Document:

contractamend6.htm

    Back to Form
8-K

    Exhibit 10.5

    
      
         

        
          	 Wellcare of Florida, Inc.
      d/b/a	 Medicaid HMO
      Contract
	  Staywell Health Plan of
      Florida	 

        

         

      

      AHCA
CONTRACT NO. FA615 

    

    
      AMENDMENT
NO. 6

    

    
       

      THIS CONTRACT, entered into
between the STATE OF FLORIDA,
AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the
“Agency,” and WELLCARE OF
FLORIDA, INC. D/B/A STAYWELL HEALTH PLAN OF FLORIDA, hereinafter referred
to as the “Vendor” or “Health Plan”, is hereby amended as
follows:

    

    
       

      
        	
                1.

              	
                Effective
      September 1, 2008, Standard Contract, Section III, Item C., Contract
      Managers, sub-item
      1, is hereby amended to now read as
  follows:

              

      

    

    
       

    

    
      
        	
                 
      

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

              

      

    

    
       

      
        	 	
                Suzanne
      Stacknik

                Agency
      for Health Care Administration

                2727
      Mahan Drive, MS #50

                Tallahassee,
      FL 32308

                (850)
      487-2355

              

      

                     

    

    
      
        	
                2.

              	
                Effective
      December 1, 2008, Attachment I, Scope of Services, is hereby amended to
      include Exhibit I-B, Second Revised Maximum Enrollment Levels, attached
      hereto and made a part of the Contract. All references in the Contract to
      Exhibit I-A, Revised Maximum Enrollment Levels, shall hereinafter also
      refer to Exhibit I-B, Second Revised Maximum Enrollment Levels, as
      appropriate.

              

      

    

    
       

      
        	
                3.

              	
                Effective
      December 1, 2008, Attachment I, Scope of Services, is hereby amended to
      include Exhibit II-D, Fourth Revised Capitation Rates, attached hereto and
      made a part of the Contract. All references in the Contract to Exhibit
      II-C, Third Revised Capitation Rates, shall hereinafter also refer to
      Exhibit II-D, Fourth Revised Capitation Rates, as
    appropriate.

              

      

    

    
       

      
        	
                4.

              	
                Effective
      September 1, 2008, Attachment I, Scope of Services, is hereby amended to
      include Exhibit III-D, September 1, 2008 - August 31, 2009 Medicaid
      Non-Reform HMO Capitation Rates, attached hereto and made a part of the
      Contract. All references in the Contract to Exhibit III-C, January 1, 2008
      – August 31, 2008 Medicaid Non-Reform HMO Capitation Rates, shall
      hereinafter also refer to Exhibit III-D, September 1, 2008 - August 31,
      2009 Medicaid Non-Reform HMO Capitation Rates, as
    appropriate.

              

      

    

    
       

      
        	 	All
      provisions in the Contract and any attachments thereto in conflict with
      this Amendment shall be and are hereby changed to conform with this
      Amendment.
	 	 
	 	All
      provisions not in conflict with this Amendment are still in effect and are
      to be performed at the level specified in the
Contract.
	 	 
	 	
                This
      Amendment and all its attachments are hereby made part of the
      Contract.

              
	 	 
	 	This Amendment
      cannot be executed unless all previous Amendments to this Contract have
      been fully executed.
	 	 

      

       

    

    
      REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK

    

    
      

      AHCA
Contract No. FA615, Amendment No. 6, Page 1 of 2

    

    
      AHCA Form
2100-0002 (Rev. NOV03)

    

    
      

        
          
             

          

          
             

            
              

            

          

          
             

          

        

      

       

    

    
      
        
          	Wellcare of Florida, Inc. d/b/a
      	Medicaid
      HMO Contract
	Staywell Health Plan of
      Florida	 

        

         

      

    

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

       

      
        	
                WELLCARE
      OF FLORIDA, INC.

                D/B/A
      STAYWELL HEALTH PLAN OF FLORIDA

                 

              	
                STATE
      OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION

              
	
                SIGNED

                BY: /s/ Heath
      Schiesser                     
      

              	
                SIGNED

                BY: /s/
      William H. Roberts for Holly
      Benson 

              
	
                NAME:
      Heath
      Schiesser                    
      

              	
                NAME:
      Holly
      Benson                                      
      

              
	
                TITLE: President
      and
      CEO                
      

              	
                TITLE:
      Secretary                                            
         

              
	
                DATE: 
      8/29/08                                   
      

              	
                DATE: 
      8/29/08                                                  
      

              

      

      
 

      List of
attachments/exhibits included as part of this Amendment:

       

    

    
      	
              Specify

              Type

            	
              Letter/

              Number

            	
              Description

            
	
              Exhibit

            	
              I-B

            	
              Second
      Revised Maximum Enrollment Levels (1 Page)

            
	
              Exhibit

            	
              II-D

            	
              Fourth
      Revised Capitation Rates (1 Page)

            
	
              Exhibit

            	
              III-D

            	
              September
      1, 2008 - August 31, 2009 Medicaid Non-Reform HMO Capitation Rates (5
      Pages)

            

    

    
       

    

    
      REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK

       

      AHCA
Contract No. FA615, Amendment No. 6, Page 2 of 2

    

    
      AHCA Form
2100-0002 (Rev. NOV03)

    

    

    
      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

     

    
      
        
          	Wellcare of Florida, Inc. d/b/a
      	Medicaid HMO
      Contract
	Staywell Health Plan of
      Florida	 

        

         

      

      
        EXHIBIT
I-B

        
          SECOND
REVISED MAXIMUM ENROLLMENT LEVELS

        

      

    

    
       

    

     

    
      	
              
                County

              

            	
              
                Maximum
      Enrollment Level

              

            
	
              
                Brevard

              

            	
              
                14,000

              

            
	
              
                Broward

              

            	
              
                25,000

              

            
	
              
                Dade

              

            	
              
                25,000

              

            
	
              
                Hernando

              

            	
              
                15,000

              

            
	
              
                Hillsborough

              

            	
              
                28,000

              

            
	
              
                Lee

              

            	
              
                15,000

              

            
	
              
                Manatee

              

            	
              
                12,000

              

            
	
              
                Palm
      Beach

              

            	
              
                15,000

              

            
	
              
                Pasco

              

            	
              
                7,000

              

            
	
              
                Pinellas

              

            	
              
                15,000

              

            
	
              
                Polk

              

            	
              
                25,000

              

            
	
              
                Orange

              

            	
              
                38,000

              

            
	
              
                Osceola

              

            	
              
                12,000

              

            
	
              
                Sarasota

              

            	
              
                6,000

              

            
	
              
                Seminole

              

            	
              
                6,000

              

            
	
              
                Sumter

              

            	
              
                4,500

              

            

    

    
      

      REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK

    

    
       

    

    
      AHCA
Contract No. FA615, Exhibit I-B, Page 1 of 1

    

    

    
      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

     

    
      
        
          	Wellcare of Florida, Inc. d/b/a
      	Medicaid HMO
      Contract
	
                  Staywell
      Health Plan of Florida

                	 

        

         

        EXHIBIT
II-D

      

    

    
      FOURTH
REVISED CAPITATION RATES

    

     

    
      A.         
Table 2 - General Capitation Rates plus Mental Health
Rates:

    

    
       

      Area
3 Counties:

    

    
      	
              
                County

              

            	
              
                Provider
      Number

              

            
	
              
                Hernando

              

            	
              
                015016901

              

            
	
              
                Sumter

              

            	
              
                015016916

              

            

    

    
       

    

    
      Area
5 Counties:

    

    
      	
              
                County

              

            	
              
                Provider
      Number

              

            
	
              
                Pasco

              

            	
              
                015016903

              

            
	
              
                Pinellas

              

            	
              
                015016904

              

            

    

    
       

      Area
6 Counties:

    

    
      	
              
                County

              

            	
              
                Provider
      Number

              

            
	
              
                Hillsborough

              

            	
              
                015016902

              

            
	
              
                Manatee

              

            	
              
                015016912

              

            
	
              
                Polk

              

            	
              
                015016905

              

            

    

    
       

      Area
7 Counties:

    

    
      	
              
                County

              

            	
              
                Provider
      Number

              

            
	
              
                Orange

              

            	
              
                015016906

              

            
	
              
                Seminole

              

            	
              
                015016908

              

            
	
              
                Osceola

              

            	
              
                015016907

              

            
	
              
                Brevard

              

            	
              
                015016913

              

            

    

    
       

      Area 8
Counties:

    

    
      	
              
                County

              

            	
              
                Provider
      Number

              

            
	
              
                Lee

              

            	
              
                015016911

              

            
	
              
                Sarasota

              

            	
              
                015016914

              

            

    

    
       

      Area
9 Counties:

    

    
      	
              
                County

              

            	
              
                Provider
      Number

              

            
	
              
                Palm
      Beach

              

            	
              
                015016910

              

            

    

    
       

      Area
10 Counties:

    

    
      	
              
                County

              

            	
              
                Provider
      Number

              

            
	
              
                Broward

              

            	
              
                015016900

              

            

    

    
       

      Area
11 Counties:

    

    
      	
