AHCA CONTRACT NO. FA971 AMENDMENT NO. 4
EX-10.5 4 ex105fa971amendment4.htm EXHIBIT Ex105FA971Amendment4
EXHIBIT 10.5
AHCA CONTRACT NO. FA971
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," or “Health Plan,” is hereby amended as follows:
1. | Effective August 1, 2013, Attachment I, Scope of Services, Capitated Health Plans, Exhibit 1, Maximum Enrollment Levels, Effective Date 09/01/12 – 08/31/15, Exhibit 1-A, Maximum Enrollment Levels, and Exhibit 1-B, Maximum Enrollment Levels, Effective Date 09/01/12 – 08/31/15, are hereby deleted in their entirety and replaced with Exhibit 1, Maximum Enrollment Levels, Effective Date 08/01/2013 – 08/31/2015, attached hereto and made part of this Contract. All references in this Contract to Exhibit 1, Maximum Enrollment Levels, Effective Date 09/01/12 – 08/31/15, Exhibit 1-A, Maximum Enrollment Levels, and Exhibit 1-B, Maximum Enrollment Levels, Effective Date 09/01/12 – 08/31/15, shall hereinafter refer to Exhibit 1, Maximum Enrollment Levels, Effective Date 08/01/2013 – 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 six (6) 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 | ||
STAYWELL HEALTH PLAN OF FLORIDA | 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: August 23, 2013 | DATE: 8/26/13 | ||
List of Attachments/Exhibits included as part of this Amendment:
Specify | Letter/ | |||
Type | Number | Description | ||
Attachment I | Exhibit I | Maximum Enrollment Levels, Effective Date | ||
08/01/2013 - 08/31/2015 (5 Pages) | ||||
AHCA Contract No. FA971, Amendment No. 4, Page 1 of 1
Medicaid Non-Reform HMO Contract
WellCare of Florida, Inc. d/b/a
Staywell Health Plan of Florida
ATTACHMENT I
EXHIBIT 1
MAXIMUM ENROLLMENT LEVELS
EFFECTIVE DATE 08/01/2013 – 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 and Exhibit 2-R 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: Okaloosa, Walton
Effective Date: 01/01/2013 | ||
County | Enrollment Level | Provider Number |
Okaloosa | 12,400 | 15016943 |
Walton | 3,700 | 15016944 |
See Exhibit 2-NR Table 2, General Capitation Rates plus Mental Health Rates
Area 2 Counties: Franklin, Taylor, Gulf, Holmes, Jackson, Washington
Effective Date: 11/01/2012 | ||
County | Enrollment Level | Provider Number |
Franklin | 1,000 | 15016926 |
Taylor | 2,500 | 15016935 |
Effective Date: 01/01/2013 | ||
Gulf | 1,300 | 15016939 |
Holmes | 2,800 | 15016940 |
Jackson | 5,500 | 15016941 |
Washington | 2,800 | 15016945 |
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
AHCA Contract No. FA971, Attachment I, Exhibit 1, Page 1 of 5
Medicaid Non-Reform HMO Contract
WellCare of Florida, Inc. d/b/a
Staywell Health Plan of Florida
See Exhibit 2-NR Table 2, General Capitation Rates plus Mental Health Rates
Area 3 Counties: | Hernando, Sumter, Columbia, Bradford, Dixie, Gilchrist, Hamilton, Lafayette, Levy, Suwannee, Union, Alachua |
Effective Dates: 09/01/2012 | ||
County | Enrollment Level | Provider Number |
Hernando | 15,000 | 15016901 |
Sumter | 4,500 | 15016916 |
Columbia | 8,200 | 15016922 |
Effective Dates: 11/01/2012 | ||
Bradford | 3,000 | 15016924 |
Dixie | 1,900 | 15016925 |
Gilchrist | 1,600 | 15016927 |
Hamilton | 1,900 | 15016929 |
Lafayette | 600 | 15016931 |
Levy | 4,900 | 15016932 |
Suwannee | 5,300 | 15016934 |
Union | 1,400 | 15016936 |
Effective Dates: 01/01/2013 | ||
Alachua | 19,100 | 15016937 |
