Amendment number 2 to Contract No. FA619 (Medicaid Non-Reform 2006-2009), between the State of Florida, Agency for Health Care Administration and HealthEase of Florida, Inc

EX-10.1 2 exhibit10-1.htm AMENDMENT NO. 2 TO FA619 exhibit10-1.htm
Back to Form 8-K
Exhibit 10.1
 
Medicaid HMO Contract
HealthEase of Florida, Inc. 
 

 
AHCA CONTRACT NO. FA619
AMENDMENT NO. 2

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 September 1, 2007, Attachment I, Scope of Services, is hereby amended to include Exhibit III-B, September 1, 2007- August 31, 2008 Medicaid Non-Reform HMO Capitation Rates, attached hereto and made a part of the Contract. All references in the Contract to Exhibit III-A, September 1, 2007 – August 31, 2008 Medicaid Non-Reform HMO Capitation Rates, shall hereinafter instead refer to Exhibit III-B, September 1, 2007- August 31, 2008 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.


HEALTHEASE OF FLORIDA, INC.
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION
SIGNED BY:   /s/  Todd S. Farha
SIGNED BY:   /s/  Andrew C. Agwunobi
NAME:  Todd S. Farha
NAME: Andrew C. Agwunobi, M.D.
TITLE:  President and CEO
TITLE:  Secretary
DATE:  12/7/07                                
DATE: 12/10/07                      
   
   
List of attachments included as part of this Amendment:
Specify Type
Letter/ Number                                
Description
Exhibit
III-B
September 1, 2007- August 31, 2008 Medicaid Non-Reform HMO Capitation Rates (5 Pages)




REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FA619, Amendment No. 2, Page 1 of 1

 
ATTACHMENT III-B
September 1, 2007- August 31, 2008
MEDICAID Non-Reform HMO CAPITATION RATES
By Area , Age and Eligibility Category
Estimated Health Plan Rates (Not for use unless approved by CMS)
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
1,131.99
202.30
105.58
66.22
135.19
72.29
265.45
167.89
347.47
  
10,081.87
1,458.88
435.95
201.26
222.08
716.10
703.88
  
270.84
  
98.28
80.72
02
1,131.99
202.30
105.58
66.22
135.19
72.29
265.45
167.89
347.47
  
10,081.87
1,458.88
435.95
201.26
222.08
716.10
703.88
  
270.84
  
98.28
80.72
03
1,296.42
233.58
122.13
77.48
156.47
84.50
308.68
196.24
408.68
  
11,326.29
1,656.79
495.12
233.33
256.55
826.59
816.63
  
272.62
  
91.40
75.41
04
1,128.87
203.75
106.78
67.92
136.68
74.01
269.88
171.79
358.59
  
10,675.98
1,563.58
467.86
220.87
242.36
781.86
772.10
  
329.54
  
94.19
77.67
05
1,260.50
227.66
119.09
75.94
152.59
82.61
301.42
191.81
400.30
  
11,774.49
1,721.01
514.94
241.96
266.53
857.42
846.21
  
228.63
  
88.38
73.66
06
1,111.64
201.87
106.04
68.10
135.60
74.02
269.07
171.81
360.32
  
10,832.05
1,590.31
475.95
225.91
247.84
799.09
790.01
  
283.50
  
85.45
70.71
07
1,129.81
204.44
107.10
68.40
137.11
74.43
271.08
172.77
361.05
  
11,163.75
1,640.70
490.80
233.68
256.10
824.52
815.86
  
326.33
  
88.91
73.77
08
1,059.95
192.36
100.83
64.75
129.15
70.40
255.88
163.25
342.35
  
9,491.26
1,388.78
415.62
196.24
215.38
694.16
685.42
  
190.94
  
84.41
69.83
09
1,098.82
197.96
103.63
65.91
132.56
71.62
261.85
166.57
346.99
  
10,597.24
1,556.56
465.60
221.41
242.54
781.98
773.10
  
204.68
  
91.80
76.03
10
1,119.46
203.01
106.51
68.32
136.20
74.23
270.06
172.18
360.84
  
13,743.01
2,028.53
606.68
290.75
319.15
1,026.77
1,016.73
  
255.52
  
105.04
86.99
11
1,448.96
260.41
136.24
86.18
174.38
94.02
343.72
218.26
453.77
  
14,396.52
2,111.55
631.62
299.15
329.01
1,058.44
1,046.51
  
335.29
  
159.90
130.52
 
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
1,132.01
202.32
107.22
77.91
146.11
83.21
269.89
172.33
351.22
  
