AHCA CONTRACT NO. FAR009 AMENDMENT NO. 12
Exhibit 10.2
Wellcare
of Florida, Inc. d/b/a
Staywell
Health Plan of Florida
|
AHCA
CONTRACT NO. FAR009
AMENDMENT
NO. 12
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
STAYWELL HEALTH PLAN OF FLORIDA., hereinafter referred to as the "Vendor"
or "Health Plan" is hereby amended as follows:
1.
|
Standard
Contract, Section III, Item C, Contract Managers, sub-item 1, is hereby
amended to now read as
follows:
|
1. The
Agency's Contract Manager's name, address and telephone number for this Contract
is as follows:
Xxxxxxx
X. Xxxxxxxx
Agency
for Health Care Administration
0000
Xxxxx Xxxxx, XX#00
Xxxxxxxxxxx,
XX 00000
(850)
487-2355
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2.
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Effective
March 1, 2009, Attachment I, Scope of Services, is hereby amended to
include Exhibit 3-E, Medicaid Reform HMO Capitation Rates, March 1, 2009 -
August 31, 2009, attached hereto and made a part of the Contract. All
references in the Contract to Exhibit 3-D, Medicaid Reform HMO Capitation
Rates, September 1, 2008 - August 31, 2009, shall hereinafter also refer
to Exhibit 3-E, Medicaid Reform HMO Capitation Rates, March 1, 2009
-August 31, 2009, 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, is hereby made 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 four (4) page Amendment (including all attachments) to be
executed by their officials thereunto duly authorized.
WELLCARE
OF FLORIDA, INC. D/B/A
STAYWELL
HEALTHPLAN OF FLORIDA
|
STATE
OF FLORIDA, AGENCY FOR
HEALTH
CARE ADMINISTRATION
|
SIGNED
BY: /s/
Xxxxx
Xxxxxxxxx
|
SIGNED
BY:
/s/ Xxxxx
Xxxxxx
|
NAME:
Xxxxx
Xxxxxxxxx
|
NAME:
Xxxxx
Xxxxxx
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TITLE:
President and
CEO
|
TITLE:
Secretary
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DATE:
____________________
|
DATE:
4/22/09
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List of
Attachments/Exhibits included as part of this Amendment:
Specify
Type
|
Letter/
Number
|
Description
|
Exhibit
|
3-E
|
Medicaid
Reform HMO Capitation Rates
March
1, 2009 - August 31, 2009 (3
Pages)
|
AHCA Contract No. FAR009, Amendment
No. 12, Page 1 of
1
AHCA Form
2100-0002 (Rev. NOV03)
EXHIBIT
3-E
|
MEDICAID
REFORM HMO CAPITATION RATES
|
(By Area,
Age, and Eligibility Category)
March
1, 2009 - August 31, 2009
TABLE
2
March 1,
2009
Area:
|
10
|
County:
|
Broward
|
ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
Eligibility
Category/ Population
|
Total
Rates for Comprehensive
and
Catastrophic Components
|
Total
Rate for
Comprehensive
Component
Only
|
Children
and Families:
|
||
Newborns
aged 0-2 months
|
$ 870.65
|
$ 752.38
|
Newborns
aged 3-11 months
|
$ 194.87
|
$ 185.35
|
Age
1 and Up - Base Rate for
Risk
adjustment
|
$ 107.38
|
$ 105.65
|
Aged
and Disabled:
|
||
No
Medicare
|
||
Newborns
aged 0-2 months
|
$ 17,615.21
|
$ 9,196.19
|
Newborns
aged 3-11 months
|
$ 3,905.88
|
$ 2,173.23
|
Age
1 and Up - Base Rate for Risk
Adjustment
|
$ 791.77
|
$ 727.47
|
Medicare
Parts A and B
|
||
Under
Age 65
|
$ 139.45
|
N/A
|
Age
65 and over
|
$ 99.73
|
N/A
|
Medicare
Part B Only
|
||
All
ages
|
$ 265.82
|
N/A
|
HIV/AIDS
Specialty Population
|
||
No
Medicare HIV
|
$ 1,828.67
|
N/A
|
No
Medicare AIDS
|
$ 3,431.73
|
N/A
|
Medicare
HIV
|
$ 256.73
|
N/A
|
Medicare
AIDS
|
$ 548.09
|
N/A
|
Kick
Payments Amounts for Covered Obstetrical Delivery
Services:
|
|||
CPT
Code
|
Obstetrical
Delivery CPT Code Description
|
Payment
Amount
|
|
59409
|
Vaginal
