Amendment number 4 to Contract No. FAR009, between the State of Florida, Agency for Health Care Administration and WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida (Medicaid Reform 2006-2009)
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EX-10.2 3 exhibit10-2.htm AMENDMENT NUMBER 4 TO AHCA CONTRACT NO. FAR009 exhibit10-2.htm
EXHIBIT 9-A
Back to Form 8-K
Exhibit 10.2
AHCA CONTRACT NO. FAR009
AMENDMENT NO. 4
THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the “Agency,” and WELLCARE OF FLORIDA, INC. D/B/A STAYWELL HEALTH PLAN OF FLORIDA, hereinafter referred to as the “Vendor,” is hereby amended as follows:
| | 1. | All references in the Contract to the Vendor’s company name are hereby changed from WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida to WellCare of Florida, Inc. d/b/a Staywell. The Vendor’s contact information, including names, addresses and telephone numbers and the Vendor’s FEID number remain unchanged. |
| 2. | Effective September 1, 2007, Standard Contract, Section II., Item A., Contract Amount, the first sentence, is hereby revised to change the total amount of the Contract from $214,516,613.00 to $233,738,003.00 (an increase of $19,221,390.00). |
| 3. | Effective September 1, 2007, Attachment I, Scope of Services, Section C., Method of Payment, Item 1., General, the first paragraph is hereby revised to now read as follows: |
| | Notwithstanding the payment amounts which may be computed with the rate tables specified in Tables 2 thru 8, the sum of total capitation payments under this Contract shall not exceed the total Contract amount of $233,738,003.00 (an increase of $19,221,390.00). |
| | 4. | Effective September 1, 2007, Attachment I, Scope of Services, Exhibits 1-A, 3-A, 4-A, 5-A, 6-A, 7-A, 8-A and 9-A, are hereby included and made a part of the Contract. All references in the Contract to Exhibits 1, 3, 4, 5, 6, 7, 8 and 9, shall hereinafter refer respectively to Exhibits 1-A, 3-A, 4-A, 5-A, 6-A, 7-A, 8-A and 9-A. |
| | 5. | Effective September 1, 2007, Attachment II, Medicaid Reform Health Plan Model Contract, Section XIII, Method of Payment, Section B, Capitation Rate Payments, is hereby revised as follows: |
-- Sub-item 1.b.(1)(b), is hereby amended to include the following:
Contract Year 2007-2008 Medicaid Reform rates under current Capitation Rate methodology.
-- Sub-item 1.b.(1)(i), the first paragraph is hereby amended to now read as follows:
| | (i) | 50% of Risk Adjusted Methodology: The capitation amount based on the percentage of Risk-Adjusted methodology (h) multiplied by the Base Rates column for Risk-Adjusted methodology after budget neutrality factor (g). |
-- Sub-item 1.b.(1)(j), the first sentence is hereby amended to now read as follows:
| | (j) | Final Rate (with Enhanced Benefit Adjustment): The current methodology capitation amount (d) added to the 50% of Risk-Adjusted methodology amount (i). |
| | 6. | This Amendment shall be effective upon execution by both parties or July 1, 2007, 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, is hereby made 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 fourteen (14) page Amendment (including all attachments) to be executed by their officials thereunto duly authorized.
