AHCA CONTRACT NO. FA614 AMENDMENT NO. 4

Exhibit 10.27.2.1

Medicaid HMO Contract

Amerigroup Florida, Inc.

d/b/a Amerigroup Community Care

AHCA CONTRACT NO. FA614
AMENDMENT NO. 4

THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the “Agency” and AMERIGROUP FLORIDA, INC. D/B/A AMERIGROUP COMMUNITY CARE, hereinafter referred to as the “Vendor” or “Health Plan”, is hereby amended as follows:

1. Attachment I, Scope of Services, is hereby amended to include Exhibit II-D, Fourth Revised Capitation Rates, attached hereto and made a part of the Contract. All references in the Contract to Exhibit II-C, Third Revised Capitation Rates, shall hereinafter also refer to Exhibit II-D, Fourth Revised Capitation Rates, as appropriate.

2. Attachment I, Scope of Services, is hereby amended to include Exhibit III-A, September 1, 2007-August 31, 2008 Medicaid Non-Reform HMO Capitation Rates, attached hereto and made a part of the Contract. All references in the Contract to Exhibit III, September 1, 2006 — August 31, 2007 HMO Rates, shall hereinafter also refer to Exhibit III-A, September 1, 2007- August 31, 2008 Medicaid Non-Reform HMO Capitation Rates, as appropriate.

3. Attachment II, Medicaid Prepaid Health Plan Model Contract, Section V, Covered Services, Item C, Expanded Services, sub-item 2 is hereby deleted in its entirety and replaced with the following:

2. The following is a list of the Health Plan’s Expanded Services:

	a.		Adult basic dental benefits, such as cleanings, simple fillings, and/or extractions.
	b.		Up to $25 credit per household each month for selected over-the-counter drugs and/or health supplies.
	c.		Respite Care services — Annual maximum of not more than an initial home health visit by an R.N. and eight (8) follow-up visits by an aide. Follow-up visits are four (4) hours in length. Maximum of sixteen (16) hours in a given month and thirty-two (32) hours per year.
	d.		Circumcisions for newborns (routine newborn circumcision up to twelve (12) weeks of age).

4. This Amendment shall have an effective date of September 1, 2007, 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.

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.

AHCA Form 2100-0002 (Rev. NOV03) AHCA Contract No. FA614, Amendment No. 4, Page 1 of 2

Amerigroup Florida, Inc.
d/b/a Amerigroup Community Care Medicaid HMO Contract

     IN WITNESS WHEREOF, the parties hereto have caused this eight (8) page Amendment (which includes all attachments hereto) to be executed by their officials thereunto duly authorized.

AMERIGROUP FLORIDA, INC.				STATE OF FLORIDA, AGENCY FOR
D/B/A/ AMERIGROUP COMMUNITY CARE				HEALTH CARE ADMINISTRATION
SIGNED BY:				SIGNED BY:
NAME:		Xxxxxxx XxXxxx		NAME:		Xxxxxx X. Xxxxxxxx, M.D
TITLE:		CEO		TITLE:		Secretary
DATE:				DATE:

List of attachments included as part of this Amendment:

Specify		Letter/
Type		Number		Description
Exhibit		II-D		Fourth Revised Capitation Rates (1 Page)
Exhibit		III-A		September 1, 2007- August 31, 2008 Medicaid Non-Reform HMO Capitation Rates (5 Pages)

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FA614, Amendment No. 4, Page 2 of 2 AHCA Form 2100-0002 (Rev. NOV03)

Amerigroup Florida, Inc.
d/b/a Amerigroup Community Care Medicaid HMO Contract

EXHIBIT II-D
FOURTH REVISED CAPITATION RATES

Table 4 — General Capitation Rates plus Mental Health Rates plus Transportation:

