling assistance for enrollees needing specialty dental care.

	
  

	
(b)

	
Documentation of referral services in enrollees' dental records, including results.

	
  

	
(c)

	
Monitoring enrollees with on-going dental conditions and coordination of services for high users such that the following functions are addressed as appropriate: acting as a liaison between the member and providers, ensuring the member is receiving routine dental care, ensuring that the member has adequate support at home, and assisting enrollees who are unable to access necessary care due to their medical or emotional conditions or who do not have adequate community resources to comply with their care.

	
  

	
(4)

	
Documentation in dental records of member emergency encounters with appropriate indicated follow-up.

	
  

	
b.

	
Adult services include adult full and partial denture services and medically necessary emergency dental procedures to alleviate pain or infection.  Emergency dental care shall be limited to emergency oral examinations, necessary x-rays, extractions, and incision and drainage of abscess.

 

	
31.

	
Attachment II, Core Contract Provisions, Exhibit 6, HMOs & Reform Health Plans, Behavioral Health Care, Item 1., Reform Health Plans and Non-Reform HMOs, sub-item A., General Provisions, sub-item 5., is hereby amended to now read as follows:

	
  

	
5.

	
The Health Plan shall provide the following services as described in the Mental Health Targeted Case Management Coverage & Limitations Handbook and the Community Behavioral Health Services Coverage & Limitations Handbook (the Handbooks).  The Health Plan shall not alter the amount, duration and scope of such services from that specified in the Handbooks. The Health Plan shall not establish service limitations that are lower than, or inconsistent with, the Handbooks.

	
  

	
a.

	
Inpatient hospital services for psychiatric conditions (ICD-9-CM codes 290 through 290.43, 290.8, 290.9, 293.0 through 298.9, 300 through 301.9, 302.7, 306.51 through 312.4 and 312.81 through 314.9, 315.3, 315.31, 315.5, 315.8, and 315.9);

	
  

	
b.

	
Outpatient hospital services for psychiatric conditions (ICD-9-CM codes 290 through 290.43, 290.8, 290.9, 293 through 298.9, 300 through 301.9, 302.7, 306.51 through 312.4 and 312.81 through 314.9, 315.3, 315.31, 315.5, 315.8, and 315.9);

 

AHCA Contract No. FA905, Amendment No. 5, Page 42 of 45

  

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  

	
c.

	
Psychiatric physician services (for psychiatric specialty codes 42, 43, 44 and ICD-9-CM codes 290 through 290.43, 290.8, 290.9, 293.0 through 298.9, 300 through 301.9, 302.7, 306.51 through 312.4 and 312.81 through 314.9, 315.3, 315.31, 315.5, 315.8, and 315.9);

	
  

	
d.

	
Community mental health services (ICD-9-CM codes 290 through 290.43, 290.8, 290.9, 293.0 through 298.9, 300 through 301.9, 302.7, 306.51 through 312.4 and 312.81 through 314.9, 315.3, 315.31, 315.5, 315.8, and 315.9); and for these procedure codes  H0031; H0031HO; H0031HN; H0031TS; H0032; H0032TS; H0046; H2000; H2000HO; H2000HP; H2010HO; H2010HE;H2010HQ; H2012;H2017; H2019; H2019HM; H2019HN; H2019HO; H2019HQ; H2019HR; T1015; T1015HE; or T1023HE;

	
  

	
e.

	
Community substance abuse services when the appropriate ICD-9 CM diagnosis code (290 through 290.43, 293 through 298.9, 302.7, 306.51 through 312.4 and 312.81 through 314.9, 315.3, 315.31, 315.5, 315.8, and 315.9) has been documented:  H0001, H0001HN; H0001HO, H0001TS, H0047, H2010HF, H2012HF, T1007, T1007TS, T1015HF or T1023HF;

	
  

	
f.

	
Mental Health Targeted Case Management (Children: T1017HA; Adults: T1017); and

	
  

	
g.

	
Mental Health Intensive Targeted Case Management (Adults: T1017HK).

 

  

	
32.

	
Attachment II, Core Contract Provisions, Exhibit 6, HMOs & Reform Health Plans, Behavioral Health Care, Item 1., Reform Health Plans and Non-Reform HMOs, sub-item C., Service Requirements, sub-item 3., Emergency Services – Behavioral Health Services is hereby deleted in its entirety and replaced with the following:

 

3.      Emergency Services – Behavioral Health Services

  The Health Plans shall provide emergency behavioral health services pursuant, but not limited, to s. 394.463, F.S.; s. 641.513, F.S.; and Title 42 CFR Chapter IV.

	
  

	
a.

	
Crisis Intervention Mental Health Services and Post-Stabilization Care Services

	
  

	
(1)

	
Crisis intervention services include intervention activities of less than twenty-four (24) hour duration (within a twenty-four (24) hour period) designed to stabilize an enrollee in a psychiatric emergency.

	
  

	
(2)

	
Post-stabilization care services include any of the mandatory services that a treating physician views as medically necessary, that are provided after an enrollee is stabilized from an emergency mental health condition in order to maintain the stabilized condition, or under the circumstances described in 42 CFR 438.114(e) to improve or resolve the enrollee’s condition.

	
  

	
b.

	
Emergency service providers shall make a reasonable attempt to notify the Health Plan within twenty-four (24) hours of the enrollee’s presenting for emergency behavioral health services.  In cases in which the enrollee has no identification, or is unable to orally identify himself/herself when presenting for behavioral health services, the provider shall notify the Health Plan within twenty-four (24) hours of learning the enrollee’s identity.

 

AHCA Contract No. FA905, Amendment No. 5, Page 43 of 45

  

  

  

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

	
  

	
c.

	
The emergency service provider shall notify the Health Plan as soon as possible prior to discharge of the enrollee from the emergency care area or notify the Health Plan within twenty-four (24) hours or on the next business day after the enrollee’s inpatient admission.

	
  

	
d.

	
The Health Plan shall process all out-of-plan emergency behavioral health service claims within the time frames specified for emergency claims payment in Attachment II, Section V, Covered Services, Item H., Coverage Provisions, sub-item 7., Emergency Services.

	
  

	
e.

	
The Health Plan shall submit to BMHC within ten (10) calendar days after the Health Plan’s final appeal determination for review and final determination all denied appeals from behavioral health care providers and out-of-plan, non-participating behavioral health care providers for denied emergency behavioral health service claims.

	
  

	
f.

	
The Health Plan shall not deny emergency services for enrollees presenting at receiving facilities for involuntary examination under the Baker Act.

 

	
  

	
(1)

	
The receiving facility will make every effort to notify the Health Plan within twenty-four (24) hours of receiving the enrollee.

	
  

	
(2)

	
The Health Plan shall begin coordinating the enrollee’s care upon notification by the receiving facility.

	
  

	
(3)

	
A stabilized condition is determined when the physician treating the enrollee decides when the enrollee may be considered stabilized for transfer or discharge, and that decision is binding on the Health Plan (42 CFR 438.114(d)(3).

	
  

	
g.

	
Fee-for-service Health Plans shall follow provisions of subparagraph f. above for receiving facilities that are not CSUs.

	
33.

	
Attachment II, Core Contract Provisions, Exhibit 6, HMOs and Reform Health Plans, Behavioral Health Care, Item 1., Reform Health Plans and Non-Reform HMOs, sub-item D., Transition Plan, sub-item 2., the second sentence is hereby amended to now read as follows:

For enrollees who have received behavioral health services for at least six (6) months from a behavioral health care provider, whether the provider is in the Health Plan’s network or not, the Health Plan shall continue to authorize all valid claims until the Health Plan has:

	
  

	 

Unless otherwise stated, this amendment is effective upon execution.

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 part of the Contract.

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

AHCA Contract No. FA905, Amendment No. 5, Page 44 of 45

  

  

  

 

	Healthease of Florida, Inc.	 	Medicaid HMO Non-Reform Contract

 

IN WITNESS WHEREOF, the Parties hereto have caused this forty-five (45) 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

	
BY:

	
/s/ Christina Cooper

	  	
BY:

	
/s/ Elizabeth Dudek

	
 

NAME:

	
 

Christina Cooper

	  	
 

NAME:

	
 

Elizabeth Dudek

	
 

TITLE:

	
 

President FL & HI Division

	  	
 

TITLE:

	
 

Secretary

	
 

DATE:

	
 

3/27/11

	  	
 

DATE:

	
 

3/31/11

 

 

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FA905, Amendment No. 5, Page 45 of 45EX-10.1

Exhibit 10.1

Halozyme Therapeutics, Inc.

2011 Stock Plan

     1.   Establishment, Purpose and Term of Plan                                                   1

                 1.1                         Establishment                                                 1
                 1.2                         Purpose                                                       1
                 1.3                         Term of Plan                                                  1

2.               Definitions and Construction                                                              1

                 2.1                         Definitions                                                   1
                 2.2                         Construction                                                  7
3.               Administration                                                                            7
                 3.1                         Administration by the Committee                               7
                 3.2                         Authority of Officers                                         7
                 3.3                         Committee Complying with Section 162(m)                       7
                 3.4                         Powers of the Committee                                       7
                 3.5                         Indemnification                                               9
                 3.6                         Arbitration                                                   9
                 3.7                         Repricing and Reloading Prohibited                            9
4.               Shares Subject to Plan                                                                   10
                 4.1                         Maximum Number of Shares Issuable                            10
                 4.2                         Adjustments for Changes in Capital Structure                 10

5.               Eligibility and Award Limitations                                                        11

                 5.1                         Persons Eligible for Awards                                  11
                 5.2                         Participation                                                11
                 5.3                         Incentive Stock Option Limitations                           11
                 5.4                         Award Limits                                                 12

6.               Terms and Conditions of Options                                                          13

                 6.1                         Exercise Price                                               13
                 6.2                         Exercisability and Term of Options                           13
                 6.3                         Payment of Exercise Price                                    13
                 6.4                         Effect of Termination of Service                             14
                 6.5                         Transferability of Options                                   14

7.               Terms and Conditions of Stock Appreciation Rights                                        15

                 7.1                         Types of SARs Authorized                                     15
                 7.2                         Exercise Price                                               15
                 7.3                         Exercisability and Term of SARs                              15
                 7.4                         Deemed Exercise of SARs                                      15
                 7.5                         Effect of Termination of Service                             15
                 7.6                         Nontransferability of SARs                                   16

