Amendment No. 6 to Medicaid HMO Contract Between State of Florida AHCA 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 (AHCA) and Wellcare of Florida, Inc., operating as Staywell Health Plan of Florida. Effective September and December 2008, it revises the contract manager's contact information, maximum enrollment levels by county, and capitation rates for Medicaid services. The amendment ensures all previous contract terms not in conflict remain in effect and requires that all prior amendments be executed before this one is valid.

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EX-10.5 6 contractamend6.htm AHCA NON-REFORM CONTRACT AMENDMENT 6, STAYWELL contractamend6.htm
Back to Form 8-K
Exhibit 10.5
 
 Wellcare of Florida, Inc. d/b/a  Medicaid HMO Contract
  Staywell Health Plan of Florida  
 
AHCA CONTRACT NO. FA615
AMENDMENT NO. 6
 
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, 2008, 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 Stacknik
Agency for Health Care Administration
2727 Mahan Drive, MS #50
Tallahassee, FL 32308
(850) 487-2355
               
2.
Effective December 1, 2008, Attachment I, Scope of Services, is hereby amended to include Exhibit I-B, Second Revised Maximum Enrollment Levels, attached hereto and made a part of the Contract. All references in the Contract to Exhibit I-A, Revised Maximum Enrollment Levels, shall hereinafter also refer to Exhibit I-B, Second Revised Maximum Enrollment Levels, as appropriate.
 
3.
Effective December 1, 2008, Attachment I, Scope of Services, is hereby amended to include Exhibit II-D, Fourth Revised Capitation Rates, attached hereto and made a part of the Contract. All references in the Contract to Exhibit II-C, Third Revised Capitation Rates, shall hereinafter also refer to Exhibit II-D, Fourth Revised Capitation Rates, as appropriate.
 
4.
Effective September 1, 2008, Attachment I, Scope of Services, is hereby amended to include Exhibit III-D, September 1, 2008 - 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-C, January 1, 2008 – August 31, 2008 Medicaid Non-Reform HMO Capitation Rates, shall hereinafter also refer to Exhibit III-D, September 1, 2008 - 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 part of the Contract.
   
  This Amendment cannot be executed unless all previous Amendments to this Contract have been fully executed.
   
 
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FA615, Amendment No. 6, Page 1 of 2
AHCA Form 2100-0002 (Rev. NOV03)

 
 
 
 
Wellcare of Florida, Inc. d/b/a Medicaid HMO Contract
Staywell Health Plan of Florida  
 
IN WITNESS WHEREOF, the parties hereto have caused this nine (9) 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/ William H. Roberts for Holly Benson
NAME: Heath Schiesser                    
NAME: Holly Benson                                      
TITLE: President and CEO                
TITLE: Secretary                                               
DATE:  8/29/08                                   
DATE:  8/29/08                                                  

 
List of attachments/exhibits included as part of this Amendment:
 
Specify
Type
Letter/
Number
Description
Exhibit
I-B
Second Revised Maximum Enrollment Levels (1 Page)
Exhibit
II-D
Fourth Revised Capitation Rates (1 Page)
Exhibit
III-D
September 1, 2008 - August 31, 2009 Medicaid Non-Reform HMO Capitation Rates (5 Pages)
 
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
 
AHCA Contract No. FA615, Amendment No. 6, Page 2 of 2
AHCA Form 2100-0002 (Rev. NOV03)

 
 
 
 
Wellcare of Florida, Inc. d/b/a Medicaid HMO Contract
Staywell Health Plan of Florida  
 
EXHIBIT I-B
SECOND REVISED MAXIMUM ENROLLMENT LEVELS
 
 
County
Maximum Enrollment Level
Brevard
14,000
Broward
25,000
Dade
25,000
Hernando
15,000
Hillsborough
28,000
Lee
15,000
Manatee
12,000
Palm Beach
15,000
Pasco
7,000
Pinellas
15,000
Polk
25,000
Orange
38,000
Osceola
12,000
Sarasota
6,000
Seminole
6,000
Sumter
4,500

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
 
AHCA Contract No. FA615, Exhibit I-B, Page 1 of 1

 
 
 
 
Wellcare of Florida, Inc. d/b/a Medicaid HMO Contract
Staywell Health Plan of Florida
  
 
EXHIBIT II-D
FOURTH REVISED CAPITATION RATES
 
A.          Table 2 - General Capitation Rates plus Mental Health Rates:
 
Area 3 Counties:
County
Provider Number
Hernando
015016901
Sumter
015016916
 
Area 5 Counties:
County
Provider Number
Pasco
015016903
Pinellas
015016904
 
Area 6 Counties:
County
Provider Number
Hillsborough
015016902
Manatee
015016912
Polk
015016905
 
Area 7 Counties:
County
Provider Number
Orange
015016906
Seminole
015016908
Osceola
015016907
Brevard
015016913
 
Area 8 Counties:
County
Provider Number
Lee
015016911
Sarasota
015016914
 
Area 9 Counties:
County
Provider Number
Palm Beach
015016910
 
Area 10 Counties:
County
Provider Number
Broward
015016900
 
Area 11 Counties:
County
Provider Number
Miami-Dade
015016909
 
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
 
AHCA Contract No. FA615, Exhibit II-D, Page 1 of 1

 
 
 
 
EXHIBIT III-D
September 1, 2008 - August 31, 2009
MEDICAID NON-REFORM HMO CAPITATION RATES
By Area, Age and Eligibility Category
 
Table 1
General Rates
                                    
 
TANF
SSI-N
SSI-B
SSS-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             AGE                 AGE
       (6-13)           (14-20)           (21-54)
     AGE
(55+)
  
       AGE            AGE
        (65-)            (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
96.82
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
 
TABLE 2
  General + Mental Health Rates:                                
 
TANF
SSl-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
835.23
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
86.73
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
 
AHCA Contract No. FA615, Exhibit III-D, Page 1 of 5

 
 
 

EXHIBIT III-D
September 1, 2008 - August 31, 2009
MEDICAID NON-REFORM HMO CAPITATION RATES
By Area, Age and Eligibility Category
 
TABLE 3
General + MH + Dental Rates:
                                  
 
TANF
   SSI-N
SSI-B
SSI-AB
Area
BTHMO+2MO
 3MC-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
773.46
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
74.48
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
                                       
 
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
1,118.74
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

AHCA Contract No. FA615, Exhibit III-D, Page 2 of 5
 
 
 
 
 
EXHIBIT III-D
September 1, 2008 - August 31, 2009
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
154.04
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

 TABLE 6
 General + Dental Rates:                                  
 
TANF
 
       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
187.39
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
84.96
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
 
AHCA Contract No. FA615, Exhibit IlI-D, Page 3 of 5

 
 
 
 
EXHIBIT IlI-D
September 1, 2008 - August 31, 2009
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)
     AGE (21-54)
               AGE
               (55+)
  BTHMO+2MO
3MO-
11MO
AGE
(1-5)
AGE
(6-13)
AGE
 (14-20)
AGE
(21-54)
AGE
(55+)
  
   AGE            AGE 
   (65-)              (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
107.79
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
 
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
1,118.74
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
1,116.75
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
206.20
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
 
AHCA Contract No. FA615, Exhibit III-D, Page 4 of 5
 
 
 
 

EXHIBIT III-D
September 1, 2008 - August 31, 2009
MEDICAID NON-REFORM HMO CAPITATION RATES
By Area, Age and Eligibility Category

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, Hamilton, 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
 
AHCA Contract No. FA615, Exhibit III-D, Page 5 of 5