              
                County

              

            	
              
                Provider
      Number

              

            
	
              
                Miami-Dade

              

            	
              
                015016909

              

            

    

     

    REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK

     

    AHCA
Contract No. FA615, Exhibit II-D, Page 1 of 1

    

    
      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

     

    
      
        EXHIBIT
III-D

      

      
        September
1, 2008 - August 31, 2009

      

      
        MEDICAID
NON-REFORM HMO CAPITATION RATES

      

      
        By
Area, Age and Eligibility Category

         

      

      
        Table 1

        
          
            	
                    General
      Rates

                  	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	
                    TANF

                  	
                    SSI-N

                  	
                    SSI-B

                  	
                    SSS-AB

                  
	
                    Area

                  	
                    BTHMO+2MO

                  	
                    3MO-

                    11MO

                  	
                    AGE
      

                    (1-5)

                  	
                    AGE
      

                    (6-13)

                  	
                         
      AGE (14-20)

                  	
                         
      AGE (21-54)

                  	
                    AGE
      

                    (55+)

                  	
                     
      BTHMO+2MO

                  	
                    3MO-

                    11MO

                  	
                    AGE

                    (1-5)

                  	
                        
         AGE         
         AGE       
               AGE

                         
       (6-13)        
        (14-20)          
      (21-54)

                  	
                        
      AGE 

                    (55+)

                  	 
      	
                          
      AGE          
       AGE

                           
      (65-)           
      (65+)

                  
	 
      	 
      	 
      	 
      	 
      	
                    Female

                  	
                    Male

                  	
                    Female

                  	
                    Male

                  	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                    01

                  	
                    1,113.37

                  	
                    187.38

                  	
                    101.38

                  	
                    61.45

                  	
                    129.49

                  	
                    69.52

                  	
                    255.23

                  	
                    153.37

                  	
                    318.51

                  	
                    10,428.92

                  	
                    1,517.58

                  	
                    445.88

                  	
                    198.88

                  	
                    213.14

                  	
                    696.73

                  	
                    700.31

                  	
                    305.88

                  	
                    94.80

                  	
                    85.77

                  
	
                    02

                  	
                    1,113.37

                  	
                    187.38

                  	
                    101.38

                  	
                    61.45

                  	
                    129.49

                  	
                    69.52

                  	
                    255.23

                  	
                    153.37

                  	
                    318.51

                  	
                    10,428.92

                  	
                    1,517.58

                  	
                    445.88

                  	
                    198.88

                  	
                    213.14

                  	
                    696.73

                  	
                    700.31

                  	
                    305.88

                  	
                    94.80

                  	
                    85.77

                  
	
                    03

                  	
                    1,217.57

                  	
                    206.51

                  	
                    112.28

                  	
                    69.11

                  	
                    143.30

                  	
                    77.85

                  	
                    283.53

                  	
                    171.42

                  	
                    359.72

                  	
                    11,442.82

                  	
                    1,680.06

                  	
                    495.07

                  	
                    226.05

                  	
                    241.47

                  	
                    787.51

                  	
                    795.55

                  	
                    340.56

                  	
                    90.01

                  	
                    81.98

                  
	
                    04

                  	
                    1,067.51

                  	
                    181.92

                  	
                    99.04

                  	
                    61.51

                  	
                    126.30

                  	
                    69.23

                  	
                    250.83

                  	
                    152.26

                  	
                    321.21

                  	
                    10,972.58

                  	
                    1,615.28

                  	
                    476.38

                  	
                    218.79

                  	
                    233.36

                  	
                    761.37

                  	
                    770.55

                  	
                    297.82

                  	
                    90.35

                  	
                    82.40

                  
	
                    05

                  	
                    1,214.96

                  	
                    206.53

                  	
                    112.30

                  	
                    69.38

                  	
                    143.25

                  	
                    78.21

                  	
                    284.08

                  	
                    172.12

                  	
                    361.87

                  	
                    12,248.94

                  	
                    1,796.88

                  	
                    528.79

                  	
                    240.95

                  	
                    256.93

                  	
                    840.31

                  	
                    849.11

                  	
                    225.19

                  	
                    81.19

                  	
                    75.29

                  
	
                    06

                  	
                    1,056.56

                  	
                    181.19

                  	
                    98.87

                  	
                    61.99

                  	
                    126.18

                  	
                    69.68

                  	
                    251.35

                  	
                    153.20

                  	
                    325.45

                  	
                    11,162.18

                  	
                    1,645.44

                  	
                    485.06

                  	
                    223.95

                  	
                    237.92

                  	
                    777.94

                  	
                    788.05

                  	
                    274.94

                  	
                    79.31

                  	
                    72.63

                  
	
                    07

                  	
                    1,092.94

                  	
                    186.84

                  	
                    101.87

                  	
                    63.49

                  	
                    129.77

                  	
                    71.35

                  	
                    258.27

                  	
                    157.02

                  	
                    332.09

                  	
                    11,810.40

                  	
                    1,744.81

                  	
                    514.41

                  	
                    238.57

                  	
                    254.24

                  	
                    828.77

                  	
                    840.70

                  	
                    373.98

                  	
                    84.56

                  	
                    77.61

                  
	
                    08

                  	
                    1,033.51

                  	
                    177.08

                  	
                    96.67

                  	
                    60.37

                  	
                    123.15

                  	
                    68.03

                  	
                    245.23

                  	
                    149.29

                  	
                    316.91

                  	
                    10,525.98

                  	
                    1,550.30

                  	
                    457.03

                  	
                    210.03

                  	
                    224.35

                  	
                    731.36

                  	
                    740.14

                  	
                    256.24

                  	
                    78.77

                  	
                    72.23

                  
	
                    09

                  	
                    1,067.78

                  	
                    181.58

                  	
                    96.82

                  	
                    61.05

                  	
                    126.06

                  	
                    68.67

                  	
                    249.80

                  	
                    151.41

                  	
                    318.38

                  	
                    11,078.29

                  	
                    1,635.46

                  	
                    482.13

                  	
                    223.68

                  	
                    237.34

                  	
                    775.59

                  	
                    785.85

                  	
                    219.29

                  	
                    84.42

                  	
                    77.20

                  
	
                    10

                  	
                    1,083.46

                  	
                    186.09

                  	
                    101.73

                  	
                    63.88

                  	
                    129.70

                  	
                    71.87

                  	
                    258.53

                  	
                    157.78

                  	
                    335.92

                  	
                    14,344.29

                  	
                    2,132.34

                  	
                    629.36

                  	
                    297.17

                  	
                    314.18

                  	
                    1,027.07

                  	
                    1,044.85

                  	
                    322.21

                  	
                    94.02

                  	
                    86.21

                  
	
                    11

                  	
                    1,372.19

                  	
                    232.59

                  	
                    126.24

                  	
                    77.54

                  	
                    161.30

                  	
                    87.46

                  	
                    319.10

                  	
                    192.88

                  	
                    404.23

                  	
                    14,488.14

                  	
                    2,131.88

                  	
                    628.05

                  	
                    289.19

                  	
                    307.93

                  	
                    1,004.54

                  	
                    1,015.98

                  	
                    370.49

                  	
                    140.27

                  	
                    126.63

                  

          

        

      

      
         

        TABLE
2

      

      
        
          
            	 
      General +
      Mental Health Rates:	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	
                    TANF

                  	
                    SSl-N

                  	
                    SSI-B

                  	
                    SSI-AB

                  
	
                    Area

                  	
                    BTHMO+2MO

                  	
                      3MO-11MO

                  	
                     AGE
      

                    (1-5)

                  	
                        AGE
      

                    (6-13)

                  	
                    AGE
      (14-20)

                  	
                         
      AGE (21-54)

                  	
                    AGE
      (55+)

                  	
                     BTHMO+2MO

                  	
                     3MO-

                    11MO

                  	
                     AGE
      

                    (1-5)

                  	
                    AGE

                     (6-13)

                  	
                     AGE
      

                    (14-20)

                  	
                    AGE
      

                    (21-54)

                  	
                    AGE
      

                    (55+)

                  	 
      	
                    AGE
      (65-)

                  	
                    AGE 
      

                    (65+)

                  
	 
      	 
      	 
      	 
      	 
      	
                    Female

                  	
                    Male

                  	
                       Female

                  	
                    Male

                  	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                    01

                  	
                    1,113.39

                  	
                    187.40

                  	
                    103.02

                  	
                    73.14

                  	
                    140.42

                  	
                    80.45

                  	
                    259.67

                  	
                    157.81

                  	
                    322.25

                  	
                    10,429.00

                  	
                    1,517.66

                  	
                    453.32

                  	
                    246.93

                  	
                    257.13

                  	
                    778.13

                  	
                    731.29

                  	
                    306.09

                  	
                    106.45

                  	
                    97.42

                  
	
                    02

                  	
                    1,113.40

                  	
                    187.41

                  	
                    104.29

                  	
                    81.71

                  	
                    142.91

                  	
                    82.94

                  	
                    258.64

                  	
                    156.78

                  	
                    321.46

                  	
                    10,429.08

                  	
                    1,517.74

                  	
                    459.67

                  	
                    277.70

                  	
                    258.36

                  	
                    749.41

                  	
                    725.19

                  	
                    326.08

                  	
                    109.81

                  	
                    100.78

                  
	