| WELLCARE OF FLORIDA, INC. D/B/A STAYWELL | STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION |
| SIGNED BY: /s/ Todd S. Farha | SIGNED BY: /s/ Andrew Agwunobi |
| NAME: Todd S. Farha | NAME: Andrew C. Agwunobi, M.D. |
| TITLE: President and CEO | TITLE: Secretary |
| DATE: 6/29/07 | DATE: 6/29/07 |
List of Attachments/Exhibits included as part of this Amendment:
| Specify Type | Letter/ Number | Description |
| Exhibit | 1-A | Benefit Grid Effective September 1, 2007 (4 Pages) |
| Exhibit | 3-A | Comprehensive Component and Catastrophic Component Capitation Rates (2 Pages) |
| Exhibit | 4-A | Comprehensive Component Only (1 Page) |
| Exhibit | 5-A | Capitation Rates SSI Medicare Part B Only and SSI Medicare Parts A and B Enrollees for All Medicaid Reform Counties (1 Page) |
| Exhibit | 6-A | Capitation Rates for HIV/AIDS Populations for Each Medicaid Reform County (1 Page) |
| Exhibit | 7-A | Capitation Rates for Children with Chronic Conditions for All Medicaid Reform Counties (1 Page) |
| Exhibit | 8-A | Kick Payment Amounts for Covered Transplant Services (1 Page) |
| Exhibit | 9-A | Kick Payment Amounts for Covered Obstetrical Delivery Services (1 Page) |
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EXHIBIT 1-A
Benefit Grid
Effective September 1, 2007
(i) Area 10 Broward- Children and Families
*IF ADDITIONAL SERVICES ARE NEEDED THEY MUST BE PRIOR AUTHORIZED.
| Enhanced benefits |
| Circumcision, boys up to one year |
| $25 OTC, per household per month |
| Adult Dental – Adult Dental – Exams / X-rays / Two Annual Standard Cleanings |
AHCA CONTRACT No. FAR009, Exhibit 1-A Page 1 of 4
(ii) Area 10 Broward- Aged and Disabled
*IF ADDITIONAL SERVICES ARE NEEDED THEY MUST BE PRIOR AUTHORIZED.
| Enhanced benefits |
| Circumcision, boys up to one year |
| $25 OTC, per household per month |
| Meals on Wheels – Home delivery up to 10 meals post discharge |
| Expanded dental services – Exams/Xrays/ Deep Cleaning/ Clear and Silver Fillings/ Crown (limited Flouride/Periodontal Scaling and root planing |
| Respite Events - up to 1 per mont) |
AHCA CONTRACT No. FAR009, Exhibit 1-A Page 2 of 4
Exhibit 1-A
Benefit Grid
(i) Area 4 Duval- Children and Families
*IF ADDITIONAL SERVICES ARE NEEDED THEY MUST BE PRIOR AUTHORIZED.
| Enhanced benefits |
| Circumcision, boys up to one year |
| $25 OTC, per household per month |
| Adult Dental Exams / X-rays / Deep Cleaning / Unlimited Silver Fillings / Two Annual Standard Cleanings |
AHCA CONTRACT No. FAR009, Exhibit 1-A Page 3 of 4
Exhibit 1-A
Benefit Grid
(ii) Area 4 Duval- Aged and Disabled
*IF ADDITIONAL SERVICES ARE NEEDED THEY MUST BE PRIOR AUTHORIZED.
