SECOND AMENDMENT TO THE AMENDED MANAGED CARE CONTRACT BETWEEN


Exhibit 10.1



SECOND AMENDMENT TO THE

BETWEEN





THE COMMONWEALTH OF KENTUCKY
ON BEHALF OF
DEPARTMENT FOR MEDICAID SERVICES
AND

WELLCARE OF KENTUCKY, INC.
STATE-WIDE

1



This Second Amendment to the Amended Medicaid Managed Care Contract State-Wide (the “Contract”) entered into on September 30, 2013 by and between the Commonwealth of Kentucky, through the Cabinet for Finance and Administration, on behalf of the Cabinet for Heath and Family Services, Department for Medicaid Services (collectively herein “Commonwealth”) and WellCare of Kentucky, Inc., is to address increases in supplemental payments required by Section 29.10 of the Contract, pursuant to Section 40.3 of the Contract.
WHEREAS, the Capitation Rates in place as of the effective date of this Second Amendment includes an actuarial amount necessary to pay Supplemental Payments required to be paid by the Cabinet to Specified Providers pursuant to Section 29.10 of the Contracts; and
WHEREAS, the Capitation rates were changed in May 2012 to increase the actuarial amount above the original actuarial amount which had been based on fiscal years 2009 and 2010 financial information due to a significant change in Supplemental Payments in 2011; and
WHEREAS, the Capitation rates were adjusted so that the Supplemental Payments for the thirty-two (32) months of the MCO contract period ending June 30, 2014 were paid over twenty-four (24) months; and
WHEREAS, the portion of the Capitation rates allocated for the Supplemental Payments as of July 1, 2014 would have been 25% higher than required to pay the Supplemental Payments for Fiscal Year 2015; and

2


WHEREAS, the Cabinet now wishes to increase the Supplemental Payments to Specified Providers and will not reduce the Capitation rates July 1, 2014 in order to fund a portion of that increase; and
WHEREAS, to fund the entire Supplemental Payments increase, the Capitation rates shall be increased by an actuarial amount effective April 1, 2014;
NOW THEREFORE, the Contract is hereby amended as follows:
Section 1. The Capitation Rates in Appendix B of the Contract, which Appendix is entitled “Approved Capitation Payment Rates” for “Existing Medicaid Per Member Per Month Rate” shall be replaced by the “Kentucky Medicaid Cabinet for Health and Family Services, WellCare of Kentucky” Capitation Payment rates attached hereto.


3


Approvals:

This Amendment to the Contract is subject to the terms and conditions as stated. The parties certify that they are authorized to bind this agreement between parties and that they accept the terms of this agreement.


CONTRACTOR:
 
WELLCARE OF KENTUCKY, INC.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
/s/ Xxxxx X. Xxxxxx
 
 
State President
 
SIGNATURE
 
 
TITLE
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Xxxxx X. Xxxxxx
 
 
4-1-14
 
PRINTED NAME
 
 
DATE
 
COMMONWEALTH OF KENTUCKY
CABINET FOR FINANCE AND ADMINISTRATION
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
/s/ Xxxxxx X. Xxxxx
 
 
Executive Director
 
SIGNATURE
 
 
TITLE
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Xxxxxx X. Xxxxx
 
 
8/22/14
 
PRINTED NAME
 
 
DATE
 



Approved As To Form And Legality:


/s/ Xxxx Xxxxxxx    
GENERAL COUNSEL
CABINET FOR FINANCE AND ADMINISTRATION

4


Kentucky Medicaid
 
 
 
 
 
 
 
Cabinet for Health and Family Services
 
 
 
 
 
 
WellCare of Kentucky
 
 
 
 
 
 
 
Existing Medicaid Per Member Per Month Rate
 
 
 
 
 
 
 
 
 
Contract Rates for the Period April 1, 2014 - June 30, 2014
Rate Groups
Region 1
Region 2
Region 4
Region 5
Region 6
Region 7
Region 8
 
Families and Children
 
 
 
 
 
 
 
 
 
Infant (age under 1)