8.               Terms and Conditions of Stock Awards                                                     16

                 8.1                         Types of Restricted Stock Awards Authorized                  16
                 8.2                         Purchase Price                                               16
                 8.3                         Purchase Period                                              16
                 8.4                         Vesting and Restrictions on Transfer                         16
                 8.5                         Voting Rights; Dividends and Distributions                   16
                 8.6                         Effect of Termination of Service                             17
                 8.7                         Nontransferability of Restricted Stock Award Rights          17

9.               Terms and Conditions of Performance Awards                                               17

                 9.1                         Types of Performance Awards Authorized                       17
                 9.2                         Initial Value of Performance Shares and Performance Units    17

	 	9.3	 	Establishment of Performance Period, Performance Goals and Performance
Award Formula 18	 

	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	9.4	 	 	Measurement of Performance Goals
	 	 	18	 
	 	 	 	 	 	9.5	 	 	Settlement of Performance Awards
	 	 	20	 
	 	 	 	 	 	9.6	 	 	Voting Rights; Dividend Equivalent Rights and Distributions
	 	 	20	 
	 	 	 	 	 	9.7	 	 	Effect of Termination of Service
	 	 	21	 
	 	 	 	 	 	9.8	 	 	Nontransferability of Performance Awards
	 	 	21	 
	 	10.	 	 	Terms and Conditions of Restricted Stock Unit Awards	 	 	21	 
	 	 	 	 	 	10.1	 	 	Grant of Restricted Stock Unit Awards
	 	 	21	 
	 	 	 	 	 	10.2	 	 	Vesting
	 	 	22	 
	 	 	 	 	 	10.3	 	 	Voting Rights, Dividend Equivalent Rights and Distributions
	 	 	22	 
	 	 	 	 	 	10.4	 	 	Effect of Termination of Service
	 	 	22	 
	 	 	 	 	 	10.5	 	 	Settlement of Restricted Stock Unit Awards
	 	 	22	 
	 	 	 	 	 	10.6	 	 	Nontransferability of Restricted Stock Unit Awards
	 	 	23	 
	 	11.	 	 	Effect of Change in Control on Awards	 	 	23	 
	 	 	 	 	 	11.1	 	 	Change in Control Transactions
	 	 	23	 
	 	 	 	 	 	11.2	 	 	Unusual or Nonrecurring Events
	 	 	23	 
	 	12.	 	 	Compliance With Securities Law	 	 	24	 
	 	13.	 	 	Tax Withholding	 	 
	 	 	24	 
	 	 	 	 	 	13.1	 	 	Tax Withholding in General
	 	 	24	 
	 	 	 	 	 	13.2	 	 	Withholding in Shares
	 	 	24	 
	 	14.	 	 	Amendment or Termination of Plan	 	 	24	 
	 	15.	 	 	Miscellaneous Provisions	 	 
	 	 	25	 
	 	 	 	 	 	15.1	 	 	Repurchase Rights
	 	 	25	 
	 	 	 	 	 	15.2	 	 	Rights as Employee, Consultant or Director
	 	 	25	 
	 	 	 	 	 	15.3	 	 	Rights as a Stockholder
	 	 	25	 
	 	 	 	 	 	15.4	 	 	Fractional Shares
	 	 	25	 
	 	 	 	 	 	15.5	 	 	Severability
	 	 	25	 
	 	 	 	 	 	15.6	 	 	Beneficiary Designation
	 	 	26	 
	 	 	 	 	 	15.7	 	 	Unfunded Obligation
	 	 	26	 

Halozyme Therapeutics, Inc.

2011 Stock Plan

1. Establishment, Purpose and Term of Plan.

1.1 Establishment. The Halozyme Therapeutics, Inc. 2011 Stock Plan (the “Plan”) is hereby
adopted March 10, 2011 subject to approval by the stockholders of the Company (the date of such
stockholder approval, the “Effective Date”). Upon the Effective Date of the Plan, the Prior Plans
shall terminate such that no additional Awards may be granted thereunder but the terms of the Prior
Plans shall remain in effect with respect to outstanding Awards until they are exercised, settled,
expired, forfeited or otherwise canceled in full.

1.2 Purpose. The purpose of the Plan is to advance the interests of the Participating Company
Group and its stockholders by providing an incentive to attract and retain the best qualified
personnel to perform services for the Participating Company Group, by motivating such persons to
contribute to the growth and profitability of the Participating Company Group, by aligning their
interests with interests of the Company’s stockholders, and by rewarding such persons for their
services by tying a significant portion of their total compensation package to the success of the
Company. The Plan seeks to achieve this purpose by providing for Awards in the form of Options,
Stock Appreciation Rights, Stock Awards, Restricted Stock Awards, Performance Shares, Performance
Units, and Restricted Stock Units as described below.

1.3 Term of Plan. The Plan shall continue in effect until the earlier of its termination by
the Board or the date on which all of the shares of Stock available for issuance under the Plan
have been issued and all restrictions on such shares under the terms of the Plan and the agreements
evidencing Awards granted under the Plan have lapsed. However, Awards shall not be granted later
than March 9, 2021. The Company intends that the Plan comply with Section 409A of the Code
(including any amendments to or replacements of such section), and the Plan shall be so construed.

2. Definitions and Construction.

2.1 Definitions. Whenever used herein, the following terms shall have their respective
meanings set forth below:

(a) “Affiliate” means (i) an entity, other than a Parent Corporation, that directly, or
indirectly through one or more intermediary entities, controls the Company or (ii) an entity, other
than a Subsidiary Corporation, that is controlled by the Company directly, or indirectly through
one or more intermediary entities. For this purpose, the term “control” (including the term
“controlled by”) means the possession, direct or indirect, of the power to direct or cause the
direction of the management and policies of the relevant entity, whether through the ownership of
voting securities, by contract or otherwise; or shall have such other meaning assigned such term
for the purposes of registration on Form S-8 under the Securities Act.

(b) “Award” means any Option, SAR, Stock Award, Restricted Stock Award, Performance Share,
Performance Unit, or Restricted Stock Unit granted under the Plan or any Prior Plan.

(c) “Award Agreement” means a written agreement between the Company and a Participant setting
forth the terms, conditions and restrictions of the Award granted to the Participant.

(d) “Board” means the Board of Directors of the Company.

(e) “Change in Control” means the occurrence of any of the following:

(i) an Ownership Change Event or series of related Ownership Change Events (collectively, a
“Transaction”) in which the stockholders of the Company immediately before the Transaction do not
retain immediately after the Transaction direct or indirect beneficial ownership of more than fifty
percent (50%) of the total combined voting power of the outstanding securities entitled to vote
generally in the election of Directors or, in the case of an Ownership Change Event described in
Section 2.1(y)(iii), the entity to which the assets of the Company were transferred (the
“Transferee”), as the case may be; or

(ii) a liquidation or dissolution of the Company;

provided, however, that a Change in Control shall be deemed not to include a transaction described
in subsection (i) of this Section 2.1(e) in which a majority of the members of the board of
directors of the continuing, surviving or successor entity, or parent thereof, immediately after
such transaction is comprised of Incumbent Directors. Notwithstanding the foregoing, to the extent
that any amount constituting deferred compensation subject to and not exempted from the
requirements of Section 409A of the Code would become payable under this Plan by reason of a Change
in Control, such amount shall become payable only if the event constituting a Change in Control
would also constitute a change in ownership or effective control of the Company or a change in the
ownership of a substantial portion of the assets of the Company within the meaning of Section 409A.

For purposes of the preceding sentence, indirect beneficial ownership shall include, without
limitation, an interest resulting from ownership of the voting securities of one or more
corporations or other business entities which own the Company or the Transferee, as the case may
be, either directly or through one or more subsidiary corporations or other business entities. The
Committee shall determine whether multiple sales or exchanges of the voting securities of the
Company or multiple Ownership Change Events are related, and its determination shall be final,
binding and conclusive.

(f) “Code” means the Internal Revenue Code of 1986, as amended, and any applicable regulations
promulgated thereunder.

(g) “Committee” means the Compensation Committee or other committee of the Board duly
appointed to administer the Plan and having such powers as shall be specified by the Board. If no
committee of the Board has been appointed to administer the Plan, the Board shall exercise all of
the powers of the Committee granted herein, and, in any event, the Board may in its discretion
exercise any or all of such powers. The Committee shall have the exclusive authority to administer
the Plan and shall have all of the powers granted herein, including, without limitation, the power
to amend or terminate the Plan at any time, subject to the terms of the Plan and any applicable
limitations imposed by law.

(h) “Company” means Halozyme Therapeutics, Inc., a Delaware corporation, or any Successor.

(i) “Consultant” means a person engaged to provide consulting or advisory services (other than
as an Employee or a member of the Board) to a Participating Company.

(j) “Director” means a member of the Board or of the board of directors of any Participating
Company.

(k) “Disability” means the permanent and total disability of the Participant, within the
meaning of Section 22(e)(3) of the Code.

(l) “Dividend Equivalent” means a credit, made at the discretion of the Committee or as
otherwise provided by the Plan, to the account of a Participant, or a cash payment, in an amount
equal to the cash dividends paid on one share of Stock for each share of Stock represented by an
Award held by such Participant.

(m) “Employee” means any person treated as an employee (including an Officer or a member of
the Board who is also treated as an employee) in the records of a Participating Company and, with
respect to any Incentive Stock Option granted to such person, who is an employee for purposes of
Section 422 of the Code; provided, however, that neither service as a member of the Board nor
payment of a director’s fee shall be sufficient to constitute employment for purposes of the Plan.
The Company shall determine in good faith and in the exercise of its discretion whether an
individual has become or has ceased to be an Employee and the effective date of such individual’s
employment or termination of employment, as the case may be. For purposes of an individual’s
rights, if any, under the Plan as of the time of the Company’s determination, all such
determinations by the Company shall be final, binding and conclusive, notwithstanding that the
Company or any court of law or governmental agency subsequently makes a contrary determination.

