AHCA CONTRACT NO. FA614 AMENDMENT NO. 11
Exhibit 10.26.3.7
Amerigroup Florida, Inc. d/b/a Amerigroup Community Care |
Medicaid HMO Contract |
AHCA CONTRACT NO.
FA614
AMENDMENT NO. 11
AMENDMENT NO. 11
THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE
ADMINISTRATION, hereinafter referred to as the “Agency” and AMERIGROUP FLORIDA, INC. D/B/A
AMERIGROUP COMMUNITY CARE hereinafter referred to as the “Vendor” or “Health Plan”, is
hereby amended as follows:
1. | Effective February 1, 2009, Attachment I, Scope of Services, is hereby amended to include Exhibit III-E, February 1, 2009 - 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-D, September 1, 2008 - August 31, 2009 Medicaid Non-Reform HMO Capitation Rates, shall hereinafter also refer to Exhibit III-E, February 1, 2009 - 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 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.
AMERIGROUP FLORIDA INC. D/B/A AMERIGROUP COMMUNITY CARE |
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION |
|||||||||
SIGNED
|
SIGNED | |||||||||
BY:
|
/s/ Xxxxxxx X. XxXxxx | BY: | /s/ Xxxxx Xxxxxx | |||||||
NAME:
|
Xxxxxxx X. XxXxxx | NAME: | Xxxxx Xxxxxx | |||||||
TITLE:
|
CEO | TITLE: | Secretary | |||||||
DATE:
|
DATE: | |||||||||
List of Attachments/Exhibits included as part of this Amendment:
Specify | Letter/ | |||
Type | Number | Description | ||
Exhibit
|
III-E | February 1, 2009 - August 31, 2009 Medicaid Non-Reform HMO Capitation Rates (5 pages) |
AHCA Contract No. FA614, Amendment No. 11, Page 1 of 1
EXHIBIT III-E
February 1, 2009 - August 31, 2009 HMO RATES
(MEDICAID Non-Reform HMO CAPITATION RATES)
By Area, Age and Eligibility Category
February 1, 2009 - August 31, 2009 HMO RATES
(MEDICAID Non-Reform HMO CAPITATION RATES)
By Area, Age and Eligibility Category
TABLE 1
General Rates:
General Rates:
XXXX | XXX-X | XXX-X | XXX-XX | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Xxxx | XXXXXx0XX | 0XX-00XX | AGE (1-5) | AGE (6-13) | AGE (14-20) | AGE (21-54) | AGE (55+) | XXXXXx0XX | 0XX-00XX | 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 | 187.38 | 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 |
1,217.67 | 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 | 98.82 | 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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
6B* |
1,056.42 | 181.17 | 98.86 | 61.98 | 126.16 | 69.67 | 251.32 | 153.18 | 325.40 | 11,161.68 | 1,645.35 | 485.04 | 223.94 | 237.91 | 777.89 | 788.02 | 274.94 | 79.31 | 72.63 |
TABLE 2
General + Mental Health Rates:
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+) | XXXXXx0XX | 0XX-00XX | 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 | 85.32 | 287.37 | 175.41 | 364.65 | 12,248.99 | 1,796.93 | 533.81 | 273.37 | 286.61 | 895.23 | 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 | 69.15 | 128.97 | 73.85 | 246.72 | 150.78 | 318.20 | 10,526.05 | 1,560.37 | 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 | 86.79 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
6B* |
1,056.44 | 181.19 | 100.61 | 74.50 | 137.86 | 81.37 | 256.07 | 157.93 | 329.41 | 11,161.75 | 1,645.42 | 491.54 | 265.93 | 276.34 | 849.01 | 815.09 | 276.25 | 83.20 | 76.52 |
AHCA Contract No. FA614, Exhibit III-E, 1 of 5
EXHIBIT III-E
February 1, 2009 -August 31, 2009 HMO RATES
(MEDICAID Non-Reform HMO CAPITATION RATES)
By Area, Age and Eligibility Category
February 1, 2009 -August 31, 2009 HMO RATES
(MEDICAID Non-Reform HMO CAPITATION RATES)
By Area, Age and Eligibility Category
TABLE 3
General + MH + Dental Rates:
General + MH + Dental Rates:
XXXX | XXX-X | XXX-X | XXX-XX | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Xxxx | XXXXXx0XX | 0XX-00XX | AGE (1-5) | AGE (6-13) | AGE (14-20) | AGE (21-54) | AGE (55+) | XXXXXx0XX | 0XX-00XX | 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 | 779.46 | 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 | 74.49 | 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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
6B* |
1,056.45 | 181.20 | 103.28 | 79.48 | 142.92 | 85.65 | 256.07 | 157.93 | 329.41 | 11,161.75 | 1,645.43 | 494.58 | 270.43 | 280.21 | 849.01 | 815.09 | 278.01 | 85.45 | 78.23 |
TABLE 4
General + MH + Transportation Rates:
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+) | XXXXXx0XX | 0XX-00XX | 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 | 325.75 | 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 | 256.26 | 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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
6B* |
