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