(n) “Exchange Act” means the Securities Exchange Act of 1934, as amended.

(o) “Fair Market Value” means, as of any date, the value of a share of Stock or other property
as determined by the Committee, in its discretion, or by the Company, in its discretion, if such
determination is expressly allocated to the Company herein, subject to the following:

(i) Except as otherwise determined by the Committee, if, on such date, the Stock is listed on
a national or regional securities exchange or market system, the Fair Market Value of a share of
Stock shall be the closing price of a share of Stock as quoted on such national or regional
securities exchange or market system constituting the primary market for the Stock on the day of
determination, as reported in The Wall Street Journal or such other source as the Company deems
reliable.

(ii) Notwithstanding the foregoing, the Committee may, in its discretion, determine the Fair
Market Value on the basis of the closing, high, low or average sale price of a share of Stock or
the actual sale price of a share of Stock received by a Participant, on such date, the preceding
trading day, the next succeeding trading day or an average determined over a period of trading
days. The Committee may vary its method of determination of the Fair Market Value as provided in
this Section for different purposes under the Plan.

(iii) If, on such date, the Stock is not listed on a national or regional securities exchange
or market system, the Fair Market Value of a share of Stock shall be as determined by the Committee
in good faith without regard to any restriction other than a restriction which, by its terms, will
never lapse.

(p) “Incentive Stock Option” means an Option intended to be (as set forth in the Award
Agreement) and which qualifies as an incentive stock option within the meaning of Section 422(b) of
the Code.

(q) “Incumbent Director” means a director who either (i) is a member of the Board as of the
Effective Date or (ii) is elected, or nominated for election, to the Board with the affirmative
votes of at least a majority of the Incumbent Directors at the time of such election or nomination,
but who was not elected or nominated in connection with an actual or threatened proxy contest
relating to the election of directors of the Company.

(r) “Insider” means an Officer, a Director, or any other person whose transactions in Stock
are subject to Section 16 of the Exchange Act.

(s) “Non-Control Affiliate” means any entity in which any Participating Company has an
ownership interest and which the Committee shall designate as a Non-Control Affiliate.

(t) “Nonemployee Director” means a Director who is not an Employee.

(u) “Nonstatutory Stock Option” means an Option not intended to be (as set forth in the Award
Agreement) an incentive stock option within the meaning of Section 422(b) of the Code.

(v) “Officer” means any person designated by the Board as an officer of the Company.

(w) “Option” means the right to purchase Stock at a stated price for a specified period of
time granted to a Participant pursuant to Section 6 of the Plan. An Option may be either an
Incentive Stock Option or a Nonstatutory Stock Option.

(x) “Option Expiration Date” means the date of expiration of the Option’s term as set forth in
the Award Agreement.

(y) “Ownership Change Event” means the occurrence of any of the following with respect to the
Company: (i) the direct or indirect sale or exchange in a single or series of related transactions
by the stockholders of the Company of more than fifty percent (50%) of the voting stock of the
Company; (ii) a merger or consolidation in which the Company is a party; or (iii) the sale,
exchange, or transfer of all or substantially all of the assets of the Company (other than a sale,
exchange or transfer to one or more subsidiaries of the Company).

(z) “Parent Corporation” means any present or future “parent corporation” of the Company, as
defined in Section 424(e) of the Code.

(aa) “Participant” means any eligible person who has been granted one or more Awards.

(bb) “Participating Company” means the Company or any Parent Corporation, Subsidiary
Corporation or Affiliate.

(cc) “Participating Company Group” means, at any point in time, all entities collectively
which are then Participating Companies.

(dd) “Performance Award” means an Award of Performance Shares or Performance Units.

(ee) “Performance Award Formula” means, for any Performance Award, a formula or table
established by the Committee pursuant to Section 9.3 of the Plan which provides the basis for
computing the value of a Performance Award at one or more threshold levels of attainment of the
applicable Performance Goal(s) measured as of the end of the applicable Performance Period.

(ff) “Performance Goal” means a performance goal established by the Committee pursuant to
Section 9.3 of the Plan.

(gg) “Performance Period” means a period established by the Committee pursuant to Section 9.3
of the Plan at the end of which one or more Performance Goals are to be measured.

(hh) “Performance Share” means a bookkeeping entry representing a right granted to a
Participant pursuant to Section 9 of the Plan to receive a payment equal to the value of a
Performance Share, as determined by the Committee, based on performance.

(ii) “Performance Unit” means a bookkeeping entry representing a right granted to a
Participant pursuant to Section 9 of the Plan to receive a payment equal to the value of a
Performance Unit, as determined by the Committee, based upon performance.

(jj) “Prior Plans” means the Company’s 2008 Stock Plan, 2006 Stock Plan, and 2004 Stock Plan
(each, a “Prior Plan”).

(kk) “Restricted Stock Award” means an Award of Restricted Stock.

(ll) “Restricted Stock Unit” or “Stock Unit” means a bookkeeping entry representing a right
granted to a Participant pursuant to Section 10 of the Plan to receive a share of Stock on a date
determined in accordance with the provisions of Section 10 and the Participant’s Award Agreement.

(mm) “Restriction Period” means the period established in accordance with Section 8.4 of the
Plan during which shares subject to a Restricted Stock Award are subject to Vesting Conditions.

(nn) “Rule 16b-3” means Rule 16b-3 under the Exchange Act, as amended from time to time, or
any successor rule or regulation.

(oo) “SAR” or “Stock Appreciation Right” means a bookkeeping entry representing, for each
share of Stock subject to such SAR, a right granted to a Participant pursuant to Section 7 of the
Plan to receive payment in any combination of shares of Stock or cash of an amount equal to the
excess, if any, of the Fair Market Value of a share of Stock on the date of exercise of the SAR
over the exercise price.

	 	 	 
	(pp)

(qq)

	 	“Section 162(m)” means Section 162(m) of the Code.

“Securities Act” means the Securities Act of 1933, as amended.

(rr) “Service” means a Participant’s employment or service with the Participating Company
Group, whether in the capacity of an Employee, a Director or a Consultant. Unless otherwise
provided by the Committee, a Participant’s Service shall not be deemed to have terminated merely
because of a change in the capacity in which the Participant renders such Service or a change in
the Participating Company for which the Participant renders such Service, provided that there is no
interruption or termination of the Participant’s Service. Furthermore, a Participant’s Service
shall not be deemed to have terminated if the Participant takes any military leave, sick leave, or
other bona fide leave of absence approved by the Company. A Participant’s Service shall be deemed
to have terminated either upon an actual termination of Service or upon the entity for which the
Participant performs Service ceasing to be a Participating Company. Subject to the foregoing, the
Company, in its discretion, shall determine whether the Participant’s Service has terminated and
the effective date of such termination.

(ss) “Stock” means the common stock of the Company, as adjusted from time to time in
accordance with Section 4.2 of the Plan.

(tt) “Stock Award” means an Award of Stock as described in Section 8 of the Plan.

(uu) “Subsidiary Corporation” means any present or future “subsidiary corporation” of the
Company, as defined in Section 424(f) of the Code.

(vv) “Successor” means a corporation into or with which the Company is merged or consolidated
or which acquires all or substantially all of the assets of the Company and which is designated by
the Board as a Successor for purposes of the Plan.

(ww) “Ten Percent Owner” means a Participant who, at the time an Option is granted to the
Participant, owns stock possessing more than ten percent (10%) of the total combined voting power
of all classes of stock of a Participating Company (other than an Affiliate) within the meaning of
Section 422(b)(6) of the Code.

(xx) “Vesting Conditions” means those conditions established in accordance with Section 8.4 or
Section 10.2 of the Plan prior to the satisfaction of which shares subject to a Restricted Stock
Award or Restricted Stock Unit Award, respectively, remain subject to forfeiture or a repurchase
option in favor of the Company upon the Participant’s termination of Service.

2.2 Construction. Captions and titles contained herein are for convenience only and shall not
affect the meaning or interpretation of any provision of the Plan. Except when otherwise indicated
by the context, the singular shall include the plural and the plural shall include the singular.
Use of the term “or” is not intended to be exclusive, unless the context clearly requires
otherwise.

3. Administration.

3.1 Administration by the Committee. The Plan shall be administered by the Committee. All
questions of interpretation of the Plan or of any Award shall be determined by the Committee, and
such determinations shall be final and binding upon all persons having an interest in the Plan or
such Award.

3.2 Authority of Officers. Any Officer shall have the authority to act on behalf of the
Company with respect to any matter, right, obligation, determination or election which is the
responsibility of or which is allocated to the Company herein, provided the Officer has been
delegated such authority by the Committee with respect to such matter, right, obligation,
determination or election.

3.3 Committee Complying with Section 162(m). While the Company is a “publicly held
corporation” within the meaning of Section 162(m), the Board may establish a Committee of “outside
directors” within the meaning of Section 162(m) to approve the grant of any Award which might
reasonably be anticipated to result in the payment of employee remuneration that would otherwise
exceed the limit on employee remuneration deductible for income tax purposes pursuant to
Section 162(m).