Area 3 Counties:
County:			Provider Number:
Hernando			015005350
Lake			015005341
Area 5 Counties:
County:			Provider Number:
Pasco			015005304
Pinellas			015005305
Area 6 Counties:
County:			Provider Number:
Hillsborough			015005300
Polk			015005307
Manatee			015005318
Area 7 Counties:
County:			Provider Number:
Orange			015005308
Seminole			015005313
Osceola			015005314
Brevard			015005336
Area 8 Counties:
County:			Provider Number:
Xxx			015005302
Sarasota			015005306
Area 9 Counties:
County:			Provider Number:
Palm Beach			015005310
Area 10 Counties:
County:			Provider Number:
Broward			015005311
Area 11 Counties:
County:			Provider Number:
Miami-Dade			015005312

AHCA Form 2100-0002 (Rev. NOV03) AHCA Contract No. FA614, Exhibit II-D, Page 1 of 1

EXHIBIT III-A
September 1, 2007- August 31, 2008
Medicaid Non-Reform HMO Capitation Rates
By Area , Age and Eligibility Category
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)

TABLE 1
General Rates:

XXXX

XXX-X

XXX-X

XXX-XX

Xxxx

XXXX0x0X0 0X0.00XX

AGE (1-5)

AGE (6-13)

AGE (14-20)

AGE (21.54)

AGE (55+)

BTHMO+2M0   3M0-11MO

AGE (1-5)

AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+)

AGE (65-)

AGE (65+)

Female

Male

Female

Male

**** REDACTED****

TABLE 2
General + Mental Health Rates:

XXXX

XXX-X

XXX-X

XXX-XX

Xxxx

XXXX0x0X0 0X0.00XX

AGE (1-5)

AGE (6-13)

AGE (14-20)

AGE (21.54)

AGE (55+)

BTHMO+2M0   3M0-11MO

AGE (1-5)

AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+)

AGE (65-)

AGE (65+)

Female

Male

Female

Male

**** REDACTED****

AHCA Contract No. FA614, Exhibit III-A, Page 1 of 5

HMO CapRates_200709-200608 08/10/2007

EXHIBIT III-A
September 1, 2007- August 31, 2008
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)

TABLE 3
General + MH + Dental Rates:

XXXX

XXX-X

XXX-X

XXX-XX

Xxxx

XXXX0x0X0 0X0.00XX

AGE (1-5)

AGE (6-13)

AGE (14-20)

AGE (21.54)

AGE (55+)

BTHMO+2M0 3M0-11MO

AGE (1-5)

AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+)

AGE (65-)

AGE (65+)

Female

Male

Female

Male

**** REDACTED****

TABLE 4
General + MH + Transportation Rates:

XXXX

XXX-X

XXX-X

XXX-XX

Xxxx

XXXX0x0X0 0X0.00XX

AGE (1-5)

AGE (6-13)

AGE (14-20)

AGE (21-54)

AGE (55+)

BTHMO+2M0 3M0-11MO

AGE (1-5)

AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+)

AGE (65-)

AGE (65+)

Female

Male

Female

Male

**** REDACTED****

AHCA Contract No. FA614, Exhibit III-A, Page 2 of 5 HMO CapRates_200709-200808 08/10/2007

EXHIBIT III-A
September 1, 2007- August 31, 2008
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)

TABLE 5
General + Transportation Rates:

XXXX

XXX-X

XXX-X

XXX-XX

Xxxx

XXXX0x0X0

0X0.00XX

AGE (1-5)

AGE (6-13)

AGE (14-20)

AGE (21.54)

AGE (55+)

BTHMO+2M0 3M0-11MO

AGE (1-5)

AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+)

AGE (65-)

AGE (65+)

Female

Male

Female

Male

**** REDACTED****

TABLE 6
General + Dental Rates:

XXXX

XXX-X

XXX-X

XXX-XX

Xxxx

XXXX0x0X0

0X0.00XX

AGE (1-5)

AGE (6-13)

AGE (14-20)

AGE (21-54)

AGE (55+)

BTHMO+2M0 3M0-11MO

AGE (1-5)

AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+)

AGE (65-)

AGE (65+)

Female

Male

Female

Male

**** REDACTED****

AHCA Contract No. FA614, Exhibit III-A, Page 3 of 5 HMO CapRates_200709-200808 08/10/2007

EXHIBIT III-A
September 1, 2007- August 31, 2008
Medicaid Non-Reform HMO Capitation Rates
By Area , Age and Eligibility Category
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)

TABLE 7
General + Dental + Transportation Rates:

XXXX

XXX-X

XXX-X

XXX-XX

Xxxx

XXXX0x0X0

0X0.00XX

AGE (1-5)

AGE (6-13)

AGE (14-20)

AGE (21.54)

AGE (55+)

BTHMO+2M0 3M0-11MO

AGE (1-5)

AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+)

AGE (65-)

AGE (65+)

Female

Male

Female

Male

**** REDACTED****

TABLE 8
General + Mental Health + Dental + Transportation Rates:

XXXX

XXX-X

XXX-X

XXX-XX

Xxxx

XXXX0x0X0

0X0.00XX

AGE (1-5)

AGE (6-13)

AGE (14-20)

AGE (21-54)

AGE (55+)

BTHMO+2M0 3M0-11MO

AGE (1-5)

AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+)

AGE (65-)

AGE (65+)

Female

Male

Female

Male

**** REDACTED****

AHCA Contract No. FA614, Exhibit III-A, Page 4 of 5 HMO CapRates_200709-200808 08/10/2007

EXHIBIT III-A
September 1, 2007- August 31, 2008
Medicaid Non-Reform HMO Capitation Rates
By Area , Age and Eligibility Category
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)

Area		Corresponding Counties
Area 1		Escambia, Okaloosa, Santa Rosa, Walton
Area 2		Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Xxxxxxxxx, Xxxx, Liberty, Madison, Taylor, Washington, Wakulla
Area 3		Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamiliton, Hemando, Lafayette, Lake, Xxxx, Xxxxxx, Putnam, Sumter, Suwannee, Union
Area 4		Baker, Clay, Duval, Flagler, Nassau, St. Xxxxx, Volusia
Area 5		Pasco, Pinellas
Area 6		Xxxxxx, Highlands, Hillsborough, Manatee, Polk
Area 7		Brevard, Orange, Osceola, Seminole
Area 8		Charlotte, Xxxxxxx, De Xxxx, Glades, Hendry, Lee, Sarasota
Area 9		Indian River, Okeechobee, St. Lucie, Martin, Palm Beach
Area 10		Broward
Area 11		Dade, Monroe

Created on August 10, 2007

AHCA Contract No. FA614, Exhibit III-A, Page 5 of 5 HMO CapRates_200709-200808 08/10/2007

Amerigroup Florida, Inc.
d/b/a Amerigroup Community Care Medicaid HMO Contract

     IN WITNESS WHEREOF, the parties hereto have caused this eight (8) page Amendment (which includes all attachments hereto) to be executed by their officials thereunto duly authorized.

AMERIGROUP FLORIDA, INC.						STATE OF FLORIDA, AGENCY FOR
D/B/A/ AMERIGROUP COMMUNITY C						HEALTH CARE ADMINISTRATION
SIGNED BY:	/S/ Xxxxxxx XxXxxx					SIGNED BY:
NAME: Xxxxxxx XxXxxx						NAME: Xxxxxx X. Xxxxxxxx, M.D
TITLE:. CEO						TITLE: Secretary
DATE: 8-31-07						DATE:
List of attachments included as part of this Amendment:

Specify		Letter/
Type		Number		Descnption
Exhibit		II-D		Fourth Revised Capitation Rates (1 Page)
Exhibit		III-A		September 1, 2007- August 31, 2008 Medicaid Non-Reform HMO Capitation Rates (5 Pages)

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FA614, Amendment No. 4, Page 2 of 2 AHCA Form 2100-0002 (Rev. NOV03)