AHCA CONTRACT NO. FA619 AMENDMENT NO. 6
AHCA
CONTRACT NO. FA619
AMENDMENT
NO. 6
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:
|
1.
|
Effective
February 1, 2009, Attachment I, Scope of Services, is hereby amended to
include Exhibit III-E, February 1, 2009 - August 31, 2009 Medicaid
Non-Reform HMO Capitation Rates, attached hereto and made a part of the
Contract. All references in the Contract to Exhibit III-D, September 1,
2008 - August 31, 2009 Medicaid Non-Reform HMO Capitation Rates, shall
hereinafter also refer to Exhibit III-E, February 1, 2009 -August 31, 2009
Medicaid Non-Reform HMO Capitation Rates, as
appropriate.
|
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.
IN WITNESS WHEREOF, the parties
hereto have caused this six (6) page Amendment (which includes all attachments
hereto) to be executed by their officials thereunto duly
authorized.
| HEALTHEASE OF FLORIDA, INC. |
STATE OF FLORIDA, AGENCY
FOR
HEALTH
CARE ADMINISTRATION
|
|
SIGNED
BY: /s/
Xxxxx
Xxxxxxxxx
|
SIGNED
BY:
/s/ Name
Illegible
|
|
NAME:
Xxxxx
Xxxxxxxxx
|
NAME:
for Xxxxx
Xxxxxx
|
|
TITLE:
President and
CEO
|
TITLE:
Secretary
|
|
DATE: 2-17-09
|
DATE:
2/19/09
|
List of
Attachments/Exhibits included as part of this Amendment:
|
Specify
Type
|
Letter/
Number
|
Description
|
|
Exhibit
|
III-E
|
February
1, 2009 - August 31, 2009 Medicaid Non-Reform HMO
Capitation
Rates (5 pages)
|
AHCA
Contract No. FA619, Amendment No. 6, Page 1 of 1
AHCA Form
2100-0002 (Rev. NOV03)
|
EXHIBIT
III-E
|
|||||||||||||||||||
|
February
1, 2009 - August 31, 2009 HMO RATES
|
|||||||||||||||||||
|
(MEDICAID
Non-Reform HMO CAPITATION RATES)
|
|||||||||||||||||||
|
By
Area , Age and Eligibility Category
|
|||||||||||||||||||
|
TABLE
1
|
|||||||||||||||||||
|
General
Rates:
|
|||||||||||||||||||
|
XXXX
|
|
XXX-X
|
XXX-X
|
XXX-XX
|
|||||||||||||||
|
Xxxx
|
XXXXXx0XX
|
0XX-00XX
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE (14-20)
|
AGE (21-54)
|
AGE
(55+)
|
XXXXXx0XX
|
0XX-00XX
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
|||
|
Female
|
Male
|
Female
|
Male
|
||||||||||||||||
|
01
|
1,113.37
|
187.38
|
101.38
|
61.45
|
129.49
|
69.52
|
255.23
|
153.37
|
318.51
|
10,428.92
|
1,517.58
|
445.88
|
198.88
|
213.14
|
696.73
|
700.31
|
305.88
|
94.80
|
85.77
|
|
02
|
1,113.37
|
187.38
|
101.38
|
61.45
|
129.49
|
69.52
|
255.23
|
153.37
|
318.51
|
10,428.92
|
1,517.58
|
445.88
|
198.88
|
213.14
|
696.73
|
700.31
|
305.88
|
94.80
|
85.77
|
|
03
|
1,217.57
|
206.51
|
112.28
|
69.11
|
143.30
|
77.85
|
283.53
|
171.42
|
359.72
|
11,442.82
|
1,680.06
|
495.07
|
226.05
|
241.47
|
787.51
|
795.55
|
340.56
|
90.01
|
81.98
|
|
04
|
1,067.51
|
181.92
|
99.04
|
61.51
|
126.30
|
69.23
|
250.83
|
152.26
|
321.21
|
10,972.58
|
1,615.28
|
476.38
|
218.79
|
233.36
|
761.37
|
770.55
|
297.82
|
90.35
|
82.40
|
|
05
|
1,214.96
|
206.53
|
112.30
|
69.38
|
143.25
|
78.21
|
284.08
|
172.12
|
361.87
|
12,248.94
|
1,796.88
|
528.79
|
240.95
|
256.93
|
840.31
|
849.11
|
225.19
|
81.19
|
75.29
|
|
06
|
1,056.56
|
181.19
|
98.87
|
61.99
