Document:

far001amend9.htm

    
      Back to Form 8-K

      Exhibit 10.1

      
Addendum
to Exhibit 3-C

      
        
           

          The
Agency and the Vendor acknowledge and agree that the rates reflected in this
AHCA Contract No. FAR 001 Amendment No. 9 do not reflect the parties' prior
understanding. Accordingly, the Agency agrees to increase the Children and
Families and Aged and Disabled (No Medicare, Medicare Parts A and B and Medicare
Part B Only) by approximately 2% to be effective September 1,
2008.

        

        
           

          WellCare
of Florida, Inc.

        

        
          d/b/a
Staywell Health Plan of Florida

        

         

        Signed

        

        By: /s/ Heath
Schiesser                                    

        Name:
Heath
Schiesser                                    

        Title:
President and
CEO                                  

        Date: August 29,
2008                                      

        
           

          State of
Florida, Agency for Health Care Administration

        

        
          

        

        
          
            By: /s/ William H.
Roberts                        
       

            
              Name: William H. Roberts for
Holly Benson

              
                Title:
Deputy General
Counsel               
         

                
                  Date:
8/29/08                                                      

                

              

            

          

        

        
           

        

        
          
            
               

            

            
               

              
                

              

            

            
               

            

          

        

        

        
          EXHIBIT
3-C

        

        
          MEDICAID
REFORM HMO CAPITATION RATES

        

        
          (By
Area, Age, and Eligibility Category)

        

        
          September
1, 2008 - August 31, 2009

           

        

        
          TABLE
2

          

        

        
          	
                  Area:
      10         
      

                	
                  County:
      Broward          
      

                	
                  September
      1, 2008

                

        

        
          

        

        
          ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)

           

        

        
          	
                  
                    Eligibility
      Category/ 

                    Population

                  

                	
                  
                    Total
      Rates for Comprehensive 

                    and
      Catastrophic Components

                  

                	
                  
                    Total
      Rate for Comprehensive 

                    Component
      Only

                  

                
	
                  
                    Children
      and Families:

                  

                	 
      	 
      
	
                  
                    Newborns
      aged 0-2 months

                  

                	
                  
                     
      $         868.52

                  

                	
                  
                     
      $       
        750.55

                  

                
	
                  
                    Newborns
      aged 3-11 months

                  

                	
                  
                     
      $         191.05

                  

                	
                  
                     
      $       
        181.72

                  

                
	
                  
                    Age
      1 and Up - Base Rate for Risk adjustment

                  

                	
                  
                     
      $       
     107.11

                  

                	
                  
                     
      $         105.39

                  

                

        

         

        
          	
                  
                    Aged
      and Disabled:

                  

                	 
      	 
      
	
                  
                    No
      Medicare

                  

                	 
      	 
      
	
                  
                    Newborns
      aged 0-2 months

                  

                	
                  
                     
      $    17,572.21

                  

                	
                  
                     
      $      9,173.75

                  

                
	
                  
                    Newborns
      aged 3-11 months

                  

                	
                  
                     
      $      3,896.35

                  

                	
                  
                     
      $      2,187.93

                  

                
	
                  
                    Age
      1 and Up - Base Rate for Risk Adjustment

                  

                	
                  
                     
      $         789.84

                  

                	
                  
                      $     
         725.69

                  

                

        

         

        
          	
                  
                    Medicare
      Parts A and B

                  

                	 
      
	
                  
                    Under
      Age 65

                  

                	
                  
                     
      $    
        139.11

                  

                	
                  
                    N/A

                  

                
	
                  
                    Age
      65 and over

                  

                	
                  
                      $    
            99.49

                  

                	
                  
                    N/A

                  

                

        

         

        
          	
                  
                    Medicare
      Part B Only

                  

                	 
      	 
      
	
                  
                    All
      ages

                  

                	
                  
                     
      $    
        265.17

                  

                	
                  
                    N/A

                  

                

        

         

        
          	
                  
                    HIV/AIDS
      Specialty Population

                  

                	 
      	 
      
	
                  
                    No
      Medicare HIV

                  

                	
                  
                     
      $      1,823.74

                  

                	
                  
                    N/A

                  

                
	
                  
                    No
      Medicare AIDS

                  

                	
                  
                     
      $      3,422.47

                  

                	
                  
                    N/A

                  

                
	
                  
                    Medicare
      HIV

                  

                	
                  
                     
      $         256.03

                  

                	
                  
                    N/A

                  

                
	
                  
                    Medicare
      AIDS

                  

                	
                  
                     
      $         546.61

                  

                	
                  
                    N/A

                  

                

        

         

        
          	
                   

                  Kick
      Payments Amounts for Covered Obstetrical Delivery Services:

                   

                
	
                  CPT

                  Code

                	
                  Obstetrical
      Delivery CPT Code Description

                   

                	
                  Payment

                  Amount

                
	
                  59409

                	
                  Vaginal
      delivery only

                	
                   

                   

                  $3,941.45

                
	
                  59410

                	
                  Vaginal
      delivery including postpartum care

                
	
                  59515

                	
                  Cesarean
      delivery including postpartum care

                
	
                  59612

                	
                  Vaginal
      delivery only, after previous cesarean delivery

                
	
                  59614

                	
                  Vaginal
      delivery only, after previous cesarean delivery including postpartum
      care

                
	
                  59622

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

                

        

        
           

        

        
          AHCA
Contract No. FAR001, Exhibit 3-C, Page 1 of
3

        

        

        
          
            
               

            

            
               

              
                

              

            

            
               

            

          

        

        

        
          EXHIBIT
3-C

        

        
          MEDICAID REFORM HMO CAPITATION
RATES

        

        
          (By Area,
Age, and Eligibility Category)

        

        
          September
1, 2008 - August 31, 2009

        

        
                                                                                                   September
1, 2008

        

        
          Area:  4   
      County:  Duval.
Bakar, Clay and Nassau

        

        
          

          ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)

        

         

        
          	
                  
                    Eligibility
      Category/

                    Population

                  

                	
                  
                    Total
      Rates for Comprehensive 

                    and
      Catastrophic Component

                  

                	
                  
                    Total
      Rate for 

                    Comprehensive

                    Component
      Only

                  

                
	
                  
                    Children
      and Families:

                  

                	 
      	 
      
	
                  
                    Newborns
      aged 0-2 months

                  

                	
                  
                     
      $            895.21

                  

                	
                  
                     
      $                773.61

                  

                
	
                  
                    Newborns
      aged 3-11 months

                  

                	
                  
                     
      $         
        196.74

                  

                	
                  
                     
      $        
             187.13

                  

                
	
                  
                    Age
      1 and Up - Base Rate for Risk Adjustment

                  

                	
                  
                     
      $         
        110.24

                  

                	
                  
                     
      $         
            108.46

                  

                
	 
      
	
                  
                    Aged
      and Disabled:

                  

                	 
      	 
      
	
                  
                    No
      Medicare

                  

                	 
      	 
      
	
                  
                    Newborns
      aged 0-2 months

                  

                	
                  
                     
      $       14,234.51

                  

                	
                  
                     
      $             7,431.27

                  

                
	
                  
                    Newborns
      aged 3-11 months

                  

                	
                  
                     
      $         3,172.94

                  

                	
                  
                     
      $             1,765.42

                  

                
	
                  
                    Age1
      and Up-Base Rate for Risk Adjustment

                  

                	
                  
                     
      $          
       610.65

                  

                	
                  
                     
      $          
           561.06

                  

                
	 
      	 
      
	
                  
                    Medicare
      Parts A and B

                  

                	 
      	 
      
	
                  
                    Under
      Age 65

                  

                	
                  