| Enhanced benefits |
| Circumcision, boys up to one year |
| $25 OTC, per household per month |
| Meals on Wheels – Home delivery up to 10 meals post discharge |
| Adult Dental – Exams / X-rays / Deep Cleaning / Clear and Silver Fillings / Crown (limited) / Fluoride / Periodontal Scaling and Root Planing) |
| Respite Events - up to 1 per month |
EXHIBIT 3-A
COMPREHENSIVE COMPONENT AND CATASTROPHIC COMPONENT CAPITATION RATES
| TABLE 2 | ||
| Area: 4 | County: Duval, Clay, Baker and Nassau | September 1, 2007 |
| Age Range | FY0708 Discounted Reform rates Under Current Methodology | Percentage of Current Methodology | 50% of Current Methodology | Preliminary FY0708 Base rates for Risk Adjusted Methodology | Budget Neutrality Factor | FY0708 Base rates for Risk Adjusted Methodology after Budget Neutrality | Percentage of Risk Adjusted Methodology | 50% of Risk Adjusted Methodology | Final Rates (with Enhanced Benefit Adjustment) | |||||||||||||||||||||||||||||
| a | | b | | c | d | e | f | g | h | i | j | |||||||||||||||||||||||||||
| Eligibility Category: | Children and Family | |||||||||||||||||||||||||||||||||||||
| Month 0-2 All | $ | 942.31 | ||||||||||||||||||||||||||||||||||||
| Month 3-11 All | $ | 218.74 | ||||||||||||||||||||||||||||||||||||
| 1-5 All | $ | 113.17 | 50 | % | $ | 56.58 | $ | 124.53 | 1.04120 | $ | 129.66 | 50 | % | $ | 64.83 | $ | 118.98 | |||||||||||||||||||||
| 6-13 All | $ | 82.75 | 50 | % | $ | 41.37 | $ | 124.53 | 1.04120 | $ | 129.66 | 50 | % | $ | 64.83 | $ | 104.08 | |||||||||||||||||||||
| 14-20 Female | $ | 119.81 | 50 | % | $ | 59.91 | $ | 124.53 | 1.04120 | $ | 129.66 | 50 | % | $ | 64.83 | $ | 122.24 | |||||||||||||||||||||
| 14-20 Male | $ | 81.70 | 50 | % | $ | 40.85 | $ | 124.53 | 1.04120 | $ | 129.66 | 50 | % | $ | 64.83 | $ | 103.56 | |||||||||||||||||||||
| 21-54 Female | $ | 218.13 | 50 | % | $ | 109.06 | $ | 124.53 | 1.04120 | $ | 129.66 | 50 | % | $ | 64.83 | $ | 170.41 | |||||||||||||||||||||
| 21-54 Male | $ | 158.54 | 50 | % | $ | 79.27 | $ | 124.53 | 1.04120 | $ | 129.66 | 50 | % | $ | 64.83 | $ | 141.22 | |||||||||||||||||||||
| 55+ All | $ | 350.55 | 50 | % | $ | 175.28 | $ | 124.53 | 1.04120 | $ | 129.66 | 50 | % | $ | 64.83 | $ | 235.30 | |||||||||||||||||||||
| | ||||||||||||||||||||||||||||||||||||||
| Composite Based on Total Casemonths | $ | 119.40 | $ | 129.66 | $ | 0.00 | $ | 122.04 | ||||||||||||||||||||||||||||||
| | | | ||||||||||||||||||||||||||||||||||||
| Eligibility Category: | Aged and Disabled | | | |||||||||||||||||||||||||||||||||||
| | | |||||||||||||||||||||||||||||||||||||
| Month 0-2 All | | $ | 14,803.79 | |||||||||||||||||||||||||||||||||||
| Month 3-11 All | | $ | 3,019.63 | |||||||||||||||||||||||||||||||||||
| 1-5 All | $ | 537.41 | 50 | % | $ | 268.70 | $ | 657.05 | 1.05080 | $ | 690.42 | 50 | % | $ | 345.21 | $ | 601.64 | |||||||||||||||||||||
| 6-13 All | $ | 312.13 | 50 | % | $ | 156.06 | $ | 657.05 | 1.05080 | $ | 690.42 | 50 | % | $ | 345.21 | $ | 491.25 | |||||||||||||||||||||
| 14-20 All | $ | 296.53 | 50 | % | $ | 148.27 | $ | 657.05 | 1.05080 | $ | 690.42 | 50 | % | $ | 345.21 | $ | 483.61 | |||||||||||||||||||||
