Amendment number 8 to Contract No. FA615, dated September 1, 2006, between the State of Florida, Agency for Health Care Administration and WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida (Medicaid Non-Reform Contract 2006-2009)

EX-10.1 2 staywellamendment8.htm AMENDMENT 8 TO STAYWELL CONTRACT staywellamendment8.htm
Back to Form 8-K
Exhibit 10.1
 
WellCare of Florida, Inc. d/b/a           
Staywell Health Plan of Florida                                                                              
 
 Medicaid HMO Contract

 
AHCA CONTRACT NO. FA615
AMENDMENT NO. 8

 
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 February 1, 2009, Attachment I, Scope of Services, is hereby amended to include Exhibit III-E, February 1, 2009 - August 31, 2009 Medicaid Non-Reform HMO Capitation Rates, attached hereto and made a part of the Contract. All references in the Contract to Exhibit III-D, September 1, 2008 - August 31, 2009 Medicaid Non-Reform HMO Capitation Rates, shall hereinafter also refer to Exhibit III-E, February 1, 2009 -August 31, 2009 Medicaid Non-Reform HMO Capitation Rates, 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 are hereby made a 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 six (6) page Amendment (which includes all attachments hereto) to be executed by their officials thereunto duly authorized.
                                                                                         
WELLCARE OF FLORIDA, INC.
D/B/A STAYWELL HEALTH PLAN
OF FLORIDA         
                                                                           
    
STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
 
SIGNED
BY: /s/ Heath Schiesser                    
SIGNED
BY: /s/ Name Illegible                         
NAME: Heath Schiesser                  
NAME: for Holly Benson                  
TITLE: President and CEO               
TITLE: Secretary                                 
DATE: 2-17-09                                   
DATE: 2/19/09                                     
   

List of Attachments/Exhibits included as part of this Amendment:
 
Specify
Type
Letter/
Number
 
Description
Exhibit
III-E
February 1, 2009 - August 31, 2009 Medicaid Non-Reform HMO
Capitation Rates (5 pages)

 
AHCA Contract No. FA615, Amendment No. 8, Page 1 of 1
AHCA Form 2100-0002 (Rev. NOV03)

 
 
 
 
EXHIBIT III-E
February 1, 2009 - August 31, 2009 HMO RATES
(MEDICAID Non-Reform HMO CAPITATION RATES)
By Area , Age and Eligibility Category
                                       
 
TABLE 1
                                    
General Rates:
                                  
                                       
 
TANF
              
 
     
SSI-N
      
SSI-B
SSI-AB
  
Area
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
         AGE (14-20)
     AGE (21-54)
AGE (55+)
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
AGE (14-20)
AGE (21-54)
AGE (55+)
  
AGE (65-)
AGE (65+)
         
Female
Male
Female
Male
                      
01
1,113.37
187.38
101.38
61.45
129.49
69.52
255.23
153.37
318.51
10,428.92
1,517.58
445.88
198.88
213.14
696.73
700.31
305.88
94.80
85.77
02
1,113.37
187.38
101.38
61.45
129.49
69.52
255.23
153.37
318.51
10,428.92
1,517.58
445.88
198.88
213.14
696.73
700.31
305.88
94.80
85.77
03
1,217.57
206.51
112.28
69.11
143.30
77.85
283.53
171.42
359.72
11,442.82
1,680.06
495.07
226.05
241.47
787.51
795.55
340.56
90.01
81.98
04
1,067.51
181.92
99.04
61.51
126.30
69.23
250.83
152.26
321.21
10,972.58
1,615.28
476.38
218.79
233.36
761.37
770.55
297.82
90.35
82.40
05
1,214.96
206.53
112.30
69.38
143.25
78.21
284.08
172.12
361.87
12,248.94
1,796.88
528.79
240.95
256.93
840.31
849.11
225.19
81.19
75.29
06
1,056.56
181.19
98.87
61.99
126.18
69.68
251.35
153.20
325.45
11,162.18
1,645.44
485.06
223.95
237.92
777.94
788.05
274.94
79.31
72.63
07
1,092.94
186.84
101.87
63.49
129.77
71.35
258.27
157.02
332.09
11,810.40
1,744.81
514.41
238.57
254.24
828.77
840.70
373.98
84.56
77.61
08
1,033.51
177.08
96.67
60.37
123.15
68.03
245.23
149.29
316.91
10,525.98
1,550.30
457.03
210.03
224.35
731.36
740.14
256.24
78.77
72.23
09
1,067.78
181.58
98.82
61.05
126.06
68.67
249.80
151.41
318.38
11,078.29
1,635.46
482.13
223.68
237.34
775.59
785.85
219.29
84.42
77.20
10
1,083.46
186.09
101.73
63.88
129.70
71.87
258.53
157.78
335.92
14,344.29
2,132.34
629.36
297.17
314.18
1,027.07
1,044.85
322.21
94.02
86.21
11
1,372.19
232.59
126.24
77.54
161.30
87.46
319.10
192.88
404.23
14,488.14
2,131.88
628.05
289.19
307.93
1,004.54
1,015.98
370.49
140.27
126.63
6B*
1,056.42
181.17
98.86
61.98
126.16
69.67
251.32
153.18
325.40
11,161.68
1,645.35
485.04
223.94
237.91
777.89
788.02
274.94
79.31
72.63
 
