AHCA CONTRACT NO. FA615
Exhibit
10.3
Wellcare
of Florida, Inc. d/b/a Staywell Health Plan of
Florida
AHCA
CONTRACT NO. FA615
AMENDMENT
NO. 1
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", is hereby amended as
follows:
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1.
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Standard
Contract, Section II, Item A, Contract Amount, the first sentence
is
hereby revised to now read as
follows:
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To
pay for contracted services according to the conditions of Attachment
I in
an amount not to exceed $1,246,085,621.00 (an increase of $28,056,746.00),
subject to availability of funds.
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2.
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Standard
Contract, Section III, Item C., Contract Managers, sub-item 2. is
hereby
amended to now read as follows:
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2.
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The
Vendor’s Contract Manager’s name, address and telephone number for this
Contract is as follows:
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Xxxxxxxx
X. Xxxxxx
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HealthEase
Health Plan of Florida, Inc.
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0000
Xxxxxxxxx Xxxx
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Xxxxx,
XX 00000-0000
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(000)
000-0000
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3.
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Attachment
I, Section B, Method of Payment, Item 1, General, the first paragraph
is
hereby revised to now read as
follows:
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Notwithstanding
the payment amounts which may be computed with the rate tables specified
in Exhibit III, the sum of total capitation payments under this Contract
shall not exceed the total Contract amount of $1,246,085,621.00 (an
increase of $28,056,746.00).
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4.
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Attachment
I, Exhibit I, Maximum Enrollment Levels, is hereby deleted in its
entirety
and replaced with Exhibit I-A, Revised Maximum Enrollment Levels,
attached
hereto and made a part of the Contract. All references in the
Contract to Exhibit I, Maximum Enrollment Levels shall, hereinafter
refer
to Exhibit I-A, Revised Maximum Enrollment
Levels.
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5.
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Attachment
I, Exhibit II, Capitation Rates, is hereby deleted in its entirety
and
replaced with Exhibit II-A, Revised Capitation Rates, attached hereto
and
made a part of the Contract. All references in the Contract to
Exhibit II, Capitation Rates, shall hereinafter refer to Exhibit
II-A,
Revised Capitation Rates.
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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.
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.
AHCA
CONTRACT No. FA615, Amendment No.1, Page 1 of 2
Wellcare
of Florida, Inc. d/b/a Staywell Health Plan of
Florida
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 four (4) page amendment
(which includes all attachments hereto) to be executed by their officials
thereunto duly authorized.
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WELLCARE
OF FLORIDA, INC. D/B/A STAYWELL HEALTH PLAN OF
FLORIDA
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STATE
OF FLORIDA, AGENCY FOR HEALTH CARE
ADMINISTRATION
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SIGNED
BY: /s/ Xxxx X. Xxxxx
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SIGNED
BY: /s/ Xxxxxx X. Xxxxxxxx
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NAME:
Xxxx X. Xxxxx
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NAME:
Xxxxxx X. Xxxxxxxx, M.D.
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TITLE:
President and CEO
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TITLE:
Secretary
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DATE:
5/29/2007
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DATE:
5/31/2007
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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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I-A
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Revised
Maximum Enrollment Levels (1 Page)
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Exhibit
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II-A
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Revised
Capitation Rates (1 Page)
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REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
AHCA
CONTRACT No. FA615, Amendment No.1, Page 2 of 2
EXHIBIT
I-A
REVISED
MAXIMUM ENROLLMENT LEVELS
TABLE
1
ENROLLMENT
LEVELS
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County
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Maximum
Enrollment Level
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Brevard
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14,000
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Broward
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25,000
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Dade
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25,000
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Hernando
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15,000
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Hillsborough
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28,000
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Xxx
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15,000
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Manatee
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12,000
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Palm
Beach
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15,000
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Pasco
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7,000
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Pinellas
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15,000
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Polk
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25,000
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Orange
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38,000
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Osceola
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12,000
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Sarasota
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6,000
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Seminole
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6,000
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St.
Lucie
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4,500
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Sumter
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4,500
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REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
AHCA
Contract No. FA615, Exhibit I-A, Page 1 of
1
EXHIBIT
II-A
REVISED
CAPITATION RATES
A. Table
2 - General Capitation Rates plus Mental Health Rates:
Area
3 Counties:
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County
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Provider
Number
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Sumter
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015016916
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Area
9 Counties:
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County
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Provider
Number
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St.
Lucie
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015016915
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B. Table
4 - General Capitation Rates plus Mental Health Rates plus
Transportation:
Area
3 Counties:
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County
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Provider
Number
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Hernando
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015016901
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Area
5 Counties:
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County
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Provider
Number
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Pasco
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015016903
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Pinellas
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015016904
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Area
6 Counties:
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County
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Provider
Number
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Hillsborough
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015016902
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Manatee
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015016912
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Polk
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015016905
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Area
7 Counties:
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County
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Provider
Number
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Orange
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015016906
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Seminole
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015016908
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Osceola
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015016907
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Xxxxxxx
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000000000
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Xxxx
0 Xxxxxxxx:
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Xxxxxx
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Provider
Number
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Xxx
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015016911
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Sarasota
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015016914
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Area
9 Counties:
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County
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Provider
Number
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Palm
Beach
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015016910
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Area
10 Counties:
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County
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Provider
Number
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Broward
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015016900
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Area
11 Counties:
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County
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Provider
Number
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Miami-Dade
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015016909
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AHCA
Contract No. FA615, Exhibit II-A, Page 1 of
1
