AHCA CONTRACT NO. FA614

AMENDMENT NO. 9

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 September 1, 2008, Standard Contract, Section III, Item C., Contract Managers, sub-item 1,

is hereby amended to now read as follows:

The Agency’s Contract Manager’s name, address and telephone number for this Contract is as follows:

Xxxxxxxx Xxxxxxxxx
Agency for Health Care Administration 0000 Xxxxx Xxxxx, XX #00

Xxxxxxxxxxx, XX 00000

(000) 000-0000

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.

3. Effective, December 1, 2008, Attachment II, Medicaid Prepaid Health Plan Model Contract, Section V,

Covered Services, Item C, Expanded Services, sub-item 2 is hereby deleted in its entirety and replaced with the following:

2. The following is a list of the Health Plan’s Expanded Services:

OTC Medications — Up to ten ($10.00) credit per household each month for selected over- the-counter drugs and/or health supplies.

Respite Care Services — Annual maximum of not more than an initial homehealth visit by RN @ $65.00 and eight (8) follow-up visits by an aide at $23.00 per visit. Follow-up visits are four (4) hours in length. Maximum of sixteen (16) hours in a given month and thirty- two (32) hours per year.

Enhanced Hearing Aid Benefit — Upgrade from standard medically necessary, behind-theear hearing aid benefit to digital canal hearing aid up to $500.

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 seven (7) page Amendment (which includes all attachments hereto) to be executed by their officials thereunto duly authorized.

AMERIGROUP FLORIDA, INC. STATE OF FLORIDA, AGENCY
D/B/A AMERIGROUP COMMUNITY CARE FOR HEALTH CARE ADMISTRATIONSIGNED SIGNED


BY: /S/ Xxxxxxx X. XxXxxx		BY:

NAME: Xxxxxxx X. XxXxxx		NAME: Xxxxx Xxxxxx

TITLE: CEO		TITLE: Secretary

DATE: 8/29/08		DATE:

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

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:
Area	1	2	3	4	5	6	7	8	9	10	11
TANF BTHM0+2M0	1,113.37	1,113.37	1,217.57	1,067.51	1,214.96	1,056.56	1,092.94	1,033.51	1,067.78	1,083.46	1,372.19
TANF 3M0-11MO	187.38	187.38	206.51	181.92	206.53	181.19	186.84	177.08	181.58	186.46	232.59
TANF AGE (1-5)	101.38	101.38	112.28	99.04	112.30	98.87	101.87	96.67	98.82	101.73	126.24
TANF AGE (6-13)	61.45	61.45	69.11	61.51	69.38	61.99	63.49	60.37	61.05	63.88	77.54
TANF AGE (14-20)Female	129.49	129.49	143.30	126.30	143.25	126.18	129.77	123.15	126.06	129.70	161.30
TANF AGE (14-20) Male	69.52	69.52	77.85	69.23	78.21	69.68	71.35	68.03	68.67	71.87	87.46
TANF AGE (21-54)Female	255.23	255.23	283.53	250.83	284.08	251.35	258.27	245.23	249.80	258.53	319.10
TANF AGE (21-54) Male	153.37	153.37	171.42	152.26	172.12	153.20	157.02	149.29	151.41	157.78	192.88
TANF AGE (55+) 318.51	318.51	359.72	321.21	361.87	325.45	332.09	316.91	318.38	335.92	404.23
SSI-N BTHMO+2M0	10,428.92	10,428.92	11,442.82	10,972.58	12,248.94	11,162.18	11,810.40	10,525.98	11,078.29	14,344.29	14,488.14
SSI-N 3M0-11MO	1,517.58	1,517.58	1,680.06	1,615.28	1,796.88	1,645.44	1,744.81	1,550.30	1,635.46	2,132.34	2,131.88
SSI-N AGE (1-5)	445.88	445.88	495.07	476.38	528.79	485.06	514.41	457.03	482.13	629.36	628.05
SSI-N AGE (6-13)	198.88	198.88	226.05	218.79	240.95	223.95	238.57	210.03	223.68	297.17	289.19
SSI-N AGE (14-20) 213.14		213.14	241.47	233.36	256.93	237.92	254.24	224.35	237.34	314.18	307.93
SSI-N AGE (21-54)	696.73	696.73	787.51	761.37	840.31	777.94	828.77	731.36	775.59	1,027.07	1,004.54
SSI-N AGE (55+)	700.31	700.31	795.55	770.55	849.11	788.05	840.70	740.14	785.85	1,044.85	1,015.98
SSI-B	305.88	305.88	340.56	297.82	225.19	274.94	373.98	256.24	219.29	322.21	370.49
SSI-AB AGE (65-)	94.80	94.80	90.01	90.35	81.19	79.31	84.56	78.77	84.42	94.02	140.27
SSI-AB AGE (65+)	85.77	85.77	81.98	82.40	75.29	72.63	77.61	72.23	77.20	86.21	126.63

