AHCA CONTRACT NO. FAR009 AMENDMENT NO. 11
Exhibit 10.21
Wellcare
of Florida, Inc.
d/b/a
Staywell Health Plan of Florida
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AHCA
CONTRACT NO. FAR009
AMENDMENT
NO. 11
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:
1. Attachment
II, Table of Contents, is hereby amended as follows:
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Section
IV Enrollee Services and Marketing is hereby amended to now
read:
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Section
IV Enrollee Services, Community Outreach and Marketing
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Section
IV, Item B. is hereby amended to now
read:
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B.
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Community
Outreach and Marketing
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2.
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Attachment
II, Medicaid Reform Health Plan Model Contract, Section I, Item A.,
Definitions, is hereby amended as
follows:
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The
definition of Community Outreach Representative is hereby included as
follows:
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Community
Outreach Representative – A person who provides Community Outreach,
including health information, information that promotes healthy lifestyles,
information that provides guidance about social assistance programs, and
information that provides culturally and linguistically appropriate health or
nutritional education. Such representatives must be appropriately
trained, certified and/or licensed, including but not limited to, social
workers, nutritionists, physical therapists and other health care
professionals.
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--
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The
definition of Community Outreach is hereby included as
follows:
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Community
Outreach – The provision of health or nutritional information, or
information for the benefit and education of, or assistance to, a community in
regard to health-related matters or public awareness that promotes healthy
lifestyles. Community Outreach also includes the provision of
information about health care services, preventive techniques and other health
care projects and the provision of information related to health, welfare, and
social services or social assistance programs offered by the State of Florida or
local communities.
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The
definition of Community Outreach Materials is hereby included as
follows:
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Community
Outreach Materials – Materials regarding health or nutritional
information, or information for the benefit and education of, or assistance to,
a community in regard to health-related matters or public awareness that
promotes healthy lifestyles; such materials are specifically meant for the
community at-large and may also include information about health care services,
preventive techniques and other health care projects and the provision of
information related to health, welfare, and social services or social assistance
programs offered by the State of Florida or local
communities. Community Outreach Materials are limited to brochures,
fact sheets, posters, and ad copy for radio, television, print or the
Internet.
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The
definition of Market Area is hereby amended to read as
follows:
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Market
Area – The
geographic area in which the Health Plan is authorized to conduct Community
Outreach.
AHCA
Contract No. FAR009, Amendment No. 11, Page 1 of 11
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The
definition of Marketing Representative is hereby deleted in its
entirety.
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The
definition of Pre-Enrollment is hereby amended to read as
follows:
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Pre-Enrollment
– The provision of Marketing materials to a Medicaid Recipient.
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The
definition of Pre-Enrollment Application is hereby deleted in its
entirety.
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The
definition of Public Event is hereby amended to read as
follows:
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Public
Event – An event that is organized or sponsored by an organization, for
the benefit and education of, or assistance to, a community in regard to
health-related matters or public awareness.
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The
definition of Remediation is hereby included as
follows:
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Remediation
- Remediation of encounter claims; where remediation is “the act or process of
correcting a fault or deficiency.”
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The
definition of Request for Benefit Information (RBI)is hereby deleted in
its entirety.
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3.
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Attachment
II, Medicaid Reform Health Plan Model Contract, Section I, Item B.,
Acronyms, is hereby amended as
follows:
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--
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The
acronym ACCESS is hereby included as
follows:
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ACCESS – Automated Community
Connection to Economic Self-Sufficiency: The Department of Children
and Families’ (DCF’s) public assistance service delivery system.
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The
acronym SNIP is hereby included as
follows:
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SNIP – Strategic National
Implementation Process
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The
acronym WEDI is hereby included as
follows:
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WEDI – Workgroup for
Electronic Data Interchange
4.
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Attachment
II, Medicaid Reform Health Plan Model Contract, Section III, Eligibility
and Enrollment, Item C., Disenrollment, sub-item 2.a.(4), is hereby
amended as follows:
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(4)
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A
substantiated Marketing or Community Outreach violation has
occurred.
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5.
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Attachment
II, Medicaid Reform Health Plan Model Contract, Section IV, Enrollee
Services and Marketing, is hereby retitled “Enrollee Services, Community
Outreach and Marketing.”
