AHCA CONTRACT NO. FAR009 AMENDMENT NO. 6
Exhibit
10.4
Wellcare
of Florida, Inc. d/b/a Staywell
AHCA
CONTRACT NO. FAR009
AMENDMENT
NO. 6
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, hereinafter referred to as the “Vendor,” is hereby amended as
follows:
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1.
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Effective
September 1, 2007, Attachment I, Scope of Services, is hereby amended
to
include Exhibit 5-B, attached hereto and made a part of the Contract.
All
references in the Contract to Exhibit 5-A, shall hereinafter instead
refer
to Exhibit 5-B.
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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 two (2) 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
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STATE
OF FLORIDA, AGENCY FOR
HEALTH
CARE ADMINISTRATION
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SIGNED
BY: /s/ Xxxx
X. Xxxxx
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SIGNED
BY: /s/ Xxxxxx
X. Xxxxxxxx
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NAME: Xxxx
X.
Xxxxx
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NAME:
Xxxxxx
X.
Xxxxxxxx, M.D.
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TITLE: President
and
CEO
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TITLE:
Secretary
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DATE:
12/7/07
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DATE:
12/10/07
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List
of attachments included as part of this Amendment:
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Specify
Type
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Letter/
Number
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Description
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Exhibit
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5-B
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Capitation
Rates SSI Medicare Part B Only and SSI Medicare Parts A and B Enrollees
for All Medicaid Reform Counties (1
Page)
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REMAINDER
OF THIS PAGE INTENTIONALLY LEFT BLANK
AHCA
Contract No. FAR009, Amendment No. 6, Page 1 of 1
EXHIBIT
5 - B
CAPITATION
RATES
SSI
MEDICARE PART B ONLY
AND
SSI
MEDICARE PARTS A AND B ENROLLEES
FOR
ALL MEDICAID REFORM COUNTIES
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TABLE
4
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Area: 4
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County:
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Duval,
Baker, Clay and
Nassau
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ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY
CMS)
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Under
Age 65
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Age
65 & Over
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SSI/Parts
A & B
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$159.09
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$107.50
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SSI/Part
B Only
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$368.77
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$368.77
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Area: 10
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County:
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Broward
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ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
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Under
Age 65
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Age
65 & Over
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SSI/Parts
A & B
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$151.52
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$102.61
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SSI/Part
B Only
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$248.51
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$248.51
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REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
AHCA
Contract No. FAR009, Exhibit 5-B, Page 1 of
1