3.4 Powers of the Committee. In addition to any other powers set forth in the Plan and
subject to the provisions of the Plan, the Committee shall have the full and final power and
authority, in its discretion:

(a) to determine the persons to whom, and the time or times at which, Awards shall be granted
and the number of shares of Stock or units to be subject to each Award;

(b) to determine the type of Award granted and to designate Options as Incentive Stock Options
or Nonstatutory Stock Options;

(c) to determine the Fair Market Value of shares of Stock or other property;

(d) to determine the terms, conditions and restrictions applicable to each Award (which need
not be identical) and any shares acquired pursuant thereto, including, without limitation, (i) the
exercise or purchase price of shares purchased pursuant to any Award, (ii) the method of payment
for shares purchased pursuant to any Award, (iii) the method for satisfaction of any tax
withholding obligation arising in connection with any Award, including by the withholding or
delivery of shares of Stock, (iv) the timing, terms and conditions of the exercisability or vesting
of any Award or any shares acquired pursuant thereto, (v) the Performance Award Formula and
Performance Goals applicable to any Award and the extent to which such Performance Goals have been
attained, (vi) the time of the expiration of any Award, (vii) the effect of the Participant’s
termination of Service on any of the foregoing, and (viii) all other terms, conditions and
restrictions applicable to any Award or shares acquired pursuant thereto not inconsistent with the
terms of the Plan;

(e) to determine whether an Award will be settled in shares of Stock, cash, or in any
combination thereof;

(f) to approve one or more forms of Award Agreement;

(g) to amend, modify, extend, cancel or renew any Award or to waive any restrictions or
conditions applicable to any Award or any shares acquired pursuant thereto;

(h) to accelerate, continue, extend or defer the exercisability or vesting of any Award or any
shares acquired pursuant thereto, including with respect to the period following a Participant’s
termination of Service;

(i) without the consent of the affected Participant and notwithstanding the provisions of any
Award Agreement to the contrary, to unilaterally substitute at any time a Stock Appreciation Right
providing for settlement solely in shares of Stock in place of any outstanding Option, provided
that such Stock Appreciation Right covers the same number of shares of Stock and provides for the
same exercise price (subject in each case to adjustment in accordance with Section 4.2) as the
replaced Option and otherwise provides substantially equivalent terms and conditions as the
replaced Option, as determined by the Committee;

(j) to prescribe, amend or rescind rules, guidelines and policies relating to the Plan, or to
adopt sub-plans or supplements to, or alternative versions of, the Plan, including, without
limitation, as the Committee deems necessary or desirable to comply with the laws or regulations of
or to accommodate the tax policy, accounting principles or custom of, foreign jurisdictions whose
citizens may be granted Awards;

(k) to correct any defect, supply any omission or reconcile any inconsistency in the Plan or
any Award Agreement and to make all other determinations and take such other actions with respect
to the Plan or any Award as the Committee may deem advisable to the extent not inconsistent with
the provisions of the Plan or applicable law; and

(l) to the extent permitted by applicable law, to delegate to any proper Officer the authority
to grant one or more Awards, without further approval of the Committee, to any person eligible
pursuant to Section 5, other than himself or a person who, at the time of such grant, is an
Insider; provided, however, that (i) the exercise price per share of each such Option shall be
equal to the Fair Market Value per share of the Stock on the effective date of grant, and (ii) each
such Award shall be subject to the terms and conditions of the appropriate standard form of Award
Agreement approved by the Committee and shall conform to the provisions of the Plan and such other
guidelines as shall be established from time to time by the Committee.

3.5 Indemnification. In addition to such other rights of indemnification as they may have as
members of the Board or the Committee or as officers or employees of the Participating Company
Group, members of the Board or the Committee and any officers or employees of the Participating
Company Group to whom authority to act for the Board, the Committee or the Company is delegated
shall be indemnified by the Company against all reasonable expenses, including attorneys’ fees,
actually and necessarily incurred in connection with the defense of any action, suit or proceeding,
or in connection with any appeal therein, to which they or any of them may be a party by reason of
any action taken or failure to act under or in connection with the Plan, or any right granted
hereunder, and against all amounts paid by them in settlement thereof (provided such settlement is
approved by independent legal counsel selected by the Company) or paid by them in satisfaction of a
judgment in any such action, suit or proceeding, except in relation to matters as to which it shall
be adjudged in such action, suit or proceeding that such person is liable for gross negligence, bad
faith or intentional misconduct in duties; provided, however, that within sixty (60) days after the
institution of such action, suit or proceeding, such person shall offer to the Company, in writing,
the opportunity at its own expense to handle and defend the same.

3.6 Arbitration. Any dispute or claim concerning any Awards granted (or not granted) pursuant
to this Plan and any other disputes or claims relating to or arising out of the Plan shall be
fully, finally and exclusively resolved by binding arbitration conducted pursuant to the Commercial
Arbitration Rules of the American Arbitration Association. By accepting an Award, Participants and
the Company waive their respective rights to have any such disputes or claims tried by a judge or
jury.

3.7 Repricing and Reloading Prohibited. Without the affirmative vote of holders of a majority
of the shares of Stock cast in person or by proxy at a meeting of the stockholders of the Company
at which a quorum representing a majority of all outstanding shares of Stock is present or
represented by proxy, the Committee shall not approve a program providing for either (a) the
cancellation of outstanding Options or SARs and the grant in substitution therefor of cash, other
Awards, or new Options or SARs having a lower exercise price or (b) the amendment of outstanding
Options or SARs to reduce the exercise price thereof. This paragraph shall not be construed to
apply to the issuance or assumption of an Award in a transaction to which Code section 424(a)
applies, within the meaning of Section 424 of the Code.

4. Shares Subject to Plan.

4.1 Maximum Number of Shares Issuable. Subject to adjustment as provided in Section 4.2, the
maximum number of shares of Stock that may be issued under the Plan pursuant to Awards granted
hereunder shall be Six Million (6,000,000) shares. No new Awards shall be granted under any Prior
Plan on or after the Effective Date of this Plan. Shares issuable under this Plan shall consist of
authorized but unissued or reacquired shares of Stock or any combination thereof. If an
outstanding Award granted under this Plan for any reason expires or is terminated or canceled
without having been exercised or settled in full, or if shares of Stock acquired pursuant to an
Award granted under this Plan that are subject to forfeiture or repurchase are forfeited or
repurchased by the Company, the shares of Stock allocable to the terminated portion of such Award
or such forfeited or repurchased shares of Stock shall restore to this Plan and be available for
issuance under the Plan. In the event that a SAR’s appreciation value is settled in shares of
Stock, the unissued shares that are subject to the SAR to measure its appreciation value shall not
be restored to this Plan or otherwise be made available for future issuance under the Plan. Shares
of Stock shall not be deemed to have been issued pursuant to the Plan with respect to any portion
of an Award that is settled in cash.

4.2 Adjustments for Changes in Capital Structure. Subject to any required action by the
stockholders of the Company, in the event of any change in the Stock effected without receipt of
consideration by the Company, whether through merger, consolidation, reorganization,
reincorporation, recapitalization, reclassification, stock dividend, stock split, reverse stock
split, split-up, split-off, spin-off, combination of shares, exchange of shares, or similar change
in the capital structure of the Company, or in the event of payment of a dividend or distribution
to the stockholders of the Company in a form other than Stock (excepting normal cash dividends)
that has a material effect on the Fair Market Value of shares of Stock, appropriate adjustments
shall be made in the number and kind of shares subject to the Plan and to any outstanding Awards,
in the Award limits set forth in Section 5.4, and in the exercise or purchase price per share under
any outstanding Award in order to prevent dilution or enlargement of Participants’ rights under the
Plan. For purposes of the foregoing, conversion of any convertible securities of the Company shall
not be treated as “effected without receipt of consideration by the Company.” If a majority of the
shares which are of the same class as the shares that are subject to outstanding Awards are
exchanged for, converted into, or otherwise become (whether or not pursuant to an Ownership Change
Event) shares of another corporation (the “New Shares”), the Committee may unilaterally amend the
outstanding Options to provide that such Options are exercisable for New Shares. In the event of
any such amendment, the number of shares subject to, and the exercise price per share of, the
outstanding Awards shall be adjusted in a fair and equitable manner as determined by the Committee,
in its discretion. Any fractional share resulting from an adjustment pursuant to this Section 4.2
shall be rounded down to the nearest whole number. The Committee in its sole discretion, may also
make such adjustments in the terms of any Award to reflect, or related to, such changes in the
capital structure of the Company or distributions as it deems appropriate, including modification
of Performance Goals, Performance Award Formulas, and Performance Periods, so long as such
adjustment does not prevent an Award intended to qualify as “performance-based compensation” under
Section 162(m) from being so qualified. The adjustments determined by the Committee pursuant to
this Section 4.2 shall be final, binding and conclusive.

5. Eligibility and Award Limitations.

5.1 Persons Eligible for Awards. Awards may be granted only to Employees, Consultants and
Directors. For purposes of the foregoing sentence, “Employees,” “Consultants” and “Directors”
shall include prospective Employees, prospective Consultants and prospective Directors to whom
Awards are offered to be granted in connection with written offers of an employment or other
service relationship with the Participating Company Group; provided, however, that no Stock subject
to any such Award shall vest, become exercisable or be issued prior to the date on which such
person commences Service.

5.2 Participation. Awards are granted solely at the discretion of the Committee. Eligible
persons may be granted more than one Award. However, eligibility in accordance with this Section
shall not entitle any person to be granted an Award, or, having been granted an Award, to be
granted an additional Award.

5.3 Incentive Stock Option Limitations.

(a) Persons Eligible. An Incentive Stock Option may be granted only to a person who, on the
effective date of grant, is an Employee of the Company, a Parent Corporation or a Subsidiary
Corporation (each being an “ISO-Qualifying Corporation”). Any person who is not an Employee of an
ISO-Qualifying Corporation on the effective date of the grant of an Option to such person may be
granted only a Nonstatutory Stock Option. An Incentive Stock Option granted to a prospective
Employee upon the condition that such person become an Employee of an ISO-Qualifying Corporation
shall be deemed granted effective on the date such person commences Service with an ISO-Qualifying
Corporation, with an exercise price determined as of such date in accordance with Section 6.1.

(b) Fair Market Value Limitation. To the extent that options designated as Incentive Stock
Options (granted under all stock option plans of the Participating Company Group, including the
Plan) become exercisable by a Participant for the first time during any calendar year for Stock
having a Fair Market Value greater than One Hundred Thousand Dollars ($100,000), the portion of
such options which exceeds such amount shall be treated as Nonstatutory Stock Options. For
purposes of this Section, options designated as Incentive Stock Options shall be taken into account
in the order in which they were granted, and the Fair Market Value of Stock shall be determined as
of the time the option with respect to such Stock is granted. If the Code is amended to provide
for a limitation different from that set forth in this Section, such different limitation shall be
deemed incorporated herein effective as of the date and with respect to such Options as required or
permitted by such amendment to the Code. If an Option is treated as an Incentive Stock Option in
part and as a Nonstatutory Stock Option in part by reason of the limitation set forth in this
Section, the Participant may designate which portion of such Option the Participant is exercising.
In the absence of such designation, the Participant shall be deemed to have exercised the Incentive
Stock Option portion of the Option first. Upon exercise, shares issued pursuant to each such
portion shall be separately identified.

