Amendment Nos. 008 and 009 to Medicaid HMO Contract between State of Florida Agency for Health Care Administration and Well Care HMO, Inc. d/b/a StayWell Health Plan

Summary

This amendment updates the Medicaid HMO contract between the State of Florida's Agency for Health Care Administration and Well Care HMO, Inc., doing business as StayWell Health Plan. The amendments revise enrollment limits by county, change reporting requirements for behavioral health assessments from quarterly to annually, and require compliance with a legal settlement regarding service equivalency for enrollees. The amendments take effect upon signing and are part of the ongoing contract, with all other terms remaining unchanged unless specifically amended.

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EX-10.9 9 z00001exv10w9.txt EXHIBIT 10.9 Exhibit 10.9 WELL CARE HMO, INC., D/B/A STAY WELL HEALTH PLAN MEDICAID HMO CONTRACT AHCA CONTRACT NO. FA312 AMENDMENT NO. 008 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 STAY WELL HEALTH PLAN, hereinafter referred to as the "Vendor", is hereby amended as follows: 1. Attachment I. Section 90.0, Payment and Authorized Enrollment Levels, Table 1 is amended as shown below.
TABLE 1 PROJECTED ENROLLMENT COUNTY MAXIMUM ENROLLMENT LEVEL BREVARD 14,000 BROWARD 25,000 CHARLOTTE 0 CITRUS 0 DADE 25,000 DUVAL 0 ESCAMBIA 0 HERNANDO 8,500 HIGHLANDS 0 HILLSBOROUGH 28,000 LEE 10,000 MANATEE 12,000 MARION 0 ORANGE 38,000 OSCEOLA 12,000 PALM BEACH 15,000 PASCO 7,000 PINELLAS 15,000 POLK 25,000 SANTA ROSA 0 SARASOTA 4,500 SEMINOLE 5,000 VOLUSIA 0
2. This amendment shall begin on March 22, 2004, 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. AHCA CONTRACT NO. FA312, AMENDMENT NO. 008, PAGE 1 OF 2 WELL CARE HMO, INC., D/B/A STAY WELL HEALTH PLAN MEDICAID HMO CONTRACT IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be executed by their officials thereunto duly authorized. STAY WELL HEALTH PLAN STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION SIGNED SIGNED BY: /s/ Todd S. Farha BY: /s/ Mary Pat Moore ---------------------- -------------------------- NAME: Todd S. Farha NAME: Mary Pat Moore -------------------- ------------------------ TITLE: PRESIDENT & CHIEF TITLE: INTERIM SECRETARY EXECUTIVE OFFICER ----------------------- ------------------- DATE: 4/16/04 DATE: 4/26/04 -------------------- ------------------------ THE REMAINDER OF THIS PAGE LEFT BLANK INTENTIONALLY WELL CARE HMO, INC., D/B/A STAY WELL HEALTH PLAN MEDICAID HMO CONTRACT AHCA CONTRACT NO. FA312 AMENDMENT NO. 009 THIS AMENDMENT, 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 "Provider," is hereby amended as follows: 1. Attachment I, Section 10.11.5, Functional Assessments (Behavioral Health), is amended to reduce FARS and CFARS outcome reporting from quarterly to annually, as follows. The plan shall ensure its providers administer functional assessments using the Functional Assessment Rating Scales (FARS) (for persons over age 18) and Child Functional Rating Scale (CFARS) (for persons age 18 and under). The plan shall ensure the provider administers and maintains the FARS and CFARS for recipients of behavioral health care services and upon termination of providing such services. Additionally, the plan must evaluate these data and report outcome measures to the agency on a annual basis by August 15. 2. The plan shall comply with the settlement agreement for Hernandez, et al. v. Medows, case number 02-20964 (see Attachment II). The plan shall ensure that its enrollees are receiving the functional equivalent of those received by Medicaid fee-for-service recipients in accordance with the Hernandez settlement. 3. Attachment I, Section 90.0, Payment and Authorized Enrollment Levels, is amended effective July 1, 2003 as provided in Tables 2 and 3 shown below. Any capitation claims calculated based on rates different than those indicated below are subject to recoupment in accordance with Section I.J, of the Standard Contract. Table 2. Area wide Age-banded Capitation Rates for all agency areas of the state other than Area 6 and Area 1.