TABLE 2
                                    
                                       
General + Mental Health Rates:
                              
                                       
 
TANF
                      
SSI-N
      
SSI-B
SSI-AB
  
Area
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
      AGE (14-20)
       AGE (21-54)
AGE (55+)
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
AGE (14-20)
AGE (21-54)
AGE (55+)
  
AGE (65-)
AGE (65+)
         
Female
      Male
Female
     Male
                      
01
1,113.39
187.40
103.02
73.14
140.42
80.45
259.67
157.81
322.25
10,429.00
1,517.66
453.32
246.93
257.13
778.13
731.29
306.09
106.45
97.42
02
1,113.40
187.41
104.29
81.71
142.91
82.94
258.64
156.78
321.46
10,429.08
1,517.74
459.67
277.70
258.36
749.41
725.19
326.08
109.81
100.78
03
1,217.58
206.52
113.60
78.29
149.38
83.93
285.07
172.96
361.06
11,442.89
1,680.13
501.33
261.81
261.99
811.41
806.83
347.41
98.99
90.96
04
1,067.52
181.93
100.42
71.07
132.64
75.57
252.44
153.87
322.61
10,972.69
1,615.39
486.14
274.53
265.34
798.63
788.14
322.37
107.12
99.17
05
1,214.97
206.54
113.51
78.06
151.36
86.32
287.37
175.41
364.65
12,248.99
1,796.93
533.81
273.37
286.61
895.23
870.01
227.92
94.01
88.11
06
1,056.58
181.21
100.72
75.24
138.56
82.06
256.38
158.23
329.70
11,162.25
1,645.51
491.58
266.06
276.46
849.27
815.20
276.25
83.20
76.52
07
1,092.96
186.86
103.65
76.18
141.63
83.21
263.09
161.84
336.16
11,810.46
1,744.87
520.53
278.08
290.41
895.70
866.18
376.57
95.08
88.13
08
1,033.52
177.09
97.93
69.16
128.97
73.85
246.72
150.78
318.20
10,526.05
1,550.37
463.03
244.31
244.03
754.27
750.96
263.09
91.99
85.45
09
1,067.80
181.60
100.37
71.86
133.22
75.83
251.62
153.23
319.95
11,078.36
1,635.53
488.46
259.82
258.08
799.75
797.26
226.14
94.01
86.79
10
1,083.48
186.11
103.65
77.24
138.55
80.72
260.78
160.03
337.87
14,344.39
2,132.44
637.71
344.88
341.56
1,058.95
1,059.91
329.06
102.08
94.27
11
1,372.21
232.61
127.86
88.83
168.79
94.95
321.01
194.79
405.88
14,488.22
2,131.96
635.02
328.99
330.76
1,031.14
1,028.54
377.72
148.33
134.69
6B*
1,056.44
181.19
100.61
74.50
137.86
81.37
256.07
157.93
329.41
11,161.75
1,645.42
491.54
265.93
276.34
849.01
815.09
276.25
83.20
76.52
                                       