5.4 Award Limits.

(a) Maximum Number of Shares Issuable Pursuant to Incentive Stock Options. Subject to
adjustment as provided in Section 4.2, the maximum aggregate number of shares of Stock that may be
issued under the Plan pursuant to the exercise of Incentive Stock Options shall not exceed Six
Million (6,000,000) shares. The maximum aggregate number of shares of Stock that may be issued
under the Plan pursuant to all Awards other than Incentive Stock Options shall be the number of
shares determined in accordance with Section 4.1, subject to adjustment as provided in Section 4.2
and further subject to the limitation set forth in Section 5.4(b) below.

(b) Aggregate Limit on Full Value Awards. Subject to adjustment as provided in Section 4.2,
in no event shall more than Four Million (4,000,000) shares in the aggregate be issued under the
Plan pursuant to the exercise or settlement of Stock Awards, Restricted Stock Awards, Restricted
Stock Unit Awards and Performance Awards (“Full Value Awards”).

(c) Section 162(m) Award Limits. The following limits shall apply to the grant of any Award
if, at the time of grant, the Company is a “publicly held corporation” within the meaning of
Section 162(m). Per-individual limits shall not be adjusted to effect a restoration of shares of
Stock with respect to which the related Award is terminated, surrendered, or canceled.

(i) Options and SARs. Subject to adjustment as provided in Section 4.2, no Employee shall be
granted within any fiscal year of the Company one or more Options or Freestanding SARs which in the
aggregate are for more than One Million (1,000,000) shares of Stock reserved for issuance under the
Plan; provided, however, that such maximum number shall be Two Million (2,000,000) shares with
respect to any individual during the first fiscal year that the individual is employed with the
Participating Company Group.

(ii) Stock, Restricted Stock and Restricted Stock Unit Awards. Subject to adjustment as
provided in Section 4.2, no Employee shall be granted within any fiscal year of the Company one or
more Stock Awards, Restricted Stock Awards or Restricted Stock Unit Awards, the grant or vesting of
which is based on the attainment of Performance Goals, for more than Five Hundred Thousand
(500,000) shares of Stock reserved for issuance under the Plan; provided, however, that such
maximum number shall be One Million (1,000,000) shares with respect to any individual during the
first fiscal year that the individual is employed with the Participating Company Group.

(iii) Performance Awards. Subject to adjustment as provided in Section 4.2 and the limitation
set forth in Section 5.4(b), no Employee shall be granted within any fiscal year of the Company
(1) Performance Shares which could result in such Employee receiving more than Five Hundred
Thousand (500,000) shares of Stock reserved for issuance under the Plan for each full fiscal year
of the Company contained in the Performance Period for such Award, or (2) Performance Units having
a grant date value equal to the Fair Market Value of Five Hundred Thousand (500,000) shares of
Stock on the date of grant for each full fiscal year of the Company contained in the Performance
Period for such Award.

6. Terms and Conditions of Options.

Options shall be evidenced by Award Agreements specifying the number of shares of Stock
covered thereby, in such form as the Committee shall from time to time establish. No Option or
purported Option shall be a valid and binding obligation of the Company unless evidenced by a fully
executed Award Agreement. Award Agreements evidencing Options may incorporate all or any of the
terms of the Plan by reference and shall comply with and be subject to the following terms and
conditions:

6.1 Exercise Price. The exercise price for each Option shall be established in the discretion
of the Committee; provided, however, that (a) the exercise price per share shall be not less than
the Fair Market Value of a share of Stock on the effective date of grant of the Option and (b) no
Incentive Stock Option granted to a Ten Percent Owner shall have an exercise price per share less
than one hundred ten percent (110%) of the Fair Market Value of a share of Stock on the effective
date of grant of the Option. Notwithstanding the foregoing, an Option (whether an Incentive Stock
Option or a Nonstatutory Stock Option) may be granted with an exercise price lower than the minimum
exercise price set forth above if such Option is granted pursuant to an assumption or substitution
for another option in a manner qualifying under the provisions of Section 424(a) of the Code.

6.2 Exercisability and Term of Options.

(a) Option Vesting and Exercisability. Options shall be exercisable at such time or times, or
upon such event or events, and subject to such terms, conditions, performance criteria and
restrictions as shall be determined by the Committee and set forth in the Award Agreement
evidencing such Option; provided, however, that (a) no Option shall be exercisable after the
expiration of ten (10) years after the effective date of grant of such Option, and (b) no Incentive
Stock Option granted to a Ten Percent Owner shall be exercisable after the expiration of five (5)
years after the effective date of grant of such Option.

(b) Participant Responsibility for Exercise of Option. Each Participant is responsible for
taking any and all actions as may be required to exercise any Option in a timely manner, and for
properly executing any documents as may be required for the exercise of an Option in accordance
with such rules and procedures as may be established from time to time. By signing an Option
Agreement each Participant acknowledges that information regarding the procedures and requirements
for the exercise of any Option is available upon such Participant’s request. The Company shall
have no duty or obligation to notify any Participant of the expiration date of any Option.

6.3 Payment of Exercise Price.

(a) Forms of Consideration Authorized. Except as otherwise provided below, payment of the
exercise price for the number of shares of Stock being purchased pursuant to any Option shall be
made (i) in cash, by check or in cash equivalent, (ii) by tender to the Company, or attestation to
the ownership, of shares of Stock owned by the Participant having a Fair Market Value not less than
the exercise price, (iii) by delivery of a properly executed notice of exercise together with
irrevocable instructions to a broker providing for the assignment to the Company of the proceeds of
a sale or loan with respect to some or all of the shares being acquired upon the exercise of the
Option (including, without limitation, through an exercise complying with the provisions of
Regulation T as promulgated from time to time by the Board of Governors of the Federal Reserve
System) (a “Cashless Exercise”), (iv) to the extent permitted by the Committee, in its sole
discretion, by net share settlement (a “Net Settlement”); provided that such Net Settlement shall
not be permitted with respect to an Incentive Stock Option unless the Participant consents to the
Option being converted to a Nonstatutory Stock Option, (v) by such other consideration as may be
approved by the Committee from time to time to the extent permitted by applicable law, or (vi) by
any combination thereof. The Committee may at any time or from time to time grant Options which do
not permit all of the foregoing forms of consideration to be used in payment of the exercise price
or which otherwise restrict one or more forms of consideration.

(b) Limitations on Forms of Consideration. Notwithstanding the foregoing, an Option may not
be exercised by tender to the Company, or attestation to the ownership, of shares of Stock to the
extent such tender or attestation would constitute a violation of the provisions of any law,
regulation or agreement restricting the redemption of the Company’s stock. The Company reserves,
at any and all times, the right, in the Company’s sole and absolute discretion, to establish,
decline to approve or terminate any program or procedures for the exercise of Options by means of a
Cashless Exercise, including with respect to one or more Participants specified by the Company
notwithstanding that such program or procedures may be available to other Participants.

6.4 Effect of Termination of Service.

(a) Option Exercisability. Subject to earlier termination of the Option as otherwise provided
herein and unless otherwise provided by the Committee, an Option shall be exercisable after a
Participant’s termination of Service only during the applicable time periods provided in the Award
Agreement.

(b) Extension if Exercise Prevented by Law. Notwithstanding the foregoing, unless the
Committee provides otherwise in the Award Agreement, if the exercise of an Option within the
applicable time periods is prevented by the provisions of Section 12 below, the Option shall remain
exercisable until three (3) months (or such longer period of time as determined by the Committee,
in its discretion) after the date the Participant is notified by the Company that the Option is
exercisable, but in any event no later than the Option Expiration Date.

6.5 Transferability of Options. During the lifetime of the Participant, an Option shall be
exercisable only by the Participant or the Participant’s guardian or legal representative. Prior
to the issuance of shares of Stock upon the exercise of an Option, the Option shall not be subject
in any manner to anticipation, alienation, sale, exchange, transfer, assignment, pledge,
encumbrance, or garnishment by creditors of the Participant or the Participant’s beneficiary,
except transfer by will or by the laws of descent and distribution. Notwithstanding the foregoing,
to the extent permitted by the Committee, in its discretion, a Nonstatutory Stock Option shall be
assignable or transferable subject to the applicable limitations, if any, described in the General
Instructions to Form S-8 Registration Statement under the Securities Act or as necessary to qualify
for an exemption from registration under Section 12(g) of the Exchange Act.

7. Terms and Conditions of Stock Appreciation Rights.

Stock Appreciation Rights shall be evidenced by Award Agreements specifying the number of
shares of Stock subject to the Award, in such form as the Committee shall from time to time
establish. No SAR or purported SAR shall be a valid and binding obligation of the Company unless
evidenced by a fully executed Award Agreement. Award Agreements evidencing SARs may incorporate
all or any of the terms of the Plan by reference and shall comply with and be subject to the
following terms and conditions:

7.1 Types of SARs Authorized. SARs may be granted in tandem with all or any portion of a
related Option (a “Tandem SAR”) or may be granted independently of any Option (a “Freestanding
SAR”). A Tandem SAR may be granted either concurrently with the grant of the related Option or at
any time thereafter prior to the complete exercise, termination, expiration or cancellation of such
related Option.

7.2 Exercise Price. The exercise price for each SAR shall be established in the discretion of
the Committee; provided, however, that (a) the exercise price per share subject to a Tandem SAR
shall be the exercise price per share under the related Option and (b) the exercise price per share
subject to a Freestanding SAR shall be not less than the Fair Market Value of a share of Stock on
the effective date of grant of the SAR.

7.3 Exercisability and Term of SARs.

(a) Tandem SARs. Tandem SARs shall be exercisable only at the time and to the extent, and
only to the extent, that the related Option is exercisable, subject to such provisions as the
Committee may specify where the Tandem SAR is granted with respect to less than the full number of
shares of Stock subject to the related Option.

(b) Freestanding SARs. Freestanding SARs shall be exercisable at such time or times, or upon
such event or events, and subject to such terms, conditions, performance criteria and restrictions
as shall be determined by the Committee and set forth in the Award Agreement evidencing such SAR;
provided, however, that no Freestanding SAR shall be exercisable after the expiration of ten (10)
years after the effective date of grant of such SAR.

