AHCA CONTRACT NO. FA972 AMENDMENT NO. 1
| Back to 8-k | Exhibit 10.4 |
AMENDMENT NO. 1
THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the "Agency" and WELLCARE OF FLORIDA, INC., D/B/A HEALTHEASE, hereinafter referred to as the "Vendor," or “Health Plan,” is hereby amended as follows:
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1.
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Standard Contract, Section III., Item A., Termination, sub-item 3., Termination for Breach, first paragraph, the third sentence is hereby amended to now read as follows:
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If applicable, the Agency may employ the default provisions in Rule 60A-1.006(3), Florida Administrative Code.
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2.
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Effective September 1, 2012, Attachment I, Scope of Services, Capitated Health Plans, Exhibit 2-NR, Medicaid Non-Reform Capitation Rates, Effective September 1, 2011, is hereby deleted in its entirety and replaced with Exhibit 2-NR, Medicaid Non-Reform HMO Capitation Rates, September 1, 2012 – August 31, 2013 (90112), attached hereto and made a part of this Contract.
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3.
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Effective January 1, 2013, Attachment II, Core Contract Provisions, Section V, Covered Services, Item H., Coverage Provisions is hereby amended to include sub-item 23. as follows:
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23.
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Primary Care Services
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The Health Plan shall process claims for and, if capitated or are approved by the Agency to subcapitate for certain covered services, pay certain physicians who provide Florida Medicaid-covered eligible primary care services in accordance with the Affordable Care Act and 42 CFR sections 438 and 447, for the period January 1, 2013, through December 31, 2014. Health Plans that are approved by the Agency to subcapitate for services shall also pay in accordance with such requirements
Unless otherwise stated, this amendment shall be effective upon execution by both Parties.
All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in this Contract.
This amendment, and all its attachments, are hereby made part of this Contract.
This amendment cannot be executed unless all previous amendments to this Contract have been fully executed.
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
IN WITNESS WHEREOF, the Parties hereto have caused this seven (7) page amendment (including all attachments) to be executed by their officials thereunto duly authorized.
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WELLCARE OF FLORIDA, INC.,
D/B/A STAYWELL HEALTH PLAN OF
FLORIDA
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STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
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SIGNED
BY:
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/s/ Xxxxxxxxx Xxxxxx |
SIGNED
BY:
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/s/Xxxxxxxxx Xxxxx | |
| NAME: | Xxxxxxxxx Xxxxxx | NAME: | Xxxxxxxxx Xxxxx | |
| TITLE: | President, FL and HI Division | TITLE: | Secretary | |
| DATE: | 1/3/13 | DATE: | 1/10/13 | |
List of Attachments/Exhibits included as part of this amendment:
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Specify
Type
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Number
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Description
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Attachment I
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Exhibit 2-NR
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Medicaid Non-Reform HMO Capitation Rates, September 1, 2012 – August 31, 2013 (90112) (5 Pages)
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REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
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EXHIBIT 2 - NR
ESTIMATED HEALTH PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS
(MEDICAID Non-Reform HMO CAPITATION RATES)
September 1, 2012 - August 31, 2013 (90112)
By Area , Age and Eligibility Category
TABLE 1
| General Rates: | ||||||||||||||||||||||||||||||||||||||
| TANF | SSI-N | SSI-B |