10,081.95
1,458.96
443.39
249.30
266.06
797.48
734.86
  
271.05
  
109.93
92.37
02
1,132.02
202.33
108.49
86.47
148.60
85.70
268.86
171.30
350.43
  
10,082.03
1,459.04
449.74
280.06
267.29
768.77
728.75
  
291.04
  
113.28
95.72
03
1,296.43
233.59
123.45
86.66
162.55
90.58
310.23
197.79
410.02
  
11,326.36
1,656.86
501.38
269.08
277.06
850.48
827.91
  
279.47
  
100.38
84.39
04
1,128.88
203.76
108.15
77.48
143.01
80.34
271.49
173.40
359.98
  
10,676.09
1,563.69
477.61
276.60
274.33
819.11
789.69
  
354.09
  
110.96
94.44
05
1,260.51
227.67
120.30
84.61
160.70
90.72
304.71
195.10
403.08
  
11,774.54
1,721.06
519.96
274.37
296.20
912.32
867.11
  
231.36
  
101.19
86.47
06
1,111.66
201.89
107.89
81.34
147.98
86.40
274.10
176.84
364.57
  
10,832.12
1,590.38
482.47
268.01
286.38
870.40
817.15
  
284.81
  
89.33
74.59
07
1,129.83
204.46
108.88
81.08
148.96
86.28
275.90
177.59
365.12
  
11,163.81
1,640.76
496.92
273.18
292.26
891.44
841.33
  
328.92
  
99.42
84.28
08
1,059.96
192.37
102.09
73.55
134.98
76.23
257.36
164.73
343.63
  
9,491.33
1,388.85
421.62
230.52
235.05
717.07
696.24
  
197.79
  
97.63
83.05
09
1,098.84
197.98
105.18
76.72
139.72
78.78
263.67
168.39
348.57
  
10,597.31
1,556.63
471.93
257.55
263.28
806.13
784.51
  
211.53
  
101.39
85.62
10
1,119.48
203.03
108.43
81.68
145.05
83.08
272.31
174.43
362.79
  
13,743.10
2,028.62
615.03
338.45
346.52
1,058.65
1,031.78
  
262.37
  
113.09
95.04
11
1,448.98
260.43
137.86
97.47
181.86
101.50
345.62
220.16
455.42
  
14,396.60
2,111.63
638.59
338.94
351.84
1,085.04
1,059.07
  
342.52
  
167.95
138.57
                                             
 
AHCA Contract No. FA619, Attachment III-B, Page 1 of 5
 
ATTACHMENT III-B
September 1, 2007- August 31, 2008
MEDICAID Non-Reform HMO CAPITATION RATES
By Area , Age and Eligibility Category
Estimated Health Plan Rates (Not for use unless approved by CMS)
 
TABLE 3
                    
General + MH + Dental 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
1,132.02
202.33
109.31
82.23
150.59
86.99
271.74
173.97
354.63
  