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6.
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Attachment
II, Medicaid Reform Health Plan Model Contract, Section IV, Enrollee
Services, Community Outreach and Marketing, Item A., Enrollee Services,
sub-item 11.d.(3), the first sentence is hereby amended to read as
follows:
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The
Health Plan may not include the redetermination date information in any file
viewable by customer service or Community Outreach staff.
7.
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Attachment
II, Medicaid Reform Health Plan Model Contract, Section IV, Item B.,
Marketing, is hereby deleted in its entirety and replaced as
follows:
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AHCA
Contract No. FAR009, Amendment No. 11, Page 2 of 11
Wellcare
of Florida, Inc.
d/b/a
Staywell Health Plan of Florida
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B.
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Community
Outreach and Marketing
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1.
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General
Provisions
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a.
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The
Health Plan’s Community Outreach Representative(s) may provide Community
Outreach at Health Fairs/Public events as noticed by the Health Plan to
the Agency in accordance with sub-item 4. of this Section. The
main purpose of a Health Fair/Public Event shall be to provide Community
Outreach and shall not be for the purpose of Medicaid Health Plan
Marketing.
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b.
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For
each new Contract Period, the Health Plan shall submit to the Agency
Bureau of Managed Health Care for written approval, all Community Outreach
material no later than sixty (60) Calendar Days prior to Contract renewal,
and for any changes in the Community Outreach material, no later than
thirty (30) Calendar Days prior to implementation. All
materials developed shall be governed by the requirements set forth in
this Section.
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c.
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To
announce participation at a specific event (Health Fair/Public Event), the
Health Plan shall submit a notice to the Agency in accordance with
sub-item B.3., Permitted
Activities.
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d.
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The
Health Plan shall be responsible for developing and implementing a written
plan designed to control the actions of its Community Outreach
Representatives.
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e.
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All
of the Community Outreach policies set forth in this Contract apply to
staff, Subcontractors, Health Plan volunteers and all persons acting for
or on behalf of the Health Plan.
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f.
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The
Health Plan is vicariously liable for any Outreach and Marketing
violations of its employees, agents or Subcontractors. Any
violations of this section shall subject the health plan to administrative
action by the Agency as determined by the Agency. The health
plan may dispute any such administrative action pursuant to Section XVI,
Item I., Disputes.
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g.
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Nothing
in this Section shall preclude a Health Plan from otherwise donating to or
sponsoring an event with a community organization where time, money or
expertise is provided for the benefit of the community. At such
events no Community Outreach materials or Marketing materials may be
distributed by the Health Plan, but the Health Plan may engage in
brand-awareness activities, including the display of Health Plan or
Product logos. Inquiries at such events from prospective
enrollees must be referred to the Health Plan’s member services section
and the Agency’s Choice Counselor/Enrollment
Broker.
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2.
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Prohibited
Activities
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The
Health Plan is prohibited from engaging in the following non-exclusive list of
activities:
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a.
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Marketing
for Enrollment to any potential members or conducting any Pre-Enrollment
activities not expressly allowed under this
Contract.
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b.
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Any
of the prohibited practices or activities listed in Section 409.912,
F.S.
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c.
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Engaging
in activities for the purpose of recruitment or
Enrollment.
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AHCA
Contract No. FAR009, Amendment No. 11, Page 3 of 11
Wellcare
of Florida, Inc.
d/b/a
Staywell Health Plan of Florida
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d.
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In
accordance with sections 409.912 and 409.91211, F.S., practices that are
discriminatory, including, but not limited to, attempts to discourage
Enrollment or reenrollment on the basis of actual or perceived health
status.
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e.
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Direct
or indirect Cold Call Marketing or other solicitation of Medicaid
Recipients, either by door-to-door, telephone or other means, in
accordance with section 4707 of the Balanced Budget Act of 1997, and
section 409.912, F.S.
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f.