                    03

                  	
                    1,217.58

                  	
                    206.52

                  	
                    113.60

                  	
                    78.29

                  	
                    149.38

                  	
                    83.93

                  	
                    285.07

                  	
                    172.96

                  	
                    361.06

                  	
                    11,442.89

                  	
                    1,680.13

                  	
                    501.33

                  	
                    261.81

                  	
                    261.99

                  	
                    811.41

                  	
                    806.83

                  	
                    347.41

                  	
                    98.99

                  	
                    90.96

                  
	
                    04

                  	
                    1,067.52

                  	
                    181.93

                  	
                    100.42

                  	
                    71.07

                  	
                    132.64

                  	
                    75.57

                  	
                    252.44

                  	
                    153.87

                  	
                    322.61

                  	
                    10,972.69

                  	
                    1,615.39

                  	
                    486.14

                  	
                    274.53

                  	
                    265.34

                  	
                    798.63

                  	
                    788.14

                  	
                    322.37

                  	
                    107.12

                  	
                    99.17

                  
	
                    05

                  	
                    1,.214.97

                  	
                    206.54

                  	
                    113.51

                  	
                    78.06

                  	
                    151.36

                  	
                    86.32

                  	
                    287.37

                  	
                    175.41

                  	
                    364.65

                  	
                    12,248.99

                  	
                    1,796.93

                  	
                    533.81

                  	
                    273.37

                  	
                    286.61

                  	
                    835.23

                  	
                    870.01

                  	
                    227.92

                  	
                    94.01

                  	
                    88.11

                  
	
                    06

                  	
                    1,056.58

                  	
                    181.21

                  	
                    100.72

                  	
                    75.24

                  	
                    138.56

                  	
                    82.06

                  	
                    256.38

                  	
                    158.23

                  	
                    329.70

                  	
                    11,162.25

                  	
                    1,645.51

                  	
                    491.58

                  	
                    266.06

                  	
                    276.46

                  	
                    849.27

                  	
                    815.20

                  	
                    276.25

                  	
                    83.20

                  	
                    76.52

                  
	
                    07

                  	
                    1,092.96

                  	
                    186.86

                  	
                    103.65

                  	
                    76.18

                  	
                    141.63

                  	
                    83.21

                  	
                    263.09

                  	
                    161.84

                  	
                    336.16

                  	
                    11,810.46

                  	
                    1,744.87

                  	
                    520.53

                  	
                    278.08

                  	
                    290.41

                  	
                    895.70

                  	
                    866.18

                  	
                    376.57

                  	
                    95.08

                  	
                    88.13

                  
	
                    08

                  	
                    1,033.52

                  	
                    177.09

                  	
                    97.93

                  	
                    69.16

                  	
                    128.97

                  	
                    73.85

                  	
                    246.72

                  	
                    150.78

                  	
                    318.20

                  	
                    10,526.05

                  	
                    1,550.37

                  	
                    463.03

                  	
                    244.31

                  	
                    244.03

                  	
                    754.27

                  	
                    750.96

                  	
                    263.09

                  	
                    91.99

                  	
                    85.45

                  
	
                    09

                  	
                    1,067.80

                  	
                    181.60

                  	
                    100.37

                  	
                    71.86

                  	
                    133.22

                  	
                    75.83

                  	
                    251.62

                  	
                    153.23

                  	
                    319.95

                  	
                    11,078.36

                  	
                    1,635.53

                  	
                    488.46

                  	
                    259.82

                  	
                    258.08

                  	
                    799.75

                  	
                    797.26

                  	
                    226.14

                  	
                    94.01

                  	
                    86.73

                  
	
                    10

                  	
                    1,083.48

                  	
                    186.11

                  	
                    103.65

                  	
                    77.24

                  	
                    138.55

                  	
                    80.72

                  	
                    260.78

                  	
                    160.03

                  	
                    337.87

                  	
                    14,344.39

                  	
                    2,132.44

                  	
                    637.71

                  	
                    344.88

                  	
                    341.56

                  	
                    1,058.95

                  	
                    1,059.91

                  	
                    329.06

                  	
                    102.08

                  	
                    94.27

                  
	
                    11

                  	
                    1,372.21

                  	
                    232.61

                  	
                    127.86

                  	
                    88.83

                  	
                    168.79

                  	
                    94.95

                  	
                    321.01

                  	
                    194.79

                  	
                    405.88

                  	
                    14,488.22

                  	
                    2,131.96

                  	
                    635.02

                  	
                    328.99

                  	
                    330.76

                  	
                    1,031.14

                  	
                    1,028.54

                  	
                    377.72

                  	
                    148.33

                  	
                    134.69

                  

          

        

         

      

      
        AHCA
Contract No. FA615, Exhibit III-D, Page 1 of 5

      

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      
        EXHIBIT
III-D

      

      
        September
1, 2008 - August 31, 2009

      

      
        MEDICAID
NON-REFORM HMO CAPITATION RATES

      

      
        By
Area, Age and Eligibility Category

      

      
         

        TABLE 3

        
          
            	
                    General
      + MH + Dental Rates:

                  	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	
                    TANF

                  	 
      SSI-N	
                    SSI-B

                  	
                    SSI-AB

                  
	
                    Area

                  	
                    BTHMO+2MO

                  	
                     3MC-11MO

                  	
                    AGE

                    (1-5)

                  	
                    AGE

                     (6-13)

                  	
                           
      AGE (14-20)

                  	
                    AGE
      (21-54)

                  	
                    AGE
      (55+)

                  	
                    BTHMO+2MO

                  	
                    3MO-

                    11MO

                  	
                    AGE
      

                    (1-5)

                  	
                    AGE

                     (6-13)

                  	
                    AGE

                     (14-20)

                  	
                    AGE

                     (21-54)

                  	
                    AGE
      

                    (55+)

                  	 
      	
                    AGE
      

                    (65-)

                  	
                    AGE
      

                    (65+)

                  
	
                     
      

                  	 
      	 
      	 
      	 
      	
                    Female

                  	
                    Male

                  	
                    Female

                  	
                    Male

                  	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                    01

                  	
                    1,113.39

                  	
                    187.41

                  	
                    104.70

                  	
                    76.25

                  	
                    143.60

                  	
                    83.14

                  	
                    260.89

                  	
                    159.07

                  	
                    325.04

                  	
                    10,429.00

                  	
                    1,517.66

                  	
                    454.94

                  	
                    249.33

                  	
                    259.19

                  	
                    773.46

                  	
                    733.15

                  	
                    306.54

                  	
                    107.57

                  	
                    98.28

                  
	
                    02

                  	
                    1,113.40

                  	
                    187.42

                  	
                    105.97

                  	
                    84.82

                  	
                    146.09

                  	
                    85.63

                  	
                    259.86

                  	
                    158.04

                  	
                    324.25

                  	
                    10,429.08

                  	
                    1,517.74

                  	
                    461.29

                  	
                    280.10

                  	
                    260.42

                  	
                    750.74

                  	
                    727.05

                  	
                    326.53

                  	
                    110.93

                  	
                    101.64

                  
	
                    03

                  	
                    1,217.59

                  	
                    206.54

                  	
                    116.65

                  	
                    83.95

                  	
                    155.15

                  	
                    88.81

                  	
                    286.81

                  	
                    174.74

                  	
                    365.03

                  	
                    11,442.89

                  	
                    1,680.14

                  	
                    504.46

                  	
                    266.45

                  	
                    265.98

                  	
                    813.29

                  	
                    809.48

                  	
                    348.44

                  	
                    100.64

                  	
                    92.22

                  
	
                    04

                  	
                    1,067.53

                  	
                    181.94

                  	
                    102.26

                  	
                    74.48

                  	
                    136.14

                  	
                    78.52

                  	
                    254.11

                  	
                    155.59

                  	
                    326.43

                  	
                    10,972.69

                  	
                    1,615.39

                  	
                    487.92

                  	
                    277.17

                  	
                    267.61

                  	
                    800.51

                  	
                    790.78

                  	
                    324.55

                  	
                    108.71

                  	
                    100.38

                  
	
                    05

                  	
                    1,214.98

                  	
                    206.56

                  	
                    116.92

                  	
                    84.39

                  	
                    157.83

                  	
                    91.79

                  	
                    290.78

                  	
                    178.92

                  	
                    372.44

                  	
                    12,249.00

                  	
                    1,796.94

                  	
                    538.03

                  	
                    279.64

                  	
                    291.99

                  	
                    898.93

                  	
                    875.21

                  	
                    231.58

                  	
                    97.80

                  	
                    91.00

                  
	
                    06

                  	
                    1,056.59

                  	
                    181.22

                  	
                    103.39

                  	
                    80.20

                  	
                    143.62

                  	
                    86.34

                  	
                    258.26

                  	
                    160.17

                  	
                    334.00

                  	
                    11,162.25

                  	
                    1,645.52

                  	
                    494.62

                  	
                    270.56

                  	
                    280.33

                  	
                    851.77

                  	
                    818.71

                  	
                    278.01

                  	
                    85.45

                  	
                    78.23

                  
	