| 21-54 All | $ | 790.16 | 50 | % | $ | 395.08 | $ | 657.05 | 1.05080 | $ | 690.42 | 50 | % | $ | 345.21 | $ | 725.49 | |||||||||||||||||||||
| 55+ All | $ | 809.32 | 50 | % | $ | 404.66 | $ | 657.05 | 1.05080 | $ | 690.42 | 50 | % | $ | 345.21 | $ | 734.88 | |||||||||||||||||||||
| | | | | |||||||||||||||||||||||||||||||||||
| Composite Based on Total Casemonths | $ | 623.67 | $ | 690.42 | $ | 0.00 | $ | 643.91 | ||||||||||||||||||||||||||||||
AHCA Contract No. FAR009, Exhibit 3-A, Page 1 of 2
EXHIBIT 3-A
COMPREHENSIVE COMPONENT AND CATASTROPHIC COMPONENT CAPITATION RATES
| TABLE 2 | September 1, 2007 |
| Area: 10 | | County: Broward | |
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
| Age Range | FY0708 Discounted Reform rates Under Current Methodology | Percentage of Current Methodology | 50% of Current Methodology | Preliminary FY0708 Base rates for Risk Adjusted Methodology | Budget Neutrality Factor | FY0708 Base rates for Risk Adjusted Methodology after Budget Neutrality | Percentage of Risk Adjusted Methodology | 50% of Risk Adjusted Methodology | Final Rates (with Enhanced Benefit Adjustment) |
| a | b | c | d | e | f | g | h | i | j |
| Eligibility Category: | Children and Family | ||||||||
| Month 0-2 All | $907.28 | ||||||||
| Month 3-11 All | $208.49 | ||||||||
| 1-5 All | $106.14 | 50% | $53.07 | $117.69 | 1.07460 | $126.47 | 50% | $63.23 | $113.98 |
| 6-13 All | $82.94 | 50% | $41.47 | $117.69 | 1.07460 | $126.47 | 50% | $63.23 | $102.61 |
| 14-20 Female | $115.00 | 50% | $57.50 | $117.69 | 1.07460 | $126.47 | 50% | $63.23 | $118.32 |
| 14-20 Male | $79.98 | 50% | $39.99 | $117.69 | 1.07460 | $126.47 | 50% | $63.23 | $101.16 |
| 21-54 Female | $202.08 | 50% | $101.04 | $117.69 | 1.07460 | $126.47 | 50% | $63.23 | $160.99 |
| 21-54 Male | $146.71 | 50% | $73.35 | $117.69 | 1.07460 | $126.47 | 50% | $63.23 | $133.86 |
| 55+ All | $325.58 | 50% | $162.79 | $117.69 | 1.07460 | $126.47 | 50% | $63.23 | $221.50 |
| | | | |||||||
| Composite Based on Total Casemonths | $108.91 | $126.47 | $0.00 | $115.34 | |||||
| | |||||||||
| Eligibility Category: | Aged and Disabled | ||||||||
| Month 0-2 All | $17,822.94 | ||||||||
| Month 3-11 All | $3,594.38 | ||||||||
| 1-5 All | $631.27 | 50% | $315.63 | $813.28 | 1.06682 | $867.63 | 50% | $433.81 | $734.46 |
| 6-13 All | $355.68 | 50% | $177.84 | $813.28 | 1.06682 | $867.63 | 50% | $433.81 | $599.42 |
| 14-20 All | $343.79 | 50% | $171.90 | $813.28 | 1.06682 | $867.63 | 50% | $433.81 | $593.59 |
| 21-54 All | $930.27 | 50% | $465.13 | $813.28 | 1.06682 | $867.63 | 50% | $433.81 | $880.97 |
| 55+ All | $965.71 | 50% | $482.85 | $813.28 | 1.06682 | $867.63 | 50% | $433.81 | $898.33 |
| | | ||||||||
| Composite Based on Total Casemonths | $758.94 | $867.63 | $0.00 | $797.02 |
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AHCA Contract No. FAR009, Exhibit 3-A, Page2 of 2
EXHIBIT 4-A
COMPREHENSIVE COMPONENT ONLY
TABLE 3
September 1, 2007
Area:______ County:______________
| ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) |
| Area ________ | |||||||||||