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In
accordance with section 409.912, F.S., activities that could mislead or
confuse Medicaid Recipients, or misrepresent the Health Plan, its
Community Outreach Representatives, or the Agency. No
fraudulent, misleading, or misrepresentative information shall be used in
Community Outreach, including information regarding other governmental
programs. Statements that could mislead or confuse include, but
are not limited to, any assertion, statement or claim (whether written or
oral) that:
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(1)
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The
Medicaid Recipient must enroll in the Health Plan in order to obtain
Medicaid, or in order to avoid losing Medicaid
benefits;
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(2)
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The
Health Plan is endorsed by any federal, State or county government, the
Agency, or CMS, or any other organization which has not certified its
endorsement in writing to the Health
Plan;
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(3)
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Community
Outreach Representatives are employees or representatives of the federal,
State or county government, or of anyone other than the Health Plan or the
organization by whom they are
reimbursed;
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(4)
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The
State or county recommends that a Medicaid Recipient enroll with the
Health Plan; and/or
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(5)
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A
Medicaid Recipient will lose benefits under the Medicaid program, or any
other health or welfare benefits to which the Recipient is legally
entitled, if the Recipient does not enroll with the Health
Plan.
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g.
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Granting
or offering of any monetary or other valuable consideration for
Enrollment.
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h.
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Offers
of insurance, such as but not limited to, accidental death, dismemberment,
disability or life insurance.
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i.
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Enlisting
the assistance of any employee, officer, elected official or agent of the
State in recruitment of Medicaid Recipients except as authorized in
writing by the Agency.
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j.
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Offers
of material or financial gain to any persons soliciting, referring or
otherwise facilitating Medicaid Recipient Enrollment. The
Health Plan shall ensure that no plan staff market the Health Plan to
Medicaid Recipients at any location including State offices or DCF ACCESS
centers.
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k.
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Giving
away promotional items in excess of $5.00 retail value. Items
to be given away shall bear the Health Plan's name and shall only be given
away at Health Fairs/Public Events. In addition, such
promotional items must be offered to the general public and shall not be
limited to Medicaid Recipients.
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l.
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Providing
any gift, commission, or any form of compensation to the Choice
Counselor/Enrollment Broker, including the Choice Counselor/Enrollment
Broker's full-time, part-time or temporary employees and
Subcontractors.
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AHCA
Contract No. FAR009, Amendment No. 11, Page 4 of 11
Wellcare
of Florida, Inc.
d/b/a
Staywell Health Plan of Florida
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m.
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Provide
information, prior to the Enrollment, about the incentives that shall be
offered to the Enrollee as described in Section VIII.B.7., Incentive
Programs. The Health Plan may inform Enrollees on or after
their Enrollment effective date about the specific incentives or programs
available.
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n.
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Discussing,
explaining or speaking to a potential member about
Health-Plan-benefit-specific information other than to refer all Health
Plan inquiries to the Member Services section of the Health Plan or the
Agency’s Choice Counselor/Enrollment
Broker.
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o.
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Distributing
any Community Outreach Materials without prior written notice to the
Agency except as otherwise allowed under Permitted Activities and Provider
Compliance subsections.
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p.
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Distributing
any Marketing materials.
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q.
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Subcontract
with any brokerage firm or independent agent as defined in Chapters 624 –
651, F.S., for purposes of Marketing or Community
Outreach.
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r.
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Pay
commission compensation to Community Outreach Representatives for new
Enrollees. The payment of a bonus to a Community Outreach
Representative shall not be considered a commission if such bonus is not
related to enrollment or membership
growth.
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s.
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All
activities included in Section 641.3903,
F.S.
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3.
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Permitted
Activities
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The
Health Plan may engage in the following activities upon prior written notice to
the Agency Bureau of Managed Health Care:
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a.
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The
Health Plan may attend Health Fairs/Public Events upon request by the
sponsor and after written notification to the Agency as described in
sub-item 4.
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b.
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The
Health Plan may leave Community Outreach materials at Health Fairs/Public
Events at which the Health Plan
participates.
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c.
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The
Health Plan may provide Agency-approved Community Outreach
Materials. Such materials may include Medicaid enrollment and
eligibility information and information related to other health care
projects and social services provided by the State of Florida or local
communities. The Health Plan staff, including Community
Outreach Representatives, must refer all Health Plan inquiries to the
member services section of the Health Plan and the Agency’s Choice
Counselor/Enrollment Broker. The Agency must approve the script
used by the Health Plan’s member services section before
usage.
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d.
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Health
Plans may distribute Community Outreach Materials to community
agencies.
