AHCA CONTRACT NO. FA521 AMENDMENT NO. 2
Exhibit 10.3
| HEALTHEASE OF FLORIDA, INC., d/b/a HEALTHEASE | Medicaid HMO Contract |
AHCA CONTRACT NO. FA521
AMENDMENT NO. 2
THIS CONTRACT, entered into between 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:
| 1. | Standard Contract, the first paragraph is hereby amended to change the Vendor’s address to the following: |
0000 Xxxxxxxxx Xxxx, Xxx 0
Xxxxx, XX 00000
| 2. | Standard Contract, Section II.A, Contract Amount, the first sentence is hereby amended to now read: |
To pay for contracted services according to the conditions of Attachment I in an amount not to exceed $806,942,900.00, (an increase of $36,504,905.00), subject to the availability of funds.
| 3. | Standard Contract, Section III.C.2 is hereby amended to change the address to the following: |
0000 Xxxxxxxxx Xxxx, Xxx 0
Xxxxx, XX 00000
| 4. | Standard Contract, Section III.E.1 is hereby amended to change the mailing address to the following: |
HealthEase of Florida, Inc.
Attn: Regulatory Affairs
X.X. Xxx 00000
Xxxxx, XX 00000-0000
| 5. | Standard Contract, Section III.E.2 is hereby amended to change the street address to the following: |
0000 Xxxxxxxxx Xxxx, Xxx 0
Xxxxx, XX 00000
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
AHCA Contract No. FA521, Amendment No. 2, Page 1 of 3
| HEALTHEASE OF FLORIDA, INC., d/b/a HEALTHEASE | Medicaid HMO Contract |
| 6. | Attachment I, Section 90.0, Payment and Authorized Enrollment Levels, Table I is hereby amended to now read: |
| Table 1 | Projected Enrollment | |
| County |
Maximum Enrollment Level | |
| BREVARD |
14,000 | |
| BROWARD |
13,500 | |
| XXXXXXX |
800 | |
| CITRUS |
5,000 | |
| XXXXX |
55,000 | |
| ESCAMBIA |
18,000 | |
| GADSDEN |
3,500 | |
| HIGHLANDS |
3,000 | |
| HILLSBOROUGH |
18,000 | |
| JEFFERSON |
1,000 | |
| LAKE |
6,000 | |
| XXXX |
6,000 | |
| LIBERTY |
400 | |
| MADISON |
1,000 | |
| MANATEE |
6,000 | |
| XXXXXX |
20,000 | |
| XXXXXX |
5,000 | |
| MIAMI-DADE |
25,000 | |
| ORANGE |
25,000 | |
| OSCEOLA |
8,000 | |
| PALM BEACH |
9,000 | |
| PASCO |
6,000 | |
| PINELLAS |
9,000 | |
| POLK |
10,000 | |
| XXXXXX |
6,000 | |
| SANTA XXXX |
4,000 | |
| SARASOTA |
3,000 | |
| SEMINOLE |
4,000 | |
| VOLUSIA |
15,000 | |
| WAKULLA |
1,000 | |
| 7. | Attachment I, Section 90.0, Payment and Authorized Enrollment Levels, Table 3, the second paragraph is hereby amended to now read: |
Notwithstanding the payment amounts which may be computed with the above rate table, the sum of total capitation payments under this contract shall not exceed the total contract amount of $806,942,900.00, (an increase of $36,504,905.00), expressed on page seven of this contract.
| 8. | This amendment shall begin on December 27, 2004, or the date on which the amendment has been signed by both parties, whichever is later. |
AHCA Contract No. FA521, Amendment No. 2, Page 2 of 3
| HEALTHEASE OF FLORIDA, INC., d/b/a HEALTHEASE | Medicaid HMO Contract |
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 3 page amendment to be executed by their officials thereunto duly authorized.
| HEALTHEASE OF FLORIDA, INC. | STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION | |||||
| SIGNED |
SIGNED | |||||
| BY: | /s/ XXXX X. XXXXX |
BY: | /s/ XXXX XXXXXX | |||
| NAME: | Xxxx X. Xxxxx | NAME: | Xxxx Xxxxxx | |||
| TITLE: | Chief Executive Officer | TITLE: | Secretary | |||
| DATE: | 1/04/05 | DATE: | 1/21/05 | |||
THE REMAINDER OF THIS PAGE LEFT BLANK INTENTIONALLY
AHCA Contract No. FA521, Amendment No. 2, Page 3 of 3