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

TABLE 2
General + Mental Health Rates:

Area

TANF BTHM0+2M0

1,113.39

1,113.40

1,217.58

1,067.52

1,214.97

1,056.58

1,092.96

1,033.52

1,067.80

1,083.48

1,372.21

TANF 3M0-11MO

187.40

187.41

206.52

181.93

206.54

181.21

186.86

177.09

181.60

186.11

232.61

TANF AGE (1-5)

103.02

104.29

113.60

100.42

113.51

100.72

103.65

97.93

100.37

103.65

127.86

TANF AGE (6-13)

73.14

81.71

78.29

71.07

78.06

75.24

76.18

69.16

71.86

77.24

88.83

TANF AGE (14-20)Female

140.42

142.91

149.38

132.64

151.36

138.56

141.63

128.97

133.22

138.55

168.79

TANF AGE (14-20) Male

80.45

82.94

83.93

75.57

86.32

82.06

83.21

73.85

75.83

80.72

94.95

TANF AGE (21-54)Female

259.67

258.64

285.07

252.44

287.37

256.38

263.09

246.72

251.62

260.78

321.01

TANF AGE (21-54) Male

157.81

156.78

172.96

153.87

175.41

158.23

161.84

150.78

153.23

160.03

194.79

TANF AGE (55+)

322.25

321.46

361.06

322.61

364.65

329.70

336.16

318.20

319.95

337.87

405.88

SSI-N BTHMO+2M0

10,429.00

10,429.08

11,442.89

10,972.69

12,248.99

11,162.25

11,810.46

10,526.05

11,078.36

14,344.39

14,488.22

SSI-N 3M0-11MO

1,517.66

1,517.74

1,680.13

1,615.39

1,796.93

1,645.51

1,744.87

1,550.37

1,635.53

2,132.44

2,131.96

SSI-N AGE (1-5)

453.32

459.67

501.33

486.14

533.81

491.58

520.53

463.03

488.46

637.71

635.02

SSI-N AGE (6-13)

246.93

277.70

261.81

274.53

273.37

266.06

278.08

244.31

259.82

344.88

328.99

SSI-N AGE (14-20)

257.13

258.36

261.99

265.34

286.61

276.46

290.41

244.03

248.08

341.56

330.76

SSI-N AGE (21-54)

778.13

749.41

811.41

798.63

895.23

849.27

895.70

754.27

799.75

1,058.95

1,031.14

SSI-N AGE (55+)

731.29

725.19

806.83

788.14

870.01

815.20

866.18

750.96

797.26

1,059.91

1,028.54

SSI-B

306.09

326.08

347.41

322.37

227.92

276.25

376.57

263.09

226.14

329.06

377.72

SSI-AB AGE (65-)

106.45

109.81

98.99

107.12

94.01

83.20

95.08

91.99

94.01

102.08

148.33

SSI-AB AGE (65+)