1,060.24 | 182.17 | 101.20 | 74.86 | 139.30 | 82.32 | 258.42 | 159.72 | 331.90 | 11,193.25 | 1,666.11 | 495.81 | 267.88 | 281.27 | 865.17 | 828.73 | 281.96 | 94.76 | 83.97 |
AHCA Contract No. FA614, Exhibit III-E, 2 of 5
EXHIBIT lll-E
February 1, 2009 - August 31, 2009 HMO RATES
(MEDICAID Non-Reform HMO CAPITATION RATES)
By Area, Age and Eligibility Category
February 1, 2009 - August 31, 2009 HMO RATES
(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+) | XXXXXx0XX | 0XX-00XX | 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 | 154.40 | 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 | 796.77 | 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 | |||||||||||||||||||
6B* | 1,060.22 | 182.15 | 99.45 | 62.34 | 127.60 | 70.62 | 253.67 | 154.97 | 327.89 | 11,193.18 | 1,666.04 | 489.31 | 225.89 | 242.84 | 794.05 | 801.66 | 280.65 | 90.87 | 80.08 |
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+) | XXXXXx0XX | 0XX-00XX | 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 | 341.69 | 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 | 176.63 | 369.66 | 12,248.95 | 1,796.89 | 533.01 | 247.22 | 262.31 | 844.01 | 854.31 | 228.85 | 84.98 | 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 | 1,845.45 | 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 | |||||||||||||||||||
6B* | 1,056.43 | 181.18 | 101.53 | 66.94 | 131.22 | 73.95 | 251.32 | 153.18 | 325.40 | 11,161.68 | 1,645.36 | 488.08 | 228.44 | 241.78 | 777.89 | 788.02 | 276.70 | 81.56 | 74.34 |
AHCA
Contract No. FA614, Exhibit III-E, 3 of 5
EXHIBIT III-E
February 1, 2009 - August 31, 2009 HMO RATES
(MED1CAID Non-Reform HMO CAPITATION RATES)
By Area, Age and Eligibility Category
February 1, 2009 - August 31, 2009 HMO RATES
(MED1CAID Non-Reform HMO CAPITATION RATES)
By Area, Age and Eligibility Category
TABLE 7
General + Dental+Transportation Rates:
TANF | AGE (14-20) | AGE (21-54) | SSI-N | XXX-XX | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Xxxx | XXXXXx0XX | 0XX-00XX | AGE (1-5) | AGE (6-13) | Female | Male | Female | Male | AGE (55+) | BTHMO+2MO | 3MO-11MO | AGE (1-5) | AGE (6-13) | AGE (14-20) | AGE (21-54) | AGE (55+) | SSI-B | AGE (65-) | AGE (65+) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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 | 76.19 | 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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
6B*
|
1,060.23 | 182.16 | 102.12 | 67.30 | 132.66 | 74.90 | 253.67 | 154.97 | 327.89 | 11,193.18 | 1,666.05 | 492.35 | 230.39 | 246.71 | 794.05 | 801.66 | 282.41 | 93.12 | 81.79 |
Table 8
General+ Mental Health + Dental + Transportation Rates:
TANF | AGE (14-20) | AGE (21-54) | SSI-N | XXX-XX | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Xxxx | XXXXXx0XX | 0XX-00XX | AGE (1-5) | AGE (6-13) | Female | Male | Female | Male | AGE (55+) | BTHMO+2MO | 3MO-11MO | AGE (1-5) | AGE (6-13) | AGE (14-20) | AGE (21-54) | AGE (55+) | SSI-B | AGE (65-) | AGE (65+) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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
|
1,118.75 | 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 | 208.20 | 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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
6B*
|
1,060.25 | 182.18 | 103.87 | 79.82 | 144.36 | 86.60 | 258.42 | 159.72 | 331.90 | 11,193.25 | 1,666.12 | 498.85 | 272.38 | 285.14 | 865.17 | 828.73 | 283.72 | 97.01 | 85.68 |
AHCA Contract No. FA614, Exhibit III-E, 4 of 5
EXHIBIT
III-E
February 1, 2009 - August 31, 2009 HMO RATES
(MEDICAID Non-Reform HMO CAPITATION RATES)
By Area, Age and Eligibility Category
February 1, 2009 - August 31, 2009 HMO RATES
(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, Xxxxxxxxx, Xxxx, Liberty, Madison, Taylor, Washington, Wakulla | |
Area 3
|
Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamillton, Hemando, Lafayette, Lake, Xxxx, Xxxxxx, Putnam, Sumter, Suwannee, Union | |
Area 4
|
Baker, Clay, Duval, Flagler, Nassau, St Xxxxx, Volusia | |
Area 5
|
Pasco, Pinellas | |
Area 6
|
Xxxxxx, Highlands, Manatee, Polk | |
Area 6B *
|
Xxxxxxxxxxxx | |
Xxxx 0
|
Brevard, Orange, Osceola, Seminole | |
Area 8
|
Charlotte, Xxxxxxx, De Xxxx, Glades, Hendry, Lee, Sarasota | |
Area 9
|
Indian River, Okeechobee, St. Lucie, Martin, Palm Beach | |
Area 00
|
Xxxxxxx | |
Xxxx 00
|
Xxxx, Xxxxxx |
AHCA
Contract No. FA614, Exhibit III-E, 5 of 5
EXHIBIT
III-E
February 1, 2009 - August 31, 2009 HMO RATES
(MEDICAID Non-Reform HMO CAPITATION RATES)
By Area, Age and Eligibility Category
February 1, 2009 - August 31, 2009 HMO RATES
(MEDICAID Non-Reform HMO CAPITATION RATES)
By Area, Age and Eligibility Category
AHCA
Contract No. FA614, Exhibit III-E, 6 of 5