|
126.18
|
69.68
|
251.35
|
153.20
|
325.45
|
11,162.18
|
1,645.44
|
485.06
|
223.95
|
237.92
|
777.94
|
788.05
|
274.94
|
79.31
|
72.63
|
|
07
|
1,092.94
|
186.84
|
101.87
|
63.49
|
129.77
|
71.35
|
258.27
|
157.02
|
332.09
|
11,810.40
|
1,744.81
|
514.41
|
238.57
|
254.24
|
828.77
|
840.70
|
373.98
|
84.56
|
77.61
|
|
08
|
1,033.51
|
177.08
|
96.67
|
60.37
|
123.15
|
68.03
|
245.23
|
149.29
|
316.91
|
10,525.98
|
1,550.30
|
457.03
|
210.03
|
224.35
|
731.36
|
740.14
|
256.24
|
78.77
|
72.23
|
|
09
|
1,067.78
|
181.58
|
98.82
|
61.05
|
126.06
|
68.67
|
249.80
|
151.41
|
318.38
|
11,078.29
|
1,635.46
|
482.13
|
223.68
|
237.34
|
775.59
|
785.85
|
219.29
|
84.42
|
77.20
|
|
10
|
1,083.46
|
186.09
|
101.73
|
63.88
|
129.70
|
71.87
|
258.53
|
157.78
|
335.92
|
14,344.29
|
2,132.34
|
629.36
|
297.17
|
314.18
|
1,027.07
|
1,044.85
|
322.21
|
94.02
|
86.21
|
|
11
|
1,372.19
|
232.59
|
126.24
|
77.54
|
161.30
|
87.46
|
319.10
|
192.88
|
404.23
|
14,488.14
|
2,131.88
|
628.05
|
289.19
|
307.93
|
1,004.54
|
1,015.98
|
370.49
|
140.27
|
126.63
|
|
6B*
|
1,056.42
|
181.17
|
98.86
|
61.98
|
126.16
|
69.67
|
251.32
|
153.18
|
325.40
|
11,161.68
|
1,645.35
|
485.04
|
223.94
|
237.91
|
777.89
|
788.02
|
274.94
|
79.31
|
72.63
|
|
TABLE
2
|
|||||||||||||||||||
|
General
+ Mental Health Rates:
|
|||||||||||||||||||
|
TANF
|
SSI-N
|
SSI-B
|
SSI-AB
|
||||||||||||||||
|
Area
|
BTHMO+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE (14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
XXXXXx0XX
|
0XX-00XX
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
|||
|
Female
|
Male
|
Female
|
Male
|
||||||||||||||||
|
01
|
1,113.39
|
187.40
|
103.02
|
73.14
|
140.42
|
80.45
|
259.67
|
157.81
|
322.25
|
10,429.00
|
1,517.66
|
453.32
|
246.93
|
257.13
|
778.13
|
731.29
|
306.09
|
106.45
|
97.42
|
|
02
|
1,113.40
|
187.41
|
104.29
|
81.71
|
142.91
|
82.94
|
258.64
|
156.78
|
321.46
|
10,429.08
|
1,517.74
|
459.67
|
277.70
|
258.36
|
749.41
|
725.19
|
326.08
|
109.81
|
100.78
|
|
03
|
1,217.58
|
206.52
|
113.60
|
78.29
|
149.38
|
83.93
|
285.07
|
172.96
|
361.06
|
11,442.89
|
1,680.13
|
501.33
|
261.81
|
261.99
|
811.41
|
806.83
|
347.41
|
98.99
|
90.96
|
|
04
|
1,067.52
|
181.93
|
100.42
|
71.07
|
132.64
|
75.57
|
252.44
|
153.87
|
322.61
|
10,972.69
|
1,615.39
|
486.14
|
274.53
|
265.34
|
798.63
|
788.14
|
322.37
|
107.12
|
99.17
|
|
05
|
1,214.97
|
206.54
|
113.51
|
78.06
|
151.36
|
86.32
|
287.37
|
175.41
|
364.65
|
12,248.99
|
1,796.93
|
533.81
|
273.37
|
286.61
|
895.23
|
870.01
|
227.92
|
94.01
|
88.11
|
|
06
|
1,056.58
|
181.21
|
100.72
|
75.24
|
138.56
|
82.06
|
256.38
|
158.23
|
329.70
|
11,162.25
|
1,645.51
|
491.58
|
266.06
|
276.46
|
849.27
|
815.20
|
276.25
|
83.20
|
76.52
|
|
07
|
1,092.96
|
186.86
|
103.65
|
76.18
|
141.63
|
83.21
|
263.09
|
161.84
|
336.16
|
11,810.46
|
1,744.87
|
520.53
|
278.08
|
290.41
|
895.70
|
866.18
|
376.57
|
95.08
|
88.13
|
|
08
|
1,033.52
|
177.09
|
97.93
|
69.16
|
128.97
|
73.85
|
246.72
|
150.78
|
318.20
|
10,526.05
|
1,550.37
|
463.03
|
244.31
|
244.03
