AHCA CONTRACT NO. FAR001 AMENDMENT NO. 10
Exhibit 10.2
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HealthEase
of Florida, Inc.
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AHCA
CONTRACT NO. FAR001
AMENDMENT
NO. 10
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," is hereby amended as follows:
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1.
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Effective
September 1, 2008, Attachment I, Scope of Services, Exhibit 3-D is hereby
included and made a part of the Contract. All references in the Contract
to Exhibit 3-C, shall hereinafter refer respectively to Exhibit
3-D.
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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.
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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, is hereby made part of the Contract.
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This
Amendment cannot be executed unless all previous Amendments to this
Contract have been fully
executed.
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IN
WITNESS WHEREOF, the parties hereto have caused this four (4) page
Amendment (including all attachments) to be executed by their officials
thereunto duly authorized.
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HEALTHEASE
OF FLORIDA, INC.
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STATE
OF FLORIDA, AGENCY FOR
HEALTH
CARE ADMINISTRATION
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SIGNED
BY:
/s/ Xxxxx
Xxxxxxxxx
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SIGNED
BY: /s/ Xxxx Xxxxxx
for Xxxxx Xxxxxx
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NAME:
Xxxxx
Xxxxxxxxx
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NAME:
Xxxxx
Xxxxxx
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TITLE:
President and
CEO
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TITLE:
Secretary
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DATE:
9-10-08
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DATE:
9/10/08
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List of
Attachments/Exhibits included as part of this Amendment:
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Specify/
Type
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Letter/
Number
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Description
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Exhibit
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3-D
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Medicaid
Reform HMO Capitation Rates (3
pages)
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REMAINDER
OF THIS PAGE INTENTIONALLY LEFT BLANK
AHCA
Contract No. FAR001, Amendment No. 10, Page 1 of 1
AHCA Form
2100-0002 (Rev. NOV03)
EXHIBIT
3-D
MEDICAID
REFORM HMO CAPITATION RATES
(By Area,
Age, and Eligibility Category)
September
1, 2008 - August 31, 2009
TABLE
2
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Area: 10
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County: Broward
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September
1, 2008
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ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
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Eligibility
Category/
Population
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Total
Rates for Comprehensive
and
Catastrophic Components
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Total
Rate for
Comprehensive
Component
Only
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Children
and Families:
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Newborns
aged 0-2 months
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$ 885.88
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$ 765.55
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Newborns
aged 3-11 months
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$ 194.87
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$ 185.35
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Age
1 and Up - Base Rate for Risk adjustment
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$ 109.25
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$ 107.50
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Aged
and Disabled:
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No
Medicare
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Newborns
aged 0-2 months
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$
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17,923.49
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$
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9,357.13
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Newborns
aged 3-11 months
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$
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3,974.24
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$
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2,211.26
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Age
1 and Up - Base Rate for Risk Adjustment
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$
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805.53
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$
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740.20
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Medicare
Parts A and B
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Under
Age 65
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$
141.89
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N/A
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Age
65 and over
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$
101.48
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N/A
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Medicare
Part B Only
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All
ages
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$
270.48
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N/A
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HIV/AIDS
Specialty Population
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No
Medicare HIV
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$ 1,860.68
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N/A
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No
Medicare AIDS
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$
3,491.79
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N/A
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Medicare
HIV
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$ 261.22
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N/A
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Medicare
AIDS
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$ 557.68
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N/A
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Kick
Payments Amounts for Covered Obstetrical Delivery Services:
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CPT
Code
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Obstetrical
Delivery CPT Code Description
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Payment
Amount
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59409
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Vaginal
delivery only
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$3,941.45
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59410
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Vaginal
delivery including postpartum care
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59515
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Cesarean
delivery including postpartum care
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59612
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Vaginal
delivery only, after previous cesarean delivery
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59614
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Vaginal
delivery only, after previous cesarean delivery including postpartum
care
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59622
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Cesarean
delivery only, following attempted vaginal delivery after previous
cesarean dcliveiy inc postpartum
care
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AHCA
Contract No. FAR001, Exhibit 3-D, Page 1 of 3
EXHIBIT
3-D
MEDICAID
REFORM HMO CAPITATION RATES
(By Area,
Age, and Eligibility Category)
September
1, 2008 - August 31,2009
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Area: 4
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County: Duval,
Baker, Clay, and Nassau
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September
1, 2008
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(ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