97.42

100.78

90.96

99.17

88.11

76.52

88.13

85.45

86.79

94.27

134.69

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category


TABLE 3
General + Mental Health + Dental Rates:
Area	1	2	3	4	5	6	7	8	9	10	11
TANF BTHM0+2M0	1,113.39	1,113.40	1,217.59	1,067.53	1,214.98	1,056.59	1,092.97	1,033.53	1,067.81	1,083.49	1,372.22
TANF 3M0-11MO	187.41	187.42	206.54	181.94	206.56	181.22	186.87	177.11	181.62	186.12	232.62
TANF AGE (1-5)	104.70	105.97	116.65	102.26	116.92	103.39	106.05	101.57	103.30	106.08	131.59
TANF AGE (6-13)	76.25	84.82	83.95	74.49	84.39	80.20	80.63	75.90	77.30	81.75	96.51
TANF AGE (14-20)Female	143.60	146.09	155.15	136.14	157.83	143.62	146.17	135.86	138.78	143.16	176.76
TANF AGE (14-20)Male	83.14	85.63	88.81	78.52	91.79	86.34	87.05	79.68	80.53	84.62	101.67
TANF AGE (21-54)Female	260.89	259.86	286.81	254.11	290.78	258.26	264.42	248.74	252.58	261.51	321.87
TANF AGE (21-54) Male	159.07	158.04	174.74	155.59	178.92	160.17	163.20	152.85	154.21	160.78	195.67
TANF AGE (55+) 325.04	324.25	365.03	326.43	372.44	334.00	339.20	322.80	322.14	339.53	407.84
SSI-N BTHMO+2M0	10,429.00	10,429.08	11,442.89	10,972.69	12,249.00	11,162.25	11,810.46	10,526.05	11,078.36	14,344.39	14,488.23
SSI-N 3M0-11MO	1,517.66	1,517.74	1,680.14	1,615.39	1,796.94	1,645.52	1,744.88	1,550.38	1,635.54	2,132.45	2,131.98
SSI-N AGE (1-5)	454.94	461.29	504.46	487.92	538.03	494.62	523.53	466.45	491.05	640.50	639.29
SSI-N AGE (6-13)	249.33	280.10	266.45	277.17	279.64	270.56	282.52	249.39	263.67	349.02	336.38
SSI-N AGE (14-20)	259.19	260.42	265.98	267.61	291.99	280.33	294.23	248.39	261.39	345.12	337.23
SSI-N AGE (21-54)	779.46	750.74	813.29	800.51	898.93	851.77	897.25	756.55	800.93	1,059.90	1,032.92
SSI-N AGE (55+)	733.15	727.05	809.48	790.78	875.21	818.71	868.36	754.16	798.91	1,061.24	1,031.04
SSI-B	306.54	326.53	348.44	324.55	231.58	278.01	377.05	264.63	227.97	329.88	381.06
SSI-AB AGE (65-)	107.57	110.93	100.64	108.71	97.80	85.45	96.60	93.66	95.08	103.38	150.49
SSI-AB AGE (65+)	98.28	101.64	92.22	100.38	91.00	78.23	89.29	86.72	87.60	95.25	136.34

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

TABLE 4
General + Mental Health + Transportation Rates:


Area	1	2	3	4	5	6	7	8	9	10	11
TANF BTHM0+2M0	1,118.74	1,118.75	1,224.01	1,072.09	1,218.84	1,060.38	1,096.99	1,038.81	1,072.91	1,086.47	1,375.30
TANF 3M0-11MO	188.77	188.78	208.18	183.11	207.54	182.19	187.89	178.45	182.92	186.89	233.40
TANF AGE (1-5)	103.85	105.12	114.60	101.13	114.11	101.31	104.28	98.76	101.17	104.12	128.34
TANF AGE (6-13)	73.64	82.21	78.89	71.50	78.42	75.60	76.56	69.66	72.34	77.52	89.12
TANF AGE (14-20)Female	142.45	144.94	151.82	134.38	152.83	140.00	143.16	130.99	135.16	139.69	169.97
TANF AGE (14-20) Male	81.79	84.28	85.54	76.72	87.29	83.01	84.23	75.18	77.11	81.47	95.73
TANF AGE (21-54)Female	262.97	261.94	289.04	255.26	289.75	258.73	265.58	249.98	254.77	262.62	322.92
TANF AGE (21-54) Male	160.32	159.29	175.98	156.01	177.22	160.02	163.74	153.26	155.63	161.43	196.24
TANF AGE (55+) 325.76	324.97	365.28	325.61	367.18	332.19	338.80	321.67	323.30	339.83	407.91
SSI-N BTHMO+2M0	10,468.09	10,468.17	11,492.20	11,011.02	12,280.81	11,193.75	11,845.21	10,564.27	11,117.70	14,370.64	14,515.60
SSI-N 3M0-11MO	1,543.33	1,543.41	1,712.51	1,640.55	1,817.81	1,666.20	1,767.68	1,575.46	1,661.37	2,149.68	2,149.93
SSI-N AGE (1-5)	458.61	464.96	508.01	491.32	538.12	495.85	525.23	468.20	493.79	641.26	638.72
SSI-N AGE (6-13)	249.36	280.13	264.88	276.91	275.35	268.01	280.23	246.69	262.27	346.51	330.69
SSI-N AGE (14-20)	263.26	264.49	269.71	271.34	291.59	281.39	295.85	250.01	264.24	345.67	335.05
SSI-N AGE (21-54)	798.19	769.47	836.72	818.29	911.55	865.43	913.53	773.87	819.93	1,072.41	1,045.18
SSI-N AGE (55+)	748.22	742.12	828.19	804.74	883.79	828.84	881.23	767.52	814.30	1,071.28	1,040.40
SSI-B	313.56	333.55	356.12	329.55	234.47	281.96	381.95	269.02	232.70	334.36	382.84
SSI-AB AGE (65-)	120.17	125.53	118.76	122.97	108.09	94.76	107.21	106.78	109.81	114.42	160.77
SSI-AB AGE (65+)	106.26	109.62	103.70	109.39	97.18	83.97	95.94	94.97	96.97	102.22	142.70