                     
      $            158.06

                  

                	
                  
                    N/A

                  

                
	
                  
                    Age
      65 and over

                  

                	
                  
                     
      $            112.96

                  

                	
                  
                    N/A

                  

                
	
                  
                     

                  

                
	
                  
                    Medicare
      Part B Only

                  

                	 
      	 
      
	
                  
                    All
      ages

                  

                	
                  
                     
      $            326.42

                  

                	
                  
                    N/A

                  

                
	 
      	 
      
	
                  
                    HIV/AIDS
      Specialty Population

                  

                	 
      	 
      
	
                  
                    No
      Medicare HIV

                  

                	
                  
                     
      $         1,161.19

                  

                	
                  
                    N/A

                  

                
	
                  
                    No
      Medicare AIDS

                  

                	
                  
                     
      $         2,285.96

                  

                	
                  
                    N/A

                  

                
	
                  
                    Medicare
      HIV

                  

                	
                  
                     
      $            157.41

                  

                	
                  
                    N/A

                  

                
	
                  
                    Medicare
      AIDS

                  

                	
                  
                     
      $      
           336.05

                  

                	
                  
                    N/A

                  

                
	 
      	 
      	 
      

        

         

        
          	
                  
                    Kick Payments
      Amounts for Covered Obstetrical Delivery
      Services:

                  

                
	
                  
                     

                    CPT
      Code

                     

                  

                	
                  
                     

                    Obstetrical
      Delivery CPT Code Description

                  

                	
                  
                     

                    Payment
      Amount

                  

                
	
                  
                    59409

                  

                	
                  
                    Vaginal
      delivery only

                  

                	
                  
                     

                  

                  
                     

                  

                  
                     

                  

                  
                     

                  

                  
                    $3,977.49

                  

                
	
                  
                    59410

                  

                	
                  
                    Vaginal
      delivery including postpartum care

                  

                
	
                  
                    59515

                  

                	
                  
                    Cesarean
      delivery including postpartum care

                  

                
	
                  
                    59612

                  

                	
                  
                    Vaginal
      delivery only, after previous cesarean delivery

                  

                
	
                  
                    59614

                  

                	
                  
                    Vaginal
      delivery only, after previous cesarean delivery including postpartum
      care

                  

                
	
                  
                    59622

                  

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

                  

                

        

        
          

          AHCA Contract No. FAR001, Exhibit 3-C,
Page 2 of
3

        

        

        
          
            
               

            

            
               

              
                

              

            

            
               

            

          

        

        

        
          EXHIBIT
3-C

        

        
          MEDICAID
REFORM HMO CAPITATION RATES

        

        
          (By
Area, Age. and Eligibility Category)

        

        
          September
1, 2008 - August 31, 2009

           

        

        
          	
                  Area:  10   
      

                	
                  County:  Broward

                	
                  September
      1, 2008

                
	
                  Area:  4    
      

                	
                  County:  Duval, Baker, Clay and
      Nassau

                	 
      

        

        
          
 

        

        
          	
                  
                    CPT
      Code

                     

                  

                	
                  
                    Transplant
      CPT Code Description

                  

                	
                  
                    Children/Adolescents
      or Adult

                  

                	
                  
                    Payment
      Amount

                  

                
	
                  
                    32851

                  

                	
                  
                    lung
      single, without bypass

                  

                	
                  
                    Children/Adolescents

                  

                	
                  
                    $320,800.00

                  

                
	
                  
                    32851

                  

                	
                  
                    lung
      single, without bypass

                  

                	
                  
                    Adult

                  

                	
                  
                    $238,000.00

                  

                
	
                  
                    32852

                  

                	
                  
                    lung
      single, with bypass

                  

                	
                  
                    Children/Adolescents

                  

                	
                  
                    $320,800.00

                  

                
	
                  
                    32852

                  

                	
                  
                    lung
      single, with bypass

                  

                	
                  
                    Adult

                  

                	
                  
                    $238,000.00

                  

                
	
                  
                    32853

                  

                	
                  
                    lung
      double, without bypass

                  

                	
                  
                    Children/Adolescents

                  

                	
                  
                    $320,800.00

                  

                
	
                  
                    32853

                  

                	
                  
                    lung
      double, without bypass

                  

                	
                  
                    Adult

                  

                	
                  
                    $238,000.00

                  

                
	
                  
                    32854

                  

                	
                  
                    lung
      double, with bypass

                  

                	
                  
                    Children/Adolescents

                  

                	
                  
                    $320,800.00

                  

                
	
                  
                    32854

                  

                	
                  
                    lung
      double, with bypass

                  

                	
                  
                    Adult

                  

                	
                  
                    $238,000.00

                  

                
	
                  
                    33945

                  

                	
                  
                    heart
      transplant with or without recipient cardiectomy

                  

                	
                  
                    All
      Age Groups

                  

                	
                  
                    $162,000.00

                  

                
	
                  
                    47135

                  

                	
                  
                    liver,
      allotransplation, orthotopic, partial or whole from cadaver or living
      donor

                  

                	
                  
                    All
      Age Groups

                  

                	
                  
                    $122,600.00

                  

                
	
                  
                    47136

                  

                	
                  
                    liver,
      heterotopic, partial or whole from cadaver or living donor any
      age

                  

                	
                  
                    All
      Age Groups

                  

                	
                  
                    $122,600.00

                  

                

        

        
          

          AHCA Contract No. FAR001, Exhibit 3-C,
Page 3 of 3

        

      

       

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

       

      
        	 HealthEase of Florida,
      Inc.	 Medicaid Reform HMO
      Contract

      

       

    

    
      AHCA
CONTRACT NO. FAR001 

      AMENDMENT
NO. 9

    

    
       

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

    

    
       

      
        	
                1.

              	
                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.

              	
                Attachment
      I, Scope of Services, Exhibit 1-B, effective January 1, 2009, is hereby
      included and made a part of the Contract. Exhibit 1-A will remain in
      effect until December 31, 2008. After January 1, 2009, all references in
      the Contract to Exhibit 1-A, shall hereinafter refer to Exhibit
      1-B.

              

      

    

    
       

      
        	
                3.

              	
                Effective
      September 1, 2008, Attachment I, Scope of Services, Exhibit 2-B is hereby
      included and made a part of the Contract. All references in the Contract
      to Exhibit 2-A, shall hereinafter refer to Exhibit
  2-B.

              

      

    

    
       

      
        	
                4.

              	
                Effective
      September 1, 2008, Attachment I, Scope of Services, Exhibit 3-C is hereby
      included and made a part of the Contract. All references in the Contract
      to Exhibits 3-B, shall hereinafter refer respectively to Exhibit
      3-C.

              

      

    

    
       

      
        	
                5.

              	
                Effective
      September 1, 2008, Attachment II, Medicaid Reform Health Plan Model
      Contract, Section XIII, Method of Payment, Section B, Capitation Rate
      Payments, is hereby revised as
follows:

              

      

    

    
       

      --      Sub-item
1.b.(1)(b), is hereby amended to include the following:

    

    
       

             
 Contract Year 2008-2009 Medicaid Reform rates under current Capitation
Rate methodology.

       

    

    
      --      Sub-item
1.b.(1)(i), the first paragraph is hereby amended to now read as
follows:

    

    
       

      
        	
                 
      

              	
                (i)
      100% of Risk Adjusted Methodology: The capitation amount based on the
      percentage of Risk-Adjusted methodology (h) multiplied by the Base Rates
      column for Risk-Adjusted methodology after budget neutrality factor
      (g).

