AHCA CONTRACT NO. FA614 AMENDMENT NO. 7
Amerigroup Florida, Inc. Medicaid HMO Contract d/b/a Amerigroup Community Care
AHCA CONTRACT NO. FA614
AMENDMENT NO. 7
THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the “Agency” and AMERIGROUP FLORIDA, INC. D/B/A AMERIGROUP COMMUNITY CARE, hereinafter referred to as the “Vendor” or “Health Plan”, is hereby amended as follows:
| 1. | Standard Contract, Section II, Item A, Contract Amount, the first sentence is hereby revised to now read as follows: |
To pay for contracted services according to the conditions of Attachment I in an amount not to exceed $1,016,426,981.00 (a decrease of $66,372,500.00), subject to availability of funds.
| 2. | Attachment I, Section B, Method of Payment, Item 1, General, the first paragraph is hereby revised now to read as follows: |
Notwithstanding the payment amounts which may be computed with the rate tables specified in Exhibit III-C, the sum total capitation payments under this Contract shall not exceed the total Contract amount of $1,016,426,981.00 (a decrease of $66,372,500.00).
| 3. | Attachment 1, Scope of Services, is hereby amended to include Exhibit III-C, January 1, 2008 – August 31, 2008 Medicaid Non-Reform HMO Capitation Rates, attached hereto and made a part of the Contract. All references in the Contract to Exhibit III-B, September 1, 2007 – August 31, 2008 Medicaid Non-Reform HMO Capitation Rates, shall hereinafter instead refer to Exhibit III-C, January 1, 2008 – August 31, 2008 Medicaid Non-Reform HMO Capitation Rates. |
| 4. | This Amendment shall have an effective date of January 1, 2008, or the date, in which both parties execute the Amendment, whichever is later. |
All provisions in the Contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to conform with this Amendment.
All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in the Contract.
This Amendment and all its attachments are hereby made a part of the Contract.
This Amendment cannot be executed unless all previous amendments to this Contract have been fully executed.
THE REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
AHCA Contract No. FA614, Amendment No. 7, Page 1 of 2
Amerigroup Florida, Inc. Medicaid HMO Contract
d/b/a Amerigroup Community Care
IN WITNESS WHEREOF, the parties hereto have caused this seven (7) page Amendment (which includes all attachments hereto) to be executed by their officials thereunto duly authorized.
| AMERIGROUP FLORIDA, INC.STATE OF FLORIDA, AGENCY FOR | ||||
| D/B/A/ AMERIGROUP COMMUNITY CAREHEALTH CARE ADMINISTRATION | ||||
SIGNED BY: | SIGNED BY: | |||
| NAME:Thomas Wilfong ....................... | NAME:Andrew C. Agwunobi, M.D | |||
| | ||||
TITLE: COO | TITLE:Secretary | |||
| DATE: 12/28/07 ........................... | DATE: | |||
| List of attachments included as part of this Amendment: | ||||
Specify Type | Letter/Number ............. | Description | ||
Exhibit | III-C | January 1, 2008- August 31, 2008 Medicaid Non-Reform HMO | ||
Capitation Rates (5 Pages)
AHCA Contract No. FA614, Amendment No. 7, Page 2 of 3
AHCA Contract No. FA614, Exhibit III-C, Page 1 of 5
EXHIBIT III-C
January 1, 2008- August 31, 2008
Medicaid Non-Reform HMO Capitation Rates
By Area , Age and Eligibility Category
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
| TABLE 1 | ||||||||
