HealthEase of Florida, Inc. Medicaid HMO Contract

EX-10.7 8 contractamend5.htm AHCA NON-REFORM CONTRACT AMENDMENT 5, HEALTHEASE contractamend5.htm
Back to Form 8-K
Exhibit 10.7
 
 HealthEase of Florida, Inc.  Medicaid HMO Contract
 
AHCA CONTRACT NO. FA619
AMENDMENT NO. 5
 
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, 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 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 LEFf BLANK
 
AHCA Contract No. FA619, Amendment No. 5, Page 1 of 2
AHCA Form 2100-0002 (Rev. NOV03)

 
 
 
 
 HealthEase of Florida, Inc.  Medicaid HMO Contract
 
IN WITNESS WHEREOF, the parties hereto have caused this seven (7) 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
SIGNED
BY: /s/ Heath Schiesser                          
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
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. FA619, Amendment No. 5, Page 2 of 2
AHCA Form 2100-0002 (Rev. NOV03)

 
 
 
 
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. FA619, 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. FA619, 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. FA619, 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
 
HCA Contract No. FA619, Exhibit III-D, Page 4 of 5
 
 
 
 

EXHIBIT Ill-D
September 1, 2008 - August 31, 2009
MEDICAID NON-REFORM HMO CAPBTATION 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
 
HCA Contract No. FA619, Exhibit III-D, Page 5 of 5