AHCA CONTRACT NO. FAR001 AMENDMENT NO. 2
Exhibit
10.12
| HealthEase Health Plan of Florida, Inc. |
AHCA
CONTRACT NO. FAR001
AMENDMENT
NO. 2
THIS
CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE
ADMINISTRATION, hereinafter referred to as the “Agency” and HEALTHEASE HEALTH
PLAN OF FLORIDA, INC. hereinafter referred to as the “Vendor”, is hereby amended
as follows:
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1.
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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.
The
Vendor’s Contract Manager’s name, address and telephone number for this Contract
is as follows:
Xxxxxxxx
X. Xxxxxx
HealthEase
Health Plan of Florida, Inc.
0000
Xxxxxxxxx Xxxx
Xxxxx,
XX
00000-0000
(000)
000-0000
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2.
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Attachment
II, Medicaid Reform Health Plan Model Contract, Section IV., Behavioral
Health Care, Item Q., Community Behavioral Health Services Annual
80/20
Expenditure Report, as included by Amendment No. 1 to this Contract,
is
hereby deleted in its entirety.
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3.
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Attachment
II, Medicaid Reform Health Plan Model Contract, Section XII., Reporting
Requirements, as replaced by Amendment No. 1 to this Contract,
Item A.,
Health Plan Reporting Requirements, Table 1, Summary of Reporting
Requirements, is hereby revised to delete in its entirety, the
last row of
the table containing the data set requirements for the report entitled
“Behavioral Health: Annual 80/20 Expenditure
Report.”
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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 is hereby made 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 one (1) page Amendment
to
be executed by their officials thereunto duly authorized.
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HEALTHEASE
HEALTH PLAN OF FLORIDA, INC.
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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 Xxxxxxxx, M.D.
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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:
4/19/2007
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Date:
4/26/07
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AHCA
CONTRACT NO. FAR001, Amendment No. 2, Page 1 of
1