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4.
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Community Outreach Notification
Process
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a.
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The
Health Plan shall submit in writing to the Agency Bureau of Managed Health
Care, a notice of its intent to attend and provide Community Outreach
Materials at Health Fairs/Public Events at least two (2) weeks prior to
the event (see 4.b. and c. below for further notice
information). Such submission shall include the items listed
below:
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(1)
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The
following Health Fair/Public Event disclosure information and other
information as may be required by the
Agency:
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AHCA
Contract No. FAR009, Amendment No. 11, Page 5 of 11
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(a)
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The
announcement of the event that will be given out to the
public;
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(b)
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The
date, time and location of the
event;
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(c)
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The
name and type of organization sponsoring the
event;
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(d)
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The
event contact person and contact
information;
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(e)
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The
Health Plan contact person and contact information;
and
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(f)
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Names
of participating Community Outreach Representative(s), their contact
information and services they will provide at the
event.
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(2)
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In
addition to the disclosure information listed in (1) above, if the Health
Plan is the primary organizer of the Health Fair, the Health Plan shall
submit complete disclosure of information from each organization
participating in a Health Fair prior to the event. Such
information shall include the name of the organization, contact person
information, and confirmation of
participation.
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(3)
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In
addition to the disclosure information listed in (1) above, if the Health
Plan has been invited by a community organization to be a sponsor or
attendee of an event, the Health Plan shall provide to the Agency Bureau
of Managed Health Care a copy of the letter of invitation from the Health
Fair/Public Event sponsor(s) to the Health Plan requesting sponsorship of,
or attendance at, the event.
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b.
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The
Health Plan shall submit notice to the Agency of Health Fairs/Public
Events no later than ten (10) Business Days after the Health Plan’s
receipt of the invitation to attend or, if the Health Plan is the primary
organizer of the Health Fair, no later than ten (10) days after a decision
has been made to organize the
event.
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c.
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Notwithstanding
the other notice requirements in this subsection, the two week and the
10-day advance notice requirements are waived in cases of force majeure
provided the Health Plan notices the Bureau of Managed Health Care by the
time of the event. Force majeure events includes destruction
due to hurricanes, fires, war, riots, and other similar
acts. When providing the Agency with notice of attendance at
such events, the Health Plan shall include a description of the force
majeure event requiring waiver of
notice.
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d.
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The
Agency will establish a statewide log to track the Community Outreach
notifications received and may monitor such
events.
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5.
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Provider
Compliance
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The
Health Plan shall ensure, through provider education and outreach, that its
health care Providers are aware and comply with the following
requirements:
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a.
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Health
care Providers may display Health-Plan-specific materials in their own
offices.
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b.
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Health
Care Providers cannot orally or in writing compare Benefits or provider
networks among Health Plans, other than to confirm Health Plan network
participation.
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c.
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Health
care Providers may announce a new affiliation with a Health Plan or give a
list of Health Plans with which they contract to their
patients.
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d.
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Health
care Providers may co-sponsor events, such as Health Fairs, and advertise
with the Health Plan in indirect ways; such as television, radio, posters,
fliers, and print advertisement.
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e. | Health care Providers shall not furnish lists of their Medicaid Recipients to Health Plans with which they contract, or any other entity, nor can Providers furnish other Health Plans' membership lists to any Health Plan, nor can Providers assist with Health Plan Enrollment. |
AHCA
Contract No. FAR009, Amendment No. 11, Page 6 of 11
Wellcare
of Florida, Inc.
d/b/a
Staywell Health Plan of Florida
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f.
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For
the Health Plan, health care Providers may distribute information about
non-Health-Plan-specific health care services and the provision of health,
welfare and social services provided by the State of Florida or local
communities as long as any inquiries from prospective enrollees are
referred to the member services section of the health plan or the Agency’s
Choice Counselor/Enrollment Broker.
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6.
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Community
Outreach Representatives
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a.
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The
Health Plan shall report to the Agency Bureau of Managed Health Care any
Health Plan staff or Community Outreach Representative who violates any
requirements of this Contract, within fifteen (15) Calendar Days of
knowledge of such violation.
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b.
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While
attending Health Fairs/Public Events, Community Outreach Representatives
shall wear picture identification that identifies the Health Plan
represented.