General Rates: | ||||||||
| TANF | SSI-N | SSI-B | SSI-AB |
Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21.54) AGE (55+) BTHMO+2M0 3M0-11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)
| Female | Male | Female | Male | |||||||||||||||||||||||||||||
011,113.27198.95 021,113.27198.95 31,274.97229.73 041,110.20200.37 051,239.65223.90 061,093.25198.54 071,111.11201.05 081,042.42189.18 091,080.64194.68 101,100.94199.64 111,424.99256.12 | 103.84 103.84 120.11 105.01 117.11 104.28 105.33 99.15 101.92 104.76 134.00 | 65.12 65.12 76.19 66.79 74.70 66.96 67.26 63.67 64.82 67.19 84.75 | 132.96 132.96 153.87 134.42 150.07 133.36 134.84 127.01 130.37 133.94 171.50 | 71.10 71.10 83.11 72.81 81.25 72.80 73.19 69.25 70.43 73.01 92.47 | 261.06 261.06 303.58 265.41 296.43 264.61 266.60 251.65 257.53 265.61 338.04 | 165.11 165.11 192.99 168.95 188.63 168.97 169.92 160.56 163.82 169.34 214.66 | 341.74 341.74 401.92 352.65 393.68 354.37 355.07 336.69 341.26 354.88 446.26 | 9,915.13 9,915.13 11,138.97 10,499.42 11,579.76 10,652.91 10,979.12 9,334.29 10,421.98 13,515.72 14,158.43 | 1,434.75 1,434.75 1,629.39 1,537.71 1,692.54 1,564.02 1,613.56 1,365.81 1,530.82 1,994.98 2,076.63 | 428.74 428.74 486.94 460.11 506.42 468.08 482.68 408.73 457.89 596.62 621.17 | 197.94 197.94 229.48 217.21 237.96 222.16 229.82 192.99 217.75 285.93 294.21 | 218.40 218.40 252.31 238.35 262.13 243.74 251.86 211.83 238.53 313.86 323.57 | 704.25 704.25 812.92 768.93 843.24 785.88 810.88 682.67 769.06 1,009.75 1,040.93 | 692.24 692.24 803.12 759.32 832.21 776.94 802.37 674.08 760.32 999.91 1,029.21 | 266.36 266.36 268.11 324.10 224.84 278.82 320.94 187.79 201.31 251.29 329.75 | 96.6779.38 96.6779.38 89.8974.16 92.6376.37 86.9172.45 84.0369.54 87.4479.54 83.0268.67 90.2874.77 103.3285.56 157.24128.37 | ||||||||||||||||
TABLE 2 General + Mental Health Rates: | ||||||||||||||||||||||||||||||||
| TANF | SSI-N | SSI-B | SSI-AB |
Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21.54) AGE (55+) BTHMO+2M0 3M0-11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)
| Female | Male | Female | Male | |||||||||||||||||||||||||||||||||||
01 02 03 04 05 06 07 08 09 10 11 | 1,113.29 1,113.30 1,274.98 1,110.21 1,239.66 1,093.27 1,111.13 1,042.43 1,080.66 1,100.96 1,425.01 | 198.97 198.98 229.74 200.38 223.91 198.56 201.07 189.19 194.70 199.66 256.14 | 105.45 106.70 121.41 106.36 118.30 106.10 107.08 100.39 103.44 106.65 135.59 | 76.61 85.04 85.22 76.19 83.23 79.99 79.74 72.32 75.45 80.33 95.85 | 143.70 146.15 159.85 140.65 158.04 145.53 146.50 132.74 137.41 142.64 178.86 | 81.84 84.29 89.09 79.04 89.22 84.97 84.85 74.98 77.47 81.71 99.83 | 265.43 264.41 305.10 266.99 299.67 269.56 271.34 253.11 259.32 267.82 339.91 | 169.48 168.46 194.51 170.53 191.87 173.92 174.56 162.02 165.61 171.55 216.53 | 345.42 344.65 403.24 354.02 396.42 358.55 359.07 337.96 342.81 356.80 447.88 | 9,915.21 9,915.29 11,139.04 10,499.53 11,579.81 10,652.98 10,979.18 9,334.36 10,422.05 13,515.81 14,158.51 | 1,434.83 1,434.91 1,629.46 1,537.82 1,692.59 1,564.09 1,613.62 1,365.88 1,995.07 1,995.07 2,076.71 | 436.06 442.30 493.10 469.70 511.36 474.49 488.70 414.63 604.83 604.83 628.03 | 245.19 275.44 264.64 272.02 269.84 263.57 268.67 226.70 338.45 322.84 333.34 | 261.65 262.86 272.48 269.84 291.31 281.64 287.42 231.18 258.93 340.78 346.02 | 784.29 756.05 836.42 805.57 897.24 856.02 876.69 705.20 792.81 1,041.14 1,067.09 | 722.71 716.70 814.21 776.62 852.76 803.63 827.42 684.72 771.54 1,014.71 1,041.56 | 266.57 286.23 274.85 348.24 227.52 280.11 323.49 194.53 208.05 258.03 336.86 | 108.13 111.42 98.72 109.12 99.51 87.85 97.78 96.02 99.71 111.24 165.16 | 90.84 94.13 82.99 92.86 85.05 73.36 82.88 81.67 84.20 93.47 136.29 |