 
                          
 
AHCA Contract No. FA615, Exhibit III-E, 1 of 5
 
 
EXHIBIT III-E
February 1. 2009 -August 31, 2009 HMO RATES
(MEDICAID Non-Reform HMO CAPITATION RATES)
By Area , Age and Eligibility Category
                                       
                                       
TABLE 3
                                    
General + MIH + Dental Rates:
                              
                                       
 
TANF
                  
SSI-N
 
       
SSI-B
SSI-AB
  
Area
BTHMG+2MO
 3MO-11MO
    AGE (1-5)
AGE (6-13)
         AGE (14-20)
 AGE (21-54)
AGE (55+)
  BTHMO+2MO
 3MO-11MO
AGE (1-5)
AGE (6-13)
AGE (14-20)
AGE (21-54)
 AGE (55+)
    
AGE (65-)
AGE (65+)
         
     Female
      Male
    Female
    Male
                      
01
1,113.39
187.41
104.70
76.25
143.60
83.14
260.89
159.07
325.04
10,429.00
1,517.66
454.94
249.33
259.19
779.46
733.15
306.54
107.57
98.28
02
1,113.40
187.42
105.97
84.82
146.09
85.63
259.86
158.04
324.25
10,429.08
1,517.74
461.29
280.10
260.42
750.74
727.05
326.53
110.93
101.64
03
1,217.59
206.54
116.65
83.95
155.15
88.81
286.81
174.74
365.03
11,442.89
1,680.14
504.46
266.45
265.98
813.29
809.48
348.44
100.64
92.22
04
1,067.53
181.94
102.26
74.49
136.14
78.52
254.11
155.59
326.43
10,972.69
1,615.39
487.92
277.17
267.61
800.51
790.78
324.55
108.71
100.38
05
1,214.98
206.56
116.92
84.39
157.83
91.79
290.78
178.92
372.44
12,249.00
1,796.94
538.03
279.64
291.99
898.93
875.21
231.58
97.80
91.00
06
1.056.59
181.22
103.39
80.20
143.62
86.34
258.26
160.17
334.00
11,162.25
1,645.52
494.62
270.56
280.33
851.77
818.71
278.01
85.45
78.23
07
1,092.97
186.87
106.05
80.63
146.17
87.05
264.42
163.20
339.20
11,810.46
1,744.88
523.53
282.52
294.23
897.25
868.36
377.05
96.60
89.29
08
1,033.53
177.11
101.57
75.90
135.86
79.68
248.74
152.85
322.80
10,526.05
1,550.38
466.45
249.39
248.39
756.55
754.16
264.63
93.66
86.72
09
1,067.81
181.62
103.30
77.30
138.78
80.53
252.58
154.21
322.14
11,078.36
1,635.54
491.05
263.67
261.39
800.93
798.91
227.97
95.08
87.60
10
1,083.49
186.12
106.08
81.75
143.16
84.62
261.51
160.78
339.53
14,344.39
2,132.45
640.50
349.02
345.12
1,059.90
1,061.24
329.88
103.38
95.25
11
1,372.22
232.62
131.59
96.51
176.76
101.67
321.87
195.67
407.84
14,488.23
2,131.98
639.29
336.38
337.23
1,032.92
1,031.04
381.06
150.49
136.34
6B*
1,056.45
181.20
103.28
79.46
142.92
85.65
256.07
157.93
329.41
11,161.75
1,645.43
494.58
270.43
280.21
849.01
815.09
278.01
85.45
78.23
                                       
                                       
 
TABLE 4
                                    
General + MIH + Transportation Rates:
                            
 
TANF
                      
SSI-N
      
SSI-B
SSI-AB
  
Area
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
      AGE (14-20)
    AGE (21-54)
AGE (55+)
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
  AGE (14-20)
AGE (21-54)
AGE (55+)
  
AGE (65-)
AGE (65+)
         