SSI-AB
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|||||||||||||||||||||||||||||||||||
| AGE (14-20) | AGE (21-54) | |||||||||||||||||||||||||||||||||||||
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Area
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BTHMO+2MO
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3MO-11MO
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AGE (1-5)
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AGE (6-13)
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Female Male
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Female Male
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AGE (55+)
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BTHMO+2MO
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3MO-11MO
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AGE (1-5)
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AGE (6-13)
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AGE (14-20) |
AGE (21-54)
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AGE (55+)
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AGE (65-) |
AGE(65+)
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||||||||||||||||||||||
| 01 | 1,044.10 | 176.87 | 97.38 | 60.25 | 120.03 | 62.88 | 275.12 | 123.66 | 286.22 | 23,175.16 | 2,589.79 | 260.75 | 143.76 | 178.78 | 725.48 | 788.53 | 353.96 | 99.74 | 79.65 | |||||||||||||||||||
| 02 | 962.26 | 163.01 | 90.13 | 57.49 | 112.56 | 59.89 | 255.25 | 115.67 | 264.90 | 21,691.74 | 2,423.90 | 237.61 | 117.79 | 152.73 | 651.93 | 728.05 | 353.96 | 93.24 | 74.33 | |||||||||||||||||||
| 03 | 1,132.49 | 191.85 | 106.18 | 68.14 | 132.95 | 70.97 | 300.83 | 136.55 | 312.05 | 23,983.47 | 2,680.18 | 273.22 | 157.59 | 192.69 | 765.02 | 821.29 | 353.96 | 92.76 | 73.94 | |||||||||||||||||||
| 04 | 1,224.06 | 207.35 | 113.91 | 69.29 | 139.40 | 72.40 | 321.40 | 143.83 | 334.79 | 26,645.33 | 2,977.63 | 302.25 | 171.70 | 211.14 | 844.47 | 910.43 | 353.96 | 88.79 | 70.69 | |||||||||||||||||||
| 05 | 1,314.12 | 222.62 | 123.01 | 78.07 | 153.29 | 81.36 | 348.21 | 157.58 | 361.52 | 26,552.12 | 2,967.14 | 297.54 | 161.57 | 202.09 | 826.11 | 901.56 | 353.96 | 78.87 | 62.58 | |||||||||||||||||||
| 06 | 1,233.32 | 208.96 | 116.42 | 78.18 | 148.71 | 81.20 | 331.03 | 152.13 | 342.09 | 25,907.64 | 2,895.25 | 297.29 | 175.80 | 213.01 | 835.41 | 890.51 | 353.96 | 78.53 | 62.31 | |||||||||||||||||||
| 07 | 1,189.59 | 201.49 | 110.21 | 64.80 | 132.98 | 67.86 | 310.16 | 137.59 | 323.92 | 27,626.61 | 3,087.18 | 308.28 | 164.73 | 207.33 | 854.09 | 936.03 | 353.96 | 77.12 | 61.15 | |||||||||||||||||||
| 09 | 1,228.70 | 208.14 | 114.67 | 71.23 | 141.58 | 74.33 | 324.06 | 145.83 | 337.02 | 28,336.53 | 3,166.45 | 312.52 | 159.40 | 204.33 | 860.57 | 954.38 | 353.96 | 87.68 | 69.78 | |||||||||||||||||||
| 10 | 1,087.72 | 184.27 | 101.80 | 64.51 | 126.76 | 67.23 | 288.12 | 130.34 | 299.17 | 29,961.41 | 3,348.10 | 334.98 | 180.35 | 226.33 | 929.01 | 1,016.15 | 353.96 | 91.91 | 73.25 | |||||||||||||||||||
| 11 | 1,365.87 | 231.40 | 128.48 | 84.35 | 162.48 | 87.72 | 364.68 | 166.55 | 377.59 | 26,428.69 | 2,953.34 | 295.73 | 159.73 | 200.21 | 820.51 | 896.71 | 353.96 | 104.17 | 83.26 | |||||||||||||||||||
| 6B | 1,232.80 | 208.88 | 116.40 | 78.35 | 148.84 | 81.36 | 331.06 | 152.23 | 342.07 | 25,906.00 | 2,895.07 | 297.32 | 175.93 | 213.11 | 835.58 | 890.53 | 353.96 | 78.53 | 62.31 | |||||||||||||||||||
| 8A | 1,220.23 | 206.73 | 114.76 | 75.21 | 145.02 | 78.23 | 325.67 | 148.67 | 337.25 | 27,586.10 | 3,082.83 | 316.74 | 187.71 | 227.26 | 890.38 | 948.50 | 353.96 | 88.70 | 70.62 | |||||||||||||||||||
| 8B | 1,111.87 | 188.36 | 104.24 | 66.89 | 130.51 | 69.65 | 295.33 | 134.05 | 306.36 | 25,996.71 | 2,905.10 | 292.67 | 161.74 | 200.96 | 814.57 | 884.82 | 353.96 | 85.56 | 68.05 | |||||||||||||||||||
TABLE 2
| General + Mental Health Rates: | ||||||||||||||||||||||||||||||||||||||
| TANF | SSI-N | SSI-B | SSI-AB | |||||||||||||||||||||||||||||||||||
| AGE (14-20) | AGE (21-54) | |||||||||||||||||||||||||||||||||||||
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Area
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BTHMO+2MO
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3MO-11MO
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AGE (1-5)
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AGE (6-13)