7.4 Deemed Exercise of SARs. If, on the date on which an SAR would otherwise terminate or
expire, the SAR by its terms remains exercisable immediately prior to such termination or
expiration and, if so exercised, would result in a payment to the holder of such SAR, then any
portion of such SAR which has not previously been exercised shall automatically be deemed to be
exercised as of such date with respect to such portion, except as otherwise prohibited by
applicable law.

7.5 Effect of Termination of Service. Subject to earlier termination of the SAR as otherwise
provided herein and unless otherwise provided by the Committee in the grant of an SAR and set forth
in the Award Agreement, an SAR shall be exercisable after a Participant’s termination of Service
only as provided in the Award Agreement.

7.6 Nontransferability of SARs. During the lifetime of the Participant, an SAR shall be
exercisable only by the Participant or the Participant’s guardian or legal representative. Prior
to the exercise of an SAR, the SAR shall not be subject in any manner to anticipation, alienation,
sale, exchange, transfer, assignment, pledge, encumbrance, or garnishment by creditors of the
Participant or the Participant’s beneficiary, except transfer by will or by the laws of descent and
distribution.

8. Terms and Conditions of Stock Awards.

Stock Awards may be granted with or without Vesting Conditions and may or may not require the
payment of cash consideration. Stock Awards shall be evidenced by Award Agreements specifying the
number of shares of Stock subject to the Award, in such form as the Committee shall from time to
time establish. No Stock Award or purported Stock Award shall be a valid and binding obligation of
the Company unless evidenced by a fully executed Award Agreement. Award Agreements evidencing
Stock Awards may incorporate all or any of the terms of the Plan by reference and shall comply with
and be subject to the following terms and conditions:

8.1 Types of Restricted Stock Awards Authorized. Restricted Stock Awards may or may not
require the payment of cash consideration for the stock. Restricted Stock Awards may be granted
upon such conditions as the Committee shall determine, including, without limitation, upon the
attainment of one or more Performance Goals described in Section 9.4. If either the grant of a
Restricted Stock Award or the lapsing of the Restriction Period is to be contingent upon the
attainment of one or more Performance Goals, the Committee shall follow procedures substantially
equivalent to those set forth in Sections 9.3 through 9.5(a).

8.2 Purchase Price. The purchase price, if any, for shares of Stock issuable under each Stock
Award and the means of payment shall be established by the Committee in its discretion.

8.3 Purchase Period. A Stock Award requiring the payment of cash consideration shall be
exercisable within a period established by the Committee.

8.4 Vesting and Restrictions on Transfer. Shares issued pursuant to any Stock Award may or
may not be made subject to Vesting Conditions based upon the satisfaction of such Service
requirements, conditions, restrictions or performance criteria, including, without limitation,
Performance Goals as described in Section 9.4, as shall be established by the Committee and set
forth in the Award Agreement evidencing such Award. During any Restriction Period in which shares
acquired pursuant to a Restricted Stock Award remain subject to Vesting Conditions, such shares may
not be sold, exchanged, transferred, pledged, assigned or otherwise disposed of other than as
provided in the Award Agreement or as provided in Section 8.7. Upon request by the Company, each
Participant shall execute any agreement evidencing such transfer restrictions prior to the receipt
of shares of Stock hereunder.

8.5 Voting Rights; Dividends and Distributions. Except as provided in this Section,
Section 8.4 and any Award Agreement, during the Restriction Period applicable to shares subject to
a Restricted Stock Award, the Participant shall have all of the rights of a stockholder of the
Company holding shares of Stock, including the right to vote such shares and to receive all
dividends and other distributions paid with respect to such shares. However, in the event of a
dividend or distribution paid in shares of Stock or any other adjustment made upon a change in the
capital structure of the Company as described in Section 4.2, any and all new, substituted or
additional securities or other property (other than normal cash dividends) to which the Participant
is entitled by reason of the Participant’s Restricted Stock Award shall be immediately subject to
the same Vesting Conditions as the shares subject to the Restricted Stock Award with respect to
which such dividends or distributions were paid or adjustments were made.

8.6 Effect of Termination of Service. Unless otherwise provided by the Committee in the grant
of a Restricted Stock Award and set forth in the Award Agreement, if a Participant’s Service
terminates for any reason, whether voluntary or involuntary (including the Participant’s death or
disability), then the Participant shall forfeit to the Company any shares acquired by the
Participant pursuant to a Restricted Stock Award which remain subject to Vesting Conditions as of
the date of the Participant’s termination of Service in exchange for the payment of the purchase
price, if any, paid by the Participant. The Company shall have the right to assign at any time any
repurchase right it may have, whether or not such right is then exercisable, to one or more persons
as may be selected by the Company.

8.7 Nontransferability of Restricted Stock Award Rights. Prior to the issuance of shares of
Stock pursuant to a Restricted Stock Award, rights to acquire such shares shall not be subject in
any manner to anticipation, alienation, sale, exchange, transfer, assignment, pledge, encumbrance
or garnishment by creditors of the Participant or the Participant’s beneficiary, except transfer by
will or the laws of descent and distribution. All rights with respect to a Restricted Stock Award
granted to a Participant hereunder shall be exercisable during his or her lifetime only by such
Participant or the Participant’s guardian or legal representative.

9. Terms and Conditions of Performance Awards.

Performance Awards shall be evidenced by Award Agreements in such form as the Committee shall
from time to time establish. No Performance Award or purported Performance Award shall be a valid
and binding obligation of the Company unless evidenced by a fully executed Award Agreement. Award
Agreements evidencing Performance Awards may incorporate all or any of the terms of the Plan by
reference and shall comply with and be subject to the following terms and conditions:

9.1 Types of Performance Awards Authorized. Performance Awards may be in the form of either
Performance Shares or Performance Units. Each Award Agreement evidencing a Performance Award shall
specify the number of Performance Shares or Performance Units subject thereto, the Performance
Award Formula, the Performance Goal(s) and Performance Period applicable to the Award, and the
other terms, conditions and restrictions of the Award.

9.2 Initial Value of Performance Shares and Performance Units. Unless otherwise provided by
the Committee in granting a Performance Award, each Performance Share shall have an initial value
equal to the Fair Market Value of one (1) share of Stock, subject to adjustment as provided in
Section 4.2, on the effective date of grant of the Performance Share. Each Performance Unit shall
have an initial value determined by the Committee; provided, however, that in no event shall the
value be less than the aggregate Fair Market Value of the underlying shares on the date of grant.
The final value payable to the Participant in settlement of a Performance Award determined on the
basis of the applicable Performance Award Formula will depend on the extent to which Performance
Goals established by the Committee are attained within the applicable Performance Period
established by the Committee.

9.3 Establishment of Performance Period, Performance Goals and Performance Award Formula. In
granting each Performance Award, the Committee shall establish in writing the applicable
Performance Period, Performance Award Formula and one or more Performance Goals which, when
measured at the end of the Performance Period, shall determine on the basis of the Performance
Award Formula the final value of the Performance Award to be paid to the Participant. To the
extent compliance with the requirements under Section 162(m) with respect to “performance-based
compensation” is desired, the Committee shall establish the Performance Goal(s) and Performance
Award Formula applicable to each Performance Award no later than the earlier of (a) the date ninety
(90) days after the commencement of the applicable Performance Period or (b) the date on which 25%
of the Performance Period has elapsed, and, in any event, at a time when the outcome of the
Performance Goals remains substantially uncertain, and shall establish the Performance Goal(s) in
such a way that a third party with knowledge of the relevant facts could determine whether and to
what extent the Performance Goals have been met. Once established, the Performance Goals and
Performance Award Formula shall not be changed during the Performance Period with respect to any
Performance Award for which compliance with the requirements under Section 162(m) with respect to
“qualified performance-based compensation” is desired. The Company shall notify each Participant
granted a Performance Award of the terms of such Award, including the Performance Period,
Performance Goal(s) and Performance Award Formula.

9.4 Measurement of Performance Goals. Performance Goals shall be established by the Committee
on the basis of targets to be attained (“Performance Targets”) with respect to one or more measures
of business or financial performance (each, a “Performance Measure”), subject to the following:

(a) Performance Measures. Performance Measures shall have the same meanings as used in the
Company’s financial statements, or, if such terms are not used in the Company’s financial
statements, they shall have the meaning applied pursuant to generally accepted accounting
principles, or as used generally in the Company’s industry. Performance Measures shall be
calculated with respect to the Company and each Subsidiary Corporation and Parent Corporation
consolidated therewith for financial reporting purposes or such division or other business unit as
may be selected by the Committee. For purposes of the Plan, the Performance Measures applicable to
a Performance Award shall be calculated in accordance with generally accepted accounting
principles, but prior to the accrual or payment of any Performance Award for the same Performance
Period, if determined by the Committee, and excluding the effect (whether positive or negative) of
any change in accounting standards, as determined by the Committee, occurring after the
establishment of the Performance Goals applicable to the Performance Award. Each such adjustment,
if any, shall be made solely for the purpose of providing a consistent basis from period to period
for the calculation of Performance Measures in order to prevent the dilution or enlargement of the
Participant’s rights with respect to a Performance Award. Performance Measures may be one or more
of the following, as determined by the Committee:

(i) Earnings or Profitability Metrics: including, but not limited to, sales revenue; revenue
under collaborative agreements; earnings/loss (gross, operating, net, or adjusted); earnings/loss
before interest and taxes (“EBIT”); earnings/loss before interest, taxes, depreciation and
amortization (“EBITDA”); profit margin; operating margin; income (gross, operating or net); expense
levels or ratios; in each case adjusted to eliminate the effect of any one or more of the
following: interest expense, asset impairments, stock-based compensation expense, changes in GAAP
or critical accounting policies, or other extraordinary or non-recurring items, as specified by the
Committee when establishing the performance goals;

(ii) Return Metrics: including, but not limited to, return on investment, assets, equity or
capital (total or invested);

(iii) Cash Flow Metrics: including, but not limited to, operating cash flow; cash flow
sufficient to achieve financial ratios or a specified cash balance; free cash flow; cash flow
return on capital; net cash provided by operating activities; cash flow per share; working capital;

(iv) Liquidity Metrics: including, but not limited to, debt reduction; extension of maturity
dates of outstanding debt; debt leverage (debt to capital, net debt-to-capital, debt-to-EBITDA or
other liquidity ratios) or access to capital; debt ratings; total or net debt; other similar
measures approved by the Committee;

(v) Stock Price and Equity Metrics: including, but not limited to, return on stockholders’
equity; total shareholder return; revenue (gross, operating or net); revenue growth; stock price;
stock price appreciation; market price of stock; market capitalization; earnings/loss per share
(basic or diluted) (before or after taxes); price-to-earnings ratio; and

(vi) Strategic Metrics: including, but not limited to, product research and development;
completion of an identified special project; clinical trials; regulatory filings or approvals;
patent application or issuance; manufacturing or process development; sales or net sales; market
share; market penetration; economic value added; customer service; customer satisfaction; inventory
control; balance of cash, cash equivalents and marketable securities; growth in assets; key hires;
employee satisfaction; employee retention; business expansion; acquisitions, divestitures, joint
ventures or financing; legal compliance or safety and risk reduction; or such other measures as
determined by the Committee consistent with this Section 9.4(a).