AHCA Contract No. FA614, Exhibit III-C, Page 2 of 5
EXHIBIT III-C
January 1, 2008- August 31, 2008
Medicaid Non-Reform HMO Capitation Rates
By Area , Age and Eligibility Category
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
| TABLE 3 | ||||||
General + MH + Dental Rates: | ||||||
TANF | SSI-N | SSI-B | SSI-AB |
Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21.54) AGE (55+) BTHMO+2M0 3M0-11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)
| Female | Male | Female | Male | |||||||||||||||||||||||||||
011,113.30198.98107.51 021,113.31198.99108.76 031,274.99229.75124.44 041,110.22200.39108.37 051,239.67223.93121.70 061,093.28198.57108.70 071,111.14201.08109.20 081,042.44189.20103.37 091,080.67194.71106.32 101,100.97199.67109.45 111,425.02256.15139.41 | 80.86 89.29 91.46 80.34 90.26 85.35 84.12 78.47 81.39 86.12 103.51 | 148.10 150.55 166.32 144.96 165.34 151.09 151.04 139.11 143.57 148.64 186.81 | 85.55 88.00 94.55 82.68 95.37 89.66 88.68 80.35 82.66 86.77 106.53 | 267.24 266.22 308.06 269.75 306.75 273.12 273.83 256.08 261.04 269.62 341.50 | 171.09 170.07 197.14 172.98 198.16 177.08 176.87 164.65 167.14 173.15 217.94 | 348.77 348.00 408.70 359.12 409.49 365.12 363.67 343.42 345.98 360.11 450.82 | 9,915.21 9,915.29 11,139.05 10,499.53 11,579.82 10,652.98 10,979.18 9,334.36 10,422.05 13,515.82 14,158.52 | 1,434.84 1,434.92 1,629.48 1,537.83 1,692.61 1,564.10 1,613.63 1,365.89 1,530.90 1,995.09 2,076.73 | 438.23 444.47 496.42 471.87 516.20 477.61 491.76 417.70 466.81 608.51 632.27 | 248.95264.93 279.20266.14 270.39277.50 275.78273.08 278.22298.64 268.98286.37 273.97292.05 232.02235.83 257.94263.00 339.22346.35 340.68352.44 | 787.11 758.87 839.92 808.82 904.66 860.37 879.75 708.74 794.47 1,043.21 1,070.67 | 726.07 720.06 818.38 780.50 861.50 808.82 831.07 688.94 773.52 1,017.18 1,045.82 | 267.06 286.72 275.38 350.21 231.88 281.92 325.09 195.98 208.76 260.05 341.18 | 110.40 113.69 101.75 112.15 107.72 92.55 100.89 99.12 101.52 113.76 169.15 | 92.29 95.58 84.93 94.80 90.31 76.38 84.88 83.66 85.36 95.09 138.85 | |||||||||||||||
TABLE 4 General + MH + Transportation Rates: | ||||||||||||||||||||||||||||||
| TANF | SSI-N | SSI-B | SSI-AB |
Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) BTHMO+2M0 3M0-11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)
| Female | Male | Female | Male | |||||||||||||||||||||||||||||||||||
01 02 03 04 05 06 07 08 09 10 11 | 1,118.75 1,118.76 1,281.58 1,115.15 1,243.79 1,097.25 1.115.00 1,047.92 1,185.95 1,104.68 1,428.21 | 200.33 200.34 231.39 201.61 224.94 199.55 202.04 190.56 196.02 200.59 256.94 | 106.30 107.55 122.43 107.13 118.94 106.72 107.68 101.24 104.26 107.22 136.08 | 77.12 85.55 85.84 76.65 83.62 80.36 80.11 72.83 75.95 80.68 96.15 | 145.59 148.04 162.13 142.36 159.46 146.91 147.83 134.64 139.24 143.93 179.96 | 83.08 85.53 90.58 80.16 90.15 85.87 85.72 76.22 78.67 82.55 100.55 | 268.47 267.45 308.77 269.73 301.97 