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:


Area	1	2	3	4	5	6	7	8	9	10	11
TANF BTHM0+2M0	1,118.72	1,118.72	1,224.00	1,072.08	1,218.83	1,060.36	1,096.97	1,038.80	1,072.89	1,086.45	1,375.28
TANF 3M0-11MO	188.75	188.75	208.17	183.10	207.53	182.17	187.87	178.44	182.90	186.87	233.38
TANF AGE (1-5)	102.21	102.21	113.28	99.75	112.90	99.46	102.50	97.50	99.62	102.20	126.72
TANF AGE (6-13)	61.95	61.95	69.71	61.94	69.74	62.35	63.87	60.87	61.53	64.16	77.83
TANF AGE (14-20)Female	131.52	131.52	145.74	128.04	144.72	127.62	131.30	125.17	128.00	130.84	162.48
TANF AGE (14-20) Male	70.86	70.86	79.46	70.38	79.18	70.63	72.37	69.36	69.95	72.62	88.24
TANF AGE (21-54)Female	258.53	258.53	287.50	253.65	286.46	253.70	260.76	248.49	252.95	260.37	321.01
TANF AGE (21-54) Male	155.88	155.88	174.44	154.40	173.93	154.99	158.92	151.77	153.81	159.18	194.33
TANF AGE (55+) 322.02	322.02	363.94	324.21	364.40	327.94	334.73	320.38	321.73	337.88	406.25
SSI-N BTHMO+2M0	10,468.01	10,468.01	11,492.13	11,010.91	12,280.76	11,193.68	11,845.15	10,564.20	11,117.63	14,370.54	14,515.52
SSI-N 3M0-11MO	1,543.25	1,543.25	1,712.44	1,640.44	1,817.76	1,666.13	1,767.62	1,575.39	1,661.30	2,149.58	2,149.85
SSI-N AGE (1-5)	451.17	451.17	501.75	481.56	533.10	489.33	519.11	462.20	487.46	632.91	631.75
SSI-N AGE (6-13)	201.31	201.31	229.12	221.17	242.93	225.90	240.72	212.41	226.13	298.80	290.89
SSI-N AGE (14-20)	219.27	219.27	249.19	239.36	261.91	242.85	259.68	230.33	243.50	318.29	312.22
SSI-N AGE (21-54)	716.79	716.79	812.82	781.03	856.63	794.10	846.60	750.96	795.77	1,040.53	1,018.58
SSI-N AGE (55+)	717.24	717.24	816.91	787.15	862.89	801.69	855.75	756.70	802.89	1,056.22	1,027.84
SSI-B	313.35	313.35	349.27	305.00	231.74	280.65	379.36	262.17	225.85	327.51	375.61
SSI_AB AGE (65-)	108.52	108.52	109.78	106.20	95.27	90.87	96.69	93.56	100.22	106.36	152.71
SSI_AB AGE (65+)	94.61	94.61	94.72	92.62	84.36	80.08	85.42	81.75	87.38	94.16	134.64

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

TABLE 6

General + Dental Rates:

Area

TANF BTHM0+2M0

1,113.37

1,217.58

1,067.52

1,214.97

1,056.57

1,092.95

1,033.52

1,067.79

1,083.47

1,372.20

TANF 3M0-11MO

187.39

206.53

181.93

206.55

181.20

186.85

177.10

181.60

186.10

232.60

TANF AGE (1-5)

103.06

115.33

100.88

115.71

101.54

104.27

100.31

101.75

104.16

129.97

TANF AGE (6-13)

64.56

74.77

64.93

75.71

66.95

67.94

67.11

66.49

68.39

85.22

TANF AGE (14-20)Female

132.67

149.07

129.80

149.72

131.24

134.31

130.04

131.62

134.31

169.27

TANF AGE (14-20) Male

72.21

82.73

72.18

83.68

73.96

75.19

73.86

73.37

75.77

94.18

TANF AGE (21-54)Female

256.45

285.27

252.50

287.49

253.23

259.60

247.25

250.76

259.26

319.96

TANF AGE (21-54) Male

154.63

173.20

153.96

175.63

155.14

158.38

151.36

152.39

158.53

193.76

TANF AGE (55+)