|
754.27
|
750.96
|
263.09
|
91.99
|
85.45
|
|
09
|
1,067.80
|
181.60
|
100.37
|
71.86
|
133.22
|
75.83
|
251.62
|
153.23
|
319.95
|
11,078.36
|
1,635.53
|
488.46
|
259.82
|
258.08
|
799.75
|
797.26
|
226.14
|
94.01
|
86.79
|
|
10
|
1,083.48
|
186.11
|
103.65
|
77.24
|
138.55
|
80.72
|
260.78
|
160.03
|
337.87
|
14,344.39
|
2,132.44
|
637.71
|
344.88
|
341.56
|
1,058.95
|
1,059.91
|
329.06
|
102.08
|
94.27
|
|
11
|
1,372.21
|
232.61
|
127.86
|
88.83
|
168.79
|
94.95
|
321.01
|
194.79
|
405.88
|
14,488.22
|
2,131.96
|
635.02
|
328.99
|
330.76
|
1,031.14
|
1,028.54
|
377.72
|
148.33
|
134.69
|
|
6B*
|
1,056.44
|
181.19
|
100.61
|
74.50
|
137.86
|
81.37
|
256.07
|
157.93
|
329.41
|
11,161.75
|
1,645.42
|
491.54
|
265.93
|
276.34
|
849.01
|
815.09
|
276.25
|
83.20
|
76.52
|
|
|
|||||||||||||||||||
AHCA
Contract No. FA619, Exhibit III-E, 1 of 5
|
EXHIBIT
III-E
|
|||||||||||||||||||
|
February
1. 2009 -August 31, 2009 HMO RATES
|
|||||||||||||||||||
|
(MEDICAID
Non-Reform HMO CAPITATION RATES)
|
|||||||||||||||||||
|
By
Area , Age and Eligibility Category
|
|||||||||||||||||||
|
TABLE
3
|
|||||||||||||||||||
|
General
+ MIH + Dental Rates:
|
|||||||||||||||||||
|
TANF
|
SSI-N
|
|
SSI-B
|
SSI-AB
|
|||||||||||||||
|
Area
|
BTHMG+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE (14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
XXXXXx0XX
|
0XX-00XX
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
|
AGE
(65-)
|
AGE
(65+)
|
||
|
Female
|
Male
|
Female
|
Male
|
||||||||||||||||
|
01
|
1,113.39
|
187.41
|
104.70
|
76.25
|
143.60
|
83.14
|
260.89
|
159.07
|
325.04
|
10,429.00
|
1,517.66
|
454.94
|
249.33
|
259.19
|
779.46
|
733.15
|
306.54
|
107.57
|
98.28
|
|
02
|
1,113.40
|
187.42
|
105.97
|
84.82
|
146.09
|
85.63
|
259.86
|
158.04
|
324.25
|
10,429.08
|
1,517.74
|
461.29
|
280.10
|
260.42
|
750.74
|
727.05
|
326.53
|
110.93
|
101.64
|
|
03
|
1,217.59
|
206.54
|
116.65
|
83.95
|
155.15
|
88.81
|
286.81
|
174.74
|
365.03
|
11,442.89
|
1,680.14
|
504.46
|
266.45
|
265.98
|
813.29
|
809.48
|
348.44
|
100.64
|
92.22
|
|
04
|
1,067.53
|
181.94
|
102.26
|
74.49
|
136.14
|
78.52
|
254.11
|
155.59
|
326.43
|
10,972.69
|
1,615.39
|
487.92
|
277.17
|
267.61
|
800.51
|
790.78
|
324.55
|
108.71
|
100.38
|
|
05
|
1,214.98
|
206.56
|
116.92
|
84.39
|
157.83
|
91.79
|
290.78
|
178.92
|
372.44
|
12,249.00
|
1,796.94
|
538.03
|
279.64
|
291.99
|
898.93
|
875.21
|
231.58
|
97.80
|
91.00
|
|
06
|
1.056.59
|
181.22
|
103.39
|
80.20
|
143.62
|
86.34
|
258.26
|
160.17
|
334.00
|
11,162.25
|
1,645.52
|
494.62
|
270.56
|
280.33
|
851.77
|
818.71
|
278.01
|
85.45
|
78.23
|
|
07
|
1,092.97
|
186.87
|
106.05
|
80.63
|
146.17
|
87.05
|
264.42
|
163.20
|
339.20
|
11,810.46
|
1,744.88
|
523.53
|
282.52
|
294.23
|
897.25
|
868.36
|
377.05
|
96.60
|
89.29
|
|
08
|
1,033.53
|
177.11
|
101.57
|
75.90
|
135.86
|
79.68
|
248.74
|
152.85
|
322.80
|
10,526.05
|
1,550.38
|
466.45
|
249.39
|
248.39
|
756.55
|
754.16
|
264.63
|
93.66
|
86.72
|
|
09
|
1,067.81
|
181.62
|
103.30
|
77.30
|
138.78
|
80.53
|
252.58