delivery only
|
$3,941.45
|
|
59410
|
Vaginal
delivery including postpartum care
|
||
59515
|
Cesarean
delivery including postpartum care
|
||
59612
|
Vaginal
delivery only, after previous cesarean delivery
|
||
59614
|
Vaginal
delivery only, after previous cesarean delivery including postpartum
care
|
||
59622
|
Cesarean
delivery only, following attempted vaginal delivery after previous
cesarean delivery inc postpartum
care
|
AHCA
Contract No. FAR009, Exhibit 3-E, Page 1 of 3
EXHIBIT
3-E
MEDICAID
REFORM HMO CAPITATION RATES
|
(By
Area, Age, and Eligibility Category)
|
March 1, 2009 - August 31,
2009
Xxxxx 0,
0000
Xxxx:
|
4
|
County:
|
Duval,
Baker, Clay and Nassau
|
(ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
Eligibility
Category/ Population
|
Total
Rates for
Comprehensive
and
Catastrophic
Component
|
Total
Rate for
Comprehensive
Component
Only
|
Children
and Families:
|
||
Newborns
aged 0-2 months
|
$ 897.40
|
$
775.51
|
Newborns
aged 3-11 months
|
$ 197.22
|
$ 187.59
|
Age
1 and Up - Base Rate for Risk
Adjustment
|
$
110.51
|
$ 108.73
|
Aged
and Disabled:
|
||
No
Medicare
|
||
Newborns
aged 0-2 months
|
$ 14,269.34
|
$ 7,449.45
|
Newborns
aged 3-11 months
|
$ 3,180.71
|
$ 1,769.74
|
Age
1 and Up - Base Rate for Risk
Adjustment
|
$ 612.15
|
$ 562.43
|
Medicare
Parts A and B
|
||
Under
Age 65
|
$ 158.45
|
N/A
|
Age
65 and over
|
$ 113.24
|
N/A
|
Medicare
Part B Only
|
||
All
ages
|
$
327.22
|
N/A
|
HIV/AIDS
Specialty Population
|
||
No
Medicare HIV
|
$ 1,163.67
|
N/A
|
No
Medicare AIDS
|
$ 2,290.84
|
N/A
|
Medicare
HIV
|
$ 157.74
|
N/A
|
Medicare
AIDS
|
$ 336.77
|
N/A
|
Kick
Payments Amounts for Covered Obstetrical Delivery
Services:
|
|||
CPT
Code
|
Obstetrical
Delivery CPT Code Description
|
Payment
Amount
|
|
59409
|
Vaginal
delivery only
|
$3,977.49
|
|
59410
|
Vaginal
delivery including postpartum care
|
||
59515
|
Cesarean
delivery including postpartum care
|
||
59612
|
Vaginal
delivery only, after previous cesarean delivery
|
||
59614
|
Vaginal
delivery only, after previous cesarean delivery including postpartum
care
|
||
59622
|
Cesarean
delivery only, following attempted vaginal delivery after previous
cesarean delivery inc postpartum
care
|
AHCA
Contract No. FAR009, Exhibit 3-E, Page 2 of 3
EXHIBIT
3-E
MEDICAID
REFORM HMO CAPITATION RATES
|
(By
Area, Age, and Eligibility Category)
|
March 1, 2009 - August 31,
2009
Xxxxx 0,
0000
Xxxx:
|
10
|
County:
|
Broward
|
Area:
|
4
|
County:
|
Duval,
Baker, Clay and Nassau
|
CPT
Code
|
Transplant
CPT Code Description
|
Children/Adolescents or
Adult
|
Payment
Amount
|
32851
|
lung
single, without bypass
|
Children/Adolescents
|
$320,800.00
|
32851
|
lung
single, without bypass
|
Adult
|
$238,000.00
|
32852
|
lung
single, with bypass
|
Children/Adolescents
|
$320,800.00
|
32852
|
lung
single, with bypass
|
Adult
|
$238,000.00
|
32853
|
lung
double, without bypass
|
Children/Adolescents
|
$320,800.00
|
32853
|
lung
double, without bypass
|
Adult
|
$238,000.00
|
32854
|
lung
double, with bypass
|
Children/Adolescents
|
$320,800.00
|
32854
|
lung
double, with bypass
|
Adult
|
$238,000.00
|
33945
|
heart
transplant with or without recipient cardiectomy
|
All
Age Groups
|
$162,000.00
|
47135
|
liver,
allotransplation, orthotopic, partial or whole from cadaver or living
donor
|
All
Age Groups
|
$122,600.00
|
47136
|
liver,
heterotopic, partial or whole from cadaver or living donor any
age
|
All
Age Groups
|
$122,600.00
|
REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
AHCA
Contract No. FAR009, Exhibit 3-E, Page 3 of 3