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c.
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If
asked, the Community Outreach Representative shall inform the Medicaid
Recipient that the Representative is not an employee of the State and is
not a Choice Counseling Specialist, but is a Representative of the Health
Plan.
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d.
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The
Health Plan shall instruct and provide initial and periodic training to
its Community Outreach Representatives regarding the Community Outreach
and Marketing provisions of this
Contract.
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e.
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The
Health Plan shall implement procedures for background and reference checks
for use in its Community Outreach Representative hiring
practices.
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f.
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The
Health Plan shall register each Community Outreach Representative with the
Agency’s Bureau of Managed Health Care in accordance with Section XII of
this Contract.
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8.
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Attachment
II, Medicaid Reform Health Plan Model Contract, Section X, Administration
and Management, Item B., Staffing, sub-item 1.g., is hereby deleted in its
entirety and replaced as follows:
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g.
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Community Outreach
Oversight Coordinator: If the Health Plan engages in
Community Outreach, the Health Plan shall have a designated person,
qualified by training and experience, to assure the Health Plan adheres to
the community outreach and marketing requirements of this
Contract.
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9.
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Attachment
II, Medicaid Reform Health Plan Model Contract, Section X, Administration
and Management, Item C., Provider Contract Requirements, sub-item 2.s., is
hereby deleted in its entirety and replaced as
follows:
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s.
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Require
that any Community Outreach Materials related to this Contract that are
distributed by the Provider be submitted to the Agency for written
approval before use;
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10.
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Attachment
II, Medicaid Reform Health Plan Model Contract, Section X, Administration
and Management, Item E., Provider Services, sub-item 5.d., is hereby
deleted in its entirety and replaced as
follows:
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d.
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The
Health Plan’s call center systems shall have the capability to track call
management metrics identified in Section IV, Community Outreach and
Marketing, Item A., Enrollee Services, sub-item 7., Toll-free Help
Line.
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11.
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Attachment
II, Medicaid Reform Health Plan Model Contract, Section X, Administration
and Management, Item H., Encounter Data, is hereby deleted in its entirety
and replaced as follows:
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AHCA
Contract No. FAR009, Amendment No. 11, Page 7 of 11
Wellcare
of Florida, Inc.
d/b/a
Staywell Health Plan of Florida
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H.
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Encounter
Data
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1.
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The
Health Plan shall submit Encounter Data that meets established Agency data
quality standards as defined herein. These standards are
defined by the Agency to ensure receipt of complete and accurate data for
program administration and will be closely monitored and
enforced. The Agency will revise and amend these standards with
ninety (90) Calendar Days advance notice to the Health Plan to ensure
continuous quality improvement. The Health Plan shall make
changes or corrections to any systems, processes or data transmission
formats as needed to comply with Agency data quality standards as
originally defined or subsequently
amended.
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2.
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The
Encounter Data submission standards required to support encounter
reporting and submission are defined by the Agency in the Medicaid
Encounter Data System (MEDS) Companion Guide and this
Section. In addition, the Agency will post encounter reporting
requirements on its MEDS website for the Health Plans to follow: xxxx://xxxx.xxxxxxxxx.xxx/Xxxxxxxx/xxxx/.
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3.
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The
Health Plan shall adhere to the following requirements for the Encounter
Data submission process:
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a.
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The
Agency shall notify the Health Plan, in writing, of the start date for
resuming the submission of encounters through the current Fiscal
Agent.
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b.
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Once
the Health Plan is notified by the Agency of the date for recommencing
encounter submissions (submission start date), the Health Plan shall
submit its schedule for transmitting Encounter Data for all typical and
atypical services collected for historical claims beginning January 1,
2007, and up to the submission start
date.
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(1)
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The
Health Plan shall submit this schedule for approval to the Agency’s
Medicaid Encounter Data System team (at xxxxxxxx@xxxx.xxxxxxxxx.xxx)
within ten (10) Business days after the date of the Agency’s notice to
begin submitting encounters.
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(2)
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At
a minimum, such submission schedule must include that historical encounter
transmissions will begin no later than sixty (60) Calendar Days after the
submission start date.
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c.