|
154.21
|
322.14
|
11,078.36
|
1,635.54
|
491.05
|
263.67
|
261.39
|
800.93
|
798.91
|
227.97
|
95.08
|
87.60
|
|
10
|
1,083.49
|
186.12
|
106.08
|
81.75
|
143.16
|
84.62
|
261.51
|
160.78
|
339.53
|
14,344.39
|
2,132.45
|
640.50
|
349.02
|
345.12
|
1,059.90
|
1,061.24
|
329.88
|
103.38
|
95.25
|
|
11
|
1,372.22
|
232.62
|
131.59
|
96.51
|
176.76
|
101.67
|
321.87
|
195.67
|
407.84
|
14,488.23
|
2,131.98
|
639.29
|
336.38
|
337.23
|
1,032.92
|
1,031.04
|
381.06
|
150.49
|
136.34
|
|
6B*
|
1,056.45
|
181.20
|
103.28
|
79.46
|
142.92
|
85.65
|
256.07
|
157.93
|
329.41
|
11,161.75
|
1,645.43
|
494.58
|
270.43
|
280.21
|
849.01
|
815.09
|
278.01
|
85.45
|
78.23
|
|
TABLE
4
|
|||||||||||||||||||
|
General
+ MIH + Transportation Rates:
|
|||||||||||||||||||
|
XXXX
|
XXX-X
|
XXX-X
|
XXX-XX
|
||||||||||||||||
|
Xxxx
|
XXXXXx0XX
|
0XX-00XX
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE (14-20)
|
AGE (21-54)
|
AGE
(55+)
|
XXXXXx0XX
|
0XX-00XX
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
|||
|
Female
|
Male
|
Female
|
Male
|
||||||||||||||||
|
01
|
1,118.74
|
188.77
|
103.85
|
73.64
|
142.45
|
81.79
|
262.97
|
160.32
|
325.76
|
10,468.09
|
1,543.33
|
458.61
|
249.36
|
263.26
|
798.19
|
748.22
|
313.56
|
120.17
|
106.26
|
|
02
|
1,118.75
|
188.78
|
105.12
|
82.21
|
144.94
|
84.28
|
261.94
|
159.29
|
324.97
|
10,468.17
|
1,543.41
|
464.96
|
280.13
|
264.49
|
769.47
|
742.12
|
333.55
|
123.53
|
109.62
|
|
03
|
1,224.01
|
208.18
|
114.60
|
78.89
|
151.82
|
85.54
|
289.04
|
175.98
|
365.28
|
11,492.20
|
1,712.51
|
508.01
|
264.88
|
269.71
|
836.72
|
828.19
|
356.12
|
118.76
|
103.70
|
|
04
|
1,072.09
|
183.11
|
101.13
|
71.50
|
134.38
|
76.72
|
255.26
|
156.01
|
325.61
|
11,011.02
|
1,640.55
|
491.32
|
276.91
|
271.34
|
818.29
|
804.74
|
329.55
|
122.97
|
109.39
|
|
05
|
1,218.84
|
207.54
|
114.11
|
78.42
|
152.83
|
87.29
|
289.75
|
177.22
|
367.18
|
12,280.81
|
1,817.81
|
538.12
|
275.35
|
291.59
|
911.55
|
883.79
|
234.47
|
108.09
|
97.18
|
|
06
|
1,060.38
|
182.19
|
101.31
|
75.60
|
140.00
|
83.01
|
258.73
|
160.02
|
332.19
|
11,193.75
|
1,666.20
|
495.85
|
268.01
|
281.39
|
865.43
|
828.84
|
281.96
|
94.76
|
83.97
|
|
07
|
1,096.99
|
187.89
|
104.28
|
76.56
|
143.16
|
84.23
|
265.58
|
163.74
|
338.80
|
11,845.21
|
1,767.68
|
525.23
|
280.23
|
295.85
|
913.53
|
881.23
|
381.95
|
107.21
|
95.94
|
|
08
|
1,038.81
|
178.45
|
98.76
|
69.66
|
130.99
|
75.18
|
249.98
|
153.26
|
321.67
|
10,564.27
|
1,575.46
|
468.20
|
246.69
|
250.01
|
773.87
|
767.52
|
269.02
|
106.78
|
94.97
|
|
09
|
1,072.91
|
182.92
|
101.17
|
72.34
|
135.16
|
77.11
|
254.77
|
155.63
|
323.30
|
11,117.70
|
1,661.37
|
493.79
|
262.27
|
264.24
|
819.93
|
814.30
|
232.70
|
109.81
|
96.97
|
|
10
|
1,086.47
|
186.89
|
104.12
|
77.52
|
139.69
|
81.47
|
262.62
|
161.43
|
339.83
|
14,370.64
|
2,149.68
|
641.26
|
346.51
|
345.67
|
1,072.41
|
1,071.28
|
334.36
|
114.42
|
102.22
|
|
11
|
1,375.30
|
233.40
|
128.34
|
89.12
|
169.97
|
95.73
|
322.92
|
196.24
|
407.91
|
14,515.60
|
2,149.93
|
638.72
|
330.69
|
335.05
|
