Amendment No. 12 to Contract No. FAR001 between the Agency for Health Care Administration and HealthEase of Florida, Inc
EX-10.1 2 amend12-far001.htm AMENDMENT NO. 12 TO CONTRACT NO. FAR001 BETWEEN AHCA AND HEALTHEASE OF FLORIDA, INC. amend12-far001.htm
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Exhibit 10.1
| HealthEase of Florida, Inc | Medicaid Reform HMO Contract |
AHCA CONTRACT NO. FAR001
AMENDMENT NO. 12
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. | Standard Contract, Section III, Item C, Contract Managers, sub-item 1, is hereby amended to now read as follows: |
1. The Agency's Contract Manager's name, address and telephone number for this Contract is as follows:
| Suzanne S. Gjevukaj Agency for Health Care Administration 2727 Mahan Drive, MS#50 Tallahassee, FL 32308 (850) 487-2355 |
| 2. | Effective March 1, 2009, Attachment I, Scope of Services, is hereby amended to include Exhibit 3-E, Medicaid Reform HMO Capitation Rates, March 1, 2009 - August 31, 2009, attached hereto and made a part of the Contract. All references in the Contract to Exhibit 3-D, Medicaid Reform HMO Capitation Rates, September 1, 2008 - August 31, 2009, shall hereinafter also refer to Exhibit 3-E, Medicaid Reform HMO Capitation Rates, March 1, 2009 - August 31, 2009, as appropriate. |
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, is hereby made 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 four (4) 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/ Heath Schiesser | SIGNED BY: /s/ Holly Benson |
| NAME: Heath Schiesser | NAME: Holly Benson |
| TITLE: President and CEO | TITLE: Secretary |
| DATE: _______________________ | DATE: 4/22/09 |
List of Attachments/Exhibits included as part of this Amendment:
| Specify Type | Letter/ Number | Description |
| Exhibit | 3-E | Medicaid Reform HMO Capitation Rates March 1, 2009 - August 31, 2009 (3 Pages) |
AHCA Contract No. FAR001, Amendment No. 12, Page 1 of 1
AHCA Form 2100-0002 (Rev. NOV03)
EXHIBIT 3-E
MEDICAID REFORM HMO CAPITATION RATES
| | (By Area, Age, and Eligibility Category) |
March 1, 2009 - August 31, 2009
TABLE 2
March 1, 2009
| Area: | 10 | County: | Broward |
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
| Eligibility Category/ Population | Total Rates for Comprehensive and Catastrophic Components | Total Rate for Comprehensive Component Only | |
| Children and Families: | |||
| Newborns aged 0-2 months | $ | 870.65 | $ 752.38 |
| Newborns aged 3-11 months | $ | 194.87 | $ 185.35 |
| Age 1 and Up - Base Rate for Risk adjustment | $ | 107.38 | $ 105.65 |
| Aged and Disabled: | |||
| No Medicare | |||
| Newborns aged 0-2 months | $ | 17,615.21 | $ 9,196.19 |
| Newborns aged 3-11 months | $ | 3,905.88 | $ 2,173.23 |
| Age 1 and Up - Base Rate for Risk Adjustment | $ | 791.77 | $ 727.47 |
| Medicare Parts A and B | |||
| Under Age 65 | $ | 139.45 | N/A |
| Age 65 and over | $ | 99.73 | N/A |
| Medicare Part B Only | |||
| All ages | $ | 265.82 | N/A |
| | |||
| HIV/AIDS Specialty Population | |||
| No Medicare HIV | $ | 1,828.67 | N/A |
| No Medicare AIDS | $ | 3,431.73 | N/A |
| Medicare HIV | $ | 256.73 | N/A |
| Medicare AIDS | $ | 548.09 | N/A |
| Kick Payments Amounts for Covered Obstetrical Delivery Services: | ||
| CPT Code | Obstetrical Delivery CPT Code Description | Payment Amount |
| 59409 | Vaginal delivery only | $3,941.45 |
| 59410 | Vaginal delivery including postpartum care | |
