AHCA CONTRACT NO. FA619 AMENDMENT NO. 3
Exhibit
10.1
HealthEase of Florida,
Inc.
Medicaid HMO
Contract
AHCA
CONTRACT NO. FA619
AMENDMENT
NO. 3
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.
|
Standard
Contract, Section II, Item A, Contract Amount, the first sentence
is
hereby revised to now read as follows:
|
|
|
To
pay for contracted services according to the conditions of Attachment
I in
an amount not to exceed $1,098,394,977.00 (a decrease of $152,582,526.00),
subject to availability of funds.
|
|
2.
|
Attachment
I, Section B, Method of Payment, Item 1, General, the first paragraph
is
hereby revised to now read as follows:
|
|
|
Notwithstanding
the payment amounts which may be computed with the rate tables specified
in Exhibit III-C, the sum of total capitation payments under this
Contract
shall not exceed the total Contract amount of $1,098,394,977.00 (a
decrease of $152,582,526.00).
|
|
3.
|
Attachment
I, Scope of Services, is hereby amended to include Exhibit III-C,
January
1, 2008 – 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-B, September 1, 2007 – August 31, 2008
Medicaid Non-Reform HMO Capitation Rates, shall hereinafter instead
refer
to Exhibit III-C, January 1, 2008 - August 31, 2008 Medicaid Non-Reform
HMO Capitation Rates.
|
|
4.
|
This
Amendment shall have an effective date of January 1, 2008, 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.
REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
AHCA
Contract No. FA619, Amendment No. 3, Page 1 of 2
IN
WITNESS WHEREOF, the parties hereto
have caused this seven (7) 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/
Xxxx
X. Xxxxx
|
SIGNED
BY: /s/
Illegible
|
|
NAME: Xxxx
X. Xxxxx
|
(for)
NAME: Xxxxxx
X. Xxxxxxxx, M.D.
|
|
TITLE: President
and CEO
|
TITLE:
Secretary
|
|
DATE:1/2/08
|
DATE:
1/3/08
|
List
of
attachments included as part of this Amendment:
|
Specify
Type
|
Letter/
Number
|
Description
|
|
Exhibit
|
III-C
|
January
1, 2008 - August 31, 2008 Medicaid Non-Reform HMO Capitation
Rates (5 Pages)
|
AHCA
Contract No. FA619, Amendment No. 3, Page 2 of 2
|
EXHIBIT
III-C
|
|||||||||||||||||||
|
January
1, 2008 - August 31, 2008
|
|||||||||||||||||||
|
MEDICAID
Non-Reform HMO CAPITATION RATES
|
|||||||||||||||||||
|
By
Area , Age and Eligibility
Category
|
|||||||||||||||||||
|
TABLE
1
|
|||||||||||||||||||
|
General
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+)
|
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
|
1,113.27
|
198.95
|
103.84
|
65.12
|
132.96
|
71.10
|
261.06
|
165.11
|
341.74
|
9,915.13
|
1,434.75
|
428.74
|
197.94
|
218.40
|
704.25
|
692.24
|
266.36
|
96.67
|
79.38
|
|
02
|
1,113.27
|
198.95
|
103.84
|
65.12
|
132.96
|
71.10
|
261.06
|
165.11
|
341.74
|
9,915.13
|
