Exhibit I-C to Attachment I to Contract No. FP020 between the Agency for Health Care Administration and WellCare of Florida, Inc. (d/b/a Staywell Health Plan of Florida)

EX-10.1 2 ex101flmma8k.htm EXHIBIT I-C TO ATTACHMENT I TO CONTRACT NO. FP020 Ex101FLMMA8K

Back to Form 8-K

WellCare of Florida, Inc.

d/b/a Staywell Health Plan of Florida

Exhibit 10.1

ATTACHMENT I

EXHIBIT I-C

MANAGED CARE PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS.

REGION 2



REGION 2									HIV/AIDS				Long-Term Care Program
Age Band	TANF		SSI No Medicare		Dual Eligible		Child Welfare		Dual Eligible		Medicaid Only		Dual Eligible		Medicaid Only
0-2 Months		$1,305.22		$20,746.91				$1,469.88
3-11 Months		$183.63		$3,944.76				$421.03
1-13 Years		$107.01		$355.36				$336.22
14-54 Years Female		$322.68
14-54 Years Male		$131.26
14+ Years (Female and Male)				$791.75				$622.98
55+ Years (Female and Male)		$355.85
Under Age 65						$161.30								$296.95		$2,053.17
Age 65+						$111.44								$163.46		$1,381.41
Medicare Advantage/D-SNP					TBD
HIV-AIDS										$162.00		$2,750.00

_______________

1. This exhibit reflects the negotiated standard plan rates with the draft age factors provided in the ITN applied. Final rates will be adjusted for effective time period for the region, changes in hospital rates, CHIP transition children, and any other program changes that may occur prior to implementation.

2. A factor of 0.9 will be applied to the LTC Dual Eligible and LTC Medicaid Only rates for individuals enrolled in both the MMA and LTC components of a comprehensive plan.

3. Rates shown reflect base rates and do not include the impacts of risk adjustment.

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FP020, Attachment I, Exhibit I-C, Page 1 of 8

WellCare of Florida, Inc.

d/b/a Staywell Health Plan of Florida

ATTACHMENT I

EXHIBIT I-C

MANAGED CARE PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS.

REGION 3



REGION 3									HIV/AIDS				Long-Term Care Program
Age Band	TANF		SSI No Medicare		Dual Eligible		Child Welfare		Dual Eligible		Medicaid Only		Dual Eligible		Medicaid Only
0-2 Months		$1,524.23		$24,932.62				$1,528.29
3-11 Months		$214.44		$4,740.62				$437.76
1-13 Years		$124.97		$427.05				$349.58
14-54 Years Female		$376.83
14-54 Years Male		$153.28
14+ Years (Female and Male)				$951.48				$647.73
55+ Years (Female and Male)		$415.56
Under Age 65						$158.08								$304.95		$2,393.91
Age 65+						$109.22								$167.86		$1,610.66
Medicare Advantage/D-SNP					TBD
HIV-AIDS										$190.00		$2,800.00

_______________

2. A factor of 0.9 will be applied to the LTC Dual Eligible and LTC Medicaid Only rates for individuals enrolled in both the MMA and LTC components of a comprehensive plan.

3. Rates shown reflect base rates and do not include the impacts of risk adjustment.

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FP020, Attachment I, Exhibit I-C, Page 2 of 8

WellCare of Florida, Inc.

d/b/a Staywell Health Plan of Florida

ATTACHMENT I

EXHIBIT I-C

MANAGED CARE PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS.

REGION 4



REGION 4									HIV/AIDS				Long-Term Care Program
Age Band	TANF		SSI No Medicare		Dual Eligible		Child Welfare		Dual Eligible		Medicaid Only		Dual Eligible		Medicaid Only
0-2 Months		$1,367.96		$24,570.90				$1,759.83
3-11 Months		$192.45		$4,671.84				$504.08
1-13 Years		$112.16		$420.86				$402.54
14-54 Years Female		$338.19
14-54 Years Male		$137.57
14+ Years (Female and Male)				$937.68				$745.86
55+ Years (Female and Male)		$372.96
Under Age 65						$179.37								$294.88		$2,571.25
Age 65+						$123.93								$162.32		$1,729.98
Medicare Advantage/D-SNP					TBD
HIV-AIDS										$160.00		$2,550.00

_______________

2. A factor of 0.9 will be applied to the LTC Dual Eligible and LTC Medicaid Only rates for individuals enrolled in both the MMA and LTC components of a comprehensive plan.

3. Rates shown reflect base rates and do not include the impacts of risk adjustment.

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FP020, Attachment I, Exhibit I-C, Page 3 of 8

WellCare of Florida, Inc.

d/b/a Staywell Health Plan of Florida

ATTACHMENT I

EXHIBIT I-C

MANAGED CARE PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS.

REGION 5



REGION 5									HIV/AIDS				Long-Term Care Program
Age Band	TANF		SSI No Medicare		Dual Eligible		Child Welfare		Dual Eligible		Medicaid Only		Dual Eligible		Medicaid Only
0-2 Months		$1,731.48		$27,327.79				$2,112.01
3-11 Months		$243.60		$5,196.03				$604.96
1-13 Years		$141.96		$468.08				$483.10
14-54 Years Female		$428.06
14-54 Years Male		$174.13
14+ Years (Female and Male)				$1,042.89				$895.12
55+ Years (Female and Male)		$472.07
Under Age 65						$135.35								$283.14		$2,592.37
Age 65+						$93.52								$155.86		$1,744.19
Medicare Advantage/D-SNP					TBD
HIV-AIDS										$158.00		$3,000.00

_______________

2. A factor of 0.9 will be applied to the LTC Dual Eligible and LTC Medicaid Only rates for individuals enrolled in both the MMA and LTC components of a comprehensive plan.