Female
      Male
Female
     Male
                      
01
1,118.74
188.77
103.85
73.64
142.45
81.79
262.97
160.32
325.76
10,468.09
1,543.33
458.61
249.36
263.26
798.19
748.22
313.56
120.17
106.26
02
1,118.75
188.78
105.12
82.21
144.94
84.28
261.94
159.29
324.97
10,468.17
1,543.41
464.96
280.13
264.49
769.47
742.12
333.55
123.53
109.62
03
1,224.01
208.18
114.60
78.89
151.82
85.54
289.04
175.98
365.28
11,492.20
1,712.51
508.01
264.88
269.71
836.72
828.19
356.12
118.76
103.70
04
1,072.09
183.11
101.13
71.50
134.38
76.72
255.26
156.01
325.61
11,011.02
1,640.55
491.32
276.91
271.34
818.29
804.74
329.55
122.97
109.39
05
1,218.84
207.54
114.11
78.42
152.83
87.29
289.75
177.22
367.18
12,280.81
1,817.81
538.12
275.35
291.59
911.55
883.79
234.47
108.09
97.18
06
1,060.38
182.19
101.31
75.60
140.00
83.01
258.73
160.02
332.19
11,193.75
1,666.20
495.85
268.01
281.39
865.43
828.84
281.96
94.76
83.97
07
1,096.99
187.89
104.28
76.56
143.16
84.23
265.58
163.74
338.80
11,845.21
1,767.68
525.23
280.23
295.85
913.53
881.23
381.95
107.21
95.94
08
1,038.81
178.45
98.76
69.66
130.99
75.18
249.98
153.26
321.67
10,564.27
1,575.46
468.20
246.69
250.01
773.87
767.52
269.02
106.78
94.97
09
1,072.91
182.92
101.17
72.34
135.16
77.11
254.77
155.63
323.30
11,117.70
1,661.37
493.79
262.27
264.24
819.93
814.30
232.70
109.81
96.97
10
1,086.47
186.89
104.12
77.52
139.69
81.47
262.62
161.43
339.83
14,370.64
2,149.68
641.26
346.51
345.67
1,072.41
1,071.28
334.36
114.42
102.22
11
1,375.30
233.40
128.34
89.12
169.97
95.73
322.92
196.24
407.91
14,515.60
2,149.93
638.72
330.69
335.05
1,045.18
1,040.40
382.84
160.77
142.70
6B*
1,060.24
182.17
101.20
74.86
139.30
82.32
258.42
159.72
331.90
11,193.25
1,666.11
495.81
267.88
281.27
865.17
828.73
281.96
94.76
83.97
                                       
 
AHCA Contract No. FA615, Exhibit III-E, 2 of 5
 
 
EXHIBIT lll-E
February 1, 2009 - August 31, 2009 HMO RATES
(MEDICAID Non-Reform HMO CAPITATION RATES)
By Area , Age and Eligibility Category
                                       
TABLE 5
                                  
General + Transportation Rates:
                              
 
TANF
                  
SSI-N
    
 
   
SSi-B
SSI-AB
Area
BTHMO+2MO
3MO-11MO
AGE (1-5)
     AGE (6-13)       AGE (14-20)
AGE (21-54)
AGE (55+)
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
AGE (14-20)
 AGE (21-54)
AGE (55+)
  
AGE (65-)
  AGE (65+)
         
