Contract
| Back to 10-Q | Exhibit 10.3 | |
| HealthEase of Florida, Inc. | Medicaid HMO Non-Reform Contract | |
| AHCA CONTRACT NO. FA905 | ||
| AMENDMENT NO. 9 |
THIS CONTRACT, entered into between the 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" or “Health Plan”, is hereby amended as follows:
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1.
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Effective March 1, 2012, Attachment I, Scope of Services, Capitated Health Plans, is hereby amended to include Attachment I, Exhibit 1-C, Revised Maximum Enrollment Levels, attached hereto and made a part of the Contract. All references in the Contract to Attachment I, Exhibits 1, 1-A, and 1-B, shall hereinafter also refer to Attachment I, Exhibit 1-C, as appropriate.
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Unless otherwise stated, this amendment is effective upon execution by both parties.
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All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the Contract.
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This amendment and all its attachments are hereby made a part of the Contract.
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| This amendment cannot be executed unless all previous amenments to this Contract have been fully executed. |
IN WITNESS WHEREOF, the Parties hereto have caused this five (5) page amendment (including all attachments) 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/ Xxxxxxxxx Xxxxxx | BY: | /s/ Xxxxxxxxx Xxxxx | ||||||
| NAME: | Xxxxxxxxx Xxxxxx | NAME: | Xxxxxxxxx Xxxxx | ||||||
| TITLE: | President, FL & HI Division | TITLE: | Secretary | ||||||
| DATE: | 3/8/12 | DATE: | 3/12/12 | ||||||
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List of Attachments/Exhibits included as part of this amendment:
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Specify
Type
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Letter/
Number
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Description
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| Attachment I | Exhibit 1-C | Revised Maximum Enrollment Levels (4 Pages) | |
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AHCA Contract No. FA905, Amendment No. 9, Page 1 of 1
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| HealthEase of Florida, Inc. | Medicaid HMO Non-Reform Contract | |
| ATTACHMENT I | ||
| EXHIBIT 1-C | ||
| REVISED MAXIMUM ENROLLMENT LEVELS |
Maximum enrollment levels and Health Plan provider numbers associated with the counties and populations served. Exhibit 2-NR-C provide the capitation rate tables respective to the areas of operation listed below.
A. Non-Reform
See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates
Area 1 Counties: Escambia, Santa Xxxx
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Effective Date: 11/01/11 Escambia, 08/01/11 Santa Xxxx
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| County | Enrollment Level | Provider Number |
| Escambia | 67,500 | 015019344 |
| Santa Xxxx | 31,500 | 015019343 |
See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates
Area 2 Counties: Bay, Calhoun, Gadsden, Xxxxxxxxx, Xxxx, Liberty, Madison, Wakulla
| Effective Date: 03/01/12 Bay, 09/01/09 all other counties | ||
| County | Enrollment Level | Provider Number |
| Bay | 16,900 | TBD |
| Xxxxxxx | 800 | 015019340 |
| Gadsden | 3,500 | 015019315 |
| Jefferson | 1,000 | 015019318 |
| Xxxx | 7,000 | 015019320 |
| Liberty | 400 | 015019342 |
| Madison | 1,500 | 015019322 |
| Wakulla | 1,000 | 015019336 |
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AHCA Contract No. FA905, Attachment I, Exhibit 1-C, Page 1 of 4
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| HealthEase of Florida, Inc. | Medicaid HMO Non-Reform Contract | |
See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates
Area 3 Counties: Citrus, Xxxx, Xxxxxx, Xxxxxx
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Effective Date: 09/01/09
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County
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Enrollment Level
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Provider Number
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Citrus
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7,500
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015019309
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Lake
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7,000
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015019319
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Xxxxxx
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20,000
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015019323
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Xxxxxx
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6,000
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015019329
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See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates
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Area 4 Counties: Xxxxx, Volusia
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Effective Date: 09/01/09
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County
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Enrollment Level
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Provider Number
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Xxxxx
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55,000
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015019313
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Volusia
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15,000
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015019335
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See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates
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Area 5 Counties: Pasco, Pinellas
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Effective Date: 09/01/09
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County
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Enrollment Level
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Provider Number
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Pasco
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6,000
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015019302
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Pinellas
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9,000
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015019303
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AHCA Contract No. FA905, Attachment I, Exhibit 1-C, Page 2 of 4
| HealthEase of Florida, Inc. | Medicaid HMO Non-Reform Contract | |
See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates
Area 6 Counties: Highlands, Hillsborough, Manatee, Polk
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Effective Date: 09/01/09
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County
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Enrollment Level
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Provider Number
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Highlands
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3,000
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015019317
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Hillsborough
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18,000
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015019300
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Manatee
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6,000
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015019301
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Polk
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10,000
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015019304
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See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates Area 7 Counties: Brevard, Orange, Osceola, Seminole
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Effective Date: 09/01/09
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County
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Enrollment Level
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Provider Number
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Brevard
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14,000
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015019308
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Orange
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25,000
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015019327
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Osceola
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8,000
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015019328
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Seminole
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4,000
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015019333
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See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates Area 8 County: Sarasota
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Effective Date: 09/01/09
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County
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Enrollment Level
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Provider Number
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Sarasota
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3,000
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015019332
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AHCA Contract No. FA905, Attachment I, Exhibit 1-C, Page 3 of 4
| HealthEase of Florida, Inc. | Medicaid HMO Non-Reform Contract | |
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See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates
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Area 9 Counties: Xxxxxx, Palm Beach
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Effective Date: 09/01/09
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County
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Enrollment Level
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Provider Number
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Xxxxxx
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5,000
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015019324
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Palm Beach
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10,500
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015019339
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See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates Area 10 County: Broward
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Effective Date: 09/01/09
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County
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Enrollment Level
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Provider Number
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Broward
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13,500
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015019337
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See Exhibit 2-NR-C Table 2, General Capitation Rates plus Mental Health Rates Area 11 County: Miami-Dade
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Effective Date: 09/01/09
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County
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Enrollment Level
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Provider Number
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Miami-Dade
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25,000
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015019338
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