1,045.18
|
1,040.40
|
382.84
|
160.77
|
142.70
|
|
6B*
|
1,060.24
|
182.17
|
101.20
|
74.86
|
139.30
|
82.32
|
258.42
|
159.72
|
331.90
|
11,193.25
|
1,666.11
|
495.81
|
267.88
|
281.27
|
865.17
|
828.73
|
281.96
|
94.76
|
83.97
|
AHCA
Contract No. FA619, Exhibit III-E, 2 of 5
|
EXHIBIT
lll-E
|
|||||||||||||||||||
|
February
1, 2009 - August 31, 2009 HMO RATES
|
|||||||||||||||||||
|
(MEDICAID
Non-Reform HMO CAPITATION RATES)
|
|||||||||||||||||||
|
By
Area , Age and Eligibility Category
|
|||||||||||||||||||
|
TABLE
5
|
|||||||||||||||||||
|
General
+ Transportation Rates:
|
|||||||||||||||||||
|
TANF
|
SSI-N
|
|
SSi-B
|
SSI-AB
|
|||||||||||||||
|
Area
|
BTHMO+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE (6-13) AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
XXXXXx0XX
|
0XX-00XX
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
||||
|
Female
|
Male
|
Female
|
Male
|
||||||||||||||||
|
01
|
1,118.72
|
188.75
|
102.21
|
61.95
|
131.52
|
70.86
|
258.53
|
155.88
|
322.02
|
10,468.01
|
1,543.25
|
451.17
|
201.31
|
219.27
|
716.79
|
717.24
|
313.35
|
108.52
|
94.61
|
|
02
|
1,118.72
|
188.75
|
102.21
|
61.95
|
131.52
|
70.86
|
258.53
|
155.88
|
322.02
|
10,468.01
|
1,543.25
|
451.17
|
201.31
|
219.27
|
716.79
|
717.24
|
313.35
|
108.52
|
94.61
|
|
03
|
1,224.00
|
208.17
|
113.28
|
69.71
|
145.74
|
79.46
|
287.50
|
174.44
|
363.94
|
11,492.13
|
1,712.44
|
501.75
|
229.12
|
249.19
|
812.82
|
816.91
|
349.27
|
109.78
|
94.72
|
|
04
|
1,072.08
|
183.10
|
99.75
|
61.94
|
128.04
|
70.38
|
253.65
|
154.40
|
324.21
|
11,010.91
|
1,640.44
|
481.56
|
221.17
|
239.36
|
781.03
|
787.15
|
305.00
|
106.20
|
92.62
|
|
05
|
1,218.83
|
207.53
|
112.90
|
69.74
|
144.72
|
79.18
|
286.46
|
173.93
|
364.40
|
12,280.76
|
1,817.76
|
533.10
|
242.93
|
261.91
|
856.63
|
862.89
|
231.74
|
95.27
|
84.36
|
|
06
|
1,060.36
|
182.17
|
99.46
|
62.35
|
127.62
|
70.63
|
253.70
|
154.99
|
327.94
|
11,193.68
|
1,666.13
|
489.33
|
225.90
|
242.85
|
794.10
|
801.69
|
280.65
|
90.87
|
80.08
|
|
07
|
1,096.97
|
187.87
|
102.50
|
63.87
|
131.30
|
72.37
|
260.76
|
158.92
|
334.73
|
11,845.15
|
1,767.62
|
519.11
|
240.72
|
259.68
|
846.60
|
855.75
|
379.36
|
96.69
|
85.42
|
|
08
|
1,038.80
|
178.44
|
97.50
|
60.87
|
125.17
|
69.36
|
248.49
|
151.77
|
320.38
|
10,564.20
|
1,575.39
|
462.20
|
212.41
|
230.33
|
750.96
|
756.70
|
262.17
|
93.56
|
81.75
|
|
09
|
1,072.89
|
182.90
|
99.62
|
61.53
|
128.00
|
69.95
|
252.95
|
153.81
|
321.73
|
11,117.63
|
1,661.30
|
487.46
|
226.13
|
243.50
|
795.77
|
802.89
|
225.85
|
100.22
|
87.38
|
|
10
|
1,086.45
|
186.87
|
102.20
|
64.16
|
130.84
|
72.62
|
260.37
|
159.18
|
337.88
|
14,370.54
|
2,149.58
|
632.91
|
298.80
|
318.29
|
1,040.53
|
1,056.22
|
327.51
|
106.36
|
94.16
|
|
11
|
1,375.28
|
233.38
|
126.72
|
77.83
|
162.48
|
88.24
|
321.01
|
194.33
|
406.26
|
14,515.52
|
2,149.85
|
631.75
|
290.89
|
312.22
|
1,018.58
|
1,027.84
|
375.61
|
152.71
|
134.64
|
|
6B*
|
1,060.22
|
182.15
|
99.45
|
62.34
|
127.60
|
70.62
|
253.67
|
154.97
|
327.89
|
11,193.18
|
1,666.04