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In
accordance with the submission schedule approved by the Agency, the Health
Plan shall submit the historical encounters for all typical and atypical
services with Health Plan paid dates of January 1, 2007, up to the
submission start date.
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d.
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The
Health Plan shall submit encounters for all typical and atypical services
with Health Plan paid dates on or after the submission start date on an
ongoing basis within sixty (60) Calendar Days following the end of the
month in which the Health Plan paid the claims for
services.
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e.
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For
all encounters submitted after the recommencing of encounter submissions
(submission start date), including historical and ongoing claims, if the
Agency or its Fiscal Agent notifies the Health Plan of encounters failing
X12 Electronic Data Interface (EDI) compliance edits or FMMIS threshold
and repairable compliance edits, the Health Plan shall Remediate all such
encounters within sixty (60) Calendar Days after such
notice.
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f.
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There
will be no requirement to submit encounters for Health Plan paid dates
prior to January 1, 2007.
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4.
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The
Health Plan shall have a comprehensive automated and integrated Encounter
Data system that is capable of meeting the requirements
below. The Health Plan shall comply as
follows:
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AHCA
Contract No. FAR009, Amendment No. 11, Page 8 of 11
Wellcare
of Florida, Inc.
d/b/a
Staywell Health Plan of Florida
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a.
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All
Health Plan encounters shall be submitted to the Agency in the standard
HIPAA transaction formats, namely the ANSI X12N 837 Transaction formats (P
- Professional, I - Institutional, and D – Dental), and, for Pharmacy
services, in the National Council for Prescription Drug Programs (NCPDP)
format. Health Plan paid amounts must be provided for
non-capitated network providers.
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b.
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The
Health Plan shall collect and submit to the Agency’s Fiscal Agent,
Enrollee service level Encounter Data for all Covered
Services. Health Plans will be held responsible for errors or
noncompliance resulting from their own actions or the actions of an agent
authorized to act on their behalf.
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c.
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The
Health Plan shall convert all information that enters their claims systems
via hard copy paper claims or other proprietary formats to Encounter Data
to be submitted in the appropriate HIPAA compliant
formats.
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d.
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The
Health Plan shall provide complete and accurate encounters to the
Agency. Health Plans will implement review procedures to
validate Encounter Data submitted by
providers.
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(1)
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Complete: A
Health Plan submitting encounters that represent at least 95% of the
Covered Services provided by the Health Plan’s Providers and
non-participating providers. It is expected that the Health
Plan will strive to make every effort to achieve a 100% complete
submission rate.
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(2)
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Accurate: 95%
of the records in a Health Plan’s encounter batch submission pass X12 EDI
compliance edits and the FMMIS threshold and repairable compliance
edits. The X12 EDI compliance edits are established through
SNIP levels 1 through 4. FMMIS threshold and repairable edits
that report exceptions are defined in the MEDS Companion
Guide.
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e.
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The
Health Plan shall designate sufficient IT and staffing resources to
perform these encounter functions as determined by generally accepted best
industry practices.
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f.
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The
Health Plan shall retain submitted historical Encounter Data for a period
not less than five years as specified in I.D., Retention of Records, in
the Agency’s Standard Contract.
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5.
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Where
a Health Plan has entered into capitation reimbursement arrangements with
Providers, the Health Plan must comply with sub-item 4. of this
Section. The Health Plan shall require timely submissions from
its Providers as a condition of the capitation
payment.
|
|
6.
|
The
Health Plan shall participate in Agency sponsored workgroups directed at
continuous improvements in Encounter Data quality and
operations.
|
|
7.
|
If
the Agency determines that the Health Plan’s MEDS performance is not
acceptable, the Agency shall require the Health Plan to submit a
corrective action plan (CAP). If the Health Plan fails to
provide a CAP or to implement an approved CAP within the time specified by
the Agency, the Agency shall sanction the Health Plan in accordance with
the provisions of Section XIV, Sanctions, and may immediately terminate
all Enrollment activities and Mandatory Assignments. When
considering whether to impose a Sanction, the Agency will take into
account the Health Plan’s cumulative performance on all MEDS activities,
including progress made toward completeness and accuracy of Encounter Data
as defined in sub-item H.4.d. of this Section.
