WELL CARE HMO, INC., D/B/A STAYWELL HEALTH PLAN OF FLORIDA Medicaid HMO Contract AHCA CONTRACT NO. FA522 AMENDMENT NO. 6
WELL CARE HMO, INC., D/B/A STAYWELL HEALTH PLAN OF FLORIDA | Medicaid HMO Contract |
AHCA CONTRACT NO. FA522
AMENDMENT NO. 6
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 $655,855,250.00 (an increase of $2,887,417.00), subject to the availability of funds. | ||||
2. | Attachment I, 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 Agency Areas of the State other than Areas 3, 5, 6, and 7 (Orange, Osceola, and Seminole counties).
Area 07 General Rates Plan 015016913 (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 015016911 (LEE)  ###-###-#### (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 | 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 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 |
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 | 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 03 General Rates plus Mental Health 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 | 350.93 | 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- 015016903 (PASCO) 015016904 (PINELLAS)
AHCA Contract No. FA522, Amendment No. 6, Page 1 of 2
WELL CARE HMO, INC., D/B/A STAYWELL HEALTH PLAN OF FLORIDA | Medicaid HMO Contract |
<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 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 | 286.09 | 288.09 | 288.09 | 288.09 | 202.64 |
Area 07 General Rates plus Mental Health Plan 015016906(ORANGE) 015016907(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 $655,855,250.00 (an increase $2,887,417.00), 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 2 page amendment (including all attachments) to be executed by their officials thereunto duly authorized.
WELLCARE HMO, INC., D/B/A STAYWELL HEALTH PLAN OF FLORIDA | STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION SIGNED | |||||||
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: | 4-28-05 |
AHCA Contract No. FA522, Amendment No. 6, Page 2 of 2