10,081.95
1,458.97
445.59
253.12
269.40
800.35
738.28
  
271.55
  
112.24
93.85
02
1,132.03
202.34
110.58
90.79
153.08
89.48
270.71
172.94
353.84
  
10,082.03
1,459.05
451.94
283.88
270.63
771.64
732.17
  
291.54
  
115.59
97.20
03
1,296.44
233.60
126.52
93.00
169.14
96.13
313.24
200.46
415.57
  
11,326.37
1,656.88
504.76
274.93
282.17
854.04
832.15
  
280.01
  
103.46
86.37
04
1,128.89
203.77
110.20
81.71
147.39
84.03
274.30
175.89
365.17
  
10,676.09
1,563.70
479.82
280.43
277.68
822.42
793.64
  
356.10
  
114.04
96.42
05
1,260.52
227.69
123.77
91.76
168.12
96.98
311.90
201.49
416.36
  
11,774.55
1,721.08
524.88
282.89
303.65
919.87
876.10
  
235.79
  
109.53
91.82
06
1,111.67
201.90
110.53
86.79
153.63
91.17
277.72
180.05
371.26
  
10,832.13
1,590.40
485.64
273.51
291.19
874.82
822.42
  
286.65
  
94.11
77.66
07
1,129.84
204.47
111.04
85.54
153.58
90.17
278.43
179.84
369.79
  
11,163.81
1,640.77
500.03
278.58
296.97
894.55
845.04
  
330.54
  
102.58
86.31
08
1,059.97
192.38
105.11
79.80
141.46
81.69
260.37
167.40
349.19
  
9,491.34
1,388.87
424.74
235.93
239.77
720.67
700.54
  
199.27
  
100.78
85.06
09
1,098.85
197.99
108.10
82.75
145.98
84.06
265.42
169.94
351.80
  
10,597.31
1,556.64
474.66
262.28
267.41
807.81
786.52
  
212.26
  
103.23
86.80
10
1,119.49
203.04
111.29
87.56
151.15
88.23
274.13
176.05
366.16
  
13,743.11
2,028.64
618.77
344.93
352.19
1,060.76
1,034.30
  
264.42
  
115.66
96.69
11
1,448.99
260.44
141.58
105.13
189.81
108.20
347.23
221.59
458.40
  
14,396.61
2,111.65
642.83
346.28
358.26
1,088.67
1,063.40
  
346.92
  
172.01
141.17
                                             
TABLE 4
                  
General + MH + 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
1,137.56
203.71
108.08
78.43
148.03
84.47
272.98
174.71
354.40
  
