AHCA CONTRACT NO. FA972 AMENDMENT NO. 4
EX-10.34E 3 ex1034efa972amendment4.htm AMENDMENT TO FA 972 Ex1034eFA972Amendment4
Exhibit 10.34.e
AHCA CONTRACT NO. FA972
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 HEALTHEASE, hereinafter referred to as the "Vendor," or “Health Plan,” is hereby amended as follows:
1. | Effective October 1, 2013, Attachment I, Scope of Services, Capitated Health Plans, Exhibit 1, Maximum Enrollment Levels, Effective Date 09/01/2012 – 08/31/2015, is hereby deleted in its entirety and replaced with Exhibit 1, Maximum Enrollment Levels, Effective Date 10/01/2013 – 08/31/2015, attached hereto and made part of this Contract. All references in this Contract to Exhibit 1, Maximum Enrollment Levels 09/01/2012 – 08/31/2015 shall hereinafter refer to Exhibit 1, Maximum Enrollment Levels 10/01/2013 – 08/31/2015. |
Unless otherwise stated, this Amendment shall be effective upon execution by both Parties.
All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in this Contract.
This Amendment, and all its attachments, are hereby made part of this 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 five (5) page Amendment (including all attachments) to be executed by their officials thereunto duly authorized.
WELLCARE OF FLORIDA, INC., D/B/A | STATE OF FLORIDA, AGENCY FOR | |||
HEALTHEASE | HEALTH CARE ADMINISTRATION | |||
SIGNED | SIGNED | ||||
BY: | /s/ David McNichols | BY: | /s/ Elizabeth Dudek | ||
NAME: | David McNichols | NAME: | Elizabeth Dudek | |
TITLE: | President, FL and HI Division | TITLE: | Secretary | |
DATE: | Nov. 18, 2013 | DATE: | 11/22/2013 | |
List of Attachments/Exhibits included as part of this Amendment:
Specify | Letter/ | ||||
Type | Number | Description | |||
Attachment I | Exhibit I | Maximum Enrollment Levels | |||
Effective Date 10/01/2013 – 08/31/2015 (4 Pages) | |||||
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AHCA Contract No. FA972, Amendment No. 4, Page 1 of 1
WellCare of Florida, Inc. d/b/a | Medicaid HMO Non-Reform Contract | |
Healthease | ||
ATTACHMENT I
EXHIBIT 1
MAXIMUM ENROLLMENT LEVELS
EFFECTIVE DATE 10/01/2013 – 08/31/2015
Maximum enrollment levels and Health Plan provider numbers associated with the counties and populations served as denoted below. Attachment I, Scope of Services, Exhibit 2-NR provide the capitation rate tables respective to the areas of operation listed below.
A. | Non-Reform |
See Exhibit 2-NR Table 2, General Capitation Rates plus Mental Health Rates
Area1 Counties: Escambia, Santa Rosa
Effective Date: 09/01/2012 | ||
County | Enrollment Level | Provider Number |
Escambia | 67,500 | 15019344 |
Santa Rosa | 31,500 | 15019343 |
See Exhibit 2-NR Table 2, General Capitation Rates plus Mental Health Rates
Area 2 Counties: Bay, Calhoun, Gadsden, Jefferson, Leon, Liberty, Madison, Wakulla
Effective Date: 09/01/2012 | ||
County | Enrollment Level | Provider Number |
Bay | 16,900 | 15019345 |
Calhoun | 800 | 15019340 |
Gadsden | 3,500 | 15019315 |
Jefferson | 1,000 | 15019318 |
Leon | 7,000 | 15019320 |
Liberty | 400 | 15019342 |
Madison | 1,500 | 15019322 |
Wakulla | 1,000 | 15019336 |
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AHCA Contract No. FA972, Attachment I, Exhibit 1, Page 1 of 4
WellCare of Florida, Inc. d/b/a | Medicaid HMO Non-Reform Contract | |
Healthease | ||
See Exhibit 2-NR Table 2, General Capitation Rates plus Mental Health Rates
Area 3 Counties: | Citrus, Lake, Marion, Putnam |
Effective Dates: 09/01/2012 | ||
County | Enrollment Level | Provider Number |
Citrus | 7,500 | 15019309 |
Lake | 17,000 | 15019319 |
Marion | 20,000 | 15019323 |
Putnam | 6,000 | 15019329 |
See Exhibit 2-NR Table 2, General Capitation Rates plus Mental Health Rates
Area 4 Counties: Duval, Volusia
Effective Date: 09/01/2012 | ||
County | Enrollment Level | Provider Number |
Duval | 55,000 | 15019313 |
Volusia | 15,000 | 15019335 |
See Exhibit 2-NR Table 2, General Capitation Rates plus Mental Health Rates
Area 5 Counties: Pasco, Pinellas
Effective Date: 09/01/2012 | ||
County | Enrollment Level | Provider Number |
Pasco | 6,000 | 15019302 |
Pinellas | 9,000 | 15019303 |
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AHCA Contract No. FA972, Attachment I, Exhibit 1, Page 2 of 4
WellCare of Florida, Inc. d/b/a | Medicaid HMO Non-Reform Contract | |
Healthease | ||
See Exhibit 2-NR Table 2, General Capitation Rates plus Mental Health Rates
Area 6 Counties: Highlands, Hillsborough, Manatee, Polk
Effective Date: 09/01/2012 | ||
County | Enrollment Level | Provider Number |
Highlands | 3,000 | 15019317 |
Hillsborough | 18,000 | 15019300 |
Manatee | 6,000 | 15019301 |
Polk | 10,000 | 15019304 |
See Exhibit 2-NR Table 2, General Capitation Rates plus Mental Health Rates
Area 7 Counties: Brevard, Orange, Osceola, Seminole
Effective Date: 09/01/2012 | ||
County | Enrollment Level | Provider Number |
Brevard | 14,000 | 15019308 |
Orange | 25,000 | 15019327 |
Osceola | 8,000 | 15019328 |
Seminole | 4,000 | 15019333 |
See Exhibit 2-NR Table 2, General Capitation Rates plus Mental Health Rates
Area 8 County: Sarasota
Effective Dates: 09/01/2012 | ||
County | Enrollment Level | Provider Number |
Sarasota | 3,000 | 15019332 |
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AHCA Contract No. FA972, Attachment I, Exhibit 1, Page 3 of 4
WellCare of Florida, Inc. d/b/a | Medicaid HMO Non-Reform Contract | |
Healthease | ||
See Exhibit 2-NR Table 2, General Capitation Rates plus Mental Health Rates
Area 9 Counties: Martin, Palm Beach
Effective Dates: 09/01/2012 | ||
County | Enrollment Level | Provider Number |
Martin | 5,000 | 15019324 |
Palm Beach | 10,500 | 15019339 |
See Exhibit 2-NR Table 2, General Capitation Rates plus Mental Health Rates
Area 10 County: Broward
Effective Date: 09/01/2012 | ||
County | Enrollment Level | Provider Number |
Broward | 13,500 | 15019337 |
See Exhibit 2-NR Table 2, General Capitation Rates, Mental Health Rates
Area 11 County: Miami-Dade
Effective Date: 09/01/2012 | ||
County | Enrollment Level | Provider Number |
Miami-Dade | 25,000 | 15016909 |
AHCA Contract No. FA972, Attachment I, Exhibit 1, Page 4 of 4
