Amendment No. 7 to Contract No. FA905 by and between the State of Florida, Agency for Health Care Administration and HealthEase of Florida, Inc. (Medicaid Non-Reform 2009-2012)
EX-10.55.8 2 fa905amendment7.htm FA905 AMENDMENT NO. 7 fa905amendment7.htm
Back to Form 10-K Exhibit 10.55.8
| HealthEase of Florida, Inc. | Medicaid HMO Non-Reform Contract | |
| AHCA CONTRACT NO. FA905 | ||
| AMENDMENT NO. 7 |
| 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., hereinafter referred to as the "Vendor" or “Health Plan”, is hereby amended as follows: |
| 1. | Effective November 1, 2011, Attachment I, Scope of Services, Capitated Health Plans, is hereby amended to include Attachment I, Exhibit 1-B, Revised Maximum Enrollment Levels, attached hereto and made a part of the Contract. All references in the Contract to Attachment I, Exhibits 1 and 1-A, shall hereinafter also refer to Attachment I, Exhibit 1- B, as appropriate. |
| 2. | Attachment II, Core Contract Provisions, Section XVI., Terms and Conditions, is hereby amended to include Item HH. as follows: |
| HH. | Scrutinized Companies Lists |
| The Vendor shall complete Attachment VI, Vendor Certification Regarding Scrutinized Companies Lists, attached hereto and made a part of the Contract, certifying that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, created pursuant to section 215.473, Florida Statutes (F.S.). Pursuant to section 287.135(5), F.S., the Vendor agrees the Agency may immediately terminate this Contract for cause if the Vendor is found to have submitted a false certifiation or if the Vendor is placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activitites in the iran Petroleum Energy Sector List during the term of the Contract. |
| Unless otherwise stated, this amendment is 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 the Cotnract. |
| 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. |
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| AHCA Contract No. FA905, Amendment No. 7, Page 1 of 2 |
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| HealthEase of Florida, Inc. | Medicaid HMO Non-Reform Contract |
| IN WITNESS WHEREOF, the Parties hereto have caused this seven (7) 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 BY: | /s/Christina Cooper | SIGNED BY: | /s/Elizabeth Dudek | |
| NAME: | Christina Cooper | NAME: | Elizabeth Dudek | |
| TITLE: | President, FL & HI Division | TITLE: | Secretary | |
| DATE: | 11/8/11 | DATE: | 11/16/2011 | |
| List of Attachments/Exhibits included as part of this amendment: |
| Specify Type | Letter/ Number | Description |
| Exhibit | 1-B | Revised Maximum Enrollment Levels (4 Pages) |
| Attachment | VI | Vendor Certification Regarding Scrutinized Companies Lists (1 Page) |
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| AHCA Contract No. FA905, Amendment No. 7, Page 2 of 2 |
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| HealthEase of Florida, Inc. | Medicaid HMO Non-Reform Contract | |
| ATTACHMENT I | ||
| EXHIBIT 1-B | ||
| REVISED MAXIUMU ENROLLMENT LEVELS |
| Maximum enrollment levels and Health Plan provider numbers associated with the counties and populations served. Exhibit 2-NR-B provide the capitation rate tables respective to the areas of operation listed below. |
| A. | Non-Reform | |
| See Exhibit 2-NR-B Table 2, General Capitation Rates plus Mental Health Rates |
Area 1 Counties: Escambia, Santa Rosa
| Effective Date: 11/01/11 Escambia, 08/01/11 Santa Rosa | ||
| County | Enrollment Level | Provider Number |
| Escambia | 67,500 | TBD |
| Santa Rosa | 31,500 | 015019343 |
| See Exhibit 2-NR-B Table 2, General Capitation Rates plus Mental Health Rates |
Area 2 Counties: Calhoun, Gadsden, Jefferson, Leon, Liberty, Madison, Wakulla
| Effective Date: 09/01/09 | ||
| County | Enrollment Level | Provider Number |
| Calhoun | 800 | 015019340 |
| Gadsden | 3,500 | 015019315 |
| Jefferson | 1,000 | 015019318 |
| Leon | 7,000 | 015019320 |
| Liberty | 400 | 015019342 |
| Madison | 1,500 | 015019322 |
| Wakulla | 1,000 | 015019336 |
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| AHCA Contract No. FA905, Attachment I, Exhibit 1-B, Page 1 of 4 |
| HealthEase of Florida, Inc. | Medicaid HMO Non-Reform Contract |
| | See Exhibit 2-NR-B Table 2, General Capitation Rates plus Mental Health Rates |