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Female Male
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Female Male
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AGE (55+)
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BTHMO+2MO
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3MO-11MO
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AGE (1-5)
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AGE (6-13)
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AGE (14-20) |
AGE (21-54)
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AGE (55+)
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AGE (65-) |
AGE(65+)
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||||||||||||||||||||||
| 01 | 1,044.18 | 176.95 | 99.62 | 71.64 | 131.27 | 74.12 | 284.95 | 133.49 | 292.73 | 23,175.56 | 2,590.19 | 279.12 | 191.60 | 220.46 | 802.81 | 817.07 | 371.28 | 109.99 | 89.90 | |||||||||||||||||||
| 02 | 962.32 | 163.07 | 91.81 | 66.02 | 120.98 | 68.31 | 262.61 | 123.03 | 269.78 | 21,692.25 | 2,424.41 | 261.25 | 179.34 | 206.35 | 751.43 | 764.78 | 371.28 | 103.49 | 84.58 | |||||||||||||||||||
| 03 | 1,132.56 | 191.92 | 108.06 | 77.70 | 142.38 | 80.40 | 309.07 | 144.79 | 317.51 | 23,983.81 | 2,680.52 | 288.85 | 198.29 | 228.15 | 830.81 | 845.57 | 371.28 | 103.01 | 84.19 | |||||||||||||||||||
| 04 | 1,224.16 | 207.45 | 116.80 | 83.98 | 153.90 | 86.90 | 334.07 | 156.50 | 343.19 | 26,645.73 | 2,978.03 | 320.91 | 220.29 | 253.47 | 923.02 | 939.42 | 371.28 | 99.04 | 80.94 | |||||||||||||||||||
| 05 | 1,314.20 | 222.70 | 125.39 | 90.16 | 165.22 | 93.29 | 358.64 | 168.01 | 368.43 | 26,552.60 | 2,967.62 | 319.79 | 219.52 | 252.58 | 919.79 | 936.13 | 371.28 | 89.12 | 72.83 | |||||||||||||||||||
| 06 | 1,233.37 | 209.01 | 117.68 | 84.62 | 155.06 | 87.55 | 336.58 | 157.68 | 345.77 | 25,907.96 | 2,895.57 | 312.03 | 214.19 | 246.45 | 897.46 | 913.41 | 371.28 | 88.78 | 72.56 | |||||||||||||||||||
| 07 | 1,189.71 | 201.61 | 113.51 | 81.62 | 149.57 | 84.45 | 324.67 | 152.10 | 333.53 | 27,627.14 | 3,087.71 | 332.73 | 228.41 | 262.80 | 957.02 | 974.02 | 371.28 | 87.37 | 71.40 | |||||||||||||||||||
| 09 | 1,228.79 | 208.23 | 117.24 | 84.30 | 154.48 | 87.23 | 335.33 | 157.10 | 344.49 | 28,337.15 | 3,167.07 | 341.28 | 234.28 | 269.56 | 981.61 | 999.05 | 371.28 | 97.93 | 80.03 | |||||||||||||||||||
| 10 | 1,087.79 | 184.34 | 103.79 | 74.63 | 136.75 | 77.22 | 296.85 | 139.07 | 304.96 | 29,961.97 | 3,348.66 | 360.85 | 247.71 | 285.01 | 1,037.89 | 1,056.34 | 371.28 | 102.16 | 83.50 | |||||||||||||||||||
| 11 | 1,365.94 | 231.47 | 130.32 | 93.71 | 171.72 | 96.96 | 372.76 | 174.63 | 382.94 | 26,429.18 | 2,953.83 | 318.30 | 218.50 | 251.41 | 915.52 | 931.78 | 371.28 | 114.42 | 93.51 | |||||||||||||||||||
| 6B | 1,232.84 | 208.92 | 117.63 | 84.58 | 154.99 | 87.51 | 336.44 | 157.61 | 345.63 | 25,906.32 | 2,895.39 | 312.01 | 214.18 | 246.43 | 897.41 | 913.35 | 371.28 | 88.78 | 72.56 | |||||||||||||||||||
| 8A | 1,220.29 | 206.79 | 116.43 | 83.72 | 153.41 | 86.62 | 333.01 | 156.01 | 342.11 | 27,586.43 | 3,083.16 | 332.24 | 228.07 | 262.42 | 955.61 | 972.58 | 371.28 | 98.95 | 80.87 | |||||||||||||||||||
| 8B | 1,111.94 | 188.43 | 106.09 | 76.29 | 139.79 | 78.93 | 303.44 | 142.16 | 311.73 | 25,997.15 | 2,905.54 | 313.10 | 214.93 | 247.30 | 900.55 | 916.55 | 371.28 | 95.81 | 78.30 | |||||||||||||||||||
EXHIBIT 2 - NR
ESTIMATED HEALTH PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS
(MEDICAID Non-Reform HMO CAPITATION RATES)
September 1, 2012 - August 31, 2013 (90112)
By Area , Age and Eligibility Category
TABLE 3
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General + MH + Dental Rates:
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||||||||||||||||||||||||||||||||||||||
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XXXX
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XXX-X
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XXX-X
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XXX-XX
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|||||||||||||||||||||||||||||||||||
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Xxxx
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XXXXXx0XX
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0XX-00XX
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AGE (1-5)
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AGE (6-13)