1,434.75
|
428.74
|
197.94
|
218.40
|
704.25
|
692.24
|
266.36
|
96.67
|
79.38
|
|
03
|
1,274.97
|
229.73
|
120.11
|
76.19
|
153.87
|
83.11
|
303.58
|
192.99
|
401.92
|
11,138.97
|
1,629.39
|
486.94
|
229.48
|
252.31
|
812.92
|
803.12
|
268.11
|
89.89
|
74.16
|
|
04
|
1,110.20
|
200.37
|
105.01
|
66.79
|
134.42
|
72.81
|
265.41
|
168.95
|
352.65
|
10,499.42
|
1,537.71
|
460.11
|
217.21
|
238.35
|
768.93
|
759.32
|
324.10
|
92.63
|
76.37
|
|
05
|
1,239.65
|
223.90
|
117.11
|
74.70
|
150.07
|
81.25
|
296.43
|
188.63
|
393.68
|
11,579.76
|
1,692.54
|
506.42
|
237.96
|
262.13
|
843.24
|
832.21
|
224.84
|
86.91
|
72.45
|
|
06
|
1,093.25
|
198.54
|
104.28
|
66.96
|
133.36
|
72.80
|
264.61
|
168.97
|
354.37
|
10,652.91
|
1,564.02
|
468.08
|
222.16
|
243.74
|
785.88
|
776.94
|
278.82
|
84.03
|
69.54
|
|
07
|
1,111.11
|
201.05
|
105.33
|
67.26
|
134.84
|
73.19
|
266.60
|
169.92
|
355.07
|
10,979.12
|
1,613.56
|
482.68
|
229.82
|
251.86
|
810.88
|
802.37
|
320.94
|
87.44
|
72.54
|
|
08
|
1,042.42
|
189.18
|
99.15
|
63.67
|
127.01
|
69.25
|
251.65
|
160.56
|
336.69
|
9,334.29
|
1,365.81
|
408.73
|
192.99
|
211.83
|
682.67
|
674.08
|
187.79
|
83.02
|
68.67
|
|
09
|
1,080.64
|
194.68
|
101.92
|
64.82
|
130.37
|
70.43
|
257.53
|
163.82
|
341.26
|
10,421.98
|
1,530.82
|
457.89
|
217.75
|
238.53
|
769.06
|
760.32
|
201.31
|
90.28
|
74.77
|
|
10
|
1,100.94
|
199.64
|
104.76
|
67.19
|
133.94
|
73.01
|
265.61
|
169.34
|
354.88
|
13,515.72
|
1,994.98
|
596.62
|
285.93
|
313.86
|
1,009.79
|
999.91
|
251.29
|
103.32
|
85.55
|
|
11
|
1,424.99
|
256.12
|
134.00
|
84.75
|
171.50
|
92.47
|
338.04
|
214.66
|
446.26
|
14,158.43
|
2,076.63
|
621.17
|
294.21
|
323.57
|
1,040.93
|
1,029.21
|
329.75
|
157.24
|
128.37
|
|
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+)
|
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
|
1,113.29
|
198.97
|
105.45
|
76.61
|
143.70
|
81.84
|
265.43
|
169.48
|
345.42
|
9,915.21
|
1,434.83
|
436.06
|
245.19
|
261.65
|
784.29
|
722.71
|
266.57
|
108.13
|
90.84
|
|
02
|
1,113.30
|
198.98
|
106.70
|
85.04
|
146.15
|
84.29
|
264.41
|
168.46
|
344.65
|
9,915.29
|
1,434.91
|
442.30
|
275.44
|
262.86
|
756.05
|
716.70
|
286.23
|
111.42
|
94.13
|
|
03
|
1,274.98
|
229.74
|
121.41
|
85.22
|
159.85
|
89.09
|
305.10
|
194.51
|
403.24
|
11,139.04
|
1,629.46
|
493.10
|
264.64
|
272.48
|
836.42
|
814.21
|
274.85
|
98.72
|
82.99
|
|
04
|
1,110.21
|
200.38
|
106.36
|
76.19
|
140.65
|
79.04
|
266.99
|
170.53
|
354.02
|
10,499.53
|
1,537.82
|
469.70
|
272.02
|
269.79
|
805.57
|
776.62
|
348.24
|
109.12
|
92.86
|
|
05
|
1,239.66
|
223.91
|
118.30
|
83.23
|
158.04
|
89.22
|
299.67
|
191.87
|
396.42
|
11,579.81
|
1,692.59
|
511.36
|
269.84
|
291.31
|
897.24
|
852.76
|
227.52
|
99.51
|
85.05
|
|