              

      

    

    
       

      --      Sub-item
1.b.(1)(j), the first sentence is hereby amended to now read as
follows:

    

    
       

      
        	
                 
      

              	
                (j)
      Final Rate (with Enhanced Benefit Adjustment): The current methodology
      capitation amount (d) added to the 100% of Risk-Adjusted methodology
      amount (i).

              

      

    

    
       

      AHCA
Contract No. FAR001, Amendment No. 9, Page 1 of 2

    

    
      AHCA Form
2100-0002 (Rev. NOV03)

    

    
       

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

       

      
        	 HealthEase of Florida,
      Inc.	 Medicaid Reform HMO
      Contract

      

    

     

    
      
        	
                 
      

              	
                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, is 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 ten (10) page
      Amendment (including all attachments) to be executed by their officials
      thereunto duly authorized.

              

      

    

    
      

       

      

    

    
      	
              HEALTHEASE
      OF FLORIDA, INC.

            	
              STATE
      OF FLORIDA, AGENCY FOR

              HEALTH
      CARE ADMINISTRATION

            
	 
      	 
      
	
              SIGNED

            	
              SIGNED

            
	
              BY:
      /s/ Heath
      Schiesser                  
      

            	
              BY:
      /s/ William H.
      Roberts                                 
      

            
	
              NAME:
      Heath
      Schiesser                
      

            	
              NAME:
      William H. Roberts for
      Holly
      Benson  

            
	
              TITLE:
      President and
      CEO             
      

            	
              TITLE:
      Secretary                                                  
      

            
	
              DATE:

            	
              DATE:

            

    

    
       

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

       

    

    
      	
              Specify

              Type

            	
              Letter/

              Number

            	
               

              Description

            
	
              Exhibit

            	
              1-B

            	
              Benefit
      Grid (4 Pages)

            
	
              Exhibit

            	
              2-B

            	
              Second
      Revised Enrollment Levels (1 Page)

            
	
              Exhibit

            	
              3-C

            	
              Medicaid
      Reform HMO Capitation Rates (3
pages)

            

    

    
      

    

    
      REMAINDER
OF THIS PAGE INTENTIONALLY LEFT BLANK

    

    
       

    

    
      AHCA
Contract No. FAR001, Amendment No. 9, Page 2 of 2

    

    
      AHCA Form
2100-0002 (Rev. NOV03)

    

    
       

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      
        	 HealthEase of Florida,
      Inc.	2008-2009

      

                                                                                              

    

    
      Exhibit
1-B

    

    
      Benefit
Grid

      (i) Area 10 Broward- Children and
Families

    

    
      
        
          	
                  COVERED
      SERVICE CATEGORY

                	
                  Visit/Script

                  Limit

                	
                  Limit
      Period

                  (Annual/Monthly)

                	
                  Dollar
      Limit

                	
                  Limit
      Period

                  (Annual)

                	
                  Copay

                  Amount

                	
                  Copay

                  Application

                
	
                  Hospital
      Inpatient

                	 
      	 
      	 
      	 
      	 
      	 
      
	
                  Behavioral
      Health

                	 
      	 
      	 
      	 
      	
                        
      $

                	
                  admit

                
	
                   Physical
      Health

                	 
      	 
      	 
      	 
      	
                        
      $

                	
                  admit

                
	 
      	 
      
	
                  Transplant
      Services

                	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      
	
                  Outpatient
      Services

                	 
      	 
      	 
      	 
      	 
      	 
      
	
                  Emergency
      Room

                	 
      	 
      	 
      	 
      	 
      	 
      
	
                  Medical/Drug
      Therapies (Chemo, Dialysis)

                	 
      	 
      	 
      	 
      	 
      	 
      
	
                  Ambulatory
      Surgery - ASC

                	 
      	 
      	 
      	 
      	 
      	 
      
	
                  Hospital
      Outpatient Surgery

                	 
      	 
      	 
      	 
      	
                        
      $

                	
                  visit

                
	
                  Lab
      / X-ray

                	 
      	 
      	 
      	 
      	
                        
      $

                	
                  day

                
	
                  Hospital
      Outpatient Services NOS

                	 
      	 
      	 
      	
                  Annual

                	
                        
      $

                	
                  visit

                
	
                  Outpatient
      Therapy (PT/RT)

                	 
      	 
      	 
      	
                  Annual

                	
                   
      

                	 
      
	
                  Outpatient
      Therapy (OT/ST)

                	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      
	
                  Maternity
      and Family Planning Services

                	 
      	 
      	 
      	 
      	 
      	 
      
	
                  Inpatient
      Hospital

                	 
      	 
      	 
      	 
      	 
      	 
      
	
                  Birthing
      Centers

                	 
      	 
      	 
      	 
      	 
      	 
      
	
                  Physician
      Care

                	 
      	 
      	 
      	 
      	 
      	 
      
	
                  Family
      Planning

                	 
      	 
      	 
      	 
      	 
      	 
      
	
                  Pharmacy

                	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      
	
                  Physician
      and Phys Extender Services (non maternity)

                	 
      	 
      	 
      	 
      	 
      	 
      
	
                  EPSDT

                	 
      	 
      	 
      	 
      	 
      	 
      
	
                  Primary
      Care Physician

                	 
      	 
      	 
      	 
      	
                      
       
      $           -

                	
                  visit

                
	
                  Specialty
      Physician

                	 
      	 
      	 
      	 
      	
                        
      $

                	
                  visit

                
	
                  ARNP
      / Physician Assistant

                	 
      	 
      	 
      	 
      	
                     $           -

                	
                  visit

                
	
                  Clinic
      (FQHC, RHC)

                	 
      	 
      	 
      	 
      	
                        
      $

                	
                  visit

                
	
                  Clinic
      (CHD)

                	 
      	 
      	 
      	 
      	 
      	 
      
	
                  Other

                	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      
	
                  Other
      Outpatient Professional Services

                	 
      	 
      	 
      	 
      	 
      	 
      
	
                  Home
      Health Services

                	 
      	
                  Annual

                	 
      	
                  Annual

                	
                        
      $

                	
                  visit

                
	
                  Chiropractor

                	 
      	
                  Annual

                	 
      	
                  Annual

                	
                        
      $

                	
                  visit

                
	
                  Podiatrist

                	 
      	
                  Annual

                	 
      	
                  Annual

                	
                         $

                	
                  visit

                
	
                  Dental
      Services

                	 
      	
                   
      

                	 
      	
                  Annual

                	
                              
             -

                	
                  coinsurance

                
	
                  Vision
      Services

                	 
      	 
      	 
      	
                  Annual

                	
                         $           -

                	
                  visit

                
	
                   Hearing
      Services

                	 
      	 
      	 
      	
                  Annual

                	 
      	
                   
      

                
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                  Outpatient
      Mental Health

                	 
      	 
      	 
      	 
      	
                        
      $

                	
                  visit

                
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                  Outpatient
      Pharmacy

                	
                  10

                	
                  Monthly

                	 
      	
                   Annual

                	 
      	 
      
	 
      	
                   
      

                
	
                  Other
      Services

                	 
      	 
      	 
      	 
      	 
      	 
      
	
                  Ambulance

                	 
      	 
      	 
      	 
      	 
      	 
      
	
                  Non-emergent
      Transportation

                	 
      	 
      	 
      	 
      	
                        
      $

                	
                  trip

                
	
                  Durable
      Medical Equipment

                	 
      	 
      	 
      	
                  Annual

                	 
      	 
      

        

      

    

     

    
      	
              Enhanced
      benefits

            	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      

    

     

    AHCA
Contract No. FAR001, Exhibit 1-B, Page 1 of 4

     

    
      
        
          
             

          

          
             

            
              

            

          

          
             

          

        

      