|
489.31
|
225.89
|
242.84
|
794.05
|
801.66
|
280.65
|
90.87
|
80.08
|
|
TABLE
6
|
|||||||||||||||||||
|
General
+ Dental Rates:
|
|||||||||||||||||||
|
TANF
|
SSI-N
|
SSI-B
|
SSS-AB
|
||||||||||||||||
|
Area
|
BTHMO+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE (14-20)
|
AG
E (21-54)
|
AGE
(55+)
|
XXXXXx0XX
|
0XX-00XX
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
|||
|
Female
|
Male
|
Female
|
Male
|
||||||||||||||||
|
01
|
1,113.37
|
187.39
|
103.06
|
64.56
|
132.67
|
72.21
|
256.45
|
154.63
|
321.30
|
10,428.92
|
1,517.58
|
447.50
|
201.28
|
215.20
|
698.06
|
702.17
|
306.33
|
95.92
|
86.63
|
|
02
|
1,113.37
|
187.39
|
103.06
|
64.56
|
132.67
|
72.21
|
256.45
|
154.63
|
321.30
|
10,428.92
|
1,517.58
|
447.50
|
201.28
|
215.20
|
698.06
|
702.17
|
306.33
|
95.92
|
86.63
|
|
03
|
1,217.58
|
206.53
|
115.33
|
74.77
|
149.07
|
82.73
|
285.27
|
173.20
|
363.69
|
11,442.82
|
1,680.07
|
498.20
|
230.69
|
245.46
|
789.39
|
798.20
|
341.59
|
91.66
|
83.24
|
|
04
|
1,067.52
|
181.93
|
100.88
|
64.93
|
129.80
|
72.18
|
252.50
|
153.98
|
325.03
|
10,972.58
|
1,615.28
|
478.16
|
221.43
|
235.63
|
763.25
|
773.19
|
300.00
|
91.94
|
83.61
|
|
05
|
1,214.97
|
206.55
|
115.71
|
75.71
|
149.72
|
83.68
|
287.49
|
175.63
|
369.66
|
12,248.95
|
1,796.89
|
533.01
|
247.22
|
262.31
|
844.01
|
854.31
|
228.85
|
84.98
|
78.18
|
|
06
|
1,056.57
|
181.20
|
101.54
|
66.95
|
131.24
|
73.96
|
253.23
|
155.14
|
329.75
|
11,162.18
|
1,645.45
|
488.10
|
228.45
|
241.79
|
780.44
|
791.56
|
276.70
|
81.56
|
74.34
|
|
07
|
1,092.95
|
186.85
|
104.27
|
67.94
|
134.31
|
75.19
|
259.60
|
158.38
|
335.13
|
11,810.40
|
1,744.82
|
517.41
|
243.01
|
258.06
|
830.32
|
842.88
|
374.46
|
86.08
|
78.77
|
|
08
|
1,033.52
|
177.10
|
100.31
|
67.11
|
130.04
|
73.86
|
247.25
|
151.36
|
321.51
|
10,525.98
|
1,550.31
|
460.45
|
215.11
|
228.71
|
733.64
|
743.34
|
257.78
|
80.44
|
73.50
|
|
09
|
1,067.79
|
181.60
|
101.75
|
66.49
|
131.62
|
73.37
|
250.76
|
152.39
|
320.57
|
11,078.29
|
1,635.47
|
484.72
|
227.53
|
240.65
|
776.77
|
787.50
|
221.12
|
85.49
|
78.01
|
|
10
|
1,083.47
|
186.10
|
104.16
|
68.39
|
134.31
|
75.77
|
259.26
|
158.53
|
337.58
|
14,344.29
|
2,132.35
|
632.15
|
301.31
|
317.74
|
1,028.02
|
1,046.18
|
323.03
|
95.32
|
87.19
|
|
11
|
1,372.20
|
232.60
|
129.97
|
85.22
|
169.27
|
94.18
|
319.96
|
193.76
|
406.19
|
14,488.15
|
2,131.90
|
632.32
|
296.58
|
314.40
|
1,006.32
|
1,018.48
|
373.83
|
142.43
|
128.28
|
|
6B*
|
1,056.43
|
181.18
|
101.53
|
66.94
|
131.22
|
73.95
|
251.32
|
153.18
|
325.40
|
11,161.68
|
1,645.36
|
488.08
|
228.44
|
241.78
|
777.89
|
788.02
|
276.70
|
81.56
|
74.34
|
|
|
|||||||||||||||||||
AHCA
Contract No. FA619, Exhibit III-E, 3 of 5
|
EXHIBIT
III-E
|
|||||||||||||||||||
|
February
1, 2009 -August 31, 2009 HMO RATES
|
|||||||||||||||||||
|
(MEDICAID
Non-Reform HMO CAPITATION
RATES)
|
|||||||||||||||||||
|
By
Area , Age and Eligibility Category
|
|||||||||||||||||||
|
TABLE
7
|
|||||||||||||||||||
|
General
+ Dental + Transportation Rates:
|
|||||||||||||||||||
|
