HEALTHEASE OF FLORIDA, INC. Medicaid HMO Contract AHCA CONTRACT NO. FA521 AMENDMENT NO. 5

EX-10.3 4 w09522exv10w3.htm EXHIBIT 10.3 exv10w3


HEALTHEASE OF FLORIDA, INC.		Medicaid HMO Contract

AHCA CONTRACT NO. FA521
AMENDMENT NO. 5

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

1.	Standard Contract, Section II.A, Contract Amount, the first sentence is hereby amended to now read:

	To pay for contracted services according to the conditions of Attachment I in an amount not to exceed $815,961,749.00 (an increase of $4,189,037.00), subject to the availability of funds.

2.	Attachment 1, section 90.0, Payment and Authorized Enrollment Levels, Table 2 is hereby amended to read as follows:

Table 2.

Area wide Age-banded capitation Rates for All Plan Operational Counties where plan services do not include Community Mental Health and Mental Health Targeted Case Management.

Area 02 General Rates Plan — 015019315(GADSDEN) 015019318 (JEFFERSON) 015019320(LEON) 015019322(MADISON) 015019336(WAKULLA) 015019340(CALHOUN) 015019342(LIBERTY)


	<1 year		1-5		6-13		14-20 Male		14-20 Female		21-54 Male		21-54 Female		55-64
65+
TANF/FC/SOBRA		308.57		68.17		42.09		46.69		97.60		118.89		182.09		253.05
253.05
SSI/No Medicare		3048.45		366.34		187.89		197.31		197.31		564.87		564.87		545.39
545.39
SSI/Part B		323.29		323.29		323.29		323.29		323.29		323.29		323.29		323.29
323.29
SSI/Part A & B		312.99		312.99		312.99		312.99		312.99		312.99		312.99		312.99
218.99

Area 04 General Rates Plan — 015019313(DUVAL) 015019335(VOLUSIA)


	<1 year		1-5		6-13		14-20 Male		14-20 Female		21-54 Male		21-54 Female		55-64
65+
TANF/FC/SOBRA		316.95		71.10		44.92		49.61		101.93		126.35		191.96		269.58
269.58
SSI/No Medicare		3103.82		374.05		193.41		202.51		202.51		580.16		580.16		559.62
559.62
SSI/Part B		273.15		273.15		273.15		273.15		273.15		273.15		273.15		273.15
273.15
SSI/Part A & B		292.54		292.54		292.54		292.54		292.54		292.54		292.54		292.54
204.72

Area 07 General Rates Plan — 015019308 (BREVARD)


	<1 year		1-5		6-13		14-20 Male		14-20 Female		21-54 Male		21-54 Female		55-64
65+
TANF/FC/SOBRA		337. 19		75.53		47.77		52.81		108.40		134.29		204.16		286.57
286.57
SSI/No Medicare		3217.89		389.79		203.90		213.35		213.35		610.58		610.58		589.11
589.11
SSI/Part B		265.77		265.77		265.77		265.77		265.77		265.77		265.77		265.77
265. 77
SSI/Part A & B		283.96		283.96		283.96		283.96		283.96		283.96		283.96		283.96
198.62

Area 08 General Rates Plan — 015019332 (SARASOTA)


	<1 year		1-5		6-13		14-20 Male		14 -20 Female		21-51 Male		21-54 Female		55-64
65+
TANF/FC/SOBRA		296.66		66.37		41.76		46.19		95.19		117.62		179.02		250.96
250.96
SSI /No Medicare		3079.30		371.80		192.49		201.68		201.68		577.11		577.11		557.45
557. 4 5
SSI/Part B		243. 56		243.56		243.56		243.56		243.56		243.56		243.56		243.56
243.56
SSI/Part A & B		285.08		285.08		285.08		285.08		285.08		285.08		285.08		285.08
199. 41

Area 09 General Rates Plan — 015019324 (MARTIN) ###-###-#### (PALM BEACH)


	<1 year		1-5		6-13		14-20 Male		14-20 Female		21-54 Male		21-54 Female		55-64
65+
TANF/FC/SOBRA		316.78		70.74		44.52		49.17		101.48		125.24		190.60		266.97
266.97

AHCA Contract No. FA521, Amendment No. 5, Page 1 of 3


HEALTHEASE OF FLORIDA, INC.		Medicaid HMO Contract


SSI/No Medicare	3344.05	405.22	211.12	221.15	221.15	633.22	633.22	610.93
610.93
SSI/Part B	267.20	267.20	267.20	267.20	267.20	267.20	267.20	267.20
267.20
SSI/Part A & B	320.32	320.32	320.32	320.32	320.32	320.32	320.32	320.32
224.19

Area 10 General Rates Plan — 015019337 (BROWARD)


	<1 year		1-5		6-13		14-20 Male		14-20 Female		21-54 Male		21-54 Female		55-64
65+
TANF/FC/SOBRA		328.74		73.77		46.68		51.61		105.94		131.31		199.49		280.33
280.33
SSI /No Medicare		4151.82		503.54		263.75		275.32		275.32		788.23		788.23		761.08
761.08
SSI/Part B		287. 04		287.04		287.04		287.04		287.04		287.04		287.04		287.04
287.04
SSI/Part A & B		351.55		351.55		351.55		351.55		351.55		351.55		351.55		351.55
245.95

Area 11 General Rates plus Transportation plan — 015019338(DADE)


	<1 year		1-5		6-13		14-20 Male		14-20 Female		21-54 Male		21-54 Female		55-64
65+
TANF/FC/SOBRA		409.89		91.51		57.28		63.45		131.27		161.21		245.94		343.29
343.29
SSI /No Medicare		4561.77		556.46		288.69		302.80		302.80		869.67		869.67		836.38
836.38
SSI/Part B		453.72		453.72		453.72		453.72		453.72		453.72		453.72		453.72
453.72
SSI/Part A & B		429.61		429.61		429.61		429.61		429.61		429.61		429.61		429.61
297.22

3.	Attachment I, section 90.0, Payment and Authorized Enrollment Levels, Table 3 is hereby amended to read as follows:

Table 3.