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AGE (14-20)
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AGE (21-54) |
AGE (55+)
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XXXXXx0XX
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0XX-00XX
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AGE (1-5)
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AGE (6-13) | AGE (14-20) |
AGE (21-54)
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AGE (55+)
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AGE (65-)
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AGE (65+)
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||||||||||||||||||||||
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Female
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Male
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Female
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Male
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|||||||||||||||||||||||||||||||||||
| 01 | 1,044.18 | 176.96 | 101.49 | 74.61 | 134.03 | 77.30 | 286.70 | 135.13 | 295.93 | 23,175.56 | 2,590.20 | 281.06 | 194.04 | 222.64 | 804.38 | 819.27 | 373.69 | 110.98 | 90.72 | |||||||||||||||||||
| 02 | 962.33 | 163.09 | 95.76 | 72.29 | 126.81 | 75.04 | 266.15 | 126.34 | 276.24 | 21,692.26 | 2,424.43 | 265.21 | 184.33 | 210.80 | 753.49 | 767.67 | 373.69 | 104.93 | 85.77 | |||||||||||||||||||
| 03 | 1,132.58 | 191.95 | 114.35 | 87.70 | 151.68 | 91.12 | 312.29 | 147.80 | 323.38 | 23,983.82 | 2,680.55 | 295.56 | 206.73 | 235.69 | 833.00 | 848.62 | 373.69 | 104.94 | 85.78 | |||||||||||||||||||
| 04 | 1,224.17 | 207.47 | 120.41 | 89.72 | 159.24 | 93.05 | 337.91 | 160.09 | 350.20 | 26,645.74 | 2,978.05 | 324.64 | 224.98 | 257.66 | 925.96 | 943.53 | 373.69 | 101.15 | 82.68 | |||||||||||||||||||
| 05 | 1,314.22 | 222.73 | 132.37 | 101.25 | 175.54 | 105.18 | 362.92 | 172.02 | 376.25 | 26,552.61 | 2,967.65 | 326.50 | 227.96 | 260.12 | 922.47 | 939.88 | 373.69 | 91.44 | 74.74 | |||||||||||||||||||
| 06 | 1,233.38 | 209.04 | 123.44 | 93.77 | 163.57 | 97.37 | 338.87 | 159.82 | 349.94 | 25,907.97 | 2,895.59 | 317.31 | 220.83 | 252.38 | 899.06 | 915.65 | 373.69 | 90.36 | 73.86 | |||||||||||||||||||
| 07 | 1,189.73 | 201.64 | 120.12 | 92.13 | 159.35 | 95.73 | 327.55 | 154.80 | 338.79 | 27,627.15 | 3,087.74 | 339.32 | 236.70 | 270.20 | 959.00 | 976.79 | 373.69 | 89.18 | 72.89 | |||||||||||||||||||
| 09 | 1,228.81 | 208.27 | 125.84 | 97.98 | 167.20 | 101.90 | 338.50 | 160.06 | 350.27 | 28,337.16 | 3,167.10 | 349.01 | 244.00 | 278.24 | 983.98 | 1,002.36 | 373.69 | 99.99 | 81.73 | |||||||||||||||||||
| 10 | 1,087.80 | 184.36 | 108.23 | 81.68 | 143.31 | 84.78 | 298.21 | 140.34 | 307.44 | 29,961.98 | 3,348.68 | 366.05 | 254.26 | 290.86 | 1,039.64 | 1,058.79 | 373.69 | 103.56 | 84.65 | |||||||||||||||||||
| 11 | 1,366.02 | 231.55 | 139.28 | 108.79 | 184.83 | 110.07 | 374.98 | 176.70 | 386.98 | 26,429.18 | 2,953.83 | 329.16 | 230.76 | 260.96 | 918.53 | 935.98 | 373.69 | 117.45 | 96.01 | |||||||||||||||||||
| 6B | 1,232.85 | 208.95 | 123.39 | 93.73 | 163.50 | 97.33 | 338.73 | 159.75 | 349.80 | 25,906.33 | 2,895.41 | 317.29 | 220.82 | 252.36 | 899.01 | 915.59 | 373.69 | 90.36 | 73.86 | |||||||||||||||||||
| 8A | 1,220.32 | 206.84 | 127.98 | 102.09 | 170.49 | 106.32 | 336.78 | 159.53 | 348.99 | 27,586.45 | 3,083.20 | 342.39 | 240.83 | 273.82 | 958.31 | 976.35 | 373.69 | 101.47 | 82.95 | |||||||||||||||||||
| 8B | 1,111.97 | 188.48 | 116.21 | 92.38 | 154.76 | 96.19 | 306.24 | 144.78 | 316.84 | 25,997.16 | 2,905.57 | 321.27 | 225.21 | 256.48 | 902.57 | 919.37 | 373.69 | 97.46 | 79.66 | |||||||||||||||||||
TABLE 4
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General + MH + Transportation Rates:
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TANF
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SSI-N
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SSI-B
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SSI-AB
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|||||||||||||||||||||||||||||||||||
| AGE (14-20) | AGE (21-54) | |||||||||||||||||||||||||||||||||||||
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Area
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BTHMO+2MO
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3MO-11MO
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AGE (1-5)