XXXX
|
XXX-X
|
XXX-X
|
XXX-XX
|
||||||||||||||||
|
Xxxx
|
XXXXXx0XX
|
0XX-00XX
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE (14-20)
|
AG
E (21-54)
|
AGE
(55+)
|
BTHMO+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
|||
|
Female
|
Male
|
Female
|
Male
|
||||||||||||||||
|
01
|
1,118.72
|
188.76
|
103.89
|
65.06
|
134.70
|
73.55
|
259.75
|
157.14
|
324.81
|
10,468.01
|
1,543.25
|
452.79
|
203.71
|
221.33
|
718.12
|
719.10
|
313.80
|
109.64
|
95.47
|
|
02
|
1,118.72
|
188.76
|
103.89
|
65.06
|
134.70
|
73.55
|
259.75
|
157.14
|
324.81
|
10,468.01
|
1,543.25
|
452.79
|
203.71
|
221.33
|
718.12
|
719.10
|
313.80
|
109.64
|
95.47
|
|
03
|
1,224.01
|
208.19
|
116.33
|
75.37
|
151.51
|
84.34
|
289.24
|
176.22
|
367.91
|
11,492.13
|
1,712.45
|
504.88
|
233.76
|
253.18
|
814.70
|
819.56
|
350.30
|
111.43
|
95.98
|
|
04
|
1,072.09
|
183.11
|
101.59
|
65.36
|
131.54
|
73.33
|
255.32
|
156.12
|
328.03
|
11,010.91
|
1,640.44
|
483.34
|
223.81
|
241.63
|
782.91
|
789.79
|
307.18
|
107.78
|
93.83
|
|
05
|
1,218.84
|
207.55
|
116.31
|
76.07
|
151.19
|
84.65
|
289.87
|
177.44
|
372.19
|
12,280.77
|
1,817.77
|
537.32
|
249.20
|
267.29
|
860.33
|
868.09
|
235.40
|
99.06
|
87.25
|
|
06
|
1,060.37
|
182.18
|
102.13
|
67.31
|
132.68
|
74.91
|
255.58
|
156.93
|
332.24
|
11,193.68
|
1,666.14
|
492.37
|
230.40
|
246.72
|
796.60
|
805.20
|
282.41
|
93.12
|
81.79
|
|
07
|
1,096.98
|
187.88
|
104.90
|
68.32
|
135.84
|
76.21
|
262.09
|
160.28
|
337.77
|
11,845.15
|
1,767.63
|
522.11
|
245.16
|
263.50
|
848.15
|
857.93
|
379.84
|
98.21
|
86.58
|
|
08
|
1,038.81
|
178.46
|
101.14
|
67.61
|
132.06
|
75.19
|
250.51
|
153.84
|
324.98
|
10,564.20
|
1,575.40
|
465.62
|
217.49
|
234.69
|
753.24
|
759.90
|
263.71
|
95.23
|
83.02
|
|
09
|
1,072.90
|
182.92
|
102.55
|
66.97
|
133.56
|
74.65
|
253.91
|
154.79
|
323.92
|
11,117.63
|
1,661.31
|
490.05
|
229.98
|
246.81
|
796.95
|
804.54
|
227.68
|
101.29
|
88.19
|
|
10
|
1,086.46
|
186.88
|
104.63
|
68.67
|
135.45
|
76.52
|
261.10
|
159.93
|
339.54
|
14,370.54
|
2,149.59
|
635.70
|
302.94
|
321.85
|
1,041.48
|
1,057.55
|
328.33
|
107.66
|
95.14
|
|
11
|
1,375.29
|
233.39
|
130.45
|
85.51
|
170.45
|
94.96
|
321.87
|
195.21
|
408.22
|
14,515.53
|
2,149.87
|
636.02
|
298.28
|
318.69
|
1,020.36
|
1,030.34
|
378.95
|
154.87
|
136.29
|
|
6B*
|
1,060.23
|
182.16
|
102.12
|
67.30
|
132.66
|
74.90
|
253.67
|
154.97
|
327.89
|
11,193.18
|
1,666.05
|
492.35
|
230.39
|
246.71
|
794.05
|
801.66
|
282.41
|
93.12
|
81.79
|
|
TABLE
8
|
|||||||||||||||||||
|
General
+ Mental Health + Dental + Transportation Rates:
|
|||||||||||||||||||
|
TANF
|
SSI-N
|
SSI-B
|
SSE-AB
|
||||||||||||||||
|
Area
|
BTHMO+2MO
|
3MO-11MO AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
XXXXXx0XX
|
0XX-00XX
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
||||
|
Female
|
Male
|
Female
|
Male
|
||||||||||||||||
|
01
|
1,118.74
|
188.78
|
105.53
|
76.75
|
145.63
|
84.48
|
264.19
|
161.58
|
328.55
|
10,468.09
|
1,543.33
|
460.23
|
251.76
|
265.32
|
799.52
|
750.08
|
314.01
|
121.29
|
107.12