         Female
       Male
      Female
     Male
                      
01
1,118.72
188.75
102.21
61.95
131.52
70.86
258.53
155.88
322.02
10,468.01
1,543.25
451.17
201.31
219.27
716.79
717.24
313.35
108.52
94.61
02
1,118.72
188.75
102.21
61.95
131.52
70.86
258.53
155.88
322.02
10,468.01
1,543.25
451.17
201.31
219.27
716.79
717.24
313.35
108.52
94.61
03
1,224.00
208.17
113.28
69.71
145.74
79.46
287.50
174.44
363.94
11,492.13
1,712.44
501.75
229.12
249.19
812.82
816.91
349.27
109.78
94.72
04
1,072.08
183.10
99.75
61.94
128.04
70.38
253.65
154.40
324.21
11,010.91
1,640.44
481.56
221.17
239.36
781.03
787.15
305.00
106.20
92.62
05
1,218.83
207.53
112.90
69.74
144.72
79.18
286.46
173.93
364.40
12,280.76
1,817.76
533.10
242.93
261.91
856.63
862.89
231.74
95.27
84.36
06
1,060.36
182.17
99.46
62.35
127.62
70.63
253.70
154.99
327.94
11,193.68
1,666.13
489.33
225.90
242.85
794.10
801.69
280.65
90.87
80.08
07
1,096.97
187.87
102.50
63.87
131.30
72.37
260.76
158.92
334.73
11,845.15
1,767.62
519.11
240.72
259.68
846.60
855.75
379.36
96.69
85.42
08
1,038.80
178.44
97.50
60.87
125.17
69.36
248.49
151.77
320.38
10,564.20
1,575.39
462.20
212.41
230.33
750.96
756.70
262.17
93.56
81.75
09
1,072.89
182.90
99.62
61.53
128.00
69.95
252.95
153.81
321.73
11,117.63
1,661.30
487.46
226.13
243.50
795.77
802.89
225.85
100.22
87.38
10
1,086.45
186.87
102.20
64.16
130.84
72.62
260.37
159.18
337.88
14,370.54
2,149.58
632.91
298.80
318.29
1,040.53
1,056.22
327.51
106.36
94.16
11
1,375.28
233.38
126.72
77.83
162.48
88.24
321.01
194.33
406.26
14,515.52
2,149.85
631.75
290.89
312.22
1,018.58
1,027.84
375.61
152.71
134.64
6B*
1,060.22
182.15
99.45
62.34
127.60
70.62
253.67
154.97
327.89
11,193.18
1,666.04
489.31
225.89
242.84
794.05
801.66
280.65
90.87
80.08
                                       
 
TABLE 6
                                    
General + Dental Rates:
                                
 
TANF
                  
SSI-N
          
SSI-B
SSS-AB
Area
BTHMO+2MO
  3MO-11MO
AGE (1-5)
AGE (6-13)
    AGE (14-20)
   AG E (21-54)
AGE (55+)
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
AGE (14-20)
AGE (21-54)
AGE (55+)
  
AGE (65-)
   AGE (65+)
         
  Female
        Male
     Female
     Male
                      
01
1,113.37
187.39
103.06
64.56
132.67
72.21
256.45
154.63
321.30
10,428.92
1,517.58
447.50
201.28
215.20
698.06
702.17
306.33
95.92
86.63
02
1,113.37
187.39
103.06
64.56
132.67
72.21
256.45
154.63
321.30
10,428.92
1,517.58
447.50
201.28
215.20
698.06
702.17
306.33
95.92
86.63
03
1,217.58
206.53
115.33
74.77
149.07
82.73
285.27
173.20
363.69
11,442.82
1,680.07
498.20
230.69
245.46
789.39
798.20
341.59
91.66
83.24
04
1,067.52
181.93
100.88
64.93
129.80
72.18
252.50
153.98
325.03
10,972.58
1,615.28
478.16
221.43
235.63
763.25
773.19
300.00
91.94
83.61
05
1,214.97
206.55
115.71
75.71
149.72
83.68
287.49
175.63
369.66
12,248.95
1,796.89
533.01
247.22
262.31
844.01
854.31
228.85
84.98
78.18
06
1,056.57
181.20
101.54
66.95
131.24
73.96
253.23
155.14
329.75
11,162.18
1,645.45
488.10
228.45
241.79
780.44
791.56
276.70
81.56
74.34
07
1,092.95
186.85
104.27
67.94
134.31
75.19
259.60
158.38
335.13
11,810.40
1,744.82
517.41
243.01
258.06
830.32
842.88
374.46
86.08
78.77
08
1,033.52
177.10
100.31
67.11
130.04
73.86
247.25
151.36
321.51
10,525.98
1,550.31
460.45
215.11
228.71
733.64
743.34
257.78
80.44
73.50
09
1,067.79
181.60
101.75
66.49
131.62
73.37
250.76
152.39
320.57
11,078.29
1,635.47
484.72
227.53
240.65
776.77
787.50
221.12
85.49
78.01
10
1,083.47
186.10
104.16
68.39
134.31
75.77
259.26
158.53
337.58
14,344.29
2,132.35
632.15
301.31
317.74
1,028.02
1,046.18
323.03
95.32
87.19
11
1,372.20
232.60
129.97
85.22
169.27
94.18
319.96
193.76
406.19
14,488.15
2,131.90
632.32
296.58
314.40
1,006.32
1,018.48
373.83
142.43
128.28
6B*
1,056.43
181.18
101.53
66.94
131.22
73.95
251.32
153.18
325.40
11,161.68
1,645.36
488.08
228.44
241.78
777.89
788.02
276.70
81.56
74.34
                                       