|
8. | The Encounter Data submission time frames specified in this Section do not affect time frames specified in Section XII for either pharmacy data encounter reporting for risk adjustment or behavioral health encounter (including pharmacy) reporting. |
AHCA
Contract No. FAR009, Amendment No. 11, Page 9 of 11
Wellcare
of Florida, Inc.
d/b/a
Staywell Health Plan of Florida
|
12.
|
Attachment
II, Medicaid Reform Health Plan Model Contract, Section XII, Reporting
Requirements, Item A., Health Plan Reporting Requirements, sub-item 7.,
Digit 1 Report Identifiers table, is hereby deleted in its entirety and
replaced as follows:
|
Digit
1 Report Identifiers
|
|
R
|
Community Outreach Representative
|
I
|
Information Systems Availability
|
G
|
Grievance System Reporting
|
H
|
Inpatient Discharge Reporting
|
F
|
Financial Reporting
|
M
|
Minority Reporting
|
C
|
Claims Inventory
|
T
|
Transportation
|
S
|
Critical Incident Summary
|
E
|
Behavioral Health Encounter Data
|
B
|
Behavioral Health Pharmacy Encounter Data
|
P
|
Behavioral Health Required Staff/Providers
|
O
|
FARS/CFARS
|
13.
|
Attachment
II, Medicaid Reform Health Plan Model Contract, Section XII, Reporting
Requirements, Table 1, Summary of Reporting Requirements, “Marketing
Representative Report” is hereby retitled “Community Outreach
Representative Report.”
|
14.
|
Attachment
II, Medicaid Reform Health Plan Model Contract, Section XII, Reporting
Requirements, Item E., Marketing Representative Report, is hereby deleted
in its entirety and replaced as
follows:
|
|
E.
|
Community Outreach
Representative Report
|
|
1.
|
The
Health Plan shall register each Community Outreach Representative with the
Agency as specified below. The registration file must be
submitted to the Agency at the following e-mail address prior to any
initial Community Outreach
activity: XXXXXXX@xxxx.xxxxxxxxx.xxx. The
Agency-supplied template must be used – Community Outreach Representative
Registration Template.xls. This template is provided at
xxxx://xxx.xxxx.xxxxxxxxx.xxx/xxxx/xxxxxxx_xxxxxx_xxxx/xxxx/xxx_xxxx.xxxxx.
|
|
2.
|
Changes
to the Community Outreach Representative’s initial registration must be
submitted to the Agency immediately upon occurrence at e-mail
address: XXXXXXX@xxxx.xxxxxxxxx.xxx. The
Agency-supplied template must be used. The Health Plan shall
not change or alter the template. This template contains the following
required data elements:
|
15.
|
Attachment
II, Medicaid Reform Health Plan Model Contract, Section XVI, Terms and
Conditions, Item Q., Termination Procedures, sub-item 2.c., is hereby
deleted in its entirety and replaced as
follows:
|
|
c.
|
Terminate
all Community Outreach activities and subcontracts relating to Community
Outreach.
|
This Amendment shall have an effective
date of March 1, 2009, or the date on which both parties execute the Amendment,
whichever is later.
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.
AHCA
Contract No. FAR009, Amendment No. 11, Page 10 of
11
Wellcare
of Florida, Inc.
d/b/a
Staywell Health Plan of Florida
|
Medicaid Reform HMO
Contract
|
This
Amendment, and all its attachments, are 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 eleven (11) page Amendment
(including all attachments) to be executed by their officials thereunto duly
authorized.
WELLCARE
OF FLORIDA, INC. D/B/A
STAYWELL
HEALTH PLAN OF FLORIDA
|
STATE
OF FLORIDA, AGENCY FOR
HEALTH
CARE ADMINISTRATION
|
SIGNED
BY:
|
/s/ Xxxxx Xxxxxxxxx
|
SIGNED
BY:
|
/s/ Xxxxx Xxxxxx
|
|
NAME:
|
Xxxxx
Xxxxxxxxx
|
NAME:
|
Xxxxx
Xxxxxx
|
|
TITLE:
|
President
& CEO
|
TITLE:
|
Secretary
|
|
DATE:
|
24 March 2009
|
DATE:
|
3/26/09
|
REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
AHCA
Contract No. FAR009, Amendment No. 11, Page 11 of
11