                    07

                  	
                    1,092.97

                  	
                    186.87

                  	
                    106.05

                  	
                    80.63

                  	
                    146.17

                  	
                    87.05

                  	
                    264.42

                  	
                    163.20

                  	
                    339.20

                  	
                    11,810.46

                  	
                    1,744.88

                  	
                    523.53

                  	
                    282.52

                  	
                    294.23

                  	
                    897.25

                  	
                    868.36

                  	
                    377.05

                  	
                    96.60

                  	
                    89.29

                  
	
                    08

                  	
                    1,033.53

                  	
                    177.11

                  	
                    101.57

                  	
                    75.90

                  	
                    135.86

                  	
                    79.68

                  	
                    248.74

                  	
                    152.85

                  	
                    322.80

                  	
                    10,526.05

                  	
                    1,550.38

                  	
                    466.45

                  	
                    249.39

                  	
                    248.39

                  	
                    756.55

                  	
                    754.16

                  	
                    264.63

                  	
                    93.66

                  	
                    86.72

                  
	
                    09

                  	
                    1,067.81

                  	
                    181.62

                  	
                    103.30

                  	
                    77.30

                  	
                    138.78

                  	
                    80.53

                  	
                    252.58

                  	
                    154.21

                  	
                    322.14

                  	
                    11,078.36

                  	
                    1,635.54

                  	
                    491.05

                  	
                    263.67

                  	
                    261.39

                  	
                    800.93

                  	
                    798.91

                  	
                    227.97

                  	
                    95.08

                  	
                    87.60

                  
	
                    10

                  	
                    1,083.49

                  	
                    186.12

                  	
                    106.08

                  	
                    81.75

                  	
                    143.16

                  	
                    84.62

                  	
                    261.51

                  	
                    160.78

                  	
                    339.53

                  	
                    14,344.39

                  	
                    2,132.45

                  	
                    640.50

                  	
                    349.02

                  	
                    345.12

                  	
                    1,059.90

                  	
                    1,061.24

                  	
                    329.88

                  	
                    103.38

                  	
                    95.25

                  
	
                    11

                  	
                    1,372.22

                  	
                    232.62

                  	
                    131.59

                  	
                    96.51

                  	
                    176.76

                  	
                    101.67

                  	
                    321.87

                  	
                    195.67

                  	
                    407.84

                  	
                    14,488.23

                  	
                    2,131.98

                  	
                    639.29

                  	
                    336.38

                  	
                    337.23

                  	
                    1,032.92

                  	
                    1,031.04

                  	
                    381.06

                  	
                    150.49

                  	
                    136.34

                  
	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      

          

        

        
           

        

        
          TABLE 4

          
            
              	
                      General
      + MH + Transportation Rates:

                    	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	
                       

                    	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	
                      TANF

                    	
                       
       
      SSI-N

                    	
                      SSI-B

                    	
                      SSI-AB

                    
	
                      Area

                    	
                      BTHMO+2MO

                    	
                       
      3MO-

                       11MO

                    	
                      AGE

                      (1-5)

                    	
                      AGE

                      (6-13)

                    	
                              AGE
      (14-20)

                    	
                            AGE
      (21-54)

                    	
                      AGE

                      (55+)

                    	
                      BTHMO+2MO

                    	
                      3MO-

                      11MO

                    	
                      AGE

                      (1-5)

                    	
                      AGE

                      (6-13)

                    	
                      AGE

                      (14-20)

                    	
                      AGE

                      (21-54)

                    	
                      AGE

                      (55+)

                    	 
      	
                      AGE

                      (65-)

                    	
                      AGE

                      (65+)

                    
	 
      	 
      	 
      	 
      	 
      	
                      Female

                    	
                      Male

                    	
                      Female

                    	
                      Male

                    	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                      01

                    	
                      1,118.74

                    	
                      188.77

                    	
                      103.85

                    	
                      73.64

                    	
                      142.45

                    	
                      81.79

                    	
                      262.97

                    	
                      160.32

                    	
                      325.76

                    	
                      10,468.09

                    	
                      1,543.33

                    	
                      458.61

                    	
                      249.36

                    	
                      263.26

                    	
                      798.19

                    	
                      748.22

                    	
                      313.56

                    	
                      120.17

                    	
                      106.26

                    
	
                      02

                    	
                      1,118.75

                    	
                      188.78

                    	
                      105.12

                    	
                      82.21

                    	
                      144.94

                    	
                      84.28

                    	
                      261.94

                    	
                      159.29

                    	
                      324.97

                    	
                      10,468.17

                    	
                      1,543.41

                    	
                      464.96

                    	
                      280.13

                    	
                      264.49

                    	
                      769.47

                    	
                      742.12

                    	
                      333.55

                    	
                      123.53

                    	
                      109.62

                    
	
                      03

                    	
                      1,224.01

                    	
                      208.18

                    	
                      114.60

                    	
                      78.89

                    	
                      151.82

                    	
                      85.54

                    	
                      289.04

                    	
                      175.98

                    	
                      365.28

                    	
                      11,492.20

                    	
                      1,712.51

                    	
                      508.01

                    	
                      264.88

                    	
                      269.71

                    	
                      836.72

                    	
                      828.19

                    	
                      356.12

                    	
                      118.76

                    	
                      103.70

                    
	
                      04

                    	
                      1,072.09

                    	
                      183.11

                    	
                      101.13

                    	
                      71.50

                    	
                      134.38

                    	
                      76.72

                    	
                      255.26

                    	
                      156.01

                    	
                      325.61

                    	
                      11,011.02

                    	
                      1,640.55

                    	
                      491.32

                    	
                      276.91

                    	
                      271.34

                    	
                      818.29

                    	
                      804.74

                    	
                      329.55

                    	
                      122.97

                    	
                      109.39

                    
	
                      05

                    	
                      1,218.84

                    	
                      207.54

                    	
                      114.11

                    	
                      78.42

                    	
                      152.83

                    	
                      87.29

                    	
                      289.75

                    	
                      177.22

                    	
                      367.18

                    	
                      12,280.81

                    	
                      1,817.81

                    	
                      538.12

                    	
                      275.35

                    	
                      291.59

                    	
                      911.55

                    	
                      883.79

                    	
                      234.47

                    	
                      108.09

                    	
                      97.18

                    
	
                      06

                    	
                      1,060.38

                    	
                      182.19

                    	
                      101.31

                    	
                      75.60

                    	
                      140.00

                    	
                      83.01

                    	
                      258.73

                    	
                      160.02

                    	
                      332.19

                    	
                      11,193.75

                    	
                      1,666.20

                    	
                      495.85

                    	
                      268.01

                    	
                      281.39

                    	
                      865.43

                    	
                      828.84

                    	
                      281.96

                    	
                      94.76

                    	
                      83.97

                    
	
                      07

                    	
                      1,096.99

                    	
                      187.89

                    	
                      104.28

                    	
                      76.56

                    	
                      143.16

                    	
                      84.23

                    	
                      265.58

                    	
                      163.74

                    	
                      338.80

                    	
                      11,845.21

                    	
                      1,767.68

                    	
                      525.23

                    	
                      280.23

                    	
                      295.85

                    	
                      913.53

                    	
                      881.23

                    	
                      381.95

                    	
                      107.21

                    	
                      95.94

                    
	
                      08

                    	
                      1,038.81

                    	
                      178.45

                    	
                      98.76

                    	
                      69.66

                    	
                      130.99

                    	
                      75.18

                    	
                      249.98

                    	
                      153.26

                    	
                      321.67

                    	
                      10,564.27

                    	
                      1,575.46

                    	
                      468.20

                    	
                      246.69

                    	
                      250.01

                    	
                      773.87

                    	
                      767.52

                    	
                      269.02

                    	
                      106.78

                    	
                      94.97

                    
	
                      09

                    	
                      1,072.91

                    	
                      182.92

                    	
                      101.17

                    	
                      72.34

                    	
                      135.16

                    	
                      77.11

                    	
                      254.77

                    	
                      155.63

                    	
                      323.30

                    	
                      11,117.70

                    	
                      1,661.37

                    	
                      493.79

                    	
                      262.27

                    	
                      264.24

                    	
                      819.93

                    	
                      814.30

                    	
                      232.70

                    	
                      109.81

                    	
                      96.97

                    
	
                      10

                    	
                      1,086.47

                    	
                      186.89

                    	
                      104.12

                    	
                      77.52

                    	
                      139.69

                    	
                      81.47

                    	
                      262.62

                    	
                      161.43

                    	
                      339.83

                    	
                      14,370.64

                    	
                      2,149.68

                    	
                      641.26

                    	
                      346.51

                    	
                      345.67

                    	
                      1,072.41

                    	
                      1,071.28

                    	
                      334.36

                    	
                      114.42

                    	
                      102.22

                    
	
                      11

                    	
                      1,375.30

                    	
                      233.40

                    	
                      128.34

                    	
                      89.12

                    	
                      169.97

                    	
                      95.73

                    	
                      322.92

                    	
                      196.24

                    	
                      407.91

                    	
                      14,515.60

                    	
                      2,149.93

                    	
                      638.72

                    	
                      330.69

                    	
                      335.05

                    	
                      1,045.18

                    	
                      1,040.40

                    	
                      382.84

                    	
                      160.77

                    	
                      142.70

                    