321.30

363.69

325.03

369.66

329.75

335.13

321.51

320.57

337.58

406.19

SSI-N BTHMO+2M0

10,428.92

11,442.82

10,972.58

12,248.95

11,162.18

11,810.40

10,525.98

11,078.29

14,344.29

14,488.15

SSI-N 3M0-11MO

1,517.58

1,680.07

1,615.28

1,796.89

1,645.45

1,744.82

1,550.31

1,635.47

2,132.35

2,131.90

SSI-N AGE (1-5)

447.50

498.20

478.16

533.01

488.10

517.41

460.45

484.72

632.15

632.32

SSI-N AGE (6-13)

201.28

230.69

221.43

247.22

228.45

243.01

215.11

227.53

301.31

296.58

SSI-N AGE (14-20)

215.20

245.46

235.63

262.31

241.79

258.06

228.71

240.65

317.74

314.40

SSI-N AGE (21-54)

698.06

789.39

763.25

844.01

780.44

830.32

733.64

776.77

1,028.02

1,006.32

SSI-N AGE (55+)

702.17

798.20

773.19

854.31

791.56

842.88

743.34

787.50

1,046.18

1,018.48

SSI-B

306.33

341.59

300.00

228.85

276.70

374.46

257.78

221.12

323.03

373.83

SSI-AB AGE (65-)

95.92

91.66

91.94

84.98

81.56

86.08

80.44

85.49

95.32

142.43

SSI-AB AGE (65+)

86.63

83.24

83.61

78.18

74.34

78.77

73.50

78.01

87.19

128.28

EXHIBIT III-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:


Area	1	2	3	4	5	6	7	8	9	10	11
TANF BTHM0+2M0	1,118.72	1,118.72	1,224.01	1,072.09	1,218.84	1,060.37	1,096.98	1,038.81	1,072.90	1,086.46	1,375.29
TANF 3M0-11MO	188.76	188.76	208.19	183.11	207.55	182.18	187.88	178.46	182.92	186.88	233.39
TANF AGE (1-5)	103.89	103.89	116.33	101.59	116.31	102.13	104.90	101.14	102.55	104.63	130.45
TANF AGE (6-13)	65.06	65.06	75.37	65.36	76.07	67.31	68.32	67.61	66.97	68.67	85.51
TANF AGE (14-20) Female	134.70	134.70	151.51	131.54	151.19	132.68	135.84	132.06	133.56	135.45	170.45
TANF AGE (14-20) Male	73.55	73.55	84.34	73.33	84.65	74.91	76.21	75.19	74.65	76.52	94.96
TANF AGE (21-54) Female	259.75	259.75	289.24	255.32	289.87	255.58	262.09	250.51	253.91	261.10	321.87
TANF AGE (21-54) Male	157.14	157.14	176.22	156.12	177.44	156.93	160.28	153.84	154.79	159.93	195.21
TANF AGE (55+) 324.81	324.81	367.91	328.03	372.19	332.24	337.77	324.98	323.92	339.54	408.22
SSI-N BTHMO+2M0	10,468.01	10,468.01	11,492.13	11,010.91	12,280.77	11,193.68	11,845.15	10,564.20	11,117.63	14,370.54	14,515.53
SSI-N 3M0-11MO	1,543.25	1,543.25	1,712.45	1,640.44	1,817.77	1,666.14	1,767.63	1,575.40	1,661.31	2,149.59	2,149.87
SSI-N AGE (1-5)	452.79	452.79	504.88	483.34	537.32	492.37	522.11	465.62	490.05	635.70	636.02
SSI-N AGE (6-13)	203.71	203.71	233.76	223.81	249.20	230.40	245.16	217.49	229.98	302.94	298.28
SSI-N AGE (14-20)	221.33	221.33	253.18	241.63	267.29	246.72	263.50	234.69	246.81	321.85	318.69
SSI-N AGE (21-54)	718.12	718.12	814.70	782.91	860.33	796.60	848.15	753.24	796.95	1,041.48	1,020.36
SSI-N AGE (55+)	719.10	719.10	819.56	789.79	868.09	805.20	857.93	759.90	804.54	1,057.55	1,030.34
SSI-B	313.80	313.80	350.30	307.18	235.40	282.41	379.84	263.71	227.68	328.33	378.95
SSI-AB AGE (65-)	109.64	109.64	111.43	107.79	99.06	93.12	98.21	95.23	101.29	107.66	154.87
SSI-AB AGE (65+)	95.47	95.47	95.98	93.83	87.25	81.79	86.58	83.02	88.19	95.14	136.29

