AHCA CONTRACT NO. FA522 AMENDMENT NO. 5


WELL CARE HMO, INC., D/B/A STAYWELL		Medicaid HMO Contract
HEALTH PLAN OF FLORIDA

AHCA CONTRACT NO. FA522
AMENDMENT NO. 5

THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the “Agency” and WELL CARE HMO, INC., d/b/a STAYWELL HEALTH PLAN OF FLORIDA, hereinafter referred to as the “Vendor”, is hereby amended as follows:

1.	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 $652,967,833.00 (an increase of $7,130,175.00), subject to the availability of funds.

2.	Attachment I, section 90.0, Payment and Authorized Enrollment Levels, Table 2 is hereby amended to now read as follows:

Table 2.

Area wide Age-banded Capitation Rates for All Plan Operational Counties where plan services do not include Community Mental Health and Mental Health Targeted Case Management.

Area 03 General Rates Plan — 015016901 (HERNANDO)


	<1 year		1-5		6-13		14-20 Male		14-20 Female		21-54 Male		21-54 Female		55-64		65+
TANF/FC/SOBRA		350.92		78.21		49.06		54.22		112.21		138.15		210.55		294.57		294.57
SSI/No Medicare		3231.65		390.26		202.93		212.35		212.35		607.41		607.41		586.66		586.66
SSI /Part B		302.31		302.31		302.31		302.31		302.31		302.31		302.31		302.31		302.31
SSI/Part A & B		288.40		288.40		288.40		288.40		288.40		288.40		288.40		288.40		201.67

Area 05 General Rates Plan — 015016903 (PASCO) 015016904 (PINELLAS)


	<1 year		1-5		6-13		14-20 Male		14-20 Female		21-54 Male		21-54 Female		55-64		65+
TANF/FC/SOBRA		345.76		77.31		48.55		53.69		110.74		136.76		208.19		291-55		291.55
SSI/No Medicare		3265.62		394.06		204.41		214.18		214.18		612.49		612.49		591.04		591.04
SSI/Part B		266.55		266.55		266.55		266.55		266.55		266.55		266.55		266.55		266.55
SSI/Part A & B		309.27		309.27		309.27		309.27		309.27		309.27		309.27		309.27		216.32

Area 07 General Rates Plan — 015016913 (BREVARD)


	<1 year		1-5		6-13		14-20 Xxxx		14-20 Female		21-54 Male		21-54 Female		55-64		65+
TANF/ FC/SOBRA		337.19		75.53		47.77		52.81		108.40		134.29		204.16		286.57		286.57
SSI/No Medicare		3217.89		389.79		203.90		213.35		213.35		610.58		610.58		589.11		589.11
SSI/Part B		265.77		265.77		265.77		265.77		265.77		265.77		265.77		265.77		265.77
SSI/Part A & B		283.96		283.96		283.96		283.96		283.96		283.96		283.96		283.96		198.62

Xxxx 00 General Rates Plan — 015016911(XXX) 015016914 (SARASOTA)


	<1 year		1-5		6-13		14-20 Male		14-20 Female		21-54 Male		21-54 Female		55-64		65+
TANF/FC/SOBRA		296.66		66.37		41.76		46.19		95.19		117.62		179.02		250.96		250.96
SSI/No Medicare		3079.30		371.80		192.49		201.68		201.68		577.71		577.71		557.45		557.45
SSI/Part B		243.56		243.56		243.56		243.56		243.56		243.56		243.56		243.56		243.56
SSI/Part A & B		285.08		285.08		285.08		285.08		285.08		285.08		285.08		285.08		199.47

Area 00 Xxxxxxx Xxxxx Xxxx — 000000000 (XXXX XXXXX)


	<1 year		1-5		6-13		14-20 Male		14-20 Female		21-54 Male		21-54 Female		55-64		65+
TANF/FC/SOBRA		316.78		70.74		44.52		49.17		101.48		125.24		190.60		266.97		266.97
SSI/No Medicare		3344.05		405.22		211.12		231.15		221.15		633.22		633.22		610.93		610.93
SSI/Part B		267.20		267.20		267.20		267.20		267.20		267.20		267.20		267.20		267.20
SSI/Part A & B		320.32		320.32		320.32		320.32		320.32		320.32		320.32		320.32		224.19

Area 10 General Rates Plan — 015016900 (BROWARD)


