AMENDMENT #5 TO CONTRACT NO. 0654 BETWEEN GEORGIA DEPARTMENT OF COMMUNITY HEALTH AND WELLCARE OF GEORGIA, INC.
Exhibit 10.3
AMENDMENT
#5 TO CONTRACT NO. 0654 BETWEEN
GEORGIA
DEPARTMENT OF COMMUNITY HEALTH AND
WELLCARE
OF GEORGIA, INC.
This Amendment is between the Georgia
Department of Community Health (hereinafter referred to as "DCH" or the
"Department") and WellCare of Georgia, Inc. (hereinafter referred to
as
"Contractor") and is made effective this 15th day of September , 2008
(hereinafter referred
to as the "Effective Date"). Other than the changes, modifications and additions
specifically articulated in this Amendment #5 to Contract # 0654,
RFP#00000-000-0000000000, the original Contract shall remain in effect and
binding on and against DCH and Contractor. Unless expressly modified or added in
this Amendment #5, the terms and conditions of the original Contract are
expressly incorporated into this Amendment #5 as if completely restated
herein.
WHEREAS, DCH and Contractor executed a contract
for the provision of services to members of the Georgia Families
Program;
WHEREAS, DCH pays Contractor a per member per
month capitation rate for each Georgia Families member enrolled in the
Contractor's plan;
WHEREAS, DCH has sought permission from the
Centers for Medicare and Medicaid Services (hereinafter referred to as "CMS") to
revise the capitation rates payable to Contractor for State Fiscal Year 2009;
and
WHEREAS, pursuant to Section 32.0, Amendments in Writing, DCH and
Contractor desire to amend the above-referenced Contract by adding additional
funding as set forth below.
NOW
THEREFORE, for and in consideration of the mutual promises of the
Parties, the terms, provisions and conditions of this Amendment and other good
and valuable consideration, the sufficiency of which is hereby acknowledged, DC
11 and Contractor hereby agree as follows:
|
I.
|
Upon
receiving written notice from CMS indicating that agency's approval of the
revised capitation rates, the parties shall delete the current Attachment H, Capitation Payment, in its
entirety and replace it with the new Attachment H, Capitation Payment, contained at Exhibit 1 to this
Amendment.
|
|
II.
|
DCH
and Contractor agree that they have assumed an obligation to perform the
covenants, agreements, duties and obligations of the Contract, as modified
and amended herein, and agree to abide by all the provisions, terms and
conditions contained in the Contract as modified and
amended.
|
|
III.
|
This
Amendment shall be binding and inure to the benefit of the parties hereto,
their heirs, representatives, successors and assigns. Whenever the
provisions of this Amendment and the Contract are in conflict, the
provisions of this Amendment shall take precedence and
control.
|
Amendment
#5
Contract
#0654
Page 1 of
4
|
VI.
|
It
is understood by the Parties hereto that, if any part, term, or provision
of this Amendment or this entire Amendment is held to be illegal or in
conflict with any law of this State, then DCH, at its sole option, may
enforce the remaining unaffected portions or provisions of this Amendment
or of the Contract and the rights and obligations of the parties shall be
construed and enforced as if the Contract or Amendment did not contain the
particular part, term or provision held to be
invalid.
|
|
VII.
|
This
Amendment shall become effective as stated herein and shall remain
effective for so long as the Contract is in
effect.
|
|
VIII
|
This
Amendment shall be construed in accordance with the laws of the State of
Georgia.
|
|
IX.
|
All
other terms and conditions contained in the Contract and any amendment
thereto, not amended by this Amendment, shall remain in full force and
effect.
|
- SIGNATURES ON THE
FOLLOWING PAGE -
| Amendment #5 | |
| Contract #0654 |
Page 2 of
4
|
SIGNATURE PAGE
|
|
IN WITNESS WHEREOF, DCH
and Contractor, through their authorized officers and agents, have caused
this Amendment to be executed on their behalf as of the date
indicated.
|
GEORGIA
DEPARTMENT OF COMMUNITY HEALTH
|
/s/
Xxxxxx
Xxxxxx
Xx.
Xxxxxx X. Xxxxxx, M.D.
Commissioner
|
9/15/08
Date
|
WELLCARE
OF GEORGIA, INC.
|
/s/ Xxxxxx X.