See Exhibit 2-NR Table 2, General Capitation Rates plus Mental Health Rates
Area 4 Counties: St. Johns, Flagler
Effective Date: 09/01/2012 | ||
County | Enrollment Level | Provider Number |
St. Johns | 8,300 | 15016920 |
Flagler | 7,400 | 15016923 |
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AHCA Contract No. FA971, Attachment I, Exhibit 1, Page 2 of 5
Medicaid Non-Reform HMO Contract
WellCare of Florida, Inc. d/b/a
Staywell Health Plan of Florida
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 | 7,000 | 15016903 |
Pinellas | 15,000 | 15016904 |
See Exhibit 2-NR Table 2, General Capitation Rates plus Mental Health Rates
Area 6 Counties: Hillsborough, Manatee, Polk, Hardee
Effective Date: 09/01/12 | ||
County | Enrollment Level | Provider Number |
Hillsborough | 28,000 | 15016902 |
Manatee | 12,000 | 15016912 |
Polk | 25,000 | 15016905 |
Hardee | 4,100 | 15016921 |
See Exhibit 2-NR Table 2, General Capitation Rates plus Mental Health Rates
Area 7 Counties: Orange, Seminole, Osceola, Brevard
Effective Date: 09/01/2012 | ||
County | Enrollment Level | Provider Number |
Orange | 75,000 | 15016906 |
Seminole | 10,000 | 15016908 |
Osceola | 30,000 | 15016907 |
Brevard | 30,000 | 15016913 |
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AHCA Contract No. FA971, Attachment I, Exhibit 1, Page 3 of 5
Medicaid Non-Reform HMO Contract
WellCare of Florida, Inc. d/b/a
Staywell Health Plan of Florida
See Exhibit 2-NR Table 2, General Capitation Rates plus Mental Health Rates
Area 8 Counties: DeSoto, Lee, Sarasota, Charlotte, Glades, Hendry, Collier
Effective Dates: 09/01/2012 | ||
County | Enrollment Level | Provider Number |
DeSoto | 4,100 | 15016919 |
Lee | 15,000 | 15016911 |
Sarasota | 6,000 | 15016914 |
Charlotte | 27,000 | 15016917 |
Effective Dates: 11/01/2012 | ||
Glades | 500 | 15016928 |
Hendry | 6,000 | 15016930 |
Effective Dates: 01/01/2013 | ||
Collier | 22,800 | 15016938 |
See Exhibit 2-NR Table 2, General Capitation Rates plus Mental Health Rates
Area 9 Counties: Palm Beach, St. Lucie, Indian River, Okeechobee
Effective Dates: 09/01/2012 | ||
County | Enrollment Level | Provider Number |
Palm Beach | 15,000 | 15016910 |
St. Lucie | 4,500 | 15016915 |
Indian River | 10,500 | 15016918 |
Effective Dates: 11/01/2012 | ||
Okeechobee | 5,000 | 15016933 |
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 | 25,000 | 15016900 |
AHCA Contract No. FA971, Attachment I, Exhibit 1, Page 4 of 5
Medicaid Non-Reform HMO Contract
WellCare of Florida, Inc. d/b/a
Staywell Health Plan of Florida
See Exhibit 2-NR Table 2, General Capitation Rates, Mental Health Rates
Area 11 County: Miami-Dade, Monroe
Effective Date: 09/01/2012 | ||
County | Enrollment Level | Provider Number |
Miami-Dade | 25,000 | 15016909 |
Effective Date: 01/01/2013 | ||
Monroe | 3,600 | 15016942 |
B. Reform
See Exhibit 2-R (Baker, Clay, Duval, Nassau)
Agency Area 4
Effective Date: 01/01/2013 | ||
County | Enrollment Level | Provider Number |
Baker | 5,000 | 7293703 |
Clay | 5,000 | 7293704 |
Duval | 20,000 | 7293701 |
Nassau | 5,000 | 7293702 |
See Exhibit 2-R (Broward)
Agency Area 10
Effective Date: 01/01/2013 | ||
County | Enrollment Level | Provider Number |
Broward | 10,000 | 7293700 |
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AHCA Contract No. FA971, Attachment I, Exhibit 1, Page 5 of 5