06
|
1,093.27
|
198.56
|
106.10
|
79.99
|
145.53
|
84.97
|
269.56
|
173.92
|
358.55
|
10,652.98
|
1,564.09
|
474.49
|
263.57
|
281.64
|
856.02
|
803.63
|
280.11
|
87.85
|
73.36
|
|
07
|
1,111.13
|
201.07
|
107.08
|
79.74
|
146.50
|
84.85
|
271.34
|
174.66
|
359.07
|
10,979.18
|
1,613.62
|
488.70
|
268.67
|
287.42
|
876.69
|
827.42
|
323.49
|
97.78
|
82.88
|
|
08
|
1,042.43
|
189.19
|
100.39
|
72.32
|
132.74
|
74.98
|
253.11
|
162.02
|
337.95
|
9,334.36
|
1,365.88
|
414.63
|
226.70
|
231.18
|
705.20
|
684.72
|
194.53
|
96.02
|
81.67
|
|
09
|
1,080.66
|
194.70
|
103.44
|
75.45
|
137.41
|
77.47
|
259.32
|
165.61
|
342.81
|
10,422.05
|
1,530.89
|
464.12
|
253.29
|
258.93
|
792.81
|
771.54
|
208.05
|
99.71
|
84.20
|
|
10
|
1,100.96
|
199.66
|
106.65
|
80.33
|
142.64
|
81.71
|
267.82
|
171.55
|
356.80
|
13,515.81
|
1,995.07
|
604.83
|
332.84
|
340.78
|
1,041.14
|
1,014.71
|
258.03
|
111.24
|
93.47
|
|
11
|
1,425.01
|
256.14
|
135.59
|
95.85
|
178.86
|
99.83
|
339.91
|
216.53
|
447.88
|
14,158.51
|
2,076.71
|
628.03
|
333.34
|
346.02
|
1,067.09
|
1,041.56
|
336.86
|
165.16
|
136.29
|
AHCA
Contract
No.
FA619, Exhibit III-C, Page 1 of 5
|
EXHIBIT
III-C
|
|||||||||||||||||||
|
January
1, 2008 - August 31, 2008
|
|||||||||||||||||||
|
MEDICAID
Non-Reform HMO CAPITATION RATES
|
|||||||||||||||||||
|
By
Area , Age and Eligibility
Category
|
|
TABLE
3
|
|||||||||||||||||||
|
General
+ MH + 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+)
|
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
|
1,113.30
|
198.98
|
107.51
|
80.86
|
148.10
|
85.55
|
267.24
|
171.09
|
348.77
|
9,915.21
|
1,434.84
|
438.23
|
248.95
|
264.93
|
787.11
|
726.07
|
267.06
|
110.40
|
92.29
|
|
02
|
1,113.31
|
198.99
|
108.76
|
89.29
|
150.55
|
88.00
|
266.22
|
170.07
|
348.00
|
9,915.29
|
1,434.92
|
444.47
|
279.20
|
266.14
|
758.87
|
720.06
|
286.72
|
113.69
|
95.58
|
|
03
|
1,274.99
|
229.75
|
124.44
|
91.46
|
166.32
|
94.55
|
308.06
|
197.14
|
408.70
|
11,139.05
|
1,629.48
|
496.42
|
270.39
|
277.50
|
839.92
|
818.38
|
275.38
|
101.75
|
84.93
|
|
04
|
1,110.22
|
200.39
|
108.37
|
80.34
|
144.96
|
82.68
|
269.75
|
172.98
|
359.12
|
10,499.53
|
1,537.83
|
471.87
|
275.78
|
273.08
|
808.82
|
780.50
|
350.21
|
112.15
|
94.80
|
|
05
|
1,239.67
|
223.93
|
121.70
|
90.26
|
165.34
|
95.37
|
306.75
|
198.16
|
409.49
|
11,579.82
|
1,692.61
|
516.20
|
278.22
|
298.64
|
904.66
|
861.60
|
231.88
|
107.72
|
90.31
|
|
06
|
1,093.28
|
198.57
|
108.70
|
85.35
|
151.09
|
89.66
|
273.12
|
177.08
|
365.12
|
10,652.98
|
1,564.10
|
477.61
|
268.98
|
286.37
|
860.37
|
808.82
|
281.92
|
92.55
|
76.38
|
|
07
|
1,111.14
|
201.08
|
109.20
|
84.12
|
151.04
|
88.68
|
273.83
|
176.87
|
363.67
|
10,979.18
|
1,613.63
|
491.76
|
273.97
|
292.05
|