      
        	 HealthEase of Florida,
      Inc.	2008-2009

Exhibit 1-B

      Benefit Grid

      (ii)  Area 10 Broward- Aged
and Disabled

      
        	
                COVERED
      SERVICE CATEGORY

              	
                Visit/Script
      Limit

              	
                Limit
      Period (Annual/Monthly)

              	
                Dollar
      Limit

              	
                Limit
      Period (Annual)

              	
                Copay
      Amount

              	
                Copay
      Application

              
	
                Hospital
      Inpatient

              	 
      	 
      	 
      	 
      	
                        

              	
                 

              
	
                Behavioral
      Health

              	 
      	 
      	 
      	 
      	
                       
      $

              	
                admit

              
	
                Physical
      Health

              	 
      	 
      	 
      	 
      	 
      	           
       admit
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                Transplant
      Services

              	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                Outpatient
      Services

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Emergency
      Room

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Medical/Drug
      Therapies (Chemo, Dialysis)

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Ambulatory
      Surgery - ASC

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Hospital
      Outpatient Surgery

              	 
      	 
      	 
      	 
      	
                       
      $

              	
                visit

              
	
                Lab
      / X-ray

              	 
      	 
      	 
      	 
      	
                       
      $

              	
                day

              
	
                Hospital
      Outpatient Services NOS

              	 
      	 
      	 
      	
                Annual

              	
                       
      $

              	
                visit

              
	
                Outpatient
      Therapy (PT/RT)

              	 
      	 
      	 
      	
                Annual

              	 
      	 
      
	
                Outpatient
      Therapy (OT/ST)

              	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                Maternity
      and Family Planning Services

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Inpatient
      Hospital

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Birthing
      Centers

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Physician
      Care

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Family
      Planning

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Pharmacy

              	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                Physician
      and Phys Extender Services (non maternity)

              	 
      	 
      	 
      	 
      	 
      
	
                EPSDT

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Primary
      Care Physician

              	 
      	 
      	 
      	 
      	
                       
      $           -

              	
                visit

              
	
                Specialty
      Physician

              	 
      	 
      	 
      	 
      	
                       
      $

              	
                visit

              
	
                ARNP
      / Physician Assistant

              	 
      	 
      	 
      	 
      	
                       
      $           -

              	
                visit

              
	
                Clinic
      (FQHC, RHC)

              	 
      	 
      	 
      	 
      	
                       
      $

              	
                visit

              
	
                Clinic
      (CHD)

              	 
      	 
      	 
      	 
      	 
      	
                 
      

              
	
                Other

              	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                Other
      Outpatient Professional Services

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Home
      Health Services

              	 
      	
                Annual

              	 
      	
                Annual

              	
                       
      $

              	
                visit

              
	
                Chiropractor

              	 
      	
                Annual

              	 
      	
                Annual

              	
                       
      $

              	
                visit

              
	
                Podiatrist

              	 
      	
                Annual

              	 
      	
                Annual

              	
                       
      $

              	
                visit

              
	
                Dental
      Services

              	 
      	 
      	
                $

              	
                Annual

              	
                       
                  
      -

              	
                coinsurance

              
	
                Vision
      Services

              	 
      	 
      	 
      	
                Annual

              	
                      
       $          
      -

              	
                visit

              
	
                Hearing
      Services

              	 
      	 
      	 
      	
                Annual

              	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                Outpatient
      Mental Health

              	 
      	 
      	 
      	 
      	
                       
      $

              	
                visit

              
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                Outpatient
      Pharmacy

              	
                17

              	
                Monthly

              	 
      	
                           Annual

              	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                Other
      Services

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Ambulance

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Non-emergent
      Transportation

              	 
      	 
      	 
      	 
      	
                       
      $

              	
                trip

              
	
                Durable
      Medical Equipment

              	 
      	 
      	 
      	
                Annual

              	 
      	 
      

      

    

     

    
      
        	
                Enhanced
      benefits

              
	
                   
      (Circumcision, boys up to one year)

              
	
                   
      ($25 OTC, per household per month)

              
	
                   
      (Expanded dental services – Exams / X-rays / Deep Cleaning / Clear and
      Silver Fillings / Crown (limited)

              
	
                   
      Flouride / Periodontal Scaling and root planning)

              
	
                   
      (Respite Events – up to 1 per
month)

              

      

    

     

    AHCA
Contract No. FAR001, Exhibit 1-B, Page 2 of 4

     

    
      
        
          
             

          

          
             

            
              

            

          

          
             

          

        

      

      
        	 HealthEase of Florida,
      Inc.	2008-2009

      

       

      Exhibit 1-B

      Benefit Grid

      (i) Area 4 Duval- Children and
Families

      
        
          
            	
                    COVERED
      SERVICE CATEGORY

                  	
                    Visit/Script
      Limit

                  	
                    Limit
      Period (Annual/Monthly)

                  	
                    Dollar
      Limit

                  	
                    Limit
      Period (Annual)

                  	
                    Copay
      Amount

                  	
                    Copay
      Application

                  
	
                    Hospital
      Inpatient

                  	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Behavioral
      Health

                  	 
      	 
      	 
      	 
      	
                           
      $

                  	
                    admit

                  
	
                    Physical
      Health

                  	 
      	 
      	 
      	 
      	
                           
      $

                  	
                    admit

                  
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Transplant
      Services

                  	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Outpatient
      Services

                  	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Emergency
      Room

                  	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Medical/Drug
      Therapies (Chemo, Dialysis)

                  	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Ambulatory
      Surgery - ASC

                  	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Hospital
      Outpatient Surgery

                  	 
      	 
      	 
      	 
      	
                           
      $

                  	
                    visit

                  
	
                    Lab
      / X-ray

                  	 
      	 
      	 
      	 
      	
                           
      $

                  	
                    day

                  
	
                    Hospital
      Outpatient Services NOS

                  	 
      	 
      	 
      	
                    Annual

                  	
                           
      $

                  	
                    visit

                  
	
                    Outpatient
      Therapy (PT/RT)

                  	 
      	 
      	 
      	
                    Annual

                  	 
      	 
      
	
                    Outpatient
      Therapy (OT/ST)

                  	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Maternity
      and Family Planning Services

                  	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Inpatient
      Hospital

                  	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Birthing
      Centers

                  	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Physician
      Care

                  	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Family
      Planning

                  	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Pharmacy

                  	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Physician
      and Phys Extender Services (non maternity)

                  	 
      	 
      	 
      	 
      	 
      
	
                    EPSDT

                  	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Primary
      Care Physician

                  	 
      	 
      	 
      	 
      	
                           
      $           -

                  	
                    visit

                  
	
                    Specialty
      Physician

                  	 
      	 
      	 
      	 
      	
                           
      $

                  	
                    visit

                  
	
                    ARNP
      / Physician Assistant

                  	 
      	 
      	 
      	 
      	
                           
      $           -

                  	
                    visit

                  
	
                    Clinic
      (FQHC, RHC)

                  	 
      	 
      	 
      	 
      	
                           
      $

                  	
                    visit

                  
	
                    Clinic
      (CHD)

                  	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Other

                  	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Other
      Outpatient Professional Services

                  	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Home
      Health Services

                  	 
      	
                    Annual

                  	 
      	
                    Annual

                  	
                           
      $

                  	
                    visit

                  
	
                    Chiropractor

                  	 
      	
                    Annual

                  	 
      	
                    Annual

                  	
                           
      $

                  	
                    visit

                  
	
                    Podiatrist

                  	 
      	
                    Annual

                  	 
      	
                    Annual

                  	
                           
      $

                  	
                    visit

                  
	
                    Dental
      Services

                  	 
      	 
      	 
      	
                    Annual

                  	
                                        