Area 3 Counties: Citrus, Lake, Marion, Putnam
| Effective Date: 09/01/09 | ||
| County | Enrollment Level | Provider Number |
| Citrus | 7,500 | 015019309 |
| Lake | 7,000 | 015019319 |
| Marion | 20,000 | 015019323 |
| Putnam | 6,000 | 015019329 |
| | See Exhibit 2-NR-B Table 2, General Capitation Rates plus Mental Health Rates |
Area 4 Counties: Duval, Volusia
| Effective Date: 09/01/09 | ||
| County | Enrollment Level | Provider Number |
| Duval | 55,000 | 015019313 |
| Volusia | 15,000 | 015019335 |
| | See Exhibit 2-NR-B Table 2, General Capitation Rates plus Mental Health Rates |
Area 5 Counties: Pasco, Pinellas
| Effective Date: 09/01/09 | ||
| County | Enrollment Level | Provider Number |
| Pasco | 6,000 | 015019302 |
| Pinellas | 9,000 | 015019303 |
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| AHCA Contract No. FA905, Attachment I, Exhibit 1-B, Page 2 of 4 |
| HealthEase of Florida, Inc. | Medicaid HMO Non-Reform Contract |
| | See Exhibit 2-NR-B Table 2, General Capitation Rates plus Mental Health Rates |
Area 6 Counties: Highlands, Hillsborough, Manatee, Polk
| Effective Date: 09/01/09 | ||
| County | Enrollment Level | Provider Number |
| Highlands | 3,000 | 015019317 |
| Hillsborough | 18,000 | 015019300 |
| Manatee | 6,000 | 015019301 |
| Polk | 10,000 | 015019304 |
| | See Exhibit 2-NR-B Table 2, General Capitation Rates plus Mental Health Rates |
Area 7 Counties: Brevard, Orange, Osceola, Seminole
| Effective Date: 09/01/09 | ||
| County | Enrollment Level | Provider Number |
| Brevard | 14,000 | 015019308 |
| Orange | 25,000 | 015019327 |
| Osceola | 8,000 | 015019328 |
| Seminole | 4,000 | 015019333 |
| | See Exhibit 2-NR-B Table 2, General Capitation Rates plus Mental Health Rates |
Area 8 County: Sarasota
| Effective Date: 09/01/09 | ||
| County | Enrollment Level | Provider Number |
| Sarasota | 3,000 | 015019332 |
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AHCA Contract No. FA905, Attachment I, Exhibit 1-B, Page 3 of 4
| HealthEase of Florida, Inc. | Medicaid HMO Non-Reform Contract |
| | See Exhibit 2-NR-B Table 2, General Capitation Rates plus Mental Health Rates |
Area 9 Counties: Martin, Palm Beach
| Effective Date: 09/01/09 | ||
| County | Enrollment Level | Provider Number |
| Martin | 5,000 | 015019324 |
| Palm Beach | 10,500 | 015019339 |
| | See Exhibit 2-NR-B Table 2, General Capitation Rates plus Mental Health Rates |
Area 10 County: Broward
| Effective Date: 09/01/09 | ||
| County | Enrollment Level | Provider Number |
| Broward | 13,500 | 015019337 |
| | See Exhibit 2-NR-B Table 2, General Capitation Rates plus Mental Health Rates, plus Transportation |
Area 11 County: Miami-Dade
| Effective Date: 09/01/09 | ||
| County | Enrollment Level | Provider Number |
| Miami-Dade | 25,000 | 015019338 |
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| AHCA Contract No. FA905, Attachment I, Exhibit 1-B, Page 4 of 4 |
| ATTACHMENT VI |
| VENDOR CERTIFICATION REGARDING |
| SCRUTINZED COMPANIES LISTS |
| Vendor Name: | HealthEase of Florida, Inc. | ||
| Vendor FEIN: | ###-###-#### | ||
| Vendor's authorized Representative Name and Title: | Christina Cooper, President |
| Address: | 8735 Henderson Rd | |
| City: | Tampa | State: | FL | Zip: | 33634 | |
| Telephone Number: | 813 ###-###-#### | |||||
| Email Address: | chrissie.cooper @wellcare.com | |||||
| Section 287.135, Florida Statutes, prohibits agencies from contracting with companies, for goods or services over $1,000,000, that are on either the Scrutinized Compaies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List. Both lists are created pursuant to section 215.473, Florida Statutes. |
| As the person authorized to sign on behal of the Vendor, I hereby certify that the company identified above in the section entitled "Vendor Name" is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List. I understand that pursuant to section 287.135, Florida Statutes, the submission of a false certification may subject company to civil penalties, attorney's fees, and/or costs. |
| Certified By: | /s/Christina Cooper | , who is |
| authorized to sign on behalf of the above referenced company. | ||
| Authorized Signature Print Name and Title: | Christina Cooper, President | |
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| AHCA Contract No. FA905, Attachment VI, Page 1 of 1 |
