Amendment No. 3 to Medicaid HMO Contract (FA615) between State of Florida Agency for Health Care Administration and WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Contract Categories: Business Finance › Modification Agreements
Summary

This amendment updates the Medicaid HMO contract between the State of Florida's Agency for Health Care Administration and WellCare of Florida, Inc. (operating as Staywell Health Plan of Florida). Effective September 1, 2007, it replaces the previous schedule of Medicaid Non-Reform HMO capitation rates with a new schedule for the period through August 31, 2008. All contract terms conflicting with this amendment are changed accordingly, while all other terms remain in effect. The amendment is only valid if all prior amendments have been executed.

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EX-10.2 3 exhibit10-2.htm AMENDMENT NO. 3 TO FA615 exhibit10-2.htm
 
Back to Form 8-K
 
Exhibit 10.2
 
Medicaid HMO Contract
Wellcare of Florida, Inc. 
d/b/a Staywell Health Plan of Florida


AHCA CONTRACT NO. FA615
AMENDMENT NO. 3

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 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.

WELLCARE OF FLORIDA, INC.
D/B/A/ STAYWELL HEALTH PLAN OF FLORIDA
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)




AHCA Contract No. FA615, Amendment No. 3, 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. FA615, 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. FA615, 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. FA615, 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. FA615, 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. FA615, Attachment III-B, Page 5 of 5