            

AHCA Contract No. FA615, Exhibit
III-D, Page 2 of 5

           

          
            
              
                 

              

              
                 

                
                  

                

              

              
                 

              

            

          

           

          
            
              EXHIBIT
III-D

            

            
              September
1, 2008 - August 31, 2009

            

            
              MEDICAID
NON-REFORM HMO CAPITATION RATES

            

            
              By
Area, Age and Eligibility Category

            

            
               

            

          

          TABLE 5

          
            	
                    General
      + Transportation Rates:

                  	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	
                    TANF

                  	 
      SSI-N	
                         
      SSI-B

                  	
                    SSI-AB

                  
	
                    Area

                  	
                    BTHMO+2MO

                  	
                         
      3MO-   
      11MO

                  	
                    AGE

                         
      (1-5)

                  	
                         
       AGE

                          
      (6-13)

                  	
                                   
            AGE (14-20)    
    

                  	
                             
            AGE  (21-54)  
      

                  	
                             AGE (55+)

                  	
                     
      BTHMO+2MO

                  	
                            
        3MO-    11MO

                  	
                                 
       AGE

                              
          (1-5)

                  	
                             
          AGE 

                           
           (6-13)

                  	
                                  
      AGE

                           
         (14-20)

                  	
                           
      AGE         
      (21-54)

                  	
                             
      AGE

                             
       (55+)

                  	 
      	
                     
       AGE 

                     (65-)

                  	
                      AGE 
      

                    (65+)

                  
	 
      	 
      	 
      	 
      	 
      	
                                   
      Female

                  	
                                
      Male

                  	
                               Female

                  	
                                
      Male

                  	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                    01

                  	
                    1,118.72

                  	
                    188.75

                  	
                    102.21

                  	
                     
      61.95

                  	
                    131.52

                  	
                    70.86

                  	
                    258.53

                  	
                    155.88

                  	
                    322.02

                  	
                    10,468.01

                  	
                    1,543.25

                  	
                    451.17

                  	
                    201.31

                  	
                    219.27

                  	
                    716.79

                  	
                    717.24

                  	
                    313.35

                  	
                    108.52

                  	
                    94.61

                  
	
                    02

                  	
                    1,118.72

                  	
                    188.75

                  	
                    102.21

                  	
                    61.95

                  	
                    131.52

                  	
                    70.86

                  	
                    258.53

                  	
                    155.88

                  	
                    322.02

                  	
                    10,468.01

                  	
                    1,543.25

                  	
                    451.17

                  	
                    201.31

                  	
                    219.27

                  	
                    716.79

                  	
                    717.24

                  	
                    313.35

                  	
                    108.52

                  	
                    94.61

                  
	
                    03

                  	
                    1,224.00

                  	
                    208.17

                  	
                    113.28

                  	
                    69.71

                  	
                    145.74

                  	
                    79.46

                  	
                    287.50

                  	
                    174.44

                  	
                    363.94

                  	
                    11,492.13

                  	
                    1,712.44

                  	
                    501.75

                  	
                    229.12

                  	
                    249.19

                  	
                    812.82

                  	
                    816.91

                  	
                    349.27

                  	
                    109.78

                  	
                    94.72

                  
	
                    04

                  	
                    1,072.08

                  	
                    183.10

                  	
                    99.75

                  	
                    61.94

                  	
                    128.04

                  	
                    70.38

                  	
                    253.65

                  	
                    154.04

                  	
                    324.21

                  	
                    11,010.91

                  	
                    1,640.44

                  	
                    481.56

                  	
                    221.17

                  	
                    239.36

                  	
                    781.03

                  	
                    787.15

                  	
                    305.00

                  	
                    106.20

                  	
                    92.62

                  
	
                    05

                  	
                    1,218.83

                  	
                    207.53

                  	
                    112.90

                  	
                    69.74

                  	
                    144.72

                  	
                    79.18

                  	
                    286.46

                  	
                    173.93

                  	
                    364.40

                  	
                    12,280.76

                  	
                    1,817.76

                  	
                    533.10

                  	
                    242.93

                  	
                    261.91

                  	
                    856.63

                  	
                    862.89

                  	
                    231.74

                  	
                    95.27

                  	
                    84.36

                  
	
                    06

                  	
                    1,060.36

                  	
                    182.17

                  	
                    99.46

                  	
                    62.35

                  	
                    127.62

                  	
                    70.63

                  	
                    253.70

                  	
                    154.99

                  	
                    327.94

                  	
                    11,193.68

                  	
                    1,666.13

                  	
                    489.33

                  	
                    225.90

                  	
                    242.85

                  	
                    794.10

                  	
                    801.69

                  	
                    280.65

                  	
                    90.87

                  	
                    80.08

                  
	
                    07

                  	
                    1,096.97

                  	
                    187.87

                  	
                    102.50

                  	
                    63.87

                  	
                    131.30

                  	
                    72.37

                  	
                    260.76

                  	
                    158.92

                  	
                    334.73

                  	
                    11,845.15

                  	
                    1,767.62

                  	
                    519.11

                  	
                    240.72

                  	
                    259.68

                  	
                    846.60

                  	
                    855.75

                  	
                    379.36

                  	
                    96.69

                  	
                    85.42

                  
	
                    08

                  	
                    1,038.80

                  	
                    178.44

                  	
                    97.50

                  	
                    60.87

                  	
                    125.17

                  	
                    69.36

                  	
                    248.49

                  	
                    151.77

                  	
                    320.38

                  	
                    10,564.20

                  	
                    1,575.39

                  	
                    462.20

                  	
                    212.41

                  	
                    230.33

                  	
                    750.96

                  	
                    756.70

                  	
                    262.17

                  	
                    93.56

                  	
                    81.75

                  
	
                    09

                  	
                    1,072.89

                  	
                    182.90

                  	
                    99.62

                  	
                    61.53

                  	
                    128.00

                  	
                    69.95

                  	
                    252.95

                  	
                    153.81

                  	
                    321.73

                  	
                    11,117.63

                  	
                    1,661.30

                  	
                    487.46

                  	
                    226.13

                  	
                    243.50

                  	
                    795.77

                  	
                    802.89

                  	
                    225.85

                  	
                    100.22

                  	
                    87.38

                  
	
                    10

                  	
                    1,086.45

                  	
                    186.87

                  	
                    102.20

                  	
                    64.16

                  	
                    130.84

                  	
                    72.62

                  	
                    260.37

                  	
                    159.18

                  	
                    337.88

                  	
                    14,370.54

                  	
                    2,149.58

                  	
                    632.91

                  	
                    298.80

                  	
                    318.29

                  	
                    1,040.53

                  	
                    1,056.22

                  	
                    327.51

                  	
                    106.36

                  	
                    94.16

                  
	
                    11

                  	
                    1,375.28

                  	
                    233.38

                  	
                    126.72

                  	
                    77.83

                  	
                    162.48

                  	
                    88.24

                  	
                    321.01

                  	
                    194.33

                  	
                    406.26

                  	
                    14,515.52

                  	
                    2,149.85

                  	
                    631.75

                  	
                    290.89

                  	
                    312.22

                  	
                    1,018.58

                  	
                    1,027.84

                  	
                    375.61

                  	
                    152.71

                  	
                    134.64

                  

          

          
 TABLE 6

          
            	 General
      + Dental Rates:	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	
                    TANF

                  	
                     

                  	
                          
      SSI-B

                  	
                    SSI-AB

                  
	
                    Area

                  	
                    BTHMO+2MO

                  	
                          
      3MO-      11MO

                  	
                              
       AGE

                               
      (1-5)

                  	
                    AGE
      

                    (6-13)

                  	
                                 AGE 
      (14-20)

                  	
                                
      AGE  (21-54)

                  	
                     
             AGE 
      (55+)

                  	
                       
      BTHMO+2MO

                  	
                            
      3MO-

                            
      11MO

                  	
                         
      AGE

                         
      (1-5)

                  	
                             
      AGE 

                            
      (6-13)

                  	
                              
      AGE  

                           
      (14-20) 

                  	
                                 
      AGE 

                     (21-54)

                  	
                               
      AGE 

                               
      (55+)

                  	 
      	
                         
      AGE   (65-)

                  	
                     AGE

                     (65+)

                  
	 
      	 
      	 
      	 
      	 
      	
                                 
        Female

                  	
                                
      Male

                  	
                              
      Female

                  	
                              
      Male

                  	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                    01

                  	
                    1,113.37

                  	
                    187.39

                  	
                    103.06

                  	
                    64.56

                  	
                    132.67

                  	
                    72.21

                  	
                    256.45

                  	
                    154.63

                  	
                    321.30

                  	
                    10,428.92

                  	
                    1,517.58

                  	
                    447.50

                  	
                    201.28

                  	
                    215.20

                  	
                    698.06

                  	
                    702.17

                  	
                    306.33

                  	
                    95.92

                  	
                    86.63

                  
	