Xxxx
*SIGNATURE
|
9/12/08
Date
|
|
Xxxxxx X. Xxxx, SVP
& CFO
Please
Print/Type Name Here
|
|
_______________________________
AFFIX
CORPORATE SEAL HERE
(Corporations
without a seal, attach a Certificate of Corporate
Resolution)
|
|
ATTEST:
|
/s/ Xxxxx
Xxxxxx
**SIGNTAURE
|
|
Secretary
TITLE
|
______________________________________________________________________
* Must be
President, Vice President, CEO or Other Authorized Officer
** Must
be Corporate Secretary
| Amendment #5 | |
| Contract #0654 |
Page 3 of
4
|
EXHIBIT 1
CONFIDENTIAL
- NOT FOR CIRCULATION
ATTACHMENT
H
Attachment
H is a table displaying the contracted rates by rate cell for each contracted
region. These rates will be the basis for calculating capitation payments in
each contracted Region.
(The
table is displayed on the following page.)
| Amendment #5 | |
| Contract #0654 |
Page 4 of
4
|
|
FY
2009 CMO Rates
|
|||
|
Region
|
Aid
Category
|
Age/Gender
Group
|
WellCare
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
0-2
Months, Male and Female
|
$ 1,668.19
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
3-11
Months, Male and Female
|
$ 185.45
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
$ 118.26
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
6 -
13 Years, Male and Female
|
$ 107.95
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Female
|
$ 169.51
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Male
|
$ 128.19
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Female
|
$ 281.94
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Male
|
$ 304.78
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
$ 531.46
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
$ 560.83
|
|
Atlanta
|
PeachCare
|
0-2
Months, Male and Female
|
$ 148.84
|
|
Atlanta
|
PeachCare
|
3-11
Months, Male and Female
|
$ 155.46
|
|
Atlanta
|
PeachCare
|
1 -
5 Years, Male and Female
|
$ 107.31
|
|
Atlanta
|
PeachCare
|
6 -
13 Years, Male and Female
|
$ 116.58
|
|
Atlanta
|
PeachCare
|
14-20
Years, Female
|
$ 135.47
|
|
Atlanta
|
PeachCare
|
14-20
Years, Male
|
$ 137.43
|
|
Atlanta
|
Breast
and Cervical Cancer
|
All
Ages
|
$ 1,068.97
|
|
Atlanta
|
Maternity
Delivery/Kick Payment
|
$ 6,030.11
|
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
0 -
2 Months, Male and Female
|
$ 1,972.95
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
3-11
Months, Male and Female
|
$ 202.43
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
1-5
Years, Male and Female
|
$ 123.94
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
6 -
13 Years, Male and Female
|
$ 117.45
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Female
|
$ 165.93
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Male
|
$ 117.28
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
21
-44 Years, Female
|
$ 308.09
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
21
-44 Years, Male
|
$ 334.14
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
$ 589.81
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
$ 639.07
|
|
Central
|
PeachCare
|
0-2
Months, Male and Female
|
$ 143.83
|
|
Central
|
PeachCare
|
3-11
Months, Male and Female
|
$ 148.43
|
|
Central
|
PeachCare
|
1-5
Years, Male and Female
|
$ 120.34
|
|
Central
|
PeachCare
|
6 -
13 Years, Male and Female
|
$ 127.15
|
|
Central
|
PeachCare
|
14-20
Years, Female
|
$ 153.25
|
|
Central
|
PeachCare
|
14-20
Years, Male
|
$ 135.15
|
|
Central
|
Breast
and Cervical Cancer
|
All
Ages
|
$ 1,060.34
|
|
Central
|
Maternity
Delivery/Kick Payment
|
$ 6,182.35
|
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
0-2
Months, Male and Female
|
$ 1,772.63
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
3-11
Months, Male and Female
|
$ 207.78
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
$ 131.99
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
6 -
13 Years, Male and Female
|
$ 113.19
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Female
|
$ 178.26
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Male
|
$ 114.49
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Female
|
$ 302.73
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
21
-44 Years, Male
|
$ 344.15
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
$ 591.19
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
$ 651.54
|
|
East
|
PeachCare
|
0-2
Months, Male and Female
|
$ 148.84
|
|
East