10,125.36
1,486.99
449.03
251.78
272.18
817.47
751.37
  
277.82
  
123.66
101.13
02
1,137.57
203.72
109.35
86.99
150.52
86.96
271.95
173.68
353.61
  
10,125.44
1,487.07
455.38
282.54
273.41
788.76
745.26
  
297.81
  
127.01
104.48
03
1,303.13
235.26
124.49
87.29
164.87
92.09
313.95
200.67
413.86
  
11,381.17
1,692.25
508.50
272.20
284.79
875.73
848.76
  
288.09
  
120.22
97.05
04
1,133.91
205.01
108.93
77.95
144.75
81.48
274.28
175.56
362.87
  
10,720.46
1,592.34
483.38
279.13
280.59
839.55
806.56
  
361.06
  
126.74
104.50
05
1,264.71
228.72
120.95
85.01
162.15
91.67
307.04
196.90
405.49
  
11,809.84
1,743.85
524.54
276.38
301.18
928.58
880.53
  
237.24
  
115.22
95.42
06
1,115.71
202.90
108.52
81.72
149.38
87.31
276.35
178.58
366.89
  
10,866.95
1,612.87
487.00
270.00
291.30
886.44
830.40
  
290.13
  
100.93
81.99
07
1,133.77
205.44
109.49
81.45
150.32
87.17
278.09
179.28
367.38
  
11,201.13
1,664.85
501.77
275.30
297.53
908.63
855.51
  
334.56
  
111.55
92.03
08
1,065.54
193.77
102.95
74.07
136.91
77.49
260.46
167.12
346.83
  
9,532.67
1,415.54
427.00
232.88
240.88
736.11
711.96
  
203.87
  
112.43
92.50
09
1,104.22
199.32
106.02
77.23
141.58
79.99
266.66
170.70
351.65
  
10,640.50
1,584.51
477.55
260.02
269.38
826.01
800.93
  
218.45
  
117.20
95.70
10
1,123.27
203.97
109.01
82.04
146.35
83.94
274.42
176.05
364.96
  
13,782.23
2,053.89
620.11
340.69
352.05
1,076.67
1,046.66
  
269.67
  
130.75
106.30
11
1,452.24
261.24
138.36
97.78
182.98
102.24
347.43
221.56
457.29
  
14,425.98
2,130.60
642.40
340.62
355.99
1,098.57
1,070.25
  
347.44
  
180.46
146.55
                                             
 
AHCA Contract No. FA619, Attachment III-B, Page 2 of 5
 
ATTACHMENT III-B
September 1, 2007- August 31, 2008
MEDICAID Non-Reform HMO CAPITATION RATES
By Area , Age and Eligibility Category
Estimated Health Plan Rates (Not for use unless approved by CMS)
 
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
1,137.54
203.69
106.44
66.74
137.11
73.55
268.54
170.27
350.65
  
10,125.28
1,486.91
441.59
203.74
228.20
736.09
720.39
  
277.61
  
112.01
89.48
02
1,137.54
203.69
106.44
66.74
137.11
73.55
268.54
170.27
350.65
  
10,125.28
1,486.91
441.59
203.74
228.20
736.09
720.39
  
277.61
  
112.01
89.48
03
1,303.12
235.25
123.17
78.11
158.79
86.01
312.40
199.12
412.52
  
11,381.10
1,692.18
502.24
236.45
264.28
851.84
837.48
  
281.24
  
111.24
88.07
04
1,133.90
205.00
107.56
68.39
138.42
75.15
272.67
173.95
361.48
  
10,720.35
1,592.23
473.63
223.40
248.62
802.30
788.97
  
336.51
  
109.97
87.73
05
1,264.70
228.71
119.74
76.34
154.04
83.56
303.75
193.61
402.71
  
11,809.79
1,743.80
519.52
243.97
271.51
873.68
859.63
  
234.51
  
102.41
82.61
06
1,115.69
202.88
106.67
68.48
137.00
74.93
271.32
173.55
362.64
  
10,866.88
1,612.80
480.48
227.90
252.76
815.13
803.26
  
288.82
  
97.05
78.11
07
1,133.75
205.42
107.71
68.77
138.47
75.32
273.27
174.46
363.31
  
11,201.07
1,664.79
495.65
235.80
261.37
841.71
830.04
  
331.97
  
101.04
81.52
08
1,065.53
193.76
101.69
65.27
131.08
71.66
258.98
165.64
345.55
  
9,532.60
1,415.47
421.00
198.60
221.21
713.20
701.14
  
197.02
  
99.21
79.28
09
1,104.20
199.30
104.47
66.42
134.42
72.83
264.84
168.88
350.07
  
10,640.43
1,584.44
471.22
223.88
248.64
801.86
789.52
  
211.60
  
107.61
86.11
10
1,123.25
203.95
107.09
68.68
137.50
75.09
272.17
173.80
363.01
  
13,782.14
2,053.80
611.76
292.99
324.68
1,044.79
1,031.61
  
262.82
  
122.70
98.25
11
1,452.22
261.22
136.74
86.49
175.50
94.76
345.53
219.66
455.64
  
14,425.90
2,130.52
635.43
300.83
333.16
1,071.97
1,057.69
  
340.21
  
172.41
138.50
                                             
TABLE 6
                
General + Dental 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
1,132.00
202.31
107.67
70.54
139.67
76.07
267.30
169.53
350.88
  