| Age Range | FY0607 Discounted Reform rates Under Current Methodology | Percentage of Current Methodology | 75% of Current Methodology | FY0607 Base Rates for Risk-Adjusted Methodology | Percentage of Risk-Adjusted Methodology | 25% of Risk-Adjusted Methodology | Budget Neutrality Factor | Budget Adjusted of 25% of Risk Adjusted Methodology | Blended Rate (Risk = 1.00) | Final Rate (with Enhanced Benefit Adjustment) | |
| (a) | (b) | (c) | (d) | (e) | (f) | (g) | (h) | (i) | (j) | (k) | |
| Eligibility Category: | Children and Family | ||||||||||
| Month 0-2 All | $ | 75% | $ | $ | 25% | $ | $ | $ | |||
| Month 3-11 All | $ | 75% | $ | $ | 25% | $ | $ | $ | |||
| 1-5 All | $ | 75% | $ | $ | 25% | $ | $ | $ | |||
| 6-13 All | $ | 75% | $ | $ | 25% | $ | $ | $ | |||
| 14-20 Female | $ | 75% | $ | $ | 25% | $ | $ | $ | |||
| 14-20 Male | $ | 75% | $ | $ | 25% | $ | $ | $ | |||
| 21-54 Female | $ | 75% | $ | $ | 25% | $ | $ | $ | |||
| 21-54 Male | $ | 75% | $ | $ | 25% | $ | $ | $ | |||
| 55+ All | $ | 75% | $ | $ | 25% | $ | $ | $ | |||
| Composite | | | $ | $ | |||||||
| | | ||||||||||
| Eligibility Category: | Aged and Disabled | | | ||||||||
| Month 0-2 All | $ | 75% | $ | $ | 25% | $ | $ | $ | |||
| Month 3-11 All | $ | 75% | $ | $ | 25% | $ | $ | $ | |||
| 1-5 All | $ | 75% | $ | $ | 25% | $ | $ | $ | |||
| 6-13 All | $ | 75% | $ | $ | 25% | $ | $ | $ | |||
| 14-20 All | $ | 75% | $ | $ | 25% | $ | $ | $ | |||
| 21-54 All | $ | 75% | $ | $ | 25% | $ | $ | $ | |||
| 55+ All | $ | 75% | $ | $ | 25% | $ | $ | $ | |||
| Composite | $ | $ | |||||||||
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AHCA Contract No. FAR009, Exhibit 4-A, Page 1 of 1
EXHIBIT 5-A
CAPITATION RATES
SSI MEDICARE PART B ONLY
AND
SSI MEDICARE PARTS A AND B ENROLLEES
FOR ALL MEDICAID REFORM COUNTIES
TABLE 4
| Area: | 4 | County: | Duval, Baker, Clay and Nassau |
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
| |
| Under Age 65 | Age 65 & Over | |
| SSI/Parts A & B | $200.51 | $135.15 |
| SSI/Part B Only | $369.64 | $369.64 |
| Area: | 10 | County: | Broward |
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
| | |
| Under Age 65 | Age 65 & Over | |
| SSI/Parts A & B | $192.29 | $129.85 |
| SSI/Part B Only | $249.37 | $249.37 |
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AHCA Contract No. FAR009, Exhibit 5-A, Page 1 of 1
EXHIBIT 6-A
CAPITATION RATES FOR HIV/AIDS POPULATIONS FOR EACH MEDICAID REFORM COUNTY
TABLE 5
| Area: | 4 | County: | Duval, Baker, Clay and Nassau | |
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
| Capitation Rate | |
| HIV (no medicare) | $1,216.29 |
| AIDS (no medicare) | $2,394.42 |
| HIV-SSI/Parts A & B, SSI Part B Only | $ 294.90 |
| AIDS-SSI/Parts A & B, SSI Part B Only | $ 291.91 |
| Area: | 10 | County: | Broward |
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
| Capitation Rate | |
| HIV (no medicare) | $1,966.44 |
| AIDS (no medicare) | $3,690.27 |
| HIV-SSI/Parts A & B, SSI Part B Only | $ 331.60 |
| AIDS-SSI/Parts A & B, SSI Part B Only | $ 708.10 |
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EXHIBIT 7-A
AHCA Contract No. FAR009, Exhibit 6-A, Page 1 of 1
EXHIBIT 7-A
CAPITATION RATES FOR CHILDREN WITH CHRONIC CONDITIONS FOR ALL MEDICAID REFORM COUNTIES
TABLE 6