(b) Performance Targets. Performance Targets may include a minimum, maximum, target level and
intermediate levels of performance, with the final value of a Performance Award determined under
the applicable Performance Award Formula by the level attained during the applicable Performance
Period. A Performance Target may be stated as an absolute value or as a value determined relative
to a standard selected by the Committee.

9.5 Settlement of Performance Awards.

(a) Determination of Final Value. As soon as practicable following the completion of the
Performance Period applicable to a Performance Award, the Committee shall certify in writing the
extent to which the applicable Performance Goals have been attained and the resulting final value
of the Award earned by the Participant and to be paid upon its settlement in accordance with the
applicable Performance Award Formula.

(b) Discretionary Adjustment of Award Formula. In its discretion, the Committee may, either
at the time it grants a Performance Award or at any time thereafter, provide for the positive or
negative adjustment of the Performance Award Formula applicable to a Performance Award that is not
intended to constitute “qualified performance based compensation” to a “covered employee” within
the meaning of Section 162(m) (a “Covered Employee”) to reflect such Participant’s individual
performance in his or her position with the Company or such other factors as the Committee may
determine. With respect to a Performance Award intended to constitute qualified performance-based
compensation to a Covered Employee, the Committee shall have the discretion to reduce some or all
of the value of the Performance Award that would otherwise be paid to the Covered Employee upon its
settlement notwithstanding the attainment of any Performance Goal and the resulting value of the
Performance Award determined in accordance with the Performance Award Formula, but may not increase
the value of any such Performance Award.

(c) Payment in Settlement of Performance Awards. As soon as practicable following the
Committee’s determination and certification in accordance with Sections 9.5(a) and (b), payment
shall be made to each eligible Participant (or such Participant’s legal representative or other
person who acquired the right to receive such payment by reason of the Participant’s death) of the
final value of the Participant’s Performance Award. Payment of such amount shall be made in cash
in a lump sum or in installments, shares of Stock (either fully vested or subject to vesting), or a
combination thereof, as determined by the Committee.

9.6 Voting Rights; Dividend Equivalent Rights and Distributions. Participants shall have no
voting rights with respect to shares of Stock represented by Performance Awards until the date of
the issuance of such shares, if any (as evidenced by the appropriate entry on the books of the
Company or of a duly authorized transfer agent of the Company). However, the Committee, in its
discretion, may provide in the Award Agreement evidencing any Performance Award that the
Participant shall be entitled to receive Dividend Equivalents with respect to the payment of cash
dividends on Stock having a record date prior to the date on which the Performance Award is settled
or forfeited. Such Dividend Equivalents, if any, shall be credited to the Participant in the form
of additional whole Performance Shares or Performance Units as of the date of payment of such cash
dividends on Stock. The number of additional Performance Shares or Performance Units (rounded to
the nearest whole number) to be so credited shall be determined by dividing (a) the amount of cash
dividends paid on such date with respect to the number of shares of Stock represented by the
Performance Award previously credited to the Participant by (b) the Fair Market Value per share of
Stock on such date. Dividend Equivalents shall be accumulated and paid to the extent that the
Performance Award becomes nonforfeitable, as determined by the Committee. Settlement of Dividend
Equivalents may be made in cash, shares of Stock, or a combination thereof as determined by the
Committee, and may be paid on the same basis as settlement of the related Performance Award as
provided in Section 9.5. In the event of a dividend or distribution paid in shares of Stock or any
other adjustment made upon a change in the capital structure of the Company as described in
Section 4.2, appropriate adjustments shall be made in the Participant’s Performance Award so that
it represents the right to receive upon settlement any and all new, substituted or additional
securities or other property (other than normal cash dividends) to which the Participant would be
entitled by reason of the shares of Stock issuable upon settlement of the Performance Award, and
all such new, substituted or additional securities or other property shall be immediately subject
to the same Performance Goals as are applicable to the Award.

9.7 Effect of Termination of Service. Unless otherwise provided by the Committee in the grant
of a Performance Award and set forth in the Award Agreement, if the Participant’s Service
terminates for any reason, including death or Disability, before the completion of the Performance
Period applicable to the Performance Award, the final value of the Participant’s Performance Award
shall be determined by the extent to which the applicable Performance Goals have been attained with
respect to the entire Performance Period and shall be prorated based on the number of months of the
Participant’s Service during the Performance Period. Payment shall be made following the end of
the Performance Period in any manner permitted by Section 9.5.

9.8 Nontransferability of Performance Awards. Prior to settlement in accordance with the
provisions of the Plan, no Performance Award shall be subject in any manner to anticipation,
alienation, sale, exchange, transfer, assignment, pledge, encumbrance, or garnishment by creditors
of the Participant or the Participant’s beneficiary, except transfer by will or by the laws of
descent and distribution. All rights with respect to a Performance Award granted to a Participant
hereunder shall be exercisable during his or her lifetime only by such Participant or the
Participant’s guardian or legal representative.

10. Terms and Conditions of Restricted Stock Unit Awards.

Restricted Stock Unit Awards shall be evidenced by Award Agreements specifying the number of
Restricted Stock Units subject to the Award, in such form as the Committee shall from time to time
establish. No Restricted Stock Unit Award or purported Restricted Stock Unit Award shall be a
valid and binding obligation of the Company unless evidenced by a fully executed Award Agreement.
Award Agreements evidencing Restricted Stock Units may incorporate all or any of the terms of the
Plan by reference and shall comply with and be subject to the following terms and conditions:

10.1 Grant of Restricted Stock Unit Awards. Restricted Stock Unit Awards may be granted upon
such conditions as the Committee shall determine, including, without limitation, upon the
attainment of one or more Performance Goals described in Section 9.4. If either the grant of a
Restricted Stock Unit Award or the Vesting Conditions with respect to such Award is to be
contingent upon the attainment of one or more Performance Goals, the Committee shall follow
procedures substantially equivalent to those set forth in Sections 9.3 through 9.5(a).

10.2 Vesting. Restricted Stock Units may or may not be made subject to Vesting Conditions
based upon the satisfaction of such Service requirements, conditions, restrictions or performance
criteria, including, without limitation, Performance Goals as described in Section 9.4, as shall be
established by the Committee and set forth in the Award Agreement evidencing such Award.

10.3 Voting Rights, Dividend Equivalent Rights and Distributions. Participants shall have no
voting rights with respect to shares of Stock represented by Restricted Stock Units until the date
of the issuance of such shares (as evidenced by the appropriate entry on the books of the Company
or of a duly authorized transfer agent of the Company). However, the Committee, in its discretion,
may provide in the Award Agreement evidencing any Restricted Stock Unit Award that the Participant
shall be entitled to receive Dividend Equivalents with respect to the payment of cash dividends on
Stock having a record date prior to the date on which Restricted Stock Units held by such
Participant are settled. Such Dividend Equivalents, if any, shall be paid in cash or by crediting
the Participant with additional whole Restricted Stock Units as of the date of payment of such cash
dividends on Stock. The number of additional Restricted Stock Units (rounded to the nearest whole
number) to be so credited, if any, shall be determined by dividing (a) the amount of cash dividends
paid on such date with respect to the number of shares of Stock represented by the Restricted Stock
Units previously credited to the Participant by (b) the Fair Market Value per share of Stock on
such date. Such additional Restricted Stock Units, if any, shall be subject to the same terms and
conditions and shall be settled in the same manner and at the same time (or as soon thereafter as
practicable) as the Restricted Stock Units originally subject to the Restricted Stock Unit Award.
In the event of a dividend or distribution paid in shares of Stock or any other adjustment made
upon a change in the capital structure of the Company as described in Section 4.2, appropriate
adjustments shall be made in the Participant’s Restricted Stock Unit Award so that it represents
the right to receive upon settlement any and all new, substituted or additional securities or other
property (other than normal cash dividends) to which the Participant would be entitled by reason of
the shares of Stock issuable upon settlement of the Award, and all such new, substituted or
additional securities or other property shall be immediately subject to the same Vesting Conditions
as are applicable to the Award.

10.4 Effect of Termination of Service. Unless otherwise provided by the Committee in the
grant of a Restricted Stock Unit Award and set forth in the Award Agreement, if a Participant’s
Service terminates for any reason, whether voluntary or involuntary (including the Participant’s
death or disability), then the Participant shall forfeit to the Company any Restricted Stock Units
pursuant to the Award which remain subject to Vesting Conditions as of the date of the
Participant’s termination of Service.

10.5 Settlement of Restricted Stock Unit Awards. The Company shall issue to a Participant on
the date on which Restricted Stock Units subject to the Participant’s Restricted Stock Unit Award
vest or on such other date determined by the Committee, in its discretion, and set forth in the
Award Agreement one (1) share of Stock (and/or any other new, substituted or additional securities
or other property pursuant to an adjustment described in Section 11.3) for each Restricted Stock
Unit then becoming vested or otherwise to be settled on such date, subject to the withholding of
applicable taxes. Notwithstanding the foregoing, if permitted by the Committee and set forth in
the Award Agreement, the Participant may elect in accordance with terms specified in the Award
Agreement to defer receipt of all or any portion of the shares of Stock or other property otherwise
issuable to the Participant pursuant to this Section.