|
|
02
|
1,118.75
|
188.79
|
106.80
|
85.32
|
148.12
|
86.97
|
263.16
|
160.55
|
327.76
|
10,468.17
|
1,543.41
|
466.58
|
282.53
|
266.55
|
770.80
|
743.98
|
334.00
|
124.65
|
110.48
|
|
03
|
1,224.02
|
208.20
|
117.65
|
84.55
|
157.59
|
90.42
|
290.78
|
177.76
|
369.25
|
11,492.20
|
1,712.52
|
511.14
|
269.52
|
273.70
|
838.60
|
830.84
|
357.15
|
120.41
|
104.96
|
|
04
|
1,072.10
|
183.12
|
102.97
|
74.92
|
137.88
|
79.67
|
256.93
|
157.73
|
329.43
|
11,011.02
|
1,640.55
|
493.10
|
279.55
|
273.61
|
820.17
|
807.38
|
331.73
|
124.56
|
110.60
|
|
05
|
1,218.85
|
207.56
|
117.52
|
84.75
|
159.30
|
92.76
|
293.16
|
180.73
|
374.97
|
12,280.82
|
1,817.82
|
542.34
|
281.62
|
296.97
|
915.25
|
888.99
|
238.13
|
111.88
|
100.07
|
|
06
|
1,060.39
|
182.20
|
103.98
|
80.56
|
145.06
|
87.29
|
260.61
|
161.96
|
336.49
|
11,193.75
|
1,666.21
|
498.89
|
272.51
|
285.26
|
867.93
|
832.35
|
283.72
|
97.01
|
85.68
|
|
07
|
1,097.00
|
187.90
|
106.68
|
81.01
|
147.70
|
88.07
|
266.91
|
165.10
|
341.84
|
11,845.21
|
1,767.69
|
528.23
|
284.67
|
299.67
|
915.08
|
883.41
|
382.43
|
108.73
|
97.10
|
|
08
|
1,038.82
|
178.47
|
102.40
|
76.40
|
137.88
|
81.01
|
252.00
|
155.33
|
326.27
|
10,564.27
|
1,575.47
|
471.62
|
251.77
|
254.37
|
776.15
|
770.72
|
270.56
|
108.45
|
96.24
|
|
09
|
1,072.92
|
182.94
|
104.10
|
77.78
|
140.72
|
81.81
|
255.73
|
156.61
|
325.49
|
11,117.70
|
1,661.38
|
496.38
|
266.12
|
267.55
|
821.11
|
815.95
|
234.53
|
110.88
|
97.78
|
|
10
|
1,086.48
|
186.90
|
106.55
|
82.03
|
144.30
|
85.37
|
263.35
|
162.18
|
341.49
|
14,370.64
|
2,149.69
|
644.05
|
350.65
|
349.23
|
1,073.36
|
1,072.61
|
335.18
|
115.72
|
103.20
|
|
11
|
1,375.31
|
233.41
|
132.07
|
96.80
|
177.94
|
102.45
|
323.78
|
197.12
|
409.87
|
14,515.61
|
2,149.95
|
642.99
|
338.08
|
341.52
|
1,046.96
|
1,042.90
|
386.18
|
162.93
|
144.35
|
|
6B*
|
1,060.25
|
182.18
|
103.87
|
79.82
|
144.36
|
86.60
|
258.42
|
159.72
|
331.90
|
11,193.25
|
1,666.12
|
498.85
|
272.38
|
285.14
|
865.17
|
828.73
|
283.72
|
97.01
|
85.68
|
AHCA
Contract No. FA619, Exhibit III-E, 4 of 5
EXHIBIT
III-E
February
1, 2009
- August 31, 2009 HMO RATES
(MEDICAID
Non-Reform HMO CAPITATION RATES)
By
Area , Age and Eligibility Category
|
Area
|
Corresponding
Counties
|
|
Area
1
|
Escambia,
Okaloosa, Santa Xxxx, Xxxxxx
|
|
Area
2
|
Bay,
Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Xxxxxxxxx, Xxxx,
Liberty, Madison, Taylor, Washington, Wakulla
|
|
Area
3
|
Alachua,
Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando,
Lafayette, Lake, Xxxx, Xxxxxx, Putnam, Sumter, Suwannee,
Union
|
|
Ares
4
|
Baker,
Clay, Duval, Flagler, Nassau, St. Xxxxx, Volusia
|
|
Area
5
|
Pasco,
Pinellas
|
|
Area
6
|
Xxxxxx,
Highlands, Manatee, Polk
|
|
Area
6B *
|
Xxxxxxxxxxxx
|
|
Xxxx
0
|
Brevard,
Orange, Osceola, Seminole
|
|
Area
8
|
Charlotte,
Xxxxxxx, De Xxxx, Glades, Hendry, Lee, Sarasota
|
|
Area
9
|
Indian
River, Okeechobee, St. Lucie, Martin, Palm Beach
|
|
Ares
00
|
Xxxxxxx
|
|
Xxxx
00
|
Xxxx,
Xxxxxx
|
AHCA
Contract No. FA619, Exhibit III-E, 5 of 5