271.77 273.49 256.16 262.26 269.89 341.69 | 171.82 170.80 197.34 172.65 193.65 175.63 176.32 164.37 167.88 173.15 217.91 | 348.55 347.78 407.02 356.86 398.78 360.83 361.29 341.09 345.85 358.93 449.71 | 9,957.91 9,957.99 11,192.94 10,543.16 11,614.53 10,687.23 11,015.88 9,375.02 10,464.52 13,554.29 14,187.41 | 1,462.40 1,462.48 1,664.26 1,565.99 1,714.99 1,586.20 1,637.42 1,392.12 1,558.31 2,019.92 2,095.37 | 441.61 447.85 500.10 475.37 515.87 478.95 493.47 419.92 469.65 609.83 631.78 | 247.63 277.88 267.71 274.51 271.82 265.53 270.76 229.03 255.72 335.04 334.99 | 267.67 268.88 280.08 275.95 296.21 286.48 292.60 236.92 264.93 346.22 350.10 | 803.95 775.71 861.25 825.67 913.23 871.79 893.60 723.92 812.36 1,058.87 1,080.40 | 738.94 732.93 834.72 793.21 865.96 816.65 841.37 700.18 787.69 1,029.34 1,052.54 | 273.23 292.89 283.33 355.09 233.30 285.34 329.04 200.51 214.85 265.22 341.70 | 121.63 124.92 118.23 124.64 113.31 99.27 109.71 110.58 115.26 128.61 177.46 | 99.45 102.74 95.44 102.76 93.85 80.64 90.50 90.96 94.12 104.55 144.14 |
AHCA Contract No. FA614, Exhibit III-C, Page 3 of 5
EXHIBIT III-C
January 1, 2008- August 31, 2008
Medicaid Non-Reform HMO Capitation Rates
By Area , Age and Eligibility Category
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
| TABLE 5 | ||||||
General + Transportation Rates: | ||||||
TANF | SSI-N | SSI-B | SSI-AB |
Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21.54) AGE (55+) BTHMO+2M0 3M0-11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)
| Female | Male | Female | Male | |||||||||||||||||||||||||||||||
011,118.73200.31 021,118.73200.31 031,281.57231.38 041,115.14201.60 051,243.78224.93 061,097.23199.53 071,114.98202.02 081,047.91190.55 091,085.93196.00 101,104.66200.57 111,428.19256.92 | 104.69 104.69 121.13 105.78 117.75 104.90 105.93 100.00 102.74 105.33 134.49 | 65.63 65.63 76.81 67.25 75.09 67.33 67.63 64.18 65.32 67.54 85.05 | 134.85 134.85 156.15 136.13 151.49 134.74 136.17 128.91 132.20 135.23 172.60 | 72.34 72.34 84.60 73.93 82.18 73.70 74.06 70.49 71.63 73.85 93.19 | 264.10 264.10 307.25 268.15 298.73 266.82 268.75 254.70 260.47 267.68 339.82 | 167.45 167.45 195.82 171.07 190.41 170.68 171.58 162.91 166.09 170.94 216.04 | 344.87 344.87 405.70 355.49 396.04 356.65 357.29 339.83 344.30 357.01 448.09 | 9,957.83 9,957.83 11,192.87 10,543.05 11,614.48 10,687.16 11,015.82 9,374.95 10,464.45 13,554.20 14,187.33 | 1,462.32 1,462.32 1,664.19 1,565.88 1,714.94 1,586.13 1,637.26 1,392.05 1,558.24 2,019.83 2,095.29 | 434.29 434.29 493.94 465.78 510.93 472.54 487.45 414.02 463.42 601.62 624.92 | 200.38 200.38 232.55 219.70 239.94 224.12 231.91 195.32 220.18 288.13 295.86 | 224.42 224.42 259.91 244.51 267.03 248.58 257.04 217.57 244.53 319.30 327.65 | 723.91 723.91 837.75 789.03 859.23 801.65 827.79 701.39 788.61 1,027.52 1,054.24 | 708.47 708.47 823.63 775.91 845.41 789.96 816.22 689.54 776.47 1,014.54 1,040.19 | 273.02 273.02 276.59 330.95 230.62 284.05 326.49 193.77 208.11 258.48 334.59 | 110.17 110.17 109.40 108.15 100.71 95.45 99.37 97.58 105.83 120.69 169.54 | 87.99 87.99 86.61 86.27 81.25 76.82 80.16 77.96 84.69 96.63 136.22 | |||||||||||||||||
TABLE 6 General + Dental Rates: | ||||||||||||||||||||||||||||||||||
TANF | SSI-N | SSI-B | SSI-AB |
Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) BTHMO+2M0 3M0-11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)