                    02

                  	
                    1,113.37

                  	
                    187.39

                  	
                    103.06

                  	
                    64.56

                  	
                    132.67

                  	
                    72.21

                  	
                    256.45

                  	
                    154.63

                  	
                    321.30

                  	
                    10,428.92

                  	
                    1,517.58

                  	
                    447.50

                  	
                    201.28

                  	
                    215.20

                  	
                    698.06

                  	
                    702.17

                  	
                    306.33

                  	
                    95.92

                  	
                    86.63

                  
	
                    03

                  	
                    1,217.58

                  	
                    206.53

                  	
                    115.33

                  	
                    74.77

                  	
                    149.07

                  	
                    82.73

                  	
                    285.27

                  	
                    173.20

                  	
                    363.69

                  	
                    11,442.82

                  	
                    1,680.07

                  	
                    498.20

                  	
                    230.69

                  	
                    245.46

                  	
                    789.39

                  	
                    798.20

                  	
                    341.59

                  	
                    91.66

                  	
                    83.24

                  
	
                    04

                  	
                    1,067.52

                  	
                    181.93

                  	
                    100.88

                  	
                    64.93

                  	
                    129.80

                  	
                    72.18

                  	
                    252.50

                  	
                    153.98

                  	
                    325.03

                  	
                    10,972.58

                  	
                    1,615.28

                  	
                    478.16

                  	
                    221.43

                  	
                    235.63

                  	
                    763.25

                  	
                    773.19

                  	
                    300.00

                  	
                    91.94

                  	
                    83.61

                  
	
                    05

                  	
                    1,214.97

                  	
                    206.55

                  	
                    115.71

                  	
                    75.71

                  	
                    149.72

                  	
                    83.68

                  	
                    287.49

                  	
                    175.63

                  	
                    369.66

                  	
                    12,248.95

                  	
                    1,796.89

                  	
                    533.01

                  	
                    247.22

                  	
                    262.31

                  	
                    844.01

                  	
                    854.31

                  	
                    228.85

                  	
                    84.96

                  	
                    78.18

                  
	
                    06

                  	
                    1,056.57

                  	
                    181.20

                  	
                    101.54

                  	
                    66.95

                  	
                    131.24

                  	
                    73.96

                  	
                    253.23

                  	
                    155.14

                  	
                    329.75

                  	
                    11,162.18

                  	
                    1,645.45

                  	
                    488.10

                  	
                    228.45

                  	
                    241.79

                  	
                    780.44

                  	
                    791.56

                  	
                    276.70

                  	
                    81.56

                  	
                    74.34

                  
	
                    07

                  	
                    1,092.95

                  	
                    186.85

                  	
                    104.27

                  	
                    67.94

                  	
                    134.31

                  	
                    75.19

                  	
                    259.60

                  	
                    158.38

                  	
                    335.13

                  	
                    11,810.40

                  	
                    1,744.82

                  	
                    517.41

                  	
                    243.01

                  	
                    258.06

                  	
                    830.32

                  	
                    842.88

                  	
                    374.46

                  	
                    86.08

                  	
                    78.77

                  
	
                    08

                  	
                    1,033.52

                  	
                    177.10

                  	
                    100.31

                  	
                    67.11

                  	
                    130.04

                  	
                    73.86

                  	
                    247.25

                  	
                    151.36

                  	
                    321.51

                  	
                    10,525.98

                  	
                    1,550.31

                  	
                    460.45

                  	
                    215.11

                  	
                    228.71

                  	
                    733.64

                  	
                    743.34

                  	
                    257.78

                  	
                    80.44

                  	
                    73.50

                  
	
                    09

                  	
                    1,067.79

                  	
                    181.60

                  	
                    101.75

                  	
                    66.49

                  	
                    131.62

                  	
                    73.37

                  	
                    250.76

                  	
                    152.39

                  	
                    320.57

                  	
                    11,078.29

                  	
                    1,635.47

                  	
                    484.72

                  	
                    227.53

                  	
                    240.65

                  	
                    776.77

                  	
                    787.50

                  	
                    221.12

                  	
                    85.49

                  	
                    78.01

                  
	
                    10

                  	
                    1,083.47

                  	
                    186.10

                  	
                    104.16

                  	
                    68.39

                  	
                    134.31

                  	
                    75.77

                  	
                    259.26

                  	
                    158.53

                  	
                    337.58

                  	
                    14,344.29

                  	
                    2,132.35

                  	
                    632.15

                  	
                    301.31

                  	
                    317.74

                  	
                    1,028.02

                  	
                    1,046.18

                  	
                    323.03

                  	
                    95.32

                  	
                    87.19

                  
	
                    11

                  	
                    1,372.20

                  	
                    232.60

                  	
                    129.97

                  	
                    85.22

                  	
                    169.27

                  	
                    94.18

                  	
                    319.96

                  	
                    193.76

                  	
                    406.19

                  	
                    14,488.15

                  	
                    2,131.90

                  	
                    632.32

                  	
                    296.58

                  	
                    314.40

                  	
                    1,006.32

                  	
                    1,018.48

                  	
                    373.83

                  	
                    142.43

                  	
                    128.28

                  

          

        

         

        AHCA
Contract No. FA615, Exhibit IlI-D, Page 3 of 5

      

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      
         

      

      
        EXHIBIT
IlI-D

      

      
        September
1, 2008 - August 31, 2009

      

      
        MEDICAID
NON-REFORM HMO CAPITATION RATES

      

      
        By
Area, Age and Eligibility Category

      

      
         

        TABLE
7

      

      
        
          	
                  General
      + Dental + Transportation Rates:

                	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	
                  TANF

                	
                  SSI-N

                	
                       
      SSI-B

                	
                  SSI-AB

                
	
                  Area

                	
                  BTHMO+2MO

                	
                       
       3MO- 11MO

                	
                            
      AGE

                             
      (1-5)

                	
                       
      AGE

                       
      (6-13)

                	
                         
       AGE (14-20)

                	
                      
      AGE (21-54)

                	
                             
         AGE

                                 (55+)

                	
                   
      BTHMO+2MO

                	
                  3MO-

                  11MO

                	
                  AGE
      

                  (1-5)

                	
                  AGE
      

                  (6-13)

                	
                  AGE

                   (14-20)

                	
                  AGE
      

                  (21-54)

                	
                  AGE
      

                  (55+)

                	 
      	
                    
      AGE          
       AGE 

                     (65-)             
      (65+)

                
	 
      	 
      	 
      	 
      	 
      	
                  Female

                	
                               
      Male

                	
                  Female

                	
                             
      Male

                	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                  01

                	
                  1,118.72

                	
                  188.76

                	
                  103.89

                	
                  65.06

                	
                  134.70

                	
                  73.55

                	
                  259.75

                	
                  157.14

                	
                  324.81

                	
                  10,468.01

                	
                  1,543.25

                	
                  452.79

                	
                  203.71

                	
                  221.33

                	
                  718.12

                	
                  719.10

                	
                  313.80

                	
                  109.64

                	
                  95.47

                
	
                  02

                	
                  1,118.72

                	
                  188.76

                	
                  103.89

                	
                  65.06

                	
                  134.70

                	
                  73.55

                	
                  259.75

                	
                  157.14

                	
                  324.81

                	
                  10,468.01

                	
                  1,543.25

                	
                  452.79

                	
                  203.71

                	
                  221.33

                	
                  718.12

                	
                  719.10

                	
                  313.80

                	
                  109.64

                	
                  95.47

                
	
                  03

                	
                  1,224.01

                	
                  208.19

                	
                  116.33

                	
                  75.37

                	
                  151.51

                	
                  84.34

                	
                  289.24

                	
                  176.22

                	
                  367.91

                	
                  11,492.13

                	
                  1,712.45

                	
                  504.88

                	
                  233.76

                	
                  253.18

                	
                  814.70

                	
                  819.56

                	
                  350.30

                	
                  111.43

                	
                  95.98

                
	
                  04

                	
                  1,072.09

                	
                  183.11

                	
                  101.59

                	
                  65.36

                	
                  131.54

                	
                  73.33

                	
                  255.32

                	
                  156.12

                	
                  328.03

                	
                  11,010.91

                	
                  1,640.44

                	
                  483.34

                	
                  223.81

                	
                  241.63

                	
                  782.91

                	
                  789.79

                	
                  307.18

                	
                  107.79

                	
                  93.83

                
	
                  05

                	
                  1,218.84

                	
                  207.55

                	
                  116.31

                	
                  76.07

                	
                  151.19

                	
                  84.65

                	
                  289.87

                	
                  177.44

                	
                  372.19

                	
                  12,280.77

                	
                  1,817.77

                	
                  537.32

                	
                  249.20

                	
                  267.29

                	
                  860.33

                	
                  868.09

                	
                  235.40

                	
                  99.06

                	
                  87.25

                
	
                  06

                	
                  1,060.37

                	
                  182.18

                	
                  102.13

                	
                  67.31

                	
                  132.68

                	
                  74.91

                	
                  255.58

                	
                  156.93

                	
                  332.24

                	
                  11,193.68

                	
                  1,666.14

                	
                  492.37

                	
                  230.40

                	
                  246.72

                	
                  796.60

                	
                  805.20

                	
                  282.41

                	
                  93.12

                	
                  81.79

                
	
