Amendments to Medicaid HMO Contract Between HealthEase of Florida, Inc. and State of Florida Agency for Health Care Administration
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Summary
This document amends the Medicaid HMO contract between HealthEase of Florida, Inc. and the State of Florida's Agency for Health Care Administration. The amendments update maximum enrollment levels by county, change reporting requirements for behavioral health assessments from quarterly to annually, and revise capitation payment rates for various regions and recipient categories. The amendments are effective upon signing and require compliance with a legal settlement. All other contract terms remain in effect unless specifically changed by these amendments.
EX-10.10 10 z00001exv10w10.txt EXHIBIT 10.10 Exhibit 10.10 HEALTHEASE OF FLORIDA, INC., d/b/a HEALTHEASE MEDICAID HMO CONTRACT AHCA CONTRACT NO. FA305 AMENDMENT NO. 010 THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the "Agency" and HEALTHEASE of FLORIDA, INC., d/b/a HealthEase, 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
AHCA CONTRACT NO. FA305, AMENDMENT NO. 010, PAGE 1 OF 2 HEALTHEASE OF FLORIDA, INC., d/b/a HEALTHEASE MEDICAID HMO CONTRACT
2. This amendment shall begin on February 24, 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. IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment (including all attachments) to be executed by their officials thereunto duly authorized. HEALTHEASE of FLORIDA, INC 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 Executive TITLE: INTERIM SECRETARY Officer DATE: 4/27/04 DATE: 5/03/04 AHCA CONTRACT NO. FA305, AMENDMENT NO. 010, PAGE 2 OF 2 HEALTHEASE OF FLORIDA,INC., d/b/a HEALTH EASE MEDICAID HMO CONTRACT AHCA CONTRACT NO. FA305 AMENDMENT NO. 011 THIS AMENDMENT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the "Agency" and HEALTHEASE OF FLORIDA, INC., d/b/a HealthEase, 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 shown below. 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 for Hernandez, et al. v. Medows, case number 02-20964(se 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 1.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 1. Area 0 2
Area 03
Area 04
Area 05
Area 07
AHCA CONTRACT NO. FA305, AMENDMENT NO. 011, PAGE 1 OF 3
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. AHCA CONTRACT NO. FA305, AMENDMENT NO. 011, PAGE 2 OF 3 HEALTHEASE OF FLORIDA, INC., d/b/a HEALTH EASE 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. HealthEase of Florida, Inc., STATE OF FLORIDA, AGENCY FOR d/b/a HealthEase HEALTH CARE ADMINISTRATION SIGNED SIGNED BY: /s/ [ILLEGIBLE] BY: /s/ [ILLEGIBLE] --------------------------------- ------------------------- FOR NAME: [ILLEGIBLE] NAME: ALAN LEVINE TITLE: SENIOR VICE PRESIDENT & TITLE: SECRETARY GENERAL COUNSEL DATE: 6/30/04 DATE: 6-30-04 THE REMAINDER OF THIS PAGE LEFT BLANK INTENTIONALLY AHCA CONTRACT NO. FA305, AMENDMENT NO. 011, PAGE 3 OF 3