| 59515 | Cesarean delivery including postpartum care | |
| 59612 | Vaginal delivery only, after previous cesarean delivery | |
| 59614 | Vaginal delivery only, after previous cesarean delivery including postpartum care | |
| 59622 | Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery inc postpartum care | |
AHCA Contract No. FAR001, Exhibit 3-E, Page 1 of 3
EXHIBIT 3-E
MEDICAID REFORM HMO CAPITATION RATES
| | (By Area, Age, and Eligibility Category) |
March 1, 2009 - August 31, 2009
March 1, 2009
| Area: | 4 | County: | Duval, Baker, Clay and Nassau |
(ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
| Eligibility Category/ Population | Total Rates for Comprehensive and Catastrophic Component | Total Rate for Comprehensive Component Only |
| Children and Families: | ||
| Newborns aged 0-2 months | $ 897.40 | $ 775.51 |
| Newborns aged 3-11 months | $ 197.22 | $ 187.59 |
| Age 1 and Up - Base Rate for Risk Adjustment | $ 110.51 | $ 108.73 |
| Aged and Disabled: | ||
| No Medicare | ||
| Newborns aged 0-2 months | $ 14,269.34 | $ 7,449.45 |
| Newborns aged 3-11 months | $ 3,180.71 | $ 1,769.74 |
| Age 1 and Up - Base Rate for Risk Adjustment | $ 612.15 | $ 562.43 |
| Medicare Parts A and B | ||
| Under Age 65 | $ 158.45 | N/A |
| Age 65 and over | $ 113.24 | N/A |
| Medicare Part B Only | ||
| All ages | $ 327.22 | N/A |
| HIV/AIDS Specialty Population | ||
| No Medicare HIV | $ 1,163.67 | N/A |
| No Medicare AIDS | $ 2,290.84 | N/A |
| Medicare HIV | $ 157.74 | N/A |
| Medicare AIDS | $ 336.77 | N/A |
| Kick Payments Amounts for Covered Obstetrical Delivery Services: | ||
| CPT Code | Obstetrical Delivery CPT Code Description | Payment Amount |
| 59409 | Vaginal delivery only | $3,977.49 |
| 59410 | Vaginal delivery including postpartum care | |
| 59515 | Cesarean delivery including postpartum care | |
| 59612 | Vaginal delivery only, after previous cesarean delivery | |
| 59614 | Vaginal delivery only, after previous cesarean delivery including postpartum care | |
| 59622 | Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery inc postpartum care | |
AHCA Contract No. FAR001, Exhibit 3-E, Page 2 of 3
EXHIBIT 3-E
MEDICAID REFORM HMO CAPITATION RATES
(By Area, Age, and Eligibility Category)
March 1, 2009 - August 31, 2009
March 1, 2009
| Area: | 10 | County: | Broward |
| Area: | 4 | County: | Duval, Baker, Clay and Nassau |
| CPT Code | Transplant CPT Code Description | Children/Adolescents or Adult | Payment Amount |
| 32851 | lung single, without bypass | Children/Adolescents | $320,800.00 |
| 32851 | lung single, without bypass | Adult | $238,000.00 |
| 32852 | lung single, with bypass | Children/Adolescents | $320,800.00 |
| 32852 | lung single, with bypass | Adult | $238,000.00 |
| 32853 | lung double, without bypass | Children/Adolescents | $320,800.00 |
| 32853 | lung double, without bypass | Adult | $238,000.00 |
| 32854 | lung double, with bypass | Children/Adolescents | $320,800.00 |
| 32854 | lung double, with bypass | Adult | $238,000.00 |
| 33945 | heart transplant with or without recipient cardiectomy | All Age Groups | $162,000.00 |
| 47135 | liver, allotransplation, orthotopic, partial or whole from cadaver or living donor | All Age Groups | $122,600.00 |
| 47136 | liver, heterotopic, partial or whole from cadaver or living donor any age | All Age Groups | $122,600.00 |
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AHCA Contract No. FAR001, Exhibit 3-E, Page 3 of 3