                  07

                	
                  1,096.98

                	
                  187.88

                	
                  104.90

                	
                  68.32

                	
                  135.84

                	
                  76.21

                	
                  262.09

                	
                  160.28

                	
                  337.77

                	
                  11,845.15

                	
                  1,767.63

                	
                  522.11

                	
                  245.16

                	
                  263.50

                	
                  848.15

                	
                  857.93

                	
                  379.84

                	
                  98.21

                	
                  86.58

                
	
                  08

                	
                  1,038.81

                	
                  178.46

                	
                  101.14

                	
                  67.61

                	
                  132.06

                	
                  75.19

                	
                  250.51

                	
                  153.84

                	
                  324.98

                	
                  10,564.20

                	
                  1,575.40

                	
                  465.62

                	
                  217.49

                	
                  234.69

                	
                  753.24

                	
                  759.90

                	
                  263.71

                	
                  95.23

                	
                  83.02

                
	
                  09

                	
                  1,072.90

                	
                  182.92

                	
                  102.55

                	
                  66.97

                	
                  133.56

                	
                  74.65

                	
                  253.91

                	
                  154.79

                	
                  323.92

                	
                  11,117.63

                	
                  1,661.31

                	
                  490.05

                	
                  229.98

                	
                  246.81

                	
                  796.95

                	
                  804.54

                	
                  227.68

                	
                  101.29

                	
                  88.19

                
	
                  10

                	
                  1,086.46

                	
                  186.88

                	
                  104.63

                	
                  68.67

                	
                  135.45

                	
                  76.52

                	
                  261.10

                	
                  159.93

                	
                  339.54

                	
                  14,370.54

                	
                  2,149.59

                	
                  635.70

                	
                  302.94

                	
                  321.85

                	
                  1,041.48

                	
                  1,057.55

                	
                  328.33

                	
                  107.66

                	
                  95.14

                
	
                  11

                	
                  1,375.29

                	
                  233.39

                	
                  130.45

                	
                  85.51

                	
                  170.45

                	
                  94.96

                	
                  321.87

                	
                  195.21

                	
                  408.22

                	
                  14,515.53

                	
                  2,149.87

                	
                  636.02

                	
                  298.28

                	
                  318.69

                	
                  1,020.36

                	
                  1,030.34

                	
                  378.95

                	
                  154.87

                	
                  136.29

                

        

         

        TABLE 8

        
          	
                  General + Mental Health
      + Dental + Transportation Rates:

                	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	
                  TANF

                	
                  SSI-N

                	
                         
      SSI-B

                	
                  SSI-AB

                
	
                  Area

                	
                      
      BTHMO+2MO

                	
                       
      3MO- 11MO

                	
                  AGE

                   (1-5)

                	
                  AGE

                   (6-13)

                	
                                    
       AGE (14-20)

                	
                               AGE
      (21-54)

                	
                  AGE
      

                  (55+)

                	
                     
      BTHMO+2MO

                	
                  3MO-11MO

                	
                  AGE
      

                  (1-5)

                	
                  AGE
      

                  (6-13)

                	
                  AGE

                  (14-20)

                	
                  AGE
      

                  (21-54)

                	
                  AGE
      

                  (55+)

                	 
      	
                  AGE

                  (65-)

                	
                   AGE(65+)

                
	 
      	 
      	 
      	 
      	 
      	
                                 
      Female

                	
                              
      Male

                	
                            
      Female

                	
                            
      Male

                	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                  01

                	
                  1,118.74

                	
                  188.78

                	
                  105.53

                	
                  76.75

                	
                  145.63

                	
                  84.48

                	
                  264.19

                	
                  161.58

                	
                  328.55

                	
                  10,468.09

                	
                  1,543.33

                	
                  460.23

                	
                  251.76

                	
                  265.32

                	
                  799.52

                	
                  750.08

                	
                  314.01

                	
                  121.29

                	
                  107.12

                
	
                  02

                	
                  1,116.75

                	
                  188.79

                	
                  106.80

                	
                  85.32

                	
                  148.12

                	
                  86.97

                	
                  263.16

                	
                  160.55

                	
                  327.76

                	
                  10,468.17

                	
                  1,543.41

                	
                  466.58

                	
                  282.53

                	
                  266.55

                	
                  770.80

                	
                  743.98

                	
                  334.00

                	
                  124.65

                	
                  110.48

                
	
                  03

                	
                  1,224.02

                	
                  206.20

                	
                  117.65

                	
                  84.55

                	
                  157.59

                	
                  90.42

                	
                  290.78

                	
                  177.76

                	
                  369.25

                	
                  11,492.20

                	
                  1,712.52

                	
                  511.14

                	
                  269.52

                	
                  273.70

                	
                  838.60

                	
                  830.84

                	
                  357.15

                	
                  120.41

                	
                  104.96

                
	
                  04

                	
                  1,072.10

                	
                  183.12

                	
                  102.97

                	
                  74.92

                	
                  137.88

                	
                  79.67

                	
                  256.93

                	
                  157.73

                	
                  329.43

                	
                  11,011.02

                	
                  1,640.55

                	
                  493.10

                	
                  279.55

                	
                  273.61

                	
                  820.17

                	
                  807.38

                	
                  331.73

                	
                  124.56

                	
                  110.60

                
	
                  05

                	
                  1,218.85

                	
                  207.56

                	
                  117.52

                	
                  84.75

                	
                  159.30

                	
                  92.76

                	
                  293.16

                	
                  180.73

                	
                  374.97

                	
                  12,280.82

                	
                  1,817.82

                	
                  542.34

                	
                  281.62

                	
                  296.97

                	
                  915.25

                	
                  888.99

                	
                  238.13

                	
                  111.88

                	
                  100.07

                
	
                  06

                	
                  1,060.39

                	
                  182.20

                	
                  103.98

                	
                  80.56

                	
                  145.06

                	
                  87.29

                	
                  260.61

                	
                  161.96

                	
                  336.49

                	
                  11,193.75

                	
                  1,666.21

                	
                  498.89

                	
                  272.51

                	
                  285.26

                	
                  867.93

                	
                  832.35

                	
                  283.72

                	
                  97.01

                	
                  85.68

                
	
                  07

                	
                  1,097.00

                	
                  187.90

                	
                  106.68

                	
                  81.01

                	
                  147.70

                	
                  88.07

                	
                  266.91

                	
                  165.10

                	
                  341.84

                	
                  11,845.21

                	
                  1,767.69

                	
                  528.23

                	
                  284.67

                	
                  299.67

                	
                  915.08

                	
                  883.41

                	
                  382.43

                	
                  108.73

                	
                  97.10

                
	
                  08

                	
                  1,038.82

                	
                  178.47

                	
                  102.40

                	
                  76.40

                	
                  137.88

                	
                  81.01

                	
                  252.00

                	
                  155.33

                	
                  326.27

                	
                  10,564.27

                	
                  1,575.47

                	
                  471.62

                	
                  251.77

                	
                  254.37

                	
                  776.15

                	
                  770.72

                	
                  270.56

                	
                  108.45

                	
                  96.24

                
	
                  09

                	
                  1,072.92

                	
                  182.94

                	
                  104.10

                	
                  77.78

                	
                  140.72

                	
                  81.81

                	
                  255.73

                	
                  156.61

                	
                  325.49

                	
                  11,117.70

                	
                  1,661.38

                	
                  496.38

                	
                  266.12

                	
                  267.55

                	
                  821.11

                	
                  815.95

                	
                  234.53

                	
                  110.88

                	
                  97.78

                
	
                  10

                	
                  1,086.48

                	
                  186.90

                	
                  106.55

                	
                  82.03

                	
                  144.30

                	
                  85.37

                	
                  263.35

                	
                  162.18

                	
                  341.49

                	
                  14,370.64

                	
                  2,149.69

                	
                  644.05

                	
                  350.65

                	
                  349.23

                	
                  1,073.36

                	
                  1,072.61

                	
                  335.18

                	
                  115.72

                	
                  103.20

                
	
                  11

                	
                  1,375.31

                	
                  233.41

                	
                  132.07

                	
                  96.80

                	
                  177.94

                	
                  102.45

                	
                  323.78

                	
                  197.12

                	
                  409.87

                	
                  14,515.61

                	
                  2,149.95

                	
                  642.99

                	
                  338.08

                	
                  341.52

                	
                  1,046.96

                	
                  1,042.90

                	
                  386.18

                	
                  162.93

                	
                  144.35

                

        

      

       

      
        AHCA
Contract No. FA615, Exhibit III-D, Page 4 of 5

      

    

     

    
      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

    

    
      EXHIBIT
III-D

    

    
      September
1, 2008 - August 31, 2009

    

    
      MEDICAID
NON-REFORM HMO CAPITATION RATES

    

    
      By
Area, Age and Eligibility Category

    

    
      

    

    
      	
              Area

            	
              Corresponding
      Counties

            
	 	 
	
              Area
      1

            	
              Escambia,
      Okaloosa, Santa Rosa, Walton

            
	