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

TABLE 8
General + Mental Health + Dental + Transportation Rates:


Area	1	2	3	4	5	6	7	8	9	10	11
TANF BTHM0+2M0	1,118.74	1,118.75	1,224.02	1,072.10	1,218.85	1,060.39	1,097.00	1,038.82	1,072.92	1,086.48	1,375.31
TANF 3M0-11MO	188.78	188.79	208.20	183.12	207.56	182.20	187.90	178.47	182.94	186.90	233.41
TANF AGE (1-5)	105.53	106.80	117.65	102.97	117.52	103.98	106.68	102.40	104.10	106.55	132.07
TANF AGE (6-13)	76.75	85.32	84.55	74.92	84.75	80.56	81.01	76.40	77.78	82.03	96.80
TANF AGE (14-20)Female	145.63	148.12	157.59	137.88	159.30	145.06	147.70	137.88	140.72	144.30	177.94
TANF AGE (14-20) Male	84.48	86.97	90.42	79.67	92.76	87.29	88.07	81.01	81.81	85.37	102.45
TANF AGE (21-54)Female	264.19	263.16	290.78	256.93	293.16	260.61	266.91	252.00	255.73	263.35	323.78
TANF AGE (21-54) Male	161.58	160.55	177.76	157.73	180.73	161.96	165.10	155.33	156.61	162.18	197.12
TANF AGE (55+) 328.55	327.76	369.25	329.43	374.97	336.49	341.84	326.27	325.49	341.49	409.87
SSI-N BTHMO+2M0	10,468.09	10,468.17	11,492.20	11,011.02	12,280.82	11,193.75	11,845.21	10,564.27	11,117.70	14,370.64	14,515.61
SSI-N 3M0-11MO	1,543.33	1,543.41	1,712.52	1,640.55	1,817.82	1,666.21	1,767.69	1,575.47	1,661.38	2,149.69	2,149.95
SSI-N AGE (1-5)	460.23	466.58	511.14	493.10	542.34	498.89	528.23	471.62	496.38	644.05	642.99
SSI-N AGE (6-13)	251.76	282.53	269.52	279.55	281.62	272.51	284.67	251.77	266.12	350.65	338.08
SSI-N AGE (14-20)	265.32	266.55	273.70	273.61	296.97	285.26	299.67	254.37	267.55	349.23	341.52
SSI-N AGE (21-54)	799.52	770.80	838.60	820.17	915.25	867.93	915.08	776.15	821.11	1,073.36	1,046.96
SSI-N AGE (55+)	750.08	743.98	830.84	807.38	888.99	832.35	883.41	770.72	815.95	1,072.61	1,042.90
SSI-B	314.01	334.00	357.15	331.73	238.13	283.72	382.43	270.56	234.53	335.18	386.18
SSI-AB AGE (65-)	121.29	124.65	120.41	124.56	111.88	97.01	108.73	108.45	110.88	115.72	162.93
SSI-AB AGE (65+)	107.12	110.48	104.96	110.60	100.07	85.68	97.10	96.24	97.78	103.20	144.35

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category


Area		Corresponding Xxxxxxxx
Xxxx 0 Xxxx 0 Xxxx 0 Xxxx 0 Area 5 Xxxx 0 Xxxx 0 Xxxx 0 Xxxx 0 Xxxx 10 Area 11		Escambia, Okaloosa, Santa Rosa, Walton Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Xxxxxxxxx, Xxxx, Liberty, Madison, Taylor, Washington, Wakulla Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Xxxx, Xxxxxx, Putnam, Sumter, Suwannee, Union Baker, Clay, Duval, Flagler, Nassau, St. Xxxxx, Volusia Pasco, Pinellas Xxxxxx, Highlands, Hillsborough, Manatee, Polk Brevard, Orange, Osceola, Seminole Charlotte, Xxxxxxx, De Xxxx, Glades, Hendry, Lee, Sarasota Indian River, Okeechobee, St. Lucie, Martin, Palm Beach Broward Dade, Monroe

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Table of Contents

AHCA CONTRACT NO. FA614

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