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AGE (6-13)
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Female |
Male
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Female |
Male
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AGE (55+)
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BTHMO+2MO
|
3MO-11MO
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AGE (1-5)
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AGE (6-13)
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AGE (14-20) |
AGE (21-54)
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AGE (55+)
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AGE (65-) |
AGE (65+)
|
||||||||||||||||||||
| 01 | 1,050.20 | 178.92 | 100.80 | 72.42 | 132.86 | 76.58 | 287.64 | 137.29 | 296.27 | 23,220.19 | 2,624.21 | 287.27 | 197.37 | 229.60 | 827.01 | 838.17 | 374.89 | 114.19 | 93.11 | |||||||||||||||||||
| 02 | 967.80 | 164.86 | 92.88 | 66.73 | 122.43 | 70.55 | 265.06 | 126.49 | 273.00 | 21,732.42 | 2,455.03 | 268.58 | 184.53 | 214.57 | 773.21 | 783.77 | 374.89 | 107.00 | 87.26 | |||||||||||||||||||
| 03 | 1,138.56 | 193.89 | 109.23 | 78.48 | 143.97 | 82.85 | 311.76 | 148.58 | 321.04 | 24,023.02 | 2,710.41 | 296.01 | 203.36 | 236.18 | 852.07 | 864.10 | 374.89 | 107.41 | 87.55 | |||||||||||||||||||
| 04 | 1,229.96 | 209.35 | 117.94 | 84.73 | 155.43 | 89.27 | 336.66 | 160.16 | 346.61 | 26,691.49 | 3,012.91 | 329.26 | 226.20 | 262.84 | 947.83 | 961.05 | 374.89 | 104.55 | 85.15 | |||||||||||||||||||
| 05 | 1,318.77 | 224.20 | 126.29 | 90.75 | 166.43 | 95.16 | 360.69 | 170.90 | 371.12 | 26,589.93 | 2,996.07 | 326.60 | 224.34 | 260.22 | 940.03 | 953.77 | 374.89 | 93.73 | 76.35 | |||||||||||||||||||
| 06 | 1,238.15 | 210.58 | 118.62 | 85.24 | 156.32 | 89.50 | 338.72 | 160.70 | 348.59 | 25,947.17 | 2,925.46 | 319.19 | 219.26 | 254.48 | 918.72 | 931.95 | 374.89 | 92.87 | 75.68 | |||||||||||||||||||
| 07 | 1,194.72 | 203.25 | 114.49 | 82.27 | 150.89 | 86.49 | 326.91 | 155.26 | 336.48 | 27,668.14 | 3,118.96 | 340.22 | 233.71 | 271.19 | 979.25 | 993.40 | 374.89 | 90.67 | 73.92 | |||||||||||||||||||
| 09 | 1,234.50 | 210.10 | 118.36 | 85.04 | 155.99 | 89.56 | 337.89 | 160.71 | 347.85 | 28,377.81 | 3,198.06 | 348.70 | 239.54 | 277.88 | 1,003.65 | 1,018.27 | 374.89 | 102.51 | 83.53 | |||||||||||||||||||
| 10 | 1,093.71 | 186.28 | 104.95 | 75.40 | 138.31 | 79.64 | 299.50 | 142.81 | 308.45 | 30,012.86 | 3,387.45 | 370.14 | 254.29 | 295.43 | 1,065.48 | 1,080.39 | 374.89 | 106.75 | 87.00 | |||||||||||||||||||
| 11 | 1,370.41 | 232.93 | 131.19 | 94.29 | 172.90 | 98.78 | 374.76 | 177.45 | 385.57 | 26,466.18 | 2,982.03 | 325.06 | 223.28 | 258.98 | 935.58 | 949.27 | 374.89 | 117.89 | 96.16 | |||||||||||||||||||
| 6B | 1,237.62 | 210.49 | 118.57 | 85.20 | 156.25 | 89.46 | 338.58 | 160.63 | 348.45 | 25,945.53 | 2,925.28 | 319.17 | 219.25 | 254.46 | 918.67 | 931.89 | 374.89 | 92.87 | 75.68 | |||||||||||||||||||
| 8A | 1,226.17 | 208.72 | 117.58 | 84.48 | 154.96 | 89.02 | 335.64 | 159.72 | 345.57 | 27,626.55 | 3,113.74 | 339.56 | 233.26 | 270.63 | 977.36 | 991.54 | 374.89 | 101.08 | 82.50 | |||||||||||||||||||
| 8B | 1,117.96 | 190.40 | 107.27 | 77.07 | 141.38 | 81.39 | 306.13 | 145.96 | 315.27 | 26,035.24 | 2,934.58 | 320.06 | 219.85 | 255.10 | 921.20 | 934.56 | 374.89 | 99.43 | 81.07 | |||||||||||||||||||
EXHIBIT 2 - NR
ESTIMATED HEALTH PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS
(MEDICAID Non-Reform HMO CAPITATION RATES)
September 1, 2012 - August 31, 2013 (90112)
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 | 1,050.12 | 178.84 | 98.56 | 61.03 | 121.62 | 65.34 | 277.81 | 127.46 | 289.76 | 23,219.79 | 2,623.81 | 268.90 | 149.53 | 187.92 | 749.68 | 809.63 | 357.57 | 103.94 | 82.86 | |||||||||||||||||||
| 02 | 967.74 | 164.80 | 91.20 | 58.20 | 114.01 | 62.13 | 257.70 | 119.13 | 268.12 | 21,731.91 | 2,454.52 | 244.94 | 122.98 | 160.95 | 673.71 | 747.04 | 357.57 | 96.75 | 77.01 | |||||||||||||||||||
| 03 | 1,138.49 | 193.82 | 107.35 | 68.92 | 134.54 | 73.42 | 303.52 | 140.34 | 315.58 | 24,022.68 | 2,710.07 | 280.38 | 162.66 | 200.72 | 786.28 | 839.82 | 357.57 | 97.16 | 77.30 | |||||||||||||||||||
| 04 | 1,229.86 | 209.25 | 115.05 | 70.04 | 140.93 | 74.77 | 323.99 | 147.49 | 338.21 | 26,691.09 | 3,012.51 | 310.60 | 177.61 | 220.51 | 869.28 | 932.06 | 357.57 | 94.30 | 74.90 | |||||||||||||||||||