 
                          
 
AHCA Contract No. FA615, Exhibit III-E, 3 of 5
 
 
EXHIBIT III-E
February 1, 2009 -August 31, 2009 HMO RATES
(MEDICAID Non-Reform HMO CAPITATION RATES)
By Area , Age and Eligibility Category
                                       
TABLE 7
                                    
General + Dental + Transportation Rates:
                            
 
TANF
                  
SSI-N
          
SSI-B
SSI-AB
Area
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
       AGE (14-20)
      AG E (21-54)
AGE (55+)
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE(6-13)
AGE (14-20)
AGE (21-54)
AGE (55+)
  
AGE (65-)
 AGE (65+)
         
      Female
      Male
     Female
    Male
                      
01
1,118.72
188.76
103.89
65.06
134.70
73.55
259.75
157.14
324.81
10,468.01
1,543.25
452.79
203.71
221.33
718.12
719.10
313.80
109.64
95.47
02
1,118.72
188.76
103.89
65.06
134.70
73.55
259.75
157.14
324.81
10,468.01
1,543.25
452.79
203.71
221.33
718.12
719.10
313.80
109.64
95.47
03
1,224.01
208.19
116.33
75.37
151.51
84.34
289.24
176.22
367.91
11,492.13
1,712.45
504.88
233.76
253.18
814.70
819.56
350.30
111.43
95.98
04
1,072.09
183.11
101.59
65.36
131.54
73.33
255.32
156.12
328.03
11,010.91
1,640.44
483.34
223.81
241.63
782.91
789.79
307.18
107.78
93.83
05
1,218.84
207.55
116.31
76.07
151.19
84.65
289.87
177.44
372.19
12,280.77
1,817.77
537.32
249.20
267.29
860.33
868.09
235.40
99.06
87.25
06
1,060.37
182.18
102.13
67.31
132.68
74.91
255.58
156.93
332.24
11,193.68
1,666.14
492.37
230.40
246.72
796.60
805.20
282.41
93.12
81.79
07
1,096.98
187.88
104.90
68.32
135.84
76.21
262.09
160.28
337.77
11,845.15
1,767.63
522.11
245.16
263.50
848.15
857.93
379.84
98.21
86.58
08
1,038.81
178.46
101.14
67.61
132.06
75.19
250.51
153.84
324.98
10,564.20
1,575.40
465.62
217.49
234.69
753.24
759.90
263.71
95.23
83.02
09
1,072.90
182.92
102.55
66.97
133.56
74.65
253.91
154.79
323.92
11,117.63
1,661.31
490.05
229.98
246.81
796.95
804.54
227.68
101.29
88.19
10
1,086.46
186.88
104.63
68.67
135.45
76.52
261.10
159.93
339.54
14,370.54
2,149.59
635.70
302.94
321.85
1,041.48
1,057.55
328.33
107.66
95.14
11
1,375.29
233.39
130.45
85.51
170.45
94.96
321.87
195.21
408.22
14,515.53
2,149.87
636.02
298.28
318.69
1,020.36
1,030.34
378.95
154.87
136.29
6B*
1,060.23
182.16
102.12
67.30
132.66
74.90
253.67
154.97
327.89
11,193.18
1,666.05
492.35
230.39
246.71
794.05
801.66
282.41
93.12
81.79
                                       
 
 
TABLE 8
                                    
General + Mental Health + Dental + Transportation Rates:
                        
                                       
 