Area wide Age-banded Capitation Rates for All Plan Operational Counties where plan services include Community Mental Health and Mental Health Targeted Case Management.

Area 01 General Rates plus Mental Health Plan – 015019314(ESCAMBIA) 015019331(SANTA ROSA)


	<1 year		1-5		6-13		14-20 Male		14-20 Female		21-54 Male		21-54 Female		55-64
65+
TANF/FC/SOBRA		308.58		69.00		49.05		52.61		103.52		121.46		184.66		257.30
257.30
SSI/No Medicare		3048.46		371.81		243.40		238.17		238.17		607.82		607.82		569.75
569.75
SSI/Part B		330.18		330.18		330.18		330.18		330.18		330.18		330.18		330.18
330.18
SSI/Part A & B		328.66		328.66		328.66		328.66		328.66		328.66		328.66		328.66
234.66

Area 03 General Rates plus Mental Health Plan — 015019309(CITRUS) 015019319 (LAKE) ###-###-####(MARION) 015019329 (PUTNAM)


	<1 year		1-5		6-13		14-20 Male		14-20 Female		21-54 Male		21-54 Female		55-64
65+
TANF/FC/SOBRA		350.93		79.08		55.35		58.65		116.64		139.68		212.08		294.58
294.58
SSI/No Medicare		3231.66		408.26		247.79		236.33		236.33		626.37		626.37		591.60
591.60
SSI/Part B		302.32		302.32		302.32		302.32		302.32		302.32		302.32		302.32
302.32
SSI /Part A & B		295.89		295.89		295.89		295.89		295.89		295.89		295.89		295.89
209.16

Area 05 General Rates plus Mental Health Plan — 015019302(PASCO) 015019303(PINELLAS)


	<1 year		1-5		6-13		14-20 Male		14-20 Female		21-54 Male		21-54 Female		55-64
65+
TANF/FC/SOBRA		345.77		79.28		51.94		57.32		114.37		139.01		210.44		291.84
291.84
SSI /No Medicare		3265.63		429.24		240.86		235.59		235.59		628.37		628.37		594.95
594.95
SSI/Part B		266.87		266.87		266.87		266.87		266.87		266.87		266.87		266.87
266.87
SSI/Part A & B		318.72		318.72		318.72		318.72		318.72		318.72		318.72		318.72
225.77

Area 06 General Rates plus Mental Health Plan- 015019300(HILLSBOROUGH) 015019301 (MANATEE) ###-###-#### (POLK) ###-###-####(HIGHLANDS)


	<1 year		1-5		6-13		14-20 Male		14-20 Female		21-54 Male		21-54 Female		55-64
65+
TANF/FC/SOBRA		330.07		75.91		61.92		67.67		122.23		135.83		204.29		282.98
282.98

AHCA Contract No. FA521, Amendment No. 5, Page 2 of 3


HEALTHEASE OF FLORIDA, INC.		Medicaid HMO Contract


SSI/No Medicare	3017.05	371.69	265.72	243.82	243.82	647.81	647.81	587.26
587.26
SSI/Part B	242.29	242.29	242.29	242.29	242.29	242.29	242.29	242.29
242.29
SSI/Part A & B	288.09	288.09	288.09	288.09	288.09	288.09	288.09	288.09
202.64

Area 07 General Rates plus Mental Health Plan — 015019327 (ORANGE) ###-###-#### (OSCEOLA) ###-###-#### (SEMINOLE)


	<1 year		1-5		6-13		14-20 Male		14-20 Female		21-54 Male		21-54 Female		55-64
65+
TANF/FC/SOBRA		337.20		76.92		58.07		59.10		114.69		136.45		206.32		287.87
287.87
SSI /No Medicare		3217.90		406.84		260.45		239.73		239.73		628.24		628.24		594.96
594.96
SSI/Part B		266.03		266.03		266.03		266.03		266.03		266.03		266.03		266.03
266.03
SSI/Part A & B		293.59		293.59		293.59		293.59		293.59		293.59		293.59		293.59
208.25

4.	Attachment I, Section 90.0, Payment and Authorized Enrollment Levels, Table 3, the second paragraph is hereby amended to now read:

	Notwithstanding the payment amounts which may be computed with the above rate table, the sum of total capitation payments under this contract shall not exceed the total contract amount of $815,961,749.00, (an increase of $4,189,037.00), expressed on page seven of this contract.

5.	This amendment shall begin on May 1, 2005, or the date on which the amendment has been signed by both parties, 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.

IN WITNESS WHEREOF, the parties hereto have caused this 3 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/ Imtiaz H. Sattaur	BY:	/s/ Alan Levine


NAME: Imtiaz H. Sattaur		NAME: Alan Levine

TITLE: President		TITLE: Secretary

DATE: April 28, 2005		DATE: 4.28.2005

THE REMAINDER OF THIS PAGE LEFT BLANK INTENTIONALLY

AHCA Contract No. FA521, Amendment No. 5, Page 3 of 3