      -

                  	
                    coinsurance

                  
	
                    Vision
      Services

                  	 
      	 
      	 
      	
                    Annual

                  	
                           
      $           -

                  	
                    visit

                  
	
                    Hearing
      Services

                  	 
      	 
      	 
      	
                    Annual

                  	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Outpatient
      Mental Health

                  	 
      	 
      	 
      	 
      	
                           
      $

                  	
                    visit

                  
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Outpatient
      Pharmacy

                  	
                    9

                  	
                       Monthly

                  	 
      	
                     Annual

                  	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Other
      Services

                  	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Ambulance

                  	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Non-emergent
      Transportation

                  	 
      	 
      	 
      	 
      	
                           
      $

                  	
                    trip

                  
	
                    Durable
      Medical Equipment

                  	 
      	 
      	 
      	
                    Annual

                  	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                    Enhanced
      benefits

                  	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      

          

        

      

    

    AHCA Contract No. FAR001, Exhibit
1-B, Page 3 of 4

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    
      	 HealthEase of Florida,
      Inc.	2008-2009

    

     

    Exhibit
1-B

    Benefit
Grid

    (ii) Area 4 Duval- Aged and
Disabled

    
      
        	
                COVERED
      SERVICE CATEGORY

              	
                Visit/Script
      Limit

              	
                Limit
      Period (Annual/Monthly)

              	
                Dollar
      Limit

              	
                Limit
      Period (Annual)

              	
                Copay
      Amount

              	
                Copay
      Application

              
	
                Hospital
      Inpatient

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Behavioral
      Health

              	 
      	 
      	 
      	 
      	
                       
      $

              	
                admit

              
	
                Physical
      Health

              	 
      	 
      	 
      	 
      	
                       
      $

              	
                admit

              
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                Transplant
      Services

              	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                Outpatient
      Services

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Emergency
      Room

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Medical/Drug
      Therapies (Chemo, Dialysis)

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Ambulatory
      Surgery - ASC

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                 Hospital
      Outpatient Surgery

              	 
      	 
      	 
      	 
      	
                       
      $

              	
                visit

              
	
                Lab
      / X-ray

              	 
      	 
      	 
      	 
      	
                       
      $

              	
                day

              
	
                Hospital
      Outpatient Services NOS

              	 
      	 
      	 
      	
                Annual

              	
                       
      $

              	
                visit

              
	
                Outpatient
      Therapy (PT/RT)

              	 
      	 
      	 
      	
                Annual

              	 
      	 
      
	
                Outpatient
      Therapy (OT/ST)

              	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                Maternity
      and Family Planning Services

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Inpatient
      Hospital

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Birthing
      Centers

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Physician
      Care

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Family
      Planning

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Pharmacy

              	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                Physician
      and Phys Extender Services (non maternity)

              	 
      	 
      	 
      	 
      	 
      
	
                EPSDT

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Primary
      Care Physician

              	 
      	 
      	 
      	 
      	
                       
      $           -

              	
                visit

              
	
                Specialty
      Physician

              	 
      	 
      	 
      	 
      	
                       
      $

              	
                visit

              
	
                ARNP
      / Physician Assistant

              	 
      	 
      	 
      	 
      	
                       
      $           -

              	
                visit

              
	
                Clinic
      (FQHC, RHC)

              	 
      	 
      	 
      	 
      	
                       
      $

              	
                visit

              
	
                Clinic
      (CHD)

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Other

              	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                Other
      Outpatient Professional Services

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Home
      Health Services

              	 
      	
                Annual

              	 
      	
                Annual

              	
                       
      $

              	
                visit

              
	
                Chiropractor

              	 
      	
                Annual

              	 
      	
                Annual

              	
                       
      $

              	
                visit

              
	
                 Podiatrist

              	 
      	
                Annual

              	 
      	
                Annual

              	
                       
      $

              	
                visit

              
	
                 Dental
      Services

              	 
      	 
      	
                $

              	
                Annua

              	
                                 
      -

              	
                coinsurance

              
	
                Vision
      Services

              	 
      	 
      	 
      	
                Annual

              	
                       
      $           -

              	
                visit

              
	
                Hearing
      Services

              	 
      	 
      	 
      	
                Annual

              	 
      	
                 
      

              
	 
      	 
      	 
      	 
      	
                 
      

              	 
      	 
      
	
                Outpatient
      Mental Health

              	 
      	 
      	 
      	 
      	
                       
      $

              	
                visit

              
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                Outpatient
      Pharmacy

              	
                17

              	
                              
         Monthly

              	
                 Annual

              	 
      	 
      
	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	
                Other
      Services

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Ambulance

              	 
      	 
      	 
      	 
      	 
      	 
      
	
                Non-emergent
      Transportation

              	 
      	 
      	 
      	 
      	
                       
      $

              	
                trip

              
	
                Durable
      Medical Equipment

              	 
      	 
      	 
      	
                Annual

              	 
      	 
      

      

    

     

    
      
        	
                Enhanced
      benefits

              
	 
      
	 
      
	 
      

      

       

    

    AHCA Contract No. FAR001, Exhibit
1-B, Page 4 of 4

     

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

     

    
      
        HEALTHEASE
OF FLORIDA, INC.

      

      
        EXHIBIT
2-B

      

      
        SECOND
REVISED ENROLLMENT LEVELS

      

      
         

        TABLE
1 (Duval – Area 4, Broward – Area 10)

      

      
         

        
          
            	 	 Agency Area 04

          

           

        

      

      
        	
                
                  Eligibility
      

                  Category/

                  Population

                   

                

              	
                
                  County

                

              	
                
                  Health
      Plan

                

                
                  Provider

                

                
                  Number

                

              	
                
                  Plan
      Type

                

                
                  (Comp
      or Comp 

                  &
      Catastrophic)

                

              	
                
                  Maximum

                

                
                  Enrollment

                

                
                  Level

                

              
	
                
                  TANF

                   

                

              	
                
                  Duval

                

              	 
      	
                
                  Comprehensive
      & Catastrophic

                

              	
                
                   

                  35,500

                

              
	
                
                  SSI

                   

                

              	
                
                  Duval

                

              	 
      	
                
                  Comprehensive
      & Catastrophic

                

              
	
                
                  HIV/AIDS

                   

                

              	 
      	 
      	 
      	 
      
	
                
                  Children
      with

                

                
                  Chronic

                

                
                  Conditions

                

              	 
      	 
      	 
      	 
      

      

      
         

        
          
            	 	Agency Area 10

          

           

        

      

      
        	
                
                  Eligibility
      

                  Category/
      

                  Population

                   

                

              	
                
                  County

                

              	
                
                  Health
      Plan

                

                
                  Provider

                

                
                  Number

                

              	
                
                  Plan
      Type

                  (Comp
      or Comp 

                  &
      Catastrophic)

                

              	
                
                  Maximum

                

                
                  Enrollment

                

                
                  Level

                

              
	
                
                  TANF

                   

                

              	
                
                  Broward

                

              	 
      	
                
                  Comprehensive
      & Catastrophic

                

              	
                
                   

                  15,500

                

              
	
                
                  SSI

                   

                

              	
                
                  Broward

                

              	 
      	
                
                  Comprehensive
      & Catastrophic

                

              
	
                
                  HIV/AIDS

                   

                

              	 
      	 
      	 
      	 
      
	
                
                  Children
      with

                

                
                  Chronic

                

                
                  Conditions

                

              	 
      	 
      	 
      	 
      

      

      
        

        REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK

      

      
         

        AHCA
Contract No. FAR001, Exhibit 2-B, Page 1 of 1

      

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      
         

      