Area 03 <1 year 1-5 6-13 14-20 male 14-20 female 21-54 male 21-54 female 55-64 65+ tanf/fc/sobra 304.04 74.58 47.23 82.20 115.21 132.40 204.22 310.61 110.61 ssi/no medicare 1722.67 318.21 170.47 178.77 178.77 539.93 539.93 554.25 554.25 ssi/part b 288.07 288.07 288.07 288.07 288.07 288.07 288.07 288.07 288.07 ssi/part a & b 261.55 261.55 261.55 261.55 261.55 261.55 261.55 261.55 184.50 area 04 <1 year 1-5 6-13 14-20 male 14-20 female 21-54 male 21-54 female 55-64 65+ tanf/fc/sobra 271.14 66.78 42.37 47.98 103.10 118.94 183.25 279.31 279.31 ssi/no medicare 1595.82 294.29 157.35 165.25 165.25 498.99 498.99 512.40 512.40 ssi/part b 249.15 249.18 249.15 249.15 249.15 249.15 249.15 249.15 249.15 ssi/part a & b 265.42 265.42 265.42 265.42 265.42 265.42 265.42 265.42 187.52 area 05 <1 year 1-5 6-13 14-20 male 14-20 female 21-54 male 21-54 female 55-64 65+ tanf/fc/sobra 285.33 69.91 44.12 49.85 107.87 123.86 191.30 290.61 290.61 ssi/no medicare 1640.03 302.32 161.06 169.11 169.11 511.37 511.37 524.95 524.95 ssi/part b 217.17 217.17 217.17 217.17 217.17 217.17 217.17 217.17 217.17 ssi/part a & b 276.42 276.42 276.42 276.42 276.42 276.42 276.42 276.42 195.30 area 07 <1 year 1-5 6-13 14-20 male 14-20 female 21-54 male 21-54 female 55-64 65+ tanf/fc/sobra 278.86 68.56 43.44 49.09 105.94 121.93 188.01 286.09 286.09 ssi/no medicare 1590.95 298.73 157.71 165.37 165.37 499.72 499.72 512.25 512.25 ssi/part b 265.79 265.79 265.75 265.79 265.79 265.79 265.79 265.79 265.79 ssi/part a & b 259.85 259.85 259.85 259.85 259.85 258.85 259.85 259.85 183.50 area 08 <1 year 1-5 6-13 14-20 male 14-20 female 21-54 male 21-54 female 55-64 65+ tanf/fc/sobra 257.19 63.11 40.00 45.22 97.50 312.18 173.06 263.38 263.38 ssi/no medicare 1611.33 297.66 159.61 167.51 167.51 505.95 505.95 519.07 519.07 ssi/part b 250.97 250.97 250.97 250.97 250.97 250.97 250.87 250.97 250.97 ssi/part a & b 253.44 253.44 253.44 253.44 253.44 253.44 253.44 258.44 179.15
AHCA CONTRACT NO. FA312, AMENDMENT NO. 009, PAGE 1 OF 3 WELL CARE HMO, INC., D/B/A STAY WELL HEALTH PLAN MEDICAID HMO CONTRACT
Area 09 <1 year 1-5 6-13 14-20 male 14-20 female 21-54 male 21-54 female 55-64 65+ TANF/FC/SOBRA 278.08 68.26 43.21 48.86 105.44 121.17 186.89 284.35 284.35 SSI/No Medicare 1801.74 333.04 179.03 187.98 187.98 567.15 567.15 581.73 581.73 SSI/Part B 251.63 251.63 251.63 251.63 251.63 251.63 251.63 251.63 251.63 SSI/Part A & B 290.09 290.09 290.09 290.09 290.09 290.09 290.09 290.09 204.83
Area 10 <1 year 1-5 6-13 14-20 male 14-20 female 21-54 male 21-54 female 55-64 65+ TANF/FC/SOBRA 292.87 71.89 45.66 51.65 111.29 128.28 197.65 301.04 301.04 SSI/No Medicare 3177.44 402.11 215.86 226.70 226.70 684.10 684.10 701.42 701.42 SSI/Part B 267.12 267.12 267.12 267.12 267.12 267.12 267.12 267.12 267.12 SSI/Part A & B 319.69 319.69 319.69 319.69 319.69 319.69 319.69 319.69 228.90
Area 11 <1 year 1-5 6-13 14-20 male 14-20 female 21-54 male 21-54 female 55-64 65+ TANF/FC/SOBRA 346.97 84.89 53.58 60.41 130.98 150.12 231.97 352.05 352.05 SSI/No Medicare 2143.27 432.47 231.39 242.81 242.81 734.42 734.42 753.18 753.18 SSI/Part B 420.82 420.82 420.82 420.82 420.82 420.82 420.82 420.82 420.82 SSI/Part A & B 357.12 357.12 357.12 357.12 357.12 357.12 357.12 357.12 252.28
STAYWELL Medicaid HMO Contract July 1, 2003 contract Number : ________ Table 3. Area 6 or Area 1 Age-banded Capitation Rates, including Community Mental Health and Mental Health Targeted Case Management.
Area 01 <1 year 1-5 6-13 14-20 male 14-20 female 21-54 male 21-54 female 55-64 65+ TANF/FC/SOBRA 261.93 64.58 46.91 51.02 104.29 114.62 176.23 267.49 267.49 SSI/No Medicare 1637.19 305.09 213.99 207.65 207.65 549.97 549.97 544.97 544.97 SSI/Part B 289.84 289.84 289.84 289.84 289.84 289.84 289.84 289.84 289.84 SSI/Part A & B 301.66 301.66 301.66 301.66 301.66 301.66 301.66 301.66 318.69
Area 06 <1 year 1-5 6-13 14-20 male 14-20 female 21-54 male 21-54 female 55-64 65+ TANF/FC/SOBRA 279.39 71.17 59.81 65.78 122.52 124.65 190.77 289.28 289.28 SSI/No Medicare 1498.70 293.07 243.27 196.57 196.57 526.87 526.87 511.41 511.41 SSI/Part B 242.93 242.93 242.93 242.93 242.93 242.93 242.93 242.93 242.93 SSI/Part A & B 263.55 263.55 263.55 263.55 263.55 263.55 263.55 263.55 187.50
4. This amendment shall begin on June 1, 2004 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. REMAINDER OF PAGE LEFT BLANK INTENTIONALLY AHCA CONTRACT NO. FA312, AMENDMENT NO. 009, PAGE 2 OF 3 WELL CARE HMO, INC., D/B/A STAY WELL HEALTH PLAN 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. WELL CARE HMO, INC., d/b/a Stay Well Health Plan of Florida STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION SIGNED SIGNED BY: /s/ Thaddeus Bereday BY: /s/ Steven Grigas _____________________________ _____________________________ NAME: Thaddeus Bereday FOR: Alan Levine ___________________________ ___________________________ TITLE: Senior Vice President & TITLE: Secretary General Counsel __________________________ __________________________ DATE: 6/30/04 DATE: 6-30-04 __________________________ __________________________ AHCA CONTRACT NO. FA312, AMENDMENT NO. 009, PAGE 3 OF 3