3. Rates shown reflect base rates and do not include the impacts of risk adjustment.

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FP020, Attachment I, Exhibit I-C, Page 4 of 8

WellCare of Florida, Inc.

d/b/a Staywell Health Plan of Florida

ATTACHMENT I

EXHIBIT I-C

MANAGED CARE PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS.

REGION 6



REGION 6									HIV/AIDS				Long-Term Care Program
Age Band	TANF		SSI No Medicare		Dual Eligible		Child Welfare		Dual Eligible		Medicaid Only		Dual Eligible		Medicaid Only
0-2 Months		$1,506.57		$24,186.03				$1,574.26
3-11 Months		$211.95		$4,598.67				$450.93
1-13 Years		$123.52		$414.27				$360.10
14-54 Years Female		$372.46
14-54 Years Male		$151.51
14+ Years (Female and Male)				$922.99				$667.22
55+ Years (Female and Male)		$410.75
Under Age 65						$131.77								$290.00		$2,503.12
Age 65+						$91.04								$159.63		$1,684.14
Medicare Advantage/D-SNP					TBD
HIV-AIDS										$168.00		$3,050.00

_______________

2. A factor of 0.9 will be applied to the LTC Dual Eligible and LTC Medicaid Only rates for individuals enrolled in both the MMA and LTC components of a comprehensive plan.

3. Rates shown reflect base rates and do not include the impacts of risk adjustment.

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FP020, Attachment I, Exhibit I-C, Page 5 of 8

WellCare of Florida, Inc.

d/b/a Staywell Health Plan of Florida

ATTACHMENT I

EXHIBIT I-C

MANAGED CARE PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS.

REGION 7



REGION 7									HIV/AIDS				Long-Term Care Program
Age Band	TANF		SSI No Medicare		Dual Eligible		Child Welfare		Dual Eligible		Medicaid Only		Dual Eligible		Medicaid Only
0-2 Months		$1,404.70		$24,057.01				$1,802.88
3-11 Months		$197.62		$4,574.13				$516.42
1-13 Years		$115.17		$412.06				$412.39
14-54 Years Female		$347.28
14-54 Years Male		$141.26
14+ Years (Female and Male)				$918.07				$764.11
55+ Years (Female and Male)		$382.97
Under Age 65						$132.24								$289.80		$2,705.38
Age 65+						$91.37								$159.53		$1,820.23
Medicare Advantage/D-SNP					TBD
HIV-AIDS										$168.00		$2,925.00

_______________

2. A factor of 0.9 will be applied to the LTC Dual Eligible and LTC Medicaid Only rates for individuals enrolled in both the MMA and LTC components of a comprehensive plan.

3. Rates shown reflect base rates and do not include the impacts of risk adjustment.

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FP020, Attachment I, Exhibit I-C, Page 6 of 8

WellCare of Florida, Inc.

d/b/a Staywell Health Plan of Florida

ATTACHMENT I

EXHIBIT I-C

MANAGED CARE PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS.

REGION 8



REGION 8									HIV/AIDS				Long-Term Care Program
Age Band	TANF		SSI No Medicare		Dual Eligible		Child Welfare		Dual Eligible		Medicaid Only		Dual Eligible		Medicaid Only
0-2 Months		$1,505.48		$25,939.47				$1,391.90
3-11 Months		$211.80		$4,932.06				$398.70
1-13 Years		$123.43		$444.30				$318.38
14-54 Years Female		$372.19
14-54 Years Male		$151.40
14+ Years (Female and Male)				$989.91				$589.93
55+ Years (Female and Male)		$410.45
Under Age 65						$139.16								$238.14		$2,387.98
Age 65+						$96.15								$131.09		$1,606.67
Medicare Advantage/D-SNP					TBD
HIV-AIDS										$172.00		$2,950.00

_______________

2. A factor of 0.9 will be applied to the LTC Dual Eligible and LTC Medicaid Only rates for individuals enrolled in both the MMA and LTC components of a comprehensive plan.

3. Rates shown reflect base rates and do not include the impacts of risk adjustment.

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FP020, Attachment I, Exhibit I-C, Page 7 of 8

WellCare of Florida, Inc.

d/b/a Staywell Health Plan of Florida

ATTACHMENT I

EXHIBIT I-C

MANAGED CARE PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS.

REGION 11



REGION 11									HIV/AIDS				Long-Term Care Program
Age Band	TANF		SSI No Medicare		Dual Eligible		Child Welfare		Dual Eligible		Medicaid Only		Dual Eligible		Medicaid Only
0-2 Months		$1,582.86		$29,647.73				$2,292.43
3-11 Months		$222.69		$5,637.14				$656.64
1-13 Years		$129.78		$507.82				$524.37
14-54 Years Female		$391.32
14-54 Years Male		$159.18
14+ Years (Female and Male)				$1,131.42				$971.60
55+ Years (Female and Male)		$431.55
Under Age 65						$178.07								$289.82		$2,787.50
Age 65+						$123.03								$159.53		$1,875.48
Medicare Advantage/D-SNP					TBD
HIV-AIDS										$165.00		$3,525.00

_______________

2. A factor of 0.9 will be applied to the LTC Dual Eligible and LTC Medicaid Only rates for individuals enrolled in both the MMA and LTC components of a comprehensive plan.

3. Rates shown reflect base rates and do not include the impacts of risk adjustment.

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FP020, Attachment I, Exhibit I-C, Page 8 of 8