| 05 | 1,318.69 | 224.12 | 123.91 | 78.66 | 154.50 | 83.23 | 350.26 | 160.47 | 364.21 | 26,589.45 | 2,995.59 | 304.35 | 166.39 | 209.73 | 846.35 | 919.20 | 357.57 | 83.48 | 66.10 | |||||||||||||||||||
| 06 | 1,238.10 | 210.53 | 117.36 | 78.80 | 149.97 | 83.15 | 333.17 | 155.15 | 344.91 | 25,946.85 | 2,925.14 | 304.45 | 180.87 | 221.04 | 856.67 | 909.05 | 357.57 | 82.62 | 65.43 | |||||||||||||||||||
| 07 | 1,194.60 | 203.13 | 111.19 | 65.45 | 134.30 | 69.90 | 312.40 | 140.75 | 326.87 | 27,667.61 | 3,118.43 | 315.77 | 170.03 | 215.72 | 876.32 | 955.41 | 357.57 | 80.42 | 63.67 | |||||||||||||||||||
| 09 | 1,234.41 | 210.01 | 115.79 | 71.97 | 143.09 | 76.66 | 326.62 | 149.44 | 340.38 | 28,377.19 | 3,197.44 | 319.94 | 164.66 | 212.65 | 882.61 | 973.60 | 357.57 | 92.26 | 73.28 | |||||||||||||||||||
| 10 | 1,093.64 | 186.21 | 102.96 | 65.28 | 128.32 | 69.65 | 290.77 | 134.08 | 302.66 | 30,012.30 | 3,386.89 | 344.27 | 186.93 | 236.75 | 956.60 | 1,040.20 | 357.57 | 96.50 | 76.75 | |||||||||||||||||||
| 11 | 1,370.34 | 232.86 | 129.35 | 84.93 | 163.66 | 89.54 | 366.68 | 169.37 | 380.22 | 26,465.69 | 2,981.54 | 302.49 | 164.51 | 207.78 | 840.57 | 914.20 | 357.57 | 107.64 | 85.91 | |||||||||||||||||||
| 6B | 1,237.58 | 210.45 | 117.34 | 78.97 | 150.10 | 83.31 | 333.20 | 155.25 | 344.89 | 25,945.21 | 2,924.96 | 304.48 | 181.00 | 221.14 | 856.84 | 909.07 | 357.57 | 82.62 | 65.43 | |||||||||||||||||||
| 8A | 1,226.11 | 208.66 | 115.91 | 75.97 | 146.57 | 80.63 | 328.30 | 152.38 | 340.71 | 27,626.22 | 3,113.41 | 324.06 | 192.90 | 235.47 | 912.13 | 967.46 | 357.57 | 90.83 | 72.25 | |||||||||||||||||||
| 8B | 1,117.89 | 190.33 | 105.42 | 67.67 | 132.10 | 72.11 | 298.02 | 137.85 | 309.90 | 26,034.80 | 2,934.14 | 299.63 | 166.66 | 208.76 | 835.22 | 902.83 | 357.57 | 89.18 | 70.82 | |||||||||||||||||||
TABLE 6
|
General + Dental 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 | 1,044.10 | 176.88 | 99.25 | 63.22 | 122.79 | 66.06 | 276.87 | 125.30 | 289.42 | 23,175.16 | 2,589.80 | 262.69 | 146.20 | 180.96 | 727.05 | 790.73 | 356.37 | 100.73 | 80.47 | |||||||||||||||||||
| 02 | 962.27 | 163.03 | 94.08 | 63.76 | 118.39 | 66.62 | 258.79 | 118.98 | 271.36 | 21,691.75 | 2,423.92 | 241.57 | 122.78 | 157.18 | 653.99 | 730.94 | 356.37 | 94.68 | 75.52 | |||||||||||||||||||
| 03 | 1,132.51 | 191.88 | 112.47 | 78.14 | 142.25 | 81.69 | 304.05 | 139.56 | 317.92 | 23,983.48 | 2,680.21 | 279.93 | 166.03 | 200.23 | 767.21 | 824.34 | 356.37 | 94.69 | 75.53 | |||||||||||||||||||
| 04 | 1,224.07 | 207.37 | 117.52 | 75.03 | 144.74 | 78.55 | 325.24 | 147.42 | 341.80 | 26,645.34 | 2,977.65 | 305.98 | 176.39 | 215.33 | 847.41 | 914.54 | 356.37 | 90.90 | 72.43 | |||||||||||||||||||
| 05 | 1,314.14 | 222.65 | 129.99 | 89.16 | 163.61 | 93.25 | 352.49 | 161.59 | 369.34 | 26,552.13 | 2,967.17 | 304.25 | 170.01 | 209.63 | 828.79 | 905.31 | 356.37 | 81.19 | 64.49 | |||||||||||||||||||
| 06 | 1,233.33 | 208.99 | 122.18 | 87.33 | 157.22 | 91.02 | 333.32 | 154.27 | 346.26 | 25,907.65 | 2,895.27 | 302.57 | 182.44 | 218.94 | 837.01 | 892.75 | 356.37 | 80.11 | 63.61 | |||||||||||||||||||
| 07 | 1,189.61 | 201.52 | 116.82 | 75.31 | 142.76 | 79.14 | 313.04 | 140.29 | 329.18 | 27,626.62 | 3,087.21 | 314.87 | 173.02 | 214.73 | 856.07 | 938.80 | 356.37 | 78.93 | 62.64 | |||||||||||||||||||
| 09 | 1,228.72 | 208.18 | 123.27 | 84.91 | 154.30 | 89.00 | 327.23 | 148.79 | 342.80 | 28,336.54 | 3,166.48 | 320.25 | 169.12 | 213.01 | 862.94 | 957.69 | 356.37 | 89.74 | 71.48 | |||||||||||||||||||
| 10 | 1,087.73 | 184.29 | 106.24 | 71.56 | 133.32 | 74.79 | 289.48 | 131.61 | 301.65 | 29,961.42 | 3,348.12 | 340.18 | 186.90 | 232.18 | 930.76 | 1,018.60 | 356.37 | 93.31 | 74.40 | |||||||||||||||||||
| 11 | 1,365.95 | 231.48 | 137.44 | 99.43 | 175.59 | 100.83 | 366.90 | 168.62 | 381.63 | 26,428.69 | 2,953.34 | 306.59 | 171.99 | 209.76 | 823.52 | 900.91 | 356.37 | 107.20 | 85.76 | |||||||||||||||||||
| 6B | 1,232.81 | 208.91 | 122.16 | 87.50 | 157.35 | 91.18 | 333.35 | 154.37 | 346.24 | 25,906.01 | 2,895.09 | 302.60 | 182.57 | 219.04 | 837.18 | 892.77 | 356.37 | 80.11 | 63.61 | |||||||||||||||||||
| 8A | 1,220.26 | 206.78 | 126.31 | 93.58 | 162.10 | 97.93 | 329.44 | 152.19 | 344.13 | 27,586.12 | 3,082.87 | 326.89 | 200.47 | 238.66 | 893.08 | 952.27 | 356.37 | 91.22 | 72.70 | |||||||||||||||||||
