WELL CARE HMO, INC., D/B/A STAYWELL Medicaid HMO ContractHEALTH PLAN OF FLORIDA AHCA CONTRACT NO. FA522 AMENDMENT NO. 5

EX-10.4 5 w09522exv10w4.htm EXHIBIT 10.4 exv10w4
 

WELL CARE HMO, INC., D/B/A STAYWELL   Medicaid HMO Contract
HEALTH PLAN OF FLORIDA    

AHCA CONTRACT NO. FA522
AMENDMENT NO. 5

     THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the “Agency” and WELL CARE HMO, INC., d/b/a STAYWELL HEALTH PLAN OF FLORIDA, 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 $652,967,833.00 (an increase of $7,130,175.00), subject to the availability of funds.
 
2.   Attachment I, section 90.0, Payment and Authorized Enrollment Levels, Table 2 is hereby amended to now 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 03 General Rates Plan — 015016901 (HERNANDO)

                                                                         
    <1 year     1-5     6-13     14-20 Male     14-20 Female     21-54 Male     21-54 Female     55-64     65+  
TANF/FC/SOBRA
     350.92       78.21       49.06       54.22       112.21       138.15       210.55       294.57       294.57  
SSI/No Medicare
     3231.65       390.26       202.93       212.35       212.35       607.41       607.41       586.66       586.66  
SSI /Part B
     302.31       302.31       302.31       302.31       302.31       302.31       302.31       302.31       302.31  
SSI/Part A & B
     288.40       288.40       288.40       288.40       288.40       288.40       288.40       288.40       201.67  

Area 05 General Rates Plan — 015016903 (PASCO) 015016904 (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
     345.76       77.31       48.55       53.69       110.74       136.76       208.19       291-55       291.55  
SSI/No Medicare
     3265.62       394.06       204.41       214.18       214.18       612.49       612.49       591.04       591.04  
SSI/Part B
     266.55       266.55       266.55       266.55       266.55       266.55       266.55       266.55       266.55  
SSI/Part A & B
     309.27       309.27       309.27       309.27       309.27       309.27       309.27       309.27       216.32  

Area 07 General Rates Plan — 015016913 (BREVARD)

                                                                         
    <1 year     1-5     6-13     14-20 Hale     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 — 015016911(LEE) 015016914 (SARASOTA)

                                                                         
    <1 year     1-5     6-13     14-20 Male     14-20 Female     21-54 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       577.71       577.71       557.45       557.45  
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       199.47  

Area 09 General Rates Plan — 015016910 (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  
SSI/No Medicare
     3344.05       405.22       211.12       231.15       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 — 015016900 (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  

AHCA Contract No. FA522, Amendment No. 5, Page 1 of 3

 

 

WELL CARE HMO, INC., D/B/A STAYWELL
HEALTH PLAN OF FLORIDA 		  Medicaid HMO Contract

Area 11 General Rates plus Transportation Plan — 015016909(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       336.38  
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 now 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 06 General Rates plus Mental Health Plan- 015016902(HILLSBOROUGH) 015016905(POLK) 015016912(MANATEE)

                                                                         
    <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  
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- 015016906(ORANGE) 01501690(OSCEOLA) 015016908 (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 $652,967,833.00 (an increase of $7,130,175.00), expressed on page seven of this contract.
 
5.   This amendment shall begin on April 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.

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AHCA Contract No. FA522, Amendment No. 5, Page 2 of 3

 

 

WELL CARE HMO, INC., D/B/A STAYWELL
HEALTH PLAN OF FLORIDA 		  Medicaid HMO Contract

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

                             
WELLCARE HMO, INC., D/B/A STAYWELL       STATE OF FLORIDA, AGENCY FOR
HEALTH PLAN OF FLORIDA       HEALTH CARE ADMINISTRATION
 
                            
SIGNED       SIGNED
BY:
  /s/ Imtiaz (MT) Sattaur       BY:   [ILLEGIBLE]            
                           
  Imtiaz (MT) Sattaur                        
  President, Florida                        
 
NAME:
  Todd S. Farha       NAME:   Alan Levine            
 
TITLE:
  President & CEO       TITLE:   Secretary            
 
DATE:
  4/1/05       DATE:   4/1/05            

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AHCA Contract No. FA522, Amendment No. 5, Page 3 of 3