      
        EXHIBIT
3-C

        MEDICAID
REFORM HMO CAPITATION RATES

        (By
Area, Age, and Eligibility Category)

      

      
        September
1, 2008 – August 31, 2009

         

      

      
        TABLE 2 

         

        
          
            	 Area: 10     
      	 County:  Broward	 September 1,
      2008

          

          
ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)

        

      

       

      
        	
                
                  Eligibility
      Category/ 

                  Population

                

              	
                
                  Total
      Rates for Comprehensive 

                  and
      Catastrophic Components

                

              	
                
                  Total
      Rate for 

                  Comprehensive
      

                  Component
      Only

                

              
	
                
                  Children
      and Families:

                

              	 
      	 
      
	
                
                  Newborns
      aged 0-2 months

                

              	
                
                  $             
      868.52

                

              	
                
                  $             750.55

                

              
	
                
                  Newborns
      aged 3-11 months

                

              	
                
                  $             
      191.05

                

              	
                
                  $             181.72

                

              
	
                
                  Age
      1 and Up - Base Rate for Risk adjustment

                

              	
                
                  $              107.11

                

              	
                
                  $             105.39

                

              

      

       

      
        	
                
                  Aged
      and Disabled:

                

              	 
      	 
      
	
                
                  No
      Medicare

                

              	 
      	 
      
	
                
                  Newborns
      aged 0-2 months

                

              	
                
                  $         17,572.21

                

              	
                
                  $           9,173.75

                

              	 
	
                
                  Newborns
      aged 3-11 months

                

              	
                
                  $          
      3,896.35

                

              	
                
                  $           2,167.93

                

              	
                
                   

                

              
	
                
                  Age
      1 and Up - Base Rate for Risk Adjustment

                

              	
                
                  $             
      789.84

                

              	
                
                  $              725.69

                

              	
                
                   

                

              

      

       

      
        	
                
                  Medicare
      Parts A and B

                

              	 
      	 
      
	
                
                  Under
      Age 65

                

              	
                
                  $             
      139.11

                

              	
                
                         
      N/A

                

              
	
                
                  Age
      65 and over

                

              	
                
                  $               
      99.49

                

              	
                
                         
      N/A

                

              

      

       

      
        	
                
                  Medicare
      Part B Only

                

              	 
      	 
      
	
                
                  All
      ages

                

              	
                
                  $       
            265.17

                

              	
                
                         
      N/A

                

              

      

       

      
        	
                
                  HIV/AIDS
      Specialty Population

                

              	 
      	 
      
	
                
                  No
      Medicare HIV

                

              	
                
                  $     
          1,823.74

                

              	
                
                         
      N/A

                

              
	
                
                  No
      Medicare AIDS

                

              	
                
                  $      
         3,422.47

                

              	
                
                         
      N/A

                

              
	
                
                  Medicare
      HIV

                

              	
                
                  $       
           256.03

                

              	
                
                         
      N/A

                

              
	
                
                  Medicare
      AIDS

                

              	
                
                  $        
          546.61

                

              	
                
                         
      N/A

                

              

      

       

      
        	
                
                   

                  Kick Payments
      Amounts for Covered Obstetrical Delivery
      Services:

                   

                

              
	
                
                  CPT
      

                  Code

                

              	
                
                  Obstetrical
      Delivery CPT Code Description

                

              	
                
                  Payment
      

                  Amount

                

              
	
                
                  59409

                

              	
                
                  Vaginal
      delivery only

                

              	
                
                   

                   

                  $3,941.45

                

              
	
                
                  59410

                

              	
                
                  Vaginal
      delivery including postpartum care

                

              
	
                
                  59515

                

              	
                
                  Cesarean
      delivery including postpartum care

                

              
	
                
                  59612

                

              	
                
                  Vaginal
      delivery only, after previous cesarean delivery

                

              
	
                
                  59614

                

              	
                
                  Vaginal
      delivery only, after previous cesarean delivery including postpartum
      care

                

              
	
                
                  59622

                

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

                

              

      

      
         

        AHCA
Contract No. FAR001, Exhibit 3-C, Page 1 of 3

      

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      
         

      

      
        EXHIBIT
3-C

        MEDICAID
REFORM HMO CAPITATION RATES

        (By Area,
Age, and Eligibility Category)

      

      
        September
1, 2008 – August 31, 2009

      

      
        

         

      

      
        
          	 Area: 4  
      	 County: Duval, Baker, Clay and
      Nassau	 September 1,
      2008

        

             

      

      
        (ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)`

      

       

      
        	
                
                  Eligibility
      Category/ Population

                

              	
                
                  Total
      Rates for Comprehensive and Catastrophic Component

                

              	
                
                  Total
      Rate for Comprehensive Component Only

                

              
	
                
                  Children
      and Families:

                

              	 
      	 
      
	
                
                  Newborns
      aged 0-2 months

                

              	
                
                  $        
           895.21

                

              	
                
                  $                  773.61

                

              
	
                
                  Newborns
      aged 3-11 months

                

              	
                
                  $             196.74

                

              	
                
                  $                  187.13

                

              
	
                
                  Age
      1 and Up - Base Rate for Risk Adjustment

                

              	
                
                  $             110.24

                

              	
                
                  $                  108.46

                

              
	 
      
	
                
                  Aged
      and Disabled:

                

              	 
      	 
      
	
                
                  No
      Medicare

                

              	 
      	 
      
	
                
                  Newborns
      aged 0-2 months

                

              	
                
                  $     
         14,234.51

                

              	
                
                  $     
               7,431.27

                

              
	
                
                  Newborns
      aged 3-11 months

                

              	
                
                  $       
        3,172.94

                

              	
                
                  $               1,765.42

                

              
	
                
                  Age
      1 and Up - Base Rate for Risk Adjustment

                

              	
                
                  $        
          610.65

                

              	
                
                  $                  561.06

                

              
	 
      	 
      
	
                
                  Medicare
      Parts A and B

                

              	 
      	 
      
	
                
                  Under
      Age 65

                

              	
                
                  $             158.06

                

              	
                
                         
      N/A

                

              
	
                
                  Age
      65 and over

                

              	
                
                  $             112.96

                

              	
                
                         
      N/A

                

              
	 
      	 
      
	
                
                  Medicare
      Part B Only

                

              	 
      	 
      
	
                
                  All
      ages

                

              	
                
                  $            326.42

                

              	
                
                         
      N/A

                

              
	 
      	 
      
	
                
                  HIV/AIDS
      Specialty Population

                

              	 
      	 
      
	
                
                  No
      Medicare HIV

                

              	
                
                  $         1,161.19

                

              	
                
                         
      N/A

                

              
	
                
                  No
      Medicare AIDS

                

              	
                
                  $         2,285.96

                

              	
                
                         
      N/A

                

              
	
                
                  Medicare
      HIV

                

              	
                
                  $            157.41

                

              	
                
                         
      N/A

                

              
	
                
                  Medicare
      AIDS

                

              	
                
                  $            336.05

                

              	
                
                         
      N/A

                

              

      

       

      
        	
                
                  Kick Payments
      Amounts for Covered Obstetrical Delivery
      Services:

                

              
	
                
                  CPT
      Code

                

              	
                
                  Obstetrical
      Delivery CPT Code Description

                

              	
                
                  Payment
      Amount

                

              
	
                
                  59409

                

              	
                
                  Vaginal
      delivery only

                

              	
                
                   

                   

                  $3,977.49

                

              
	
                
                  59410

                

              	
                
                  Vaginal
      delivery including postpartum care

                

              
	
                
                  59515

                

              	
                
                  Cesarean
      delivery including postpartum care

                

              
	
                
                  59612

                

              	
                
                  Vaginal
      delivery only, after previous cesarean delivery

                