| 8B | 1,111.90 | 188.41 | 114.36 | 82.98 | 145.48 | 86.91 | 298.13 | 136.67 | 311.47 | 25,996.72 | 2,905.13 | 300.84 | 172.02 | 210.14 | 816.59 | 887.64 | 356.37 | 87.21 | 69.41 | |||||||||||||||||||
EXHIBIT 2 - NR
ESTIMATED HEALTH PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS
(MEDICAID Non-Reform HMO CAPITATION RATES)
September 1, 2012 - August 31, 2013 (90112)
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)
|
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 | 1,050.12 | 178.85 | 100.43 | 64.00 | 124.38 | 68.52 | 279.56 | 129.10 | 292.96 | 23,219.79 | 2,623.82 | 270.84 | 151.97 | 190.10 | 751.25 | 811.83 | 359.98 | 104.93 | 83.68 | |||||||||||||||||||
| 02 | 967.75 | 164.82 | 95.15 | 64.47 | 119.84 | 68.86 | 261.24 | 122.44 | 274.58 | 21,731.92 | 2,454.54 | 248.90 | 127.97 | 165.40 | 675.77 | 749.93 | 359.98 | 98.19 | 78.20 | |||||||||||||||||||
| 03 | 1,138.51 | 193.85 | 113.64 | 78.92 | 143.84 | 84.14 | 306.74 | 143.35 | 321.45 | 24,022.69 | 2,710.10 | 287.09 | 171.10 | 208.26 | 788.47 | 842.87 | 359.98 | 99.09 | 78.89 | |||||||||||||||||||
| 04 | 1,229.87 | 209.27 | 118.66 | 75.78 | 146.27 | 80.92 | 327.83 | 151.08 | 345.22 | 26,691.10 | 3,012.53 | 314.33 | 182.30 | 224.70 | 872.22 | 936.17 | 359.98 | 96.41 | 76.64 | |||||||||||||||||||
| 05 | 1,318.71 | 224.15 | 130.89 | 89.75 | 164.82 | 95.12 | 354.54 | 164.48 | 372.03 | 26,589.46 | 2,995.62 | 311.06 | 174.83 | 217.27 | 849.03 | 922.95 | 359.98 | 85.80 | 68.01 | |||||||||||||||||||
| 06 | 1,238.11 | 210.56 | 123.12 | 87.95 | 158.48 | 92.97 | 335.46 | 157.29 | 349.08 | 25,946.86 | 2,925.16 | 309.73 | 187.51 | 226.97 | 858.27 | 911.29 | 359.98 | 84.20 | 66.73 | |||||||||||||||||||
| 07 | 1,194.62 | 203.16 | 117.80 | 75.96 | 144.08 | 81.18 | 315.28 | 143.45 | 332.13 | 27,667.62 | 3,118.46 | 322.36 | 178.32 | 223.12 | 878.30 | 958.18 | 359.98 | 82.23 | 65.16 | |||||||||||||||||||
| 09 | 1,234.43 | 210.05 | 124.39 | 85.65 | 155.81 | 91.33 | 329.79 | 152.40 | 346.16 | 28,377.20 | 3,197.47 | 327.67 | 174.38 | 221.33 | 884.98 | 976.91 | 359.98 | 94.32 | 74.98 | |||||||||||||||||||
| 10 | 1,093.65 | 186.23 | 107.40 | 72.33 | 134.88 | 77.21 | 292.13 | 135.35 | 305.14 | 30,012.31 | 3,386.91 | 349.47 | 193.48 | 242.60 | 958.35 | 1,042.65 | 359.98 | 97.90 | 77.90 | |||||||||||||||||||
| 11 | 1,370.42 | 232.94 | 138.31 | 100.01 | 176.77 | 102.65 | 368.90 | 171.44 | 384.26 | 26,465.69 | 2,981.54 | 313.35 | 176.77 | 217.33 | 843.58 | 918.40 | 359.98 | 110.67 | 88.41 | |||||||||||||||||||
| 6B | 1,237.59 | 210.48 | 123.10 | 88.12 | 158.61 | 93.13 | 335.49 | 157.39 | 349.06 | 25,945.22 | 2,924.98 | 309.76 | 187.64 | 227.07 | 858.44 | 911.31 | 359.98 | 84.20 | 66.73 | |||||||||||||||||||
| 8A | 1,226.14 | 208.71 | 127.46 | 94.34 | 163.65 | 100.33 | 332.07 | 155.90 | 347.59 | 27,626.24 | 3,113.45 | 334.21 | 205.66 | 246.87 | 914.83 | 971.23 | 359.98 | 93.35 | 74.33 | |||||||||||||||||||
| 8B | 1,117.92 | 190.38 | 115.54 | 83.76 | 147.07 | 89.37 | 300.82 | 140.47 | 315.01 | 26,034.81 | 2,934.17 | 307.80 | 176.94 | 217.94 | 837.24 | 905.65 | 359.98 | 90.83 | 72.18 | |||||||||||||||||||
TABLE 8
| General + Mental Health + Dental + 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 | 1,050.20 | 178.93 | 102.67 | 75.39 | 135.62 | 79.76 | 289.39 | 138.93 | 299.47 | 23,220.19 | 2,624.22 | 289.21 | 199.81 | 231.78 | 828.58 | 840.37 | 377.30 | 115.18 | 93.93 | |||||||||||||||||||
| 02 | 967.81 | 164.88 | 96.83 | 73.00 | 128.26 | 77.28 | 268.60 | 129.80 | 279.46 | 21,732.43 | 2,455.05 | 272.54 | 189.52 | 219.02 | 775.27 | 786.66 | 377.30 | 108.44 | 88.45 | |||||||||||||||||||
| 03 | 1,138.58 | 193.92 | 115.52 | 88.48 | 153.27 | 93.57 | 314.98 | 151.59 | 326.91 | 24,023.03 | 2,710.44 | 302.72 | 211.80 | 243.72 | 854.26 | 867.15 | 377.30 | 109.34 | 89.14 | |||||||||||||||||||
| 04 | 1,229.97 | 209.37 | 121.55 | 90.47 | 160.77 | 95.42 | 340.50 | 163.75 | 353.62 | 26,691.50 | 3,012.93 | 332.99 | 230.89 | 267.03 | 950.77 | 965.16 | 377.30 | 106.66 | 86.89 | |||||||||||||||||||
| 05 | 1,318.79 | 224.23 | 133.27 | 101.84 | 176.75 | 107.05 | 364.97 | 174.91 | 378.94 | 26,589.94 | 2,996.10 | 333.31 | 232.78 | 267.76 | 942.71 | 957.52 | 377.30 | 96.05 | 78.26 | |||||||||||||||||||
| 06 | 1,238.16 | 210.61 | 124.38 | 94.39 | 164.83 | 99.32 | 341.01 | 162.84 | 352.76 | 25,947.18 | 2,925.48 | 324.47 | 225.90 | 260.41 | 920.32 | 934.19 | 377.30 | 94.45 | 76.98 | |||||||||||||||||||