| Area:_____________ | County: _____________________ | |
| ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) |
| Age < 1 Yr | Age 1 Yr | Age 2 - 20 Yrs | |
| Children with Chronic Conditions | $ | $ | $ |
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AHCA Contract No. FAR009, Exhibit 7-A, Page 1 of 1
EXHIBIT 8-A
KICK PAYMENT AMOUNTS FOR COVERED
TRANSPLANT SERVICES
| TABLE 7 | |
| Area: | 4 | County: | Duval, Baker, Clay and Nassau | |
| Area: | 10 | County: | Broward |
| CPT Code | Transplant CPT Code Description | Children/Adolescents or Adult | Payment Amount |
| 32851 | lung single, without bypass | Children/Adolescents | $320,800.00 |
| 32851 | lung single, without bypass | Adult | $238,000.00 |
| 32852 | lung single, with bypass | Children/Adolescents | $320,800.00 |
| 32852 | lung single, with bypass | Adult | $238,000.00 |
| 32853 | lung double, without bypass | Children/Adolescents | $320,800.00 |
| 32853 | lung double, without bypass | Adult | $238,000.00 |
| 32854 | lung double, with bypass | Children/Adolescents | $320,800.00 |
| 32854 | lung double, with bypass | Adult | $238,000.00 |
| 33945 | heart transplant with or without recipient cardiectomy | Children/Adolescents | $162,000.00 |
| 33945 | heart transplant with or without recipient cardiectomy | Adult | $162,000.00 |
| 47135 | liver, allotransplation, orthotopic, partial or whole from cadaver or living donor | Children/Adolescents | $122,600.00 |
| 47135 | liver, allotransplation, orthotopic, partial or whole from cadaver or living donor | Adult | $122,600.00 |
| 47136 | liver, heterotopic, partial or whole from cadaver or living donor any age | Children/Adolescents | $122,600.00 |
| 47136 | liver, heterotopic, partial or whole from cadaver or living donor any age | Adult | $122,600.00 |
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AHCA Contract No. FAR009, Exhibit 8-A, Page 1 of 1
EXHIBIT 9-A
KICK PAYMENT AMOUNTS FOR COVERED
OBSTETRICAL DELIVERY SERVICES
TABLE 8
| Area: 4 | County: | Duval, Baker, Clay & Nassau |
| CPT Code | Obstetrical Delivery CPT Code Description | Payment Amount |
| 59409 | Vaginal delivery only | $3,982.26 |
| 59410 | Vaginal delivery including postpartum care | |
| 59515 | Cesarean delivery including postpartum care | |
| 59612 | Vaginal delivery only, after previous cesarean delivery | |
| 59614 | Vaginal delivery only, after previous cesarean delivery including postpartum care | |
| 59622 | Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery including postpartum care |
| Area: | 10 | County: | Broward |
| CPT Code | Obstetrical Delivery CPT Code Description | Payment Amount |
| 59409 | Vaginal delivery only | $3,997.99 |
| 59410 | Vaginal delivery including postpartum care | |
| 59515 | Cesarean delivery including postpartum care | |
| 59612 | Vaginal delivery only, after previous cesarean delivery | |
| 59614 | Vaginal delivery only, after previous cesarean delivery including postpartum care | |
| 59622 | Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery including postpartum care |
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AHCA Contract No. FAR009, Exhibit 9-A, Page 1 of 1