|
PeachCare
|
3-11
Months, Male and Female
|
$ 149.30
|
|
East
|
PeachCare
|
1 -
5 Years, Male and Female
|
$ 131.50
|
|
East
|
PeachCare
|
6-13
Years, Male and Female
|
$ 120.73
|
|
East
|
PeachCare
|
14-20
Years, Female
|
$ 147.22
|
|
East
|
PeachCare
|
14-20
Years, Male
|
$ 132.58
|
|
East
|
Breast
and Cervical Cancer
|
All
Ages
|
$ 1,080.15
|
|
East
|
Maternity
Delivery/Kick Payment
|
$ 6,611.86
|
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
0-2
Months, Male and Female
|
$ 1,736.43
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
3-11
Months, Male and Female
|
$ 219.15
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
$ 140.23
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
6-13
Years, Male and Female
|
$ 142.46
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Female
|
$ 204.52
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Male
|
$ 180.34
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Female
|
$ 352.94
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
21
-44 Years, Male
|
$ 342.96
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
$ 622.97
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
$ 653.17
|
|
North
|
PeachCare
|
0 -
2 Months, Male and Female
|
$ 149.87
|
|
North
|
PeachCare
|
3-11
Months, Male and Female
|
$ 149.86
|
|
North
|
PeachCare
|
1 -
5 Years, Male and Female
|
$ 119.50
|
|
North
|
PeachCare
|
6-13
Years, Male and Female
|
$ 128.24
|
|
North
|
PeachCare
|
14-20
Years, Female
|
$ 166.01
|
|
North
|
PeachCare
|
14-20
Years, Male
|
$ 147.86
|
|
North
|
Breast
and Cervical Cancer
|
All
Ages
|
$ 1,073.79
|
|
North
|
Maternity
Delivery/Kick Payment
|
$ 6,439.10
|
1 of
2
|
FY
2009 CMO Rates
|
|||
|
Region
|
Aid
Category
|
Age/Gender
Group
|
WellCare
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
0-2
Months, Male and Female
|
$ 1,802.33
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
3-11
Months, Male and Female
|
$ 204.33
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
$ 128.40
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
6 -
13 Years, Male and Female
|
$ 121.09
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Female
|
$ 168.90
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Male
|
$ 129.17
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Female
|
$ 316.15
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Male
|
$ 309.92
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
$ 615.18
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
$ 635.83
|
|
Southeast
|
PeachCare
|
0-2
Months, Male and Female
|
$ 149.21
|
|
Southeast
|
PeachCare
|
3-11
Months, Male and Female
|
$ 149.92
|
|
Southeast
|
PeachCare
|
1 -
5 Years, Male and Female
|
$ 125.86
|
|
Southeast
|
PeachCare
|
6-13
Years, Male and Female
|
$ 130.78
|
|
Southeast
|
PeachCare
|
14-20
Years, Female
|
$ 152.22
|
|
Southeast
|
PeachCare
|
14-20
Years, Male
|
$ 128.13
|
|
Southeast
|
Breast
and Cervical Cancer
|
All
Ages
|
$ 1,113.87
|
|
Southeast
|
Maternity
Delivery/Kick Payment
|
$ 6,547.77
|
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
0-2
Months, Male and Female
|
$ 1,885.03
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
3-11
Months, Male and Female
|
$ 227.05
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
$ 148.24
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
6 -
13 Years, Male and Female
|
$ 121.01
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Female
|
$ 187.98
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Male
|
$ 122.89
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
21
-44 Years, Female
|
$ 337.89
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Male
|
$ 309.41
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
$ 568.47
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
$ 676.55
|
|
Southwest
|
PeachCare
|
0-2
Months, Male and Female
|
$ 142.53
|
|
Southwest
|
PeachCare
|
3-11
Months, Male and Female
|
$ 149.98
|
|
Southwest
|
PeachCare
|
1 -
5 Years, Male and Female
|
$ 133.79
|
|
Southwest
|
PeachCare
|
6 -
13 Years, Male and Female
|
$ 131.36
|
|
Southwest
|
PeachCare
|
14-20
Years, Female
|
$ 149.19
|
|
Southwest
|
PeachCare
|
14-20
Years, Male
|
$ 123.69
|
|
Southwest
|
Breast
and Cervical Cancer
|
All
Ages
|
$ 1,097.88
|
|
Southwest
|
Maternity
Delivery/Kick Payment
|
$ 6,070.34
|
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