$621.53


$686.50


$757.25


$937.54


$700.77


$933.98


$874.88

 
 
Child (age 1 through 5)

$138.38


$122.62


$155.75


$164.72


$125.15


$160.45


$187.02

 
 
Child (age 6 through 12)

$162.80


$179.61


$209.74


$195.90


$166.52


$190.44


$210.91

 
 
Child (age 13 through 18) - Female

$295.53


$298.14


$322.82


$337.58


$285.51


$292.23


$322.40

 
 
Child (age 13 through 18) - Male

$226.61


$267.01


$263.69


$263.87


$211.00


$201.48


$225.48

 
 
Adult (age 19 through 24) - Female

$676.40


$612.15


$620.19


$751.04


$656.44


$664.49


$656.94

 
 
Adult (age 19 through 24) - Male

$242.85


$242.27


$243.77


$259.46


$242.76


$257.92


$246.85

 
 
Adult (age 25 through 39) - Female

$596.18


$535.53


$567.83


$665.68


$616.84


$559.99


$566.67

 
 
Adult (age 25 through 39) - Male

$534.29


$388.85


$437.86


$470.76


$451.64


$359.90


$398.34

 
 
Adult (age 40 or Older) - Female

$634.42


$541.34


$654.21


$724.53


$658.46


$749.00


$654.54

 
 
Adult (age 40 or Older) - Male

$692.22


$655.07


$591.05


$802.22


$785.92


$662.90


$568.02

 
SSI Adults without Medicare
 
 
 
 
 
 
 
 
 
Adult (age 19 through 24) - Female

$658.15


$663.49


$740.95


$671.82


$600.36


$689.27


$664.10

 
 
Adult (age 19 through 24) - Male

$562.49


$446.43


$399.08


$550.71


$742.25


$548.76


$468.98

 
 
Adult (age 25 through 44) - Female

$880.35


$793.73


$866.63


$952.35


$913.47


$971.87


$886.97

 
 
Adult (age 25 through 44) - Male

$571.27


$605.89


$664.66


$833.36


$761.52


$650.52


$703.11

 
 
Adult (age 45 or older) - Female

$1,079.69


$1,140.73


$1,121.79


$1,230.22


$1,165.75


$1,196.43


$1,234.92

 
 
Adult (age 45 or older) - Male

$997.50


$1,022.10


$959.06


$1,169.63


$1,139.96


$962.07


$1,006.18

Waiver Option
 
 
 
 
 
 
 
 
Dual Eligible
 
 
 
 
 
 
 
 
 
All Ages - Female

$129.42


$159.22


$158.01


$183.84


$177.80


$183.05


$187.13

 
 
All Ages - Male

$117.38


$137.77


$141.67


$158.88


$171.50


$165.88


$165.14

 
SSI Child
 
 
 
 
 
 
 
 
 
Infant (age under 1)

$6,702.47


$6,623.23


$7,590.92


$8,285.51


$6,418.03


$7,244.45


$8,040.85

 
 
Child (age 1 through 5)

$550.70


$602.42


$753.23


$1,124.44


$1,073.35


$770.41


$771.33

 
 
Child (age 6 through 18)

$648.59


$773.78


$853.82


$798.75


$609.10


$645.83


$549.06


5


 
Xxxxxx Care
 
 
 
 
 
 
 
 
 
Infant (age under 1)

$1,699.92


$1,695.28


$1,720.54


$1,889.48


$1,678.18


$1,860.02


$2,029.61

 
 
Child (age 1 through 5)

$264.69


$317.09


$312.12


$383.92


$260.27


$320.52


$340.98

 
 
Child (age 6 through 12)

$515.69


$694.98


$696.08


$601.27


$455.83


$540.74


$532.03

 
 
Child (age 13 or older) - Female

$625.37


$887.21


$994.92


$1,040.75


$884.14


$737.18


$1,032.29

 
 
Child (age 13 or older) - Male

$1,231.89


$1,172.41


$894.39


$840.82


$864.69


$707.56


$879.24




6

AutoNDA by SimpleDocs

Document Metadata

Filed: September 15th, 2014
Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!