	<1 year		1-5		6-13		14-20 Male		14-20 Female		21-54 Male		21-54 Female		55-64		65+
TANF/FC/SOBRA		328.74		73.77		46.68		51.61		105.94		131.31		199.49		280.33		280.33
SSI/No Medicare		4151.82		503.54		263.75		275.32		275.32		788.23		788.23		761.08		761.08
SSI/Part B		287.04		287.04		287.04		287.04		287.04		287.04		287.04		287.04		287.04
SSI/Part A & B		351.55		351.55		351.55		351.55		351.55		351.55		351.55		351.55		245.95

AHCA Contract No. FA522, Amendment No. 5, Page 1 of 3


WELL CARE HMO, INC., D/B/A STAYWELL HEALTH PLAN OF FLORIDA		Medicaid HMO Contract

Area 11 General Rates plus Transportation Plan — 015016909(DADE)


	<1 year		1-5		6-13		14-20 Male		14-20 Female		21-54 Male		21-54 Female		55-64		65+
TANF/FC/SOBRA		409.89		91.51		57.28		63.45		131.27		161.21		245.94		343.29		343.29
SSI/No Medicare		4561.77		556.46		288.69		302.80		302.80		869.67		869.67		836.38		336.38
SSI/Part B		453.72		453.72		453.72		453.72		453.72		453.72		453.72		453.72		453.72
SSI/Part A & B		429.61		429.61		429.61		429.61		429.61		429.61		429.61		429.61		297.22

3.	Attachment I, section 90.0, Payment and Authorized Enrollment Levels, Table 3 is hereby amended to now read as follows:

Table 3.

Area Wide Age-banded Capitation Rates for All Plan Operational Counties where plan services include Community Mental Health and Mental Health Targeted Case Management

Area 06 General Rates plus Mental Health Plan- 015016902(HILLSBOROUGH) 015016905(POLK) 015016912(MANATEE)


	<1 year		1-5		6-13		14-20 Male		14-20 Female		21-54 Male		21-54 Female		55-64		65+
TANF/FC/SOBRA		330.07		75.91		61.92		67.67		122.23		135.83		204.29		282.98		282.98
SSI /No Medicare		3017.05		371.69		265.72		243.82		243.82		647.81		647.81		587.26		587.26
SSI /Part B		242.29		242.29		242.29		242.29		242.29		242.29		242.29		242.29		242.29
SSI/Part A & B		288.09		288.09		288.09		288.09		288.09		288.09		288.09		288.09		202.64

Xxxx 00 General Rates plus Mental Health Plan- 015016906(ORANGE) 01501690(OSCEOLA) 015016908 (SEMINOLE)


	<1 year		1-5		6-13		14-20 Male		14-20 Female		21-54 Male		21-54 female		55-64		65+
TANF/FC/SOBRA		337.20		76.92		58.07		59.10		114.69		136.45		206.32		287.87		287.87
SSI/No Medicare		3217.90		406.84		260.45		239.73		239.73		628.24		628.24		594.96		594.96
SSI/Part B		266.03		266.03		266.03		266.03		266.03		266.03		266.03		266.03		266.03
SSI/Part A & B		293.59		293.59		293.59		293.59		293.59		293.59		293.59		293.59		208.25

4.	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 $652,967,833.00 (an increase of $7,130,175.00), expressed on page seven of this contract.

5.	This amendment shall begin on April 1, 2005, or the date on which the amendment has been signed by both parties, 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.

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.

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AHCA Contract No. FA522, Amendment No. 5, Page 2 of 3


WELL CARE HMO, INC., D/B/A STAYWELL HEALTH PLAN OF FLORIDA		Medicaid HMO Contract

IN WITNESS WHEREOF, the parties hereto have caused this 3 page amendment (including all attachments) to be executed by their officials thereunto duly authorized.

WELLCARE HMO, INC., D/B/A STAYWELL

STATE OF FLORIDA, AGENCY FOR

HEALTH PLAN OF FLORIDA

HEALTH CARE ADMINISTRATION

SIGNED

BY:

/s/ Imtiaz (MT) Xxxxxxx

BY:

[ILLEGIBLE]

Imtiaz (MT) Xxxxxxx

President, Florida

NAME:

Xxxx X. Xxxxx

NAME:

Xxxx Xxxxxx

TITLE:

President & CEO

TITLE:

Secretary

DATE:

4/1/05

DATE:

4/1/05

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AHCA Contract No. FA522, Amendment No. 5, Page 3 of 3

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AHCA CONTRACT NO. FA522 AMENDMENT NO. 5

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