              Area
      2

            	
              Bay,
      Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon,
      Liberty, Madison, Taylor, Washington, Wakulla

            
	
              Area
      3

            	
              Alachua,
      Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando,
      Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee,
    Union

            
	
              Area
      4

            	
              Baker,
      Clay, Duval, Flagler, Nassau, St. Johns, Volusia

            
	
              Area
      5

            	
              Pasco,
      Pinellas

            
	
              Area
      6

            	
              Hardee,
      Highlands, Hillsborough, Manatee, Polk

            
	
              Area
      7

            	
              Brevard,
      Orange, Osceola, Seminole

            
	
              Area
      8

            	
              Charlotte,
      Collier, De Soto, Glades, Hendry, Lee, Sarasota

            
	
              Area
      9

            	
              Indian
      River, Okeechobee, St. Lucie, Martin, Palm Beach

            
	
              Area
      10

            	
              Broward

            
	
              Area
      11

            	
              Dade,
      Monroe

            

    

     

    AHCA
Contract No. FA615, Exhibit III-D, Page 5 of 5contractamend7.htm

    Back to Form 8-K

    Exhibit 10.6

     

    
      	
              WellCare
      of Florida, Inc. d/b/a

            	
              Medicaid
      HMO Contract

            
	
              Staywell
      Health Plan of Florida

            	 
      

    

    
      

    

    
      AHCA
CONTRACT NO. FA615 

      AMENDMENT
NO. 7

    

    
      

    

    
      THIS CONTRACT, entered into
between the STATE OF FLORIDA,
AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter
referred to as the "Agency," and WELLCARE OF FLORIDA, INC. D/B/A
STAYWELL HEALTH PLAN OF FLORIDA, hereinafter referred to as the "Vendor"
or "Health Plan", is hereby amended as follows:

    

    
      

    

    
      
        	
                1.

              	
                Effective
      December 1, 2008, Attachment I, Scope of Services, is hereby amended to
      include Exhibit I-C, Third Revised Maximum Enrollment Levels, attached
      hereto and made a part of the Contract. Beginning December 1, 2008, all
      references in the Contract to Exhibit I-B, Second Revised Maximum
      Enrollment Levels, shall hereinafter also refer to Exhibit I-C, Third
      Revised Maximum Enrollment Levels, as
  appropriate.

              

      

    

    
      

    

    
      
        	
                2.

              	
                Effective
      December 1, 2008, Attachment I, Scope of Services, is hereby amended to
      include Exhibit II-E, Fifth Revised Capitation Rates, attached hereto and
      made a part of the Contract. Beginning December 1, 2008, all references in
      the Contract to Exhibit II-D, Fourth Revised Capitation Rates, shall
      hereinafter also refer to Exhibit II-E, Fifth Revised Capitation Rates, as
      appropriate.

              

      

    

    
      

    

    
      
        	
                 
      

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

              

      

    

    
      

    

    
      
        	
                 
      

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

              

      

    

    
      

    

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

    

    
      

    

    
      
        	
                 
      

              	
                This
      Amendment cannot be executed unless all previous Amendments to this
      Contract have been fully
executed.

              

      

    

    
      

    

    
      
        	
                 
      

              	
                IN
      WITNESS WHEREOF, the parties hereto have caused this three (3) page
      Amendment (which includes all attachments hereto) to be executed by their
      officials thereunto duly
authorized.

              

      

    

    
      

    

    
      	
              WELLCARE
      OF FLORIDA, INC.

              D/B/A
      STAYWELL HEALTH PLAN

              OF
      FLORIDA

            	
              STATE
      OF FLORIDA, AGENCY FOR 

              HEALTH
      CARE ADMINISTRATION

            
	
               

              SIGNED

              BY:
      /s/ Heath
      Schiesser

            	
               

              SIGNED

              BY:
      /s/ Mark Thomas for Holly
      Benson

            
	
              NAME:
      Heath
      Schiesser

            	
              NAME:
      Holly
    Benson

            
	
              TITLE:
      President and
      CEO

            	
              TITLE:
      Secretary

            
	
              DATE:
      9-10-08

            	
              DATE:
      9/10/08

            

    

    
      

    

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

    

    
      

    

    
      	
              Specify

              Type

            	
              Letter/

              Number

            	
              Description

            	 
      
	
              Exhibit

            	
              I-C

            	
              Third
      Revised Maximum Enrollment Levels (1 Page)

            	 
      
	
              Exhibit

            	
              II-E

            	
              Fifth
      Revised Capitation Rates (1 Page)

            	 
      

    

    
      

    

    
      AHCA
Contract No. FA615, Amendment No. 7, Page 1 of 1

    

    
      

    

    
      AHCA Form
2100-0002 (Rev. NOV03)

    

    

    
      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

    

    
      

    

    
      	
              WellCare
      of Florida, Inc. d/b/a

            	
              Medicaid
      HMO Contract

            
	
              Staywell
      Health Plan of Florida

            	 
      

    

    
      

    

    
      EXHIBIT
I-C

    

    
      

    

    
      THIRD
REVISED MAXIMUM ENROLLMENT LEVELS

    

    

    
      	
              
                County

              

            	
              
                Maximum
      Enrollment Level

              

            
	
              
                Brevard

              

            	
              
                14,000

              

            
	
              
                Broward

              

            	
              
                25,000

              

            
	
              
                Dade

              

            	
              
                25,000

              

            
	
              
                Hernando

              

            	
              
                15,000

              

            
	
              
                Hillsborough

              

            	
              
                28,000

              

            
	
              
                Lee

              

            	
              
                15,000

              

            
	
              
                Manatee

              

            	
              
                12,000

              

            
	
              
                Palm
      Beach

              

            	
              
                15,000

              

            
	
              
                Pasco

              

            	
              
                7,000

              

            
	
              
                Pinellas

              

            	
              
                15,000

              

            
	
              
                Polk

              

            	
              
                25,000

              

            
	
              
                Orange

              

            	
              
                38,000

              

            
	
              
                Osceola

              

            	
              
                12,000

              

            
	
              
                Sarasota

              

            	
              
                6,000

              

            
	
              
                Seminole

              

            	
              
                6,000

              

            
	
              
                St.
      Lucie

              

            	
              
                4,500

              

            
	
              
                Sumter

              

            	
              
                4,500

              

            

    

    
      

    

    
      REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK

    

    
      

    

    
      AHCA
Contract No. FA615, Exhibit I-C, Page 1 of 1

    

    

    
      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

    
      

    

    
      	
              WellCare
      of Florida, Inc. d/b/a

            	
              Medicaid
      HMO Contract

            
	
              Staywell
      Health Plan of Florida

            	 
      

    

    
       

      
        EXHIBIT
II-E

        
          FIFTH
REVISED CAPITATION RATES

        

      

    

    
      

    

    
      
        	
                A.

              	
                Table
      2 - General Capitation Rates plus Mental Health
  Rates:

              

      

    

    
       

      Area
3 Counties:

    

    
      	
              
                County

              

            	
              
                Provider
      Number

              

            
	
              
                Hernando

              

            	
              
                015016901

              

            
	
              
                Sumter

              

            	
              
                015016916

              

            

    

    
       

      Area
5 Counties:

    

    
      	
              
                County

              

            	
              
                Provider
      Number

              

            
	
              
                Pasco

              

            	
              
                015016903

              

            
	
              
                Pinellas

              

            	
              
                015016904

              

            

    

    
       

      Area
6 Counties:

    

    
      	
              
                County

              

            	
              
                Provider
      Number

              

            
	
              
                Hillsborough

              

            	
              
                015016902

              

            
	
              
                Manatee

              

            	
              
                015016912

              

            
	
              
                Polk

              

            	
              
                015016905

              

            

    

    
       

      Area
7
Counties:

    

    
      	
              
                County

              

            	
              
                Provider
      Number

              

            
	
              
                Orange

              

            	
              
                015016906

              

            
	
              
                Seminole

              

            	
              
                015016908

              

            
	
              
                Osceola

              

            	
              
                015016907

              

            
	
              
                Brevard

              

            	
              
                015016913

              

            

    

    
       

      Area
8 Counties:

    

    
      	
              
                County

              

            	
              
                Provider
      Number

              

            
	
              
                Lee

              

            	
              
                015016911

              

            
	
              
                Sarasota

              

            	
              
                015016914

              

            

    

    
       

      Area
9 Counties:

    

    
      	
              
                County

              

            	
              
                Provider
      Number

              

            
	
              
                Palm
      Beach

              

            	
              
                015016910

              

            
	
              
                St.
      Lucie

              

            	
              
                015016915

              

            

    

    
       

      Area
10 Counties:

    

    
      	
              
                County

              

            	
              
                Provider
      Number

              

            
	
              
                Broward

              

            	
              
                015016900

              

            

    

    
       

      Area
11 Counties:

    

    
      	
              
                County

              

            	
              
                Provider
      Number

              

            
	
              
                Miami-Dade

              

            	
              
                015016909

              

            

    

    
       

    

    
      REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK

    

    
      

    

    
      AHCA
Contract No. FA615, Amendment No. 7, Page 1 of 1

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