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Eligibility
Category/
Population
|
Total
Rates for Comprehensive
and
Catastrophic Component
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Total
Rate for
Comprehensive
Component
Only
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Children
and Families:
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Newborns
aged 0-2 months
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$ 913.11
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$ 789.08
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Newborns
aged 3-11 months
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$ 200.67
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$ 190.87
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Age
1 and Up - Base Rate for Risk Adjustment
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$ 112.44
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$ 110.63
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Aged
and Disabled:
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No
Medicare
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Newborns
aged 0-2 months
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$ 14,519.07
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$ 7,579.82
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Newborns
aged 3-11 months
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$ 3,236.37
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$ 1,800.71
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Age
1 and Up - Base Rate for Risk Adjustment
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$ 622.86
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$ 572.27
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Medicare
Parts A and B
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Under
Age 65
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$ 161.22
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N/A
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Age
65 and over
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$ 115.22
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N/A
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Medicare
Part B Only
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All
ages
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$ 332.95
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N/A
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HIV/AIDS
Specialty Population
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No
Medicare HIV
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$ 1,184.04
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N/A
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No
Medicare AIDS
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$ 2,330.94
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N/A
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Medicare
HIV
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$ 160.51
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N/A
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Medicare
AIDS
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$ 342.66
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N/A
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Kick
Payments Amounts for Covered Obstetrical Delivery Services:
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CPT
Code
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Obstetrical
Delivery CPT Code Description
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Payment
Amount
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59409
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Vaginal
delivery only
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$3,977.49
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59410
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Vaginal
delivery including postpartum care
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59515
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Cesarean
delivery including postpartum care
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59612
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Vaginal
delivery only, after previous cesarean delivery
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59614
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Vaginal
delivery only, after previous cesarean delivery including postpartum
care
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59622
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Cesarean
delivery only, following attempted vaginal delivery after previous
cesarean delivery inc postpartum
care
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AHCA
Contract No. FAR001, Exhibit 3-D, Page 2 of 3
EXHIBIT
3-D
MEDICAID
REFORM HMO CAPITATION RATES
(By Area,
Age, and Eligibility Category)
September
1, 2008 - August 31, 2009
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Area: 10
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County: Broward
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September
1, 2008
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Area: 4
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County:
Duval,
Baker, Clay and Nassau
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CPT
Code
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Transplant
CPT Code Description
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Children/Adolescents or
Adult
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Payment
Amount
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32851
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lung
single, without bypass
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Children/Adolescents
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$320,800.00
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32851
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lung
single, without bypass
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Adult
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$238,000.00
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32852
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lung
single, with bypass
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Children/Adolescents
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$320,800.00
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32852
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lung
single, with bypass
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Adult
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$238,000.00
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32853
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lung
double, without bypass
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Children/Adolescents
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$320,800.00
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32853
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lung
double, without bypass
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Adult
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$238,000.00
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32854
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lung
double, with bypass
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Children/Adolescents
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$320,800.00
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32854
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lung
double, with bypass
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Adult
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$238,000.00
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33945
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heart
transplant with or without recipient cardiectomy
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All
Age Groups
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$162,000.00
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47135
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liver,
allotraiisplation, orthotopic, partial or whole from cadaver or living
donor
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All
Age Groups
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$122,600.00
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47136
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liver,
heterotopic, partial or whole from cadaver or living donor any
age
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All
Age Groups
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$122,600.00
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AHCA
Contract No. FAR001, Exhibit 3-D, Page 3 of 3