TANF
                  
SSI-N
          
SSI-B
SSE-AB
Area
BTHMO+2MO
3MO-11MO      AGE (1-5)
AGE (6-13)
AGE (14-20)
AGE (21-54)
AGE (55+)
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
AGE (14-20)
AGE (21-54)
AGE (55+)
  
AGE (65-)
  AGE (65+)
         
      Female
      Male
     Female
    Male
                      
01
1,118.74
188.78
105.53
76.75
145.63
84.48
264.19
161.58
328.55
10,468.09
1,543.33
460.23
251.76
265.32
799.52
750.08
314.01
121.29
107.12
02
1,118.75
188.79
106.80
85.32
148.12
86.97
263.16
160.55
327.76
10,468.17
1,543.41
466.58
282.53
266.55
770.80
743.98
334.00
124.65
110.48
03
1,224.02
208.20
117.65
84.55
157.59
90.42
290.78
177.76
369.25
11,492.20
1,712.52
511.14
269.52
273.70
838.60
830.84
357.15
120.41
104.96
04
1,072.10
183.12
102.97
74.92
137.88
79.67
256.93
157.73
329.43
11,011.02
1,640.55
493.10
279.55
273.61
820.17
807.38
331.73
124.56
110.60
05
1,218.85
207.56
117.52
84.75
159.30
92.76
293.16
180.73
374.97
12,280.82
1,817.82
542.34
281.62
296.97
915.25
888.99
238.13
111.88
100.07
06
1,060.39
182.20
103.98
80.56
145.06
87.29
260.61
161.96
336.49
11,193.75
1,666.21
498.89
272.51
285.26
867.93
832.35
283.72
97.01
85.68
07
1,097.00
187.90
106.68
81.01
147.70
88.07
266.91
165.10
341.84
11,845.21
1,767.69
528.23
284.67
299.67
915.08
883.41
382.43
108.73
97.10
08
1,038.82
178.47
102.40
76.40
137.88
81.01
252.00
155.33
326.27
10,564.27
1,575.47
471.62
251.77
254.37
776.15
770.72
270.56
108.45
96.24
09
1,072.92
182.94
104.10
77.78
140.72
81.81
255.73
156.61
325.49
11,117.70
1,661.38
496.38
266.12
267.55
821.11
815.95
234.53
110.88
97.78
10
1,086.48
186.90
106.55
82.03
144.30
85.37
263.35
162.18
341.49
14,370.64
2,149.69
644.05
350.65
349.23
1,073.36
1,072.61
335.18
115.72
103.20
11
1,375.31
233.41
132.07
96.80
177.94
102.45
323.78
197.12
409.87
14,515.61
2,149.95
642.99
338.08
341.52
1,046.96
1,042.90
386.18
162.93
144.35
6B*
1,060.25
182.18
103.87
79.82
144.36
86.60
258.42
159.72
331.90
11,193.25
1,666.12
498.85
272.38
285.14
865.17
828.73
283.72
97.01
85.68
                                       
                                       
 
AHCA Contract No. FA615, Exhibit III-E, 4 of 5

 
 
 

EXHIBIT III-E
 
 
February 1,  2009 - - August 31, 2009 HMO RATES
(MEDICAID Non-Reform HMO CAPITATION RATES)
By Area , Age and Eligibility Category

Area
Corresponding Counties
 
Area 1
Escambia, Okaloosa, Santa Ross, Walton
 
Area 2
 
Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Washington, Wakulla
 
Area 3
 
Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, Union
 
Ares 4
 
Baker, Clay, Duval, Flagler, Nassau, St. Johns, Volusia
 
Area 5
 
Pasco, Pinellas
 
Area 6
 
Hardee, Highlands, Manatee, Polk
 
Area 6B *
 
Hillsborough
 
Area 7
 
Brevard, Orange, Osceola, Seminole
 
Area 8
 
Charlotte, Collier, De Soto, Glades, Hendry, Lee, Sarasota
 
Area 9
 
Indian River, Okeechobee, St. Lucie, Martin, Palm Beach
 
Ares 10
 
Broward
 
Area 11
 
Dade, Monroe

 
AHCA Contract No. FA615, Exhibit III-E, 5 of 5