10,081.87
1,458.89
438.15
205.08
225.42
718.97
707.30
  
271.34
  
100.59
82.20
02
1,132.00
202.31
107.67
70.54
139.67
76.07
267.30
169.53
350.88
  
10,081.87
1,458.89
438.15
205.08
225.42
718.97
707.30
  
271.34
  
100.59
82.20
03
1,296.43
233.59
125.20
83.82
163.06
90.05
311.69
198.91
414.23
  
11,326.30
1,656.81
498.50
239.18
261.66
830.15
820.87
  
273.16
  
94.48
77.39
04
1,128.88
203.76
108.83
72.15
141.06
77.70
272.69
174.28
363.78
  
10,675.98
1,563.59
470.07
224.70
245.71
785.17
776.05
  
331.55
  
97.27
79.65
05
1,260.51
227.68
122.56
83.09
160.01
88.87
308.61
198.20
413.58
  
11,774.50
1,721.03
519.86
250.48
273.98
864.97
855.20
  
233.06
  
96.72
79.01
06
1,111.65
201.88
108.68
73.55
141.25
78.79
272.69
175.02
367.01
  
10,832.06
1,590.33
479.12
231.41
252.65
803.51
795.28
  
285.34
  
90.23
73.78
07
1,129.82
204.45
109.26
72.86
141.73
78.32
273.61
175.02
365.72
  
11,163.75
1,640.71
493.91
239.08
260.81
827.63
819.57
  
327.95
  
92.07
75.80
08
1,059.96
192.37
103.85
71.00
135.63
75.86
258.89
165.92
347.91
  
9,491.27
1,388.80
418.74
201.65
220.10
697.76
689.72
  
192.42
  
87.56
71.84
09
1,098.83
197.97
106.55
71.94
138.82
76.90
263.60
168.12
350.22
  
10,597.24
1,556.57
468.33
226.14
246.67
783.66
775.11
  
205.41
  
93.64
77.21
10
1,119.47
203.02
109.37
74.20
142.30
79.38
271.88
173.80
364.21
  
13,743.02
2,028.55
610.42
297.23
324.82
1,028.88
1,019.25
  
257.57
  
107.61
88.64
11
1,448.97
260.42
139.96
93.84
182.33
100.72
345.33
219.69
456.75
  
14,396.53
2,111.57
635.86
306.49
335.43
1,062.07
1,050.84
  
339.69
  
163.96
133.12
                                             
 
AHCA Contract No. FA619, Attachment III-B, Page 3 of 5
 
ATTACHMENT III-B
September 1, 2007- August 31, 2008
MEDICAID Non-Reform HMO CAPITATION RATES
By Area , Age and Eligibility Category
Estimated Health Plan Rates (Not for use unless approved by CMS)
 
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)
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
1,137.55
203.70
108.53
71.06
141.59
77.33
270.39
171.91
354.06
  