| Female | Male | Female | Male | |||||||||||||||||||||||||||||||||||
01 02 03 04 05 06 07 08 09 10 11 | 1,113.28 1,113.28 1,274.98 1,110.21 1,239.66 1,093.26 1,111.12 1,042.43 1,080.65 1,100.95 1,425.00 | 198.96 198.96 229.74 200.38 223.92 198.55 201.06 189.19 194.69 199.65 256.13 | 105.90 105.90 123.14 107.02 120.51 106.88 107.45 102.13 104.80 107.56 137.72 | 69.37 69.37 82.43 70.94 81.73 72.32 71.64 69.82 70.76 72.98 92.41 | 137.36 137.36 160.34 138.73 157.37 138.92 139.38 133.38 136.53 139.94 179.45 | 74.81 74.81 88.57 76.45 87.40 77.49 77.02 74.62 75.62 78.07 99.17 | 262.87 262.87 306.54 268.17 303.51 268.17 269.09 254.62 259.25 267.41 339.63 | 166.72 166.72 195.62 171.40 194.92 172.13 172.13 163.19 165.35 170.94 216.07 | 345.09 345.09 407.38 357.75 406.75 360.94 359.67 342.16 344.43 358.19 449.20 | 9,915.13 9,915.13 11,138.98 10,499.42 11,579.77 10,652.91 10,979.12 9,334.29 10,421.98 13,515.73 14,158.44 | 1,434.76 1,434.76 1,629.41 1,537.72 1,692.56 1,564.03 1,613.57 1,365.82 1,530.83 1,995.00 2,076.65 | 430.91 430.91 490.26 462.28 511.26 471.20 485.74 411.80 460.58 600.30 625.41 | 201.70 201.70 235.23 220.97 246.34 227.57 235.12 198.31 222.40 292.31 301.55 | 221.68 221.68 257.33 241.64 269.46 248.47 256.49 216.48 242.60 319.43 329.99 | 707.07 707.07 816.42 772.18 850.66 790.23 813.94 686.21 770.72 1,011.86 1,044.51 | 695.60 695.60 807.29 763.20 841.05 782.13 806.02 678.30 762.30 1,002.38 1,033.47 | 266.85 266.85 268.64 326.07 229.20 280.63 322.54 189.24 202.02 253.31 334.07 | 98.94 98.94 92.92 95.66 95.12 88.73 90.55 86.12 92.09 105.84 161.23 | 80.83 80.83 76.10 78.31 77.71 72.56 74.54 70.66 75.93 87.17 130.93 |
AHCA Contract No. FA614, Exhibit III-C, Page 4 of 5
EXHIBIT III-C
January 1, 2008 — August 31, 2008
Medicaid Non-Reform HMO Capitation Rates
By Area , Age and Eligibility Category
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
| TABLE 7 | ||||||
General + Dental + Transportation Rates: | ||||||
TANF | SSI-N | SSI-B | SSI-AB |
Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21.54) AGE (55+) BTHMO+2M0 3M0-11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)
| Female | Male | Female | Male | |||||||||||||||||||||||||||
011,118.74200.32106.7569.88 021,118.74200.32106.7569.88 031,281.58231.39124.1683.05 041,115.15201.61107.7971.40 051,243.79224.95121.1582.12 061,097.24199.54107.5072.69 071,114.99202.03108.0572.01 081,047.92190.56102.9870.33 091,085.94196.01105.6271.26 101,104.67200.58108.1373.33 111,428.20256.93138.2192.71 | 139.25 139.25 162.62 140.44 158.70 140.30 140.71 135.28 138.36 141.23 180.55 | 76.05 76.05 90.06 77.57 88.33 78.39 77.89 75.86 76.82 78.91 99.89 | 265.91 265.91 310.21 270.91 305.81 270.38 271.24 257.67 262.19 269.48 341.41 | 169.06 169.06 198.45 173.52 196.70 173.84 173.79 165.54 167.62 172.54 217.45 | 348.22 348.22 411.16 360.59 409.11 363.22 361.89 345.30 347.47 360.32 451.03 | 9,957.83 9,957.83 11,192.88 10,543.05 11,614.49 10,687.16 11,015.82 9,374.95 10,464.45 13,554.21 14,187.34 | 1,462.33 1,462.33 1,664.21 1,565.89 1,714.96 1,586.14 1,637.27 1,392.06 1,558.25 2,019.85 2,095.31 | 436.46 436.46 497.26 467.95 515.77 475.66 490.51 417.09 466.11 605.30 629.16 | 204.14 204.14 238.30 223.46 248.32 229.53 237.21 200.64 224.83 294.51 303.20 | 227.70 227.70 264.93 247.80 274.36 253.31 261.67 222.22 248.60 324.87 334.07 | 726.73 726.73 841.25 792.28 866.65 806.00 830.85 704.93 790.27 1,029.59 1,057.82 | 711.83 711.83 827.80 779.79 854.25 795.15 819.97 693.76 778.45 1,017.01 1,044.45 | 273.51 273.51 277.12 332.92 234.98 285.86 328.09 195.22 208.82 260.50 338.91 | 112.44 112.44 112.43 111.18 108.92 100.15 102.48 100.68 107.64 123.21 173.53 | 89.44 89.44 88.55 88.21 86.51 79.84 82.16 79.95 85.85 98.25 138.78 | |||||||||||||||