              
	
                
                  59614

                

              	
                
                  Vaginal
      delivery only, after previous cesarean delivery including postpartum
      care

                

              
	
                
                  59622

                

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

                

              

      

      
         

        AHCA
Contract No. FAR001, Exhibit 3-C, Page 2 of 3

      

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      
         

      

      
        EXHIBIT
3-C

        MEDICAID
REFORM HMO CAPITATION RATES

        (By Area,
Age, and Eligibility Category)

      

      
        September
1, 2008 – August 31, 2009

         

      

      
        
          	 Area: 4    
      	 County: Duval, Baker, Clay, Nassau  
      	 September 1,
      2008

        

         

      

      
        	
                
                  CPT
      Code

                

              	
                
                  Transplant
      CPT Code Description

                

              	
                
                  Children/Adolescents    or
      Adult

                

              	
                
                  Payment
      Amount

                   

                

              
	
                
                  32851

                

              	
                
                  lung
      single, without bypass

                

              	
                
                  Children/Adolescents

                

              	
                
                  $320,800.00

                

              
	
                
                  32851

                

              	
                
                  lung
      single, without bypass

                

              	
                
                  Adult

                

              	
                
                  $238,000.00

                

              
	
                
                  32852

                

              	
                
                  lung
      single, with bypass

                

              	
                
                  Children/Adolescents

                

              	
                
                  $320,800.00

                

              
	
                
                  32852

                

              	
                
                  lung
      single, with bypass

                

              	
                
                  Adult

                

              	
                
                  $238,000.00

                

              
	
                
                  32853

                

              	
                
                  lung
      double, without bypass

                

              	
                
                  Children/Adolescents

                

              	
                
                  $320,800.00

                

              
	
                
                  32853

                

              	
                
                  lung
      double, without bypass

                

              	
                
                  Adult

                

              	
                
                  $238,000.00

                

              
	
                
                  32854

                

              	
                
                  lung
      double, with bypass

                

              	
                
                  Children/Adolescents

                

              	
                
                  $320,800.00

                

              
	
                
                  32854

                

              	
                
                  lung
      double, with bypass

                

              	
                
                  Adult

                

              	
                
                  $238,000.00

                

              
	
                
                  33945

                

              	
                
                  heart
      transplant with or without recipient cardiectomy

                

              	
                
                  All
      Age Groups

                

              	
                
                  $162,000.00

                

              
	
                
                  47135

                

              	
                
                  liver,
      allotransplation, orthotopic, partial or whole from cadaver or living
      donor

                

              	
                
                  All
      Age Groups

                

              	
                
                  $122,600.00

                

              
	
                
                  47136

                

              	
                
                  liver,
      heterotopic, partial or whole from cadaver or living donor any
      age

                

              	
                
                  All
      Age Groups

                

              	
                
                  $122,600.00

                

              

      

      
        

        AHCA
Contract No. FAR001, Exhibit 3-C, Page 3 of
3far001amend10.htm

    Back to Form 8-K

    Exhibit 10.2

    
 

    
      	
              HealthEase
      of Florida, Inc.

            	
              Medicaid
      Reform HMO Contract

            

    

    
      

    

    
      AHCA
CONTRACT NO. FAR001

    

    
      AMENDMENT
NO. 10

    

    
      

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

    

    
      

       

      
        	
                1.

              	
                Effective
      September 1, 2008, Attachment I, Scope of Services, Exhibit 3-D is hereby
      included and made a part of the Contract. All references in the Contract
      to Exhibit 3-C, shall hereinafter refer respectively to Exhibit
      3-D.

              

      

    

    
       

      
        	
                 
      

              	
                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, is 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 four (4) page
      Amendment (including all attachments) to be executed by their officials
      thereunto duly authorized.

              

      

    

    
      

    

    
      	
              HEALTHEASE
      OF FLORIDA, INC.

            	
              STATE
      OF FLORIDA, AGENCY FOR

              HEALTH
      CARE ADMINISTRATION

            
	
               

              SIGNED

              BY:
      /s/ 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

            	
              3-D

            	
              Medicaid
      Reform HMO Capitation Rates (3
pages)

            

    

    
      

    

    
      REMAINDER
OF THIS PAGE INTENTIONALLY LEFT BLANK

    

    
      

    

    
      AHCA
Contract No. FAR001, Amendment No. 10, Page 1 of 1

    

    
      AHCA Form
2100-0002 (Rev. NOV03)

    

    

    
      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

    

    
      EXHIBIT
3-D

    

    
      MEDICAID
REFORM HMO CAPITATION RATES

    

    
      (By Area,
Age, and Eligibility Category)

    

    
      September
1, 2008 - August 31, 2009

    

    
      

    

    
      TABLE
2

    

    
      

    

    
      	
              Area: 10     

            	
              County:  Broward  
      

            	
              September
      1, 2008

            

    

    
       

      ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)

    

     

    
      	
              
                Eligibility
      Category/ 

                Population

              

            	
              
                Total
      Rates for Comprehensive 

                and
      Catastrophic Components

              

            	
              
                Total
      Rate for 

                Comprehensive
      

                Component
      Only

              

            
	
              
                Children
      and Families:

              

            	 
      	 
      
	
              
                Newborns
      aged 0-2 months

              

            	
              
                     
      $            885.88

              

            	
              
                       
      $              765.55

              

            
	
              
                Newborns
      aged 3-11 months

              

            	
              
                      $            194.87

              

            	
              
                       
      $              185.35

              

            
	
              
                Age
      1 and Up - Base Rate for Risk adjustment

              

            	
              
                      $            109.25

              

            	
              
                       
      $              107.50

              

            

    

     

    
      	
              
                Aged
      and Disabled:

              

            	 
      	 
      
	
              
                No
      Medicare

              

            	 
      	 
      
	
              
                Newborns
      aged 0-2 months

              

            	
              
                $

              

            	
              
                17,923.49

              

            	
              
                      
      $

              

            	
              
                9,357.13

              

            
	
              
                Newborns
      aged 3-11 months

              

            	
              
                $

              

            	
              
                 
      3,974.24

              

            	
              
                      
      $

              

            	
              
                2,211.26

              

            
	
              
                Age
      1 and Up - Base Rate for Risk Adjustment

              

            	
              
                $

              

            	
              
                    
      805.53

              

            	
              
                      
      $

              

            	
              
                  
      740.20

              

            

    

     

    
      	
              
                Medicare
      Parts A and B

              

            	 
      	 
      
	
              
                Under
      Age 65

              

            	
              
                      
      $
                 141.89

              

            	
              
                                          
      N/A

              

            
	
              
                Age
      65 and over

              

            	
              
                      
      $
                 101.48

              

            	
              
                                          
      N/A

              

            

    

     

    
      	
              
                Medicare
      Part B Only

              

            	 
      	 
      
	
              
                All
      ages

              

            	
              
                       $
                 270.48

              

            	
              
                                         
      N/A

              

            

    

     

    
      	
              
                HIV/AIDS
      Specialty Population

              

            	 
      	 
      
	
              
                No
      Medicare HIV

              

            	
              
                      
      $         1,860.68

              

            	
              
                                          
      N/A

              

            
	
              
                No
      Medicare AIDS

              

            	
              
                       $
              3,491.79

              

            	
              
                                           N/A

              

            
	
              
                Medicare
      HIV

              

            	
              
                      
      $            261.22

              

            	
              
                                          
      N/A

              

            
	
              
                Medicare
      AIDS

              

            	
              
                      
      $            557.68

              

            	
              
                                          
      N/A

              

            

    

    
       

      
        
          	
                  
                     

                    Kick
      Payments Amounts for Covered Obstetrical Delivery Services:

                     

                  

                

        

      

    

    
      	
              
                CPT

              

              
                Code

              

            	
              
                Obstetrical
      Delivery CPT Code Description

                 

              

            	
              
                Payment

                Amount

              

            
	
              
                59409

              

            	
              
                Vaginal
      delivery only

              

            	
              
                 

              

              
                 

              

              
                $3,941.45

              

            
	
              
                59410

              

            	
              
                Vaginal
      delivery including postpartum care

              

            
	
              
                59515

              

            	
              
                Cesarean
      delivery including postpartum care

              

            
	
              
                59612

              

            	
              
                Vaginal
      delivery only, after previous cesarean delivery

              

            
	
              
                59614

              

            	
              
                Vaginal
      delivery only, after previous cesarean delivery including postpartum
      care

              

            
	
              
                59622

              

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

              

            

    

    
       

      AHCA
Contract No. FAR001, Exhibit 3-D, Page 1 of 3

    

    

    
      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

    

    
      EXHIBIT
3-D

    

    
      MEDICAID
REFORM HMO CAPITATION RATES

    

    
      (By Area,
Age, and Eligibility Category)

    

    
      September
1, 2008 - August 31,2009

    

    
      

    

    
      	
              Area: 4     
      

            	
              County: Duval,
      Baker, Clay, and Nassau

            	
              
                September
      1, 2008

              

               

            

    

    
      (ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)

    

     

    
      	
              
                Eligibility
      Category/ 

                Population

              

            	
              
                Total
      Rates for Comprehensive 

                and
      Catastrophic Component

              

            	
              
                Total
      Rate for 

                Comprehensive
      

                Component
      Only

              

            
	
              
                Children
      and Families:

              

            	 
      	 
      
	
              
                Newborns
      aged 0-2 months

              

            	
              
                         
      $            913.11

              

            	
              
                                     
      $              789.08

              

            
	
              
                Newborns
      aged 3-11 months

              

            	
              
                         
      $            200.67

              

            	
              
                                     
      $              190.87

              

            
	
              
                Age
      1 and Up - Base Rate for Risk Adjustment

              

            	
              
                         
      $            112.44

              

            	
              
                                     
      $              110.63

              

            
	 
      
	
              
                Aged
      and Disabled:

              

            	 
      	 
      
	
              
                No
      Medicare

              

            	 
      	 
      
	
              
                Newborns
      aged 0-2 months

              

            	
              
                         
      $       14,519.07

              

            	
              
                                     
      $           7,579.82

              

            
	
              
                Newborns
      aged 3-11 months

              

            	
              
                         
      $         3,236.37
      

              

            	
              
                                     
      $           1,800.71

              

            
	
              
                Age
      1 and Up - Base Rate for Risk Adjustment

              

            	
              
                         
      $            622.86

              

            	
              
                                     
      $              572.27

              

            
	 
      	 
      
	
              
                Medicare
      Parts A and B

              

            	 
      	 
      
	
              
                Under
      Age 65

              

            	
              
                         
      $            161.22

              

            	
              
                N/A

              

            
	
              
                Age
      65 and over

              

            	
              
                         
      $            115.22

              

            	
              
                N/A

              

            
	 
      	 
      
	
              
                Medicare
      Part B Only

              

            	 
      	 
      
	
              
                All
      ages

              

            	
              
                         
      $            332.95

              

            	
              
                N/A

              

            
	 
      	 
      
	
              
                HIV/AIDS
      Specialty Population

              

            	 
      	 
      
	
              
                No
      Medicare HIV

              

            	
              
                         
      $         1,184.04

              

            	
              
                N/A

              

            
	
              
                No
      Medicare AIDS

              

            	
              
                         
      $         2,330.94

              

            	
              
                N/A

              

            
	
              
                Medicare
      HIV

              

            	
              
                         
      $            160.51

              

            	
              
                N/A

              

            
	
              
                Medicare
      AIDS 

              

            	
              
                          
      $            342.66

              

            	
              
                N/A

              

            

    

     

    
      	
              
                 

                Kick
      Payments Amounts for Covered Obstetrical Delivery Services:

                 

              

            
	
              
                CPT

              

              
                Code

              

              
                 

              

            	
              
                Obstetrical
      Delivery CPT Code Description

              

            	
              
                Payment
      

                Amount

              

            
	
              59409

            	
              
                Vaginal
      delivery only

              

            	
              
                 

              

              
                 

              

              
                $3,977.49

              

            
	
              
                59410

              

            	
              
                Vaginal
      delivery including postpartum care

              

            
	
              
                59515

              

            	
              
                Cesarean
      delivery including postpartum care

              

            
	
              
                59612

              

            	
              
                Vaginal
      delivery only, after previous cesarean delivery

              

            
	
              
                59614

              

            	
              
                Vaginal
      delivery only, after previous cesarean delivery including postpartum
      care

              

            
	
              
                59622

              

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

              

            

    

    
       

      AHCA
Contract No. FAR001, Exhibit 3-D, Page 2 of 3

    

    

    
      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

    

    
      EXHIBIT
3-D

    

    
      MEDICAID
REFORM HMO CAPITATION RATES

    

    
      (By Area,
Age, and Eligibility Category)

    

    
      September
1, 2008 - August 31, 2009

    

    
       

    

    
      	
              Area: 10        
      

            	
              County:    Broward

            	
              September
      1, 2008

            
	
              Area: 4          
      

            	
              County:  
       Duval,
      Baker, Clay and Nassau

            	 
      

    

     

    
      	
              
                CPT
      Code

              

            	
              
                Transplant
      CPT Code Description

              

            	
              
                Children/Adolescents    or
      Adult

              

            	
              
                Payment
      Amount

              

            
	
              
                32851

              

            	
              
                lung
      single, without bypass

              

            	
              
                Children/Adolescents

              

            	
              
                $320,800.00

              

            
	
              
                32851

              

            	
              
                lung
      single, without bypass

              

            	
              
                Adult

              

            	
              
                $238,000.00

              

            
	
              
                32852

              

            	
              
                lung
      single, with bypass

              

            	
              
                Children/Adolescents

              

            	
              
                $320,800.00

              

            
	
              
                32852

              

            	
              
                lung
      single, with bypass

              

            	
              
                Adult

              

            	
              
                $238,000.00

              

            
	
              
                32853

              

            	
              
                lung
      double, without bypass

              

            	
              
                Children/Adolescents

              

            	
              
                $320,800.00

              

            
	
              
                32853

              

            	
              
                lung
      double, without bypass

              

            	
              
                Adult

              

            	
              
                $238,000.00

              

            
	
              
                32854

              

            	
              
                lung
      double, with bypass

              

            	
              
                Children/Adolescents

              

            	
              
                $320,800.00

              

            
	
              
                32854

              

            	
              
                lung
      double, with bypass

              

            	
              
                Adult

              

            	
              
                $238,000.00

              

            
	
              
                33945

              

            	
              
                heart
      transplant with or without recipient cardiectomy

              

            	
              
                All
      Age Groups

              

            	
              
                $162,000.00

              

            
	
              
                47135

              

            	
              
                liver,
      allotraiisplation, orthotopic, partial or whole from cadaver or living
      donor

              

            	
              
                All
      Age Groups

              

            	
              
                $122,600.00

              

            
	
              
                47136

              

            	
              
                liver,
      heterotopic, partial or whole from cadaver or living donor any
      age

              

            	
              
                All
      Age Groups

              

            	
              
                $122,600.00

              

            

    

    
      

    

    
      AHCA
Contract No. FAR001, Exhibit 3-D, Page 3 of 3

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00147-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00147-of-00352.parquet"}]]