10,125.28
1,486.92
443.79
207.56
231.54
738.96
723.81
  
278.11
  
114.32
90.96
02
1,137.55
203.70
108.53
71.06
141.59
77.33
270.39
171.91
354.06
  
10,125.28
1,486.92
443.79
207.56
231.54
738.96
723.81
  
278.11
  
114.32
90.96
03
1,303.13
235.26
126.24
84.45
165.38
91.56
315.41
201.79
418.07
  
11,381.11
1,692.20
505.62
242.30
269.39
855.40
841.72
  
281.78
  
114.32
90.05
04
1,133.91
205.01
109.61
72.62
142.80
78.84
275.48
176.44
366.67
  
10,720.35
1,592.24
475.84
227.23
251.97
805.61
792.92
  
338.52
  
113.05
89.71
05
1,264.71
228.73
123.21
83.49
161.46
89.82
310.94
200.00
415.99
  
11,809.80
1,743.82
524.44
252.49
278.96
881.23
868.62
  
238.94
  
110.75
87.96
06
1,115.70
202.89
109.31
73.93
142.65
79.70
274.94
176.76
369.33
  
10,866.89
1,612.82
483.65
233.40
257.57
819.55
808.53
  
290.66
  
101.83
81.18
07
1,133.76
205.43
109.87
73.23
143.09
79.21
275.80
176.71
367.98
  
11,201.07
1,664.80
498.76
241.20
266.08
844.82
833.75
  
333.59
  
104.20
83.55
08
1,065.54
193.77
104.71
71.52
137.56
77.12
261.99
168.31
351.11
  
9,532.61
1,415.49
424.12
204.01
225.93
716.80
705.44
  
198.50
  
102.36
81.29
09
1,104.21
199.31
107.39
72.45
140.68
78.11
266.59
170.43
353.30
  
10,640.43
1,584.45
473.95
228.61
252.77
803.54
791.53
  
212.33
  
109.45
87.29
10
1,123.26
203.96
109.95
74.56
143.60
80.24
273.99
175.42
366.38
  
13,782.15
2,053.82
615.50
299.47
330.35
1,046.90
1,034.13
  
264.87
  
125.27
99.90
11
1,452.23
261.23
140.46
94.15
183.45
101.46
347.14
221.09
458.62
  
14,425.91
2,130.54
639.67
308.17
339.58
1,075.60
1,062.02
  
344.61
  
176.47
141.10
                                             
TABLE 8
                
General + Mental Health + Dental + 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
1,137.57
203.72
110.17
82.75
152.51
88.25
274.83
176.35
357.81
  
10,125.36
1,487.00
451.23
255.60
275.52
820.34
754.79
  
278.32
  
125.97
102.61
02
1,137.58
203.73
111.44
91.31
155.00
90.74
273.80
175.32
357.02
  
10,125.44
1,487.08
457.58
286.36
276.75
791.63
748.68
  
298.31
  
129.32
105.96
03
1,303.14
235.27
127.56
93.63
171.46
97.64
316.96
203.34
419.41
  
11,381.18
1,692.27
511.88
278.05
289.90
879.29
853.00
  
288.63
  
123.30
99.03
04
1,133.92
205.02
110.98
82.18
149.13
85.17
277.09
178.05
368.06
  
10,720.46
1,592.35
485.59
282.96
283.94
842.86
810.51
  
363.07
  
129.82
106.48
05
1,264.72
228.74
124.42
92.16
169.57
97.93
314.23
203.29
418.77
  
11,809.85
1,743.87
529.46
284.90
308.63
936.13
889.52
  
241.67
  
123.56
100.77
06
1,115.72
202.91
111.16
87.17
155.03
92.08
279.97
181.79
373.58
  
10,866.96
1,612.89
490.17
275.50
296.11
890.86
835.67
  
291.97
  
105.71
85.06
07
1,133.78
205.45
111.65
85.91
154.94
91.06
280.62
181.53
372.05
  
11,201.13
1,664.86
504.88
280.70
302.24
911.74
859.22
  
336.18
  
114.71
94.06
08
1,065.55
193.78
105.97
80.32
143.39
82.95
263.47
169.79
352.39
  
9,532.68
1,415.56
430.12
238.29
245.60
739.71
716.26
  
205.35
  
115.58
94.51
09
1,104.23
199.33
108.94
83.26
147.84
85.27
268.41
172.25
354.88
  
10,640.50
1,584.52
480.28
264.75
273.51
827.69
802.94
  
219.18
  
119.04
96.88
10
1,123.28
203.98
111.87
87.92
152.45
89.09
276.24
177.67
368.33
  
13,782.24
2,053.91
623.85
347.17
357.72
1,078.78
1,049.18
  
271.72
  
133.32
107.95
11
1,452.25
261.25
142.08
105.44
190.93
108.94
349.04
222.99
460.27
  
14,425.99
2,130.62
646.64
347.96
362.41
1,102.20
1,074.58
  
351.84
  
184.52
149.15
                                             
 
AHCA Contract No. FA619, Attachment III-B, Page 4 of 5
 
ATTACHMENT III-B
September 1, 2007- August 31, 2008
MEDICAID Non-Reform HMO CAPITATION RATES
By Area , Age and Eligibility Category
Estimated Health Plan Rates (Not for use unless approved by CMS)
 
                                       
Area
  
Corresponding Counties
                  
                                       
Area 1
  
Escambia, Okaloosa, Santa Rosa, 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, Hamiliton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, Union
Area 4
  
Baker, Clay, Duval, Flagler, Nassau, St. Johns, Volusia
      
Area 5
  
Pasco, Pinellas
                                
Area 6
  
Hardee, Highlands, Hillsborough, Manatee, Polk
            
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
Area 10
  
Broward
                                  
Area 11
  
Dade, Monroe
                                
                                       
Created on August 10, 2007
                            
                                       
 
AHCA Contract No. FA619, Attachment III-B, Page 5 of 5