| 07 | 1,194.74 | 203.28 | 121.10 | 92.78 | 160.67 | 97.77 | 329.79 | 157.96 | 341.74 | 27,668.15 | 3,118.99 | 346.81 | 242.00 | 278.59 | 981.23 | 996.17 | 377.30 | 92.48 | 75.41 | |||||||||||||||||||
| 09 | 1,234.52 | 210.14 | 126.96 | 98.72 | 168.71 | 104.23 | 341.06 | 163.67 | 353.63 | 28,377.82 | 3,198.09 | 356.43 | 249.26 | 286.56 | 1,006.02 | 1,021.58 | 377.30 | 104.57 | 85.23 | |||||||||||||||||||
| 10 | 1,093.72 | 186.30 | 109.39 | 82.45 | 144.87 | 87.20 | 300.86 | 144.08 | 310.93 | 30,012.87 | 3,387.47 | 375.34 | 260.84 | 301.28 | 1,067.23 | 1,082.84 | 377.30 | 108.15 | 88.15 | |||||||||||||||||||
| 11 | 1,370.49 | 233.01 | 140.15 | 109.37 | 186.01 | 111.89 | 376.98 | 179.52 | 389.61 | 26,466.18 | 2,982.03 | 335.92 | 235.54 | 268.53 | 938.59 | 953.47 | 377.30 | 120.92 | 98.66 | |||||||||||||||||||
| 6B | 1,237.63 | 210.52 | 124.33 | 94.35 | 164.76 | 99.28 | 340.87 | 162.77 | 352.62 | 25,945.54 | 2,925.30 | 324.45 | 225.89 | 260.39 | 920.27 | 934.13 | 377.30 | 94.45 | 76.98 | |||||||||||||||||||
| 8A | 1,226.20 | 208.77 | 129.13 | 102.85 | 172.04 | 108.72 | 339.41 | 163.24 | 352.45 | 27,626.57 | 3,113.78 | 349.71 | 246.02 | 282.03 | 980.06 | 995.31 | 377.30 | 103.60 | 84.58 | |||||||||||||||||||
| 8B | 1,117.99 | 190.45 | 117.39 | 93.16 | 156.35 | 98.65 | 308.93 | 148.58 | 320.38 | 26,035.25 | 2,934.61 | 328.23 | 230.13 | 264.28 | 923.22 | 937.38 | 377.30 | 101.08 | 82.43 | |||||||||||||||||||
EXHIBIT 2 - NR
ESTIMATED HEALTH PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS
(MEDICAID Non-Reform HMO CAPITATION RATES)
September 1, 2012 - August 31, 2013 (90112)
By Area , Age and Eligibility Category
TABLE 9
| 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 | 0.08 | 0.08 | 2.24 | 11.39 | 11.24 | 11.24 | 9.83 | 9.83 | 6.51 | 0.40 | 0.40 | 18.37 | 47.84 | 41.68 | 77.33 | 28.54 | 17.32 | 10.25 | 10.25 | |||||||||||||||||||
| 02 | 0.06 | 0.06 | 1.68 | 8.53 | 8.42 | 8.42 | 7.36 | 7.36 | 4.88 | 0.51 | 0.51 | 23.64 | 61.55 | 53.62 | 99.50 | 36.73 | 17.32 | 10.25 | 10.25 | |||||||||||||||||||
| 03 | 0.07 | 0.07 | 1.88 | 9.56 | 9.43 | 9.43 | 8.24 | 8.24 | 5.46 | 0.34 | 0.34 | 15.63 | 40.70 | 35.46 | 65.79 | 24.28 | 17.32 | 10.25 | 10.25 | |||||||||||||||||||
| 04 | 0.10 | 0.10 | 2.89 | 14.69 | 14.50 | 14.50 | 12.67 | 12.67 | 8.40 | 0.40 | 0.40 | 18.66 | 48.59 | 42.33 | 78.55 | 28.99 | 17.32 | 10.25 | 10.25 | |||||||||||||||||||
| 05 | 0.08 | 0.08 | 2.38 | 12.09 | 11.93 | 11.93 | 10.43 | 10.43 | 6.91 | 0.48 | 0.48 | 22.25 | 57.95 | 50.49 | 93.68 | 34.57 | 17.32 | 10.25 | 10.25 | |||||||||||||||||||
| 06 | 0.05 | 0.05 | 1.26 | 6.44 | 6.35 | 6.35 | 5.55 | 5.55 | 3.68 | 0.32 | 0.32 | 14.74 | 38.39 | 33.44 | 62.05 | 22.90 | 17.32 | 10.25 | 10.25 | |||||||||||||||||||
| 07 | 0.12 | 0.12 | 3.30 | 16.82 | 16.59 | 16.59 | 14.51 | 14.51 | 9.61 | 0.53 | 0.53 | 24.45 | 63.68 | 55.47 | 102.93 | 37.99 | 17.32 | 10.25 | 10.25 | |||||||||||||||||||
| 09 | 0.09 | 0.09 | 2.57 | 13.07 | 12.90 | 12.90 | 11.27 | 11.27 | 7.47 | 0.62 | 0.62 | 28.76 | 74.88 | 65.23 | 121.04 | 44.67 | 17.32 | 10.25 | 10.25 | |||||||||||||||||||
| 10 | 0.07 | 0.07 | 1.99 | 10.12 | 9.99 | 9.99 | 8.73 | 8.73 | 5.79 | 0.56 | 0.56 | 25.87 | 67.36 | 58.68 | 108.88 | 40.19 | 17.32 | 10.25 | 10.25 | |||||||||||||||||||
| 11 | 0.07 | 0.07 | 1.84 | 9.36 | 9.24 | 9.24 | 8.08 | 8.08 | 5.35 | 0.49 | 0.49 | 22.57 | 58.77 | 51.20 | 95.01 | 35.07 | 17.32 | 10.25 | 10.25 | |||||||||||||||||||
| 6B | 0.04 | 0.04 | 1.23 | 6.23 | 6.15 | 6.15 | 5.38 | 5.38 | 3.56 | 0.32 | 0.32 | 14.69 | 38.25 | 33.32 | 61.83 | 22.82 | 17.32 | 10.25 | 10.25 | |||||||||||||||||||
| 8A | 0.06 | 0.06 | 1.67 | 8.51 | 8.39 | 8.39 | 7.34 | 7.34 | 4.86 | 0.33 | 0.33 | 15.50 | 40.36 | 35.16 | 65.23 | 24.08 | 17.32 | 10.25 | 10.25 | |||||||||||||||||||
| 8B | 0.07 | 0.07 | 1.85 | 9.40 | 9.28 | 9.28 | 8.11 | 8.11 | 5.37 | 0.44 | 0.44 | 20.43 | 53.19 | 46.34 | 85.98 | 31.73 | 17.32 | 10.25 | 10.25 | |||||||||||||||||||
| 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, Hernando, 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, Manatee, Polk | |
| Area 6B | Hillsborough | |
| Area 7 | Brevard, Orange, Osceola, Seminole | |
| Area 0X | Xxx | |
| Xxxx 0X | Xxxxxxxxx, Xxxxxxx, Xx Xxxx, Glades, Xxxxxx, Sarasota | |
| Area 9 | Indian River, Okeechobee, St. Lucie, Martin, Palm Beach | |
| Area 00 | Xxxxxxx | |
| Xxxx 00 | Xxxx, Xxxxxx |
AHCA Contract No. FA972, Attachment I, Exhibit 2-NR, Page 5 of 5