TABLE 8 General + Mental Health + Dental + Transportation Rates: | ||||||||||||||||||||||||||||||
TANF | SSI-N | SSI-B | SSI-AB |
Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) BTHMO+2M0 3M0-11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)
| Female | Male | Female | Male | |||||||||||||||||||||||||||||||||||
01 02 03 04 05 06 07 08 09 10 11 | 1,118.76 1,118.77 1,281.59 1,115.16 1,243.80 1,097.26 1,115.01 1,047.93 1,085.96 1,104.69 1,428.22 | 200.34 200.35 231.40 201.62 224.96 199.56 202.05 190.57 196.03 200.60 256.95 | 108.36 109.61 125.46 109.14 122.34 109.32 109.80 104.22 107.14 110.02 139.80 | 81.37 89.80 92.08 80.80 90.65 85.72 84.49 78.98 81.89 86.47 103.81 | 149.99 152.44 168.60 146.67 166.76 152.47 152.37 141.01 145.40 149.93 187.91 | 86.79 89.24 96.04 83.80 96.30 90.56 89.55 81.59 83.86 87.61 107.25 | 270.28 269.26 311.73 272.49 309.05 275.33 275.98 259.13 263.98 271.69 343.28 | 173.43 172.41 199.97 175.10 199.94 178.79 178.53 167.00 169.41 174.75 219.32 | 351.90 351.13 412.48 361.96 411.85 367.40 365.89 346.56 349.02 362.24 452.65 | 9,957.91 9,957.99 11,192.95 10,543.16 11,614.54 10,687.23 11,015.88 9,375.02 10,464.52 13,554.30 14,187.42 | 1,462.41 1,462.49 1,664.28 1,566.00 1,715.01 1,586.21 1,637.33 1,392.13 1,558.32 2,019.94 2,095.39 | 443.78 450.02 503.42 477.54 520.71 482.07 496.53 422.99 472.34 613.51 636.02 | 251.39 281.64 273.46 278.27 280.20 270.94 276.06 234.35 260.37 341.42 342.33 | 270.95 272.16 285.10 279.24 303.54 291.21 297.33 241.57 269.00 351.79 356.52 | 806.77 778.53 864.75 828.92 920.65 876.14 896.66 727.46 814.02 1,060.94 1,083.98 | 742.30 736.29 838.89 797.09 874.80 821.84 845.02 704.40 789.67 1,031.81 1,056.80 | 273.72 293.38 283.86 357.06 237.66 287.15 330.64 201.96 215.56 267.24 346.02 | 123.90 127.19 121.26 127.67 121.52 103.97 112.82 113.68 117.07 131.13 181.45 | 100.90 104.19 97.38 104.70 99.11 83.66 92.50 92.95 95.28 106.17 146.70 |
EXHIBIT III-C
January 1, 2008- August 31, 2008
Medicaid Non-Reform HMO Capitation Rates
By Area , Age and Eligibility Category
Area Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 10 Area 11 | ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Corresponding Counties Escambia, Okaloosa, Santa Rosa, Walton Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Washington, Wakulla Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamiliton, Hemando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, Union Baker, Clay, Duval, Flagler, Nassau, St. Johns, Volusia Pasco, Pinellas Hardee, Highlands, Hillsborough, Manatee, Polk Brevard, Orange, Osceola, Seminole Charlotte, Collier, De Soto, Glades, Hendry, Lee, Sarasota Indian River, Okeechobee, St. Lucie, Martin, Palm Beach Broward Dade, Monroe |
Created on August 19, 2006 modified on September 11, 2006 – increased dental ratesAHCA Contract No. FA614, Exhibit III-C, Page 5 of 5