10.6 Nontransferability of Restricted Stock Unit Awards. Prior to the issuance of shares of
Stock in settlement of a Restricted Stock Unit Award, the Award shall not be subject in any manner
to anticipation, alienation, sale, exchange, transfer, assignment, pledge, encumbrance, or
garnishment by creditors of the Participant or the Participant’s beneficiary, except transfer by
will or by the laws of descent and distribution. All rights with respect to a Restricted Stock
Unit Award granted to a Participant hereunder shall be exercisable during his or her lifetime only
by such Participant or the Participant’s guardian or legal representative.

11. Effect of Change in Control on Awards.

11.1 Change in Control Transactions. In the event of any transaction resulting in a Change in
Control of the Company, outstanding Awards that are payable in or convertible into Stock under the
Plan will terminate upon the effective time of such Change in Control unless provision is made by
the Company in connection with the transaction for the continuation or assumption of such Awards
by, or for the substitution of equivalent awards of, the surviving or successor entity or a parent
thereof. All determinations as to whether any, some or all outstanding Awards and, if any, which
such Awards, will be continued, assumed or substituted in a transaction and whether any such
substitution is for equivalent awards shall be made in the sole discretion of the Committee, and
such continuation, assumption, or substitution may be effectuated without the consent of the holder
of any such outstanding Award. In the event of such termination, the holders of Awards that will
be terminated upon the effective time of the Change in Control will be permitted, immediately
before the Change in Control, to exercise or convert all portions of such Awards under the Plan
that are then exercisable or convertible or which become exercisable or convertible upon or prior
to the effective time of the Change in Control. In the event of any transaction resulting in a
Change in Control of the Company prior to the end of a Performance Period for any Performance
Award, the Committee may determine that one or more Participants who were awarded a Performance
Award for the Performance Period in which such Change in Control of the Company occurs may receive
payment of such Performance Award for the Performance Period, in such amount and at such time as
the Committee determines; provided, however, that, to the extent such Performance Award constitutes
deferred compensation under Section 409A of the Code, any such payment with respect to the
Performance Award shall be made in compliance with Section 409A of the Code.

11.2 Unusual or Nonrecurring Events. The Committee is authorized to make, in its discretion
and without the consent of holders of Awards, adjustments in the terms and conditions of, and the
criteria included in, Awards in recognition of unusual or nonrecurring events affecting the
Company, or the financial statements of the Company, or of changes in applicable laws, regulations,
or accounting principles, whenever the Committee determines that such adjustments are appropriate
in order to prevent dilution or enlargement of the benefits or potential benefits intended to be
made available under the Plan.

12. Compliance With Securities Law.

The grant of Awards and the issuance of shares of Stock pursuant to any Award shall be subject
to compliance with all applicable requirements of federal, state and foreign law with respect to
such securities and the requirements of any stock exchange or market system upon which the Stock
may then be listed. In addition, no Award may be exercised or shares issued pursuant to an Award
unless (a) a registration statement under the Securities Act shall at the time of such exercise or
issuance be in effect with respect to the shares issuable pursuant to the Award or (b) in the
opinion of legal counsel to the Company, the shares issuable pursuant to the Award may be issued in
accordance with the terms of an applicable exemption from the registration requirements of the
Securities Act. The inability of the Company to obtain from any regulatory body having
jurisdiction the authority, if any, deemed by the Company’s legal counsel to be necessary to the
lawful issuance and sale of any shares hereunder shall relieve the Company of any liability in
respect of the failure to issue or sell such shares as to which such requisite authority shall not
have been obtained. As a condition to issuance of any Stock, the Company may require the
Participant to satisfy any qualifications that may be necessary or appropriate, to evidence
compliance with any applicable law or regulation and to make any representation or warranty with
respect thereto as may be requested by the Company.

13. Tax Withholding.

13.1 Tax Withholding in General. The Company shall have the right to deduct from any and all
payments made under the Plan, or to require the Participant, through payroll withholding, cash
payment or otherwise, including by means of a Cashless Exercise or net exercise of an Option, or
net settlement of other types of Awards, to make adequate provision for, the federal, state, local
and foreign taxes, if any, required by law to be withheld by the Participating Company Group with
respect to an Award or the shares acquired pursuant thereto. The Company shall have no obligation
to deliver shares of Stock, to release shares of Stock from an escrow established pursuant to an
Award Agreement, or to make any payment in cash under the Plan until the Participating Company
Group’s tax withholding obligations have been satisfied by the Participant.

13.2 Withholding in Shares. The Company shall have the right, but not the obligation, to
deduct from the shares of Stock issuable to a Participant upon the exercise or settlement of an
Award, or to accept from the Participant the tender of, a number of whole shares of Stock having a
Fair Market Value, as determined by the Company, equal to all or any part of the tax withholding
obligations of the Participating Company Group. The Fair Market Value of any shares of Stock
withheld or tendered to satisfy any such tax withholding obligations shall not exceed the amount
determined by the applicable minimum statutory withholding rates.

14. Amendment or Termination of Plan.

The Board or the Committee may amend, suspend or terminate the Plan at any time. However,
without the approval of the Company’s stockholders, there shall be (a) no increase in the maximum
aggregate number of shares of Stock that may be issued under the Plan (except by operation of the
provisions of Section 4.2), (b) no change in the class of persons eligible to receive Incentive
Stock Options, the prohibition on repricing and reloading in Section 3.7, the Award limits in
Section 5.4, the minimum exercise price, maximum term, and vesting period of Options or SARs, and
any limitation on the Vesting Conditions of Restricted Stock or Restricted Stock Units, and (c) no
other amendment of the Plan that would require approval of the Company’s stockholders under any
applicable law, regulation or rule. No amendment, suspension or termination of the Plan shall
affect any then outstanding Award unless expressly provided by the Board or the Committee. In any
event, no amendment, suspension or termination of the Plan may adversely affect any then
outstanding Award without the consent of the Participant unless necessary to comply with any
applicable law, regulation or rule.

15. Miscellaneous Provisions.

15.1 Repurchase Rights. Shares issued under the Plan may be subject to one or more repurchase
options, or other conditions and restrictions as determined by the Committee in its discretion at
the time the Award is granted. The Company shall have the right to assign at any time any
repurchase right it may have, whether or not such right is then exercisable, to one or more persons
as may be selected by the Company. Upon request by the Company, each Participant shall execute any
agreement evidencing such transfer restrictions prior to the receipt of shares of Stock hereunder
and shall promptly present to the Company any and all certificates representing shares of Stock
acquired hereunder for the placement on such certificates of appropriate legends evidencing any
such transfer restrictions.

15.2 Rights as Employee, Consultant or Director. No person, even though eligible pursuant to
Section 5, shall have a right to be selected as a Participant, or, having been so selected, to be
selected again as a Participant. Nothing in the Plan or any Award granted under the Plan shall
confer on any Participant a right to remain an Employee, Consultant or Director or interfere with
or limit in any way any right of a Participating Company to terminate the Participant’s Service at
any time. To the extent that an Employee of a Participating Company other than the Company
receives an Award under the Plan, that Award shall in no event be understood or interpreted to mean
that the Company is the Employee’s employer or that the Employee has an employment relationship
with the Company.

15.3 Rights as a Stockholder. A Participant shall have no rights as a stockholder with
respect to any shares covered by an Award until the date of the issuance of such shares (as
evidenced by the appropriate entry on the books of the Company or of a duly authorized transfer
agent of the Company). No adjustment shall be made for dividends, distributions or other rights
for which the record date is prior to the date such shares are issued, except as provided in
Section 4.2 or another provision of the Plan.

15.4 Fractional Shares. The Company shall not be required to issue fractional shares upon the
exercise or settlement of any Award.

15.5 Severability. If any one or more of the provisions (or any part thereof) of this Plan
shall be held invalid, illegal or unenforceable in any respect, such provision shall be modified so
as to make it valid, legal and enforceable, and the validity, legality and enforceability of the
remaining provisions (or any part thereof) of the Plan shall not in any way be affected or impaired
thereby.

15.6 Beneficiary Designation. Subject to local laws and procedures, each Participant may file
with the Company a written designation of a beneficiary who is to receive any benefit under the
Plan to which the Participant is entitled in the event of such Participant’s death before he or she
receives any or all of such benefit. Each designation will revoke all prior designations by the
same Participant, shall be in a form prescribed by the Company, and will be effective only when
filed by the Participant in writing with the Company during the Participant’s lifetime. If a
married Participant designates a beneficiary other than the Participant’s spouse, the effectiveness
of such designation may be subject to the consent of the Participant’s spouse, if required by
applicable law or the Company. If a Participant dies without an effective designation of a
beneficiary who is living at the time of the Participant’s death, the Company will pay any
remaining unpaid benefits to the Participant’s legal representative.

15.7 Unfunded Obligation. Participants shall have the status of general unsecured creditors
of the Company. Any amounts payable to Participants pursuant to the Plan shall be unfunded and
unsecured obligations for all purposes, including, without limitation, Title I of the Employee
Retirement Income Security Act of 1974. No Participating Company shall be required to segregate
any monies from its general funds, or to create any trusts, or establish any special accounts with
respect to such obligations. The Company shall retain at all times beneficial ownership of any
investments, including trust investments, which the Company may make to fulfill its payment
obligations hereunder. Any investments or the creation or maintenance of any trust or any
Participant account shall not create or constitute a trust or fiduciary relationship between the
Committee or any Participating Company and a Participant, or otherwise create any vested or
beneficial interest in any Participant or the Participant’s creditors in any assets of any
Participating Company. The Participants shall have no claim against any Participating Company for
any changes in the value of any assets which may be invested or reinvested by the Company with
respect to the Plan. Each Participating Company shall be responsible for making benefit payments
pursuant to the Plan on behalf of its Participants or for reimbursing the Company for the cost of
such payments, as determined by the Company in its sole discretion. In the event the respective
Participating Company fails to make such payment or reimbursement, a Participant’s (or other
individual’s) sole recourse shall be against the respective Participating Company, and not against
the Company. A Participant’s acceptance of an Award pursuant to the Plan shall constitute
agreement with this provision.

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