879.75
|
831.07
|
325.09
|
100.89
|
84.88
|
|
08
|
1,042.44
|
189.20
|
103.37
|
78.47
|
139.11
|
80.35
|
256.08
|
164.65
|
343.42
|
9,334.36
|
1,365.89
|
417.70
|
232.02
|
235.83
|
708.74
|
688.94
|
195.98
|
99.12
|
83.66
|
|
09
|
1,080.67
|
194.71
|
106.32
|
81.39
|
143.57
|
82.66
|
261.04
|
167.14
|
345.98
|
10,422.05
|
1,530.90
|
466.81
|
257.94
|
263.00
|
794.47
|
773.52
|
208.76
|
101.52
|
85.36
|
|
10
|
1,100.97
|
199.67
|
109.45
|
86.12
|
148.64
|
86.77
|
269.62
|
173.15
|
360.11
|
13,515.82
|
1,995.09
|
608.51
|
339.22
|
346.35
|
1,043.21
|
1,017.18
|
260.05
|
113.76
|
95.09
|
|
11
|
1,425.02
|
256.15
|
139.31
|
103.51
|
186.81
|
106.53
|
341.50
|
217.94
|
450.82
|
14,158.52
|
2,076.73
|
632.27
|
340.68
|
352.44
|
1,070.67
|
1,045.82
|
341.18
|
169.15
|
138.85
|
|
TABLE
4
|
|||||||||||||||||||
|
General
+ MH + 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+)
|
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
|
1,118.75
|
200.33
|
106.30
|
77.12
|
145.59
|
83.08
|
268.47
|
171.82
|
348.55
|
9,957.91
|
1,462.40
|
441.61
|
247.63
|
267.67
|
803.95
|
738.94
|
273.23
|
121.63
|
99.45
|
|
02
|
1,118.76
|
200.34
|
107.55
|
85.55
|
148.04
|
85.53
|
267.45
|
170.80
|
347.78
|
9,957.99
|
1,462.48
|
447.85
|
277.88
|
268.88
|
775.71
|
732.93
|
292.89
|
124.92
|
102.74
|
|
03
|
1,281.58
|
231.39
|
122.43
|
85.84
|
162.13
|
90.58
|
308.77
|
197.34
|
407.02
|
11,192.94
|
1,664.26
|
500.10
|
267.71
|
280.08
|
861.25
|
834.72
|
283.33
|
118.23
|
95.44
|
|
04
|
1,115.15
|
201.61
|
107.13
|
76.65
|
142.36
|
80.16
|
269.73
|
172.65
|
356.86
|
10,543.16
|
1,565.99
|
475.37
|
274.51
|
275.95
|
825.67
|
793.21
|
355.09
|
124.64
|
102.76
|
|
05
|
1,243.79
|
224.94
|
118.94
|
83.62
|
159.46
|
90.15
|
301.97
|
193.65
|
398.78
|
11,614.53
|
1,714.99
|
515.87
|
271.82
|
296.21
|
913.23
|
865.96
|
233.30
|
113.31
|
93.85
|
|
06
|
1,097.25
|
199.55
|
106.72
|
80.36
|
146.91
|
85.87
|
271.77
|
175.63
|
360.83
|
10,687.23
|
1,586.20
|
478.95
|
265.53
|
286.48
|
871.79
|
816.65
|
285.34
|
99.27
|
80.64
|
|
07
|
1,115.00
|
202.04
|
107.68
|
80.11
|
147.83
|
85.72
|
273.49
|
176.32
|
361.29
|
11,015.88
|
1,637.32
|
493.47
|
270.76
|
292.60
|
893.60
|
841.37
|
329.04
|
109.71
|
90.50
|
|
08
|
1,047.92
|
190.56
|
101.24
|
72.83
|
134.64
|
76.22
|
256.16
|
164.37
|
341.09
|
9,375.02
|
1,392.12
|
419.92
|
229.03
|
236.92
|
723.92
|
700.18
|
200.51
|
110.58
|
90.96
|
|
09
|
1,085.95
|
196.02
|
104.26
|
75.95
|
139.24
|
78.67
|
262.26
|
167.88
|
345.85
|
10,464.52
|
1,558.31
|
469.65
|
255.72
|
264.93
|
812.36
|
787.69
|
214.85
|
115.26
|
94.12
|
|
10
|
1,104.68
|
200.59
|
107.22
|
80.68
|
143.93
|
82.55
|
269.89
|
173.15
|
358.93
|
13,554.29
|
2,019.92
|
609.83
|
335.04
|
346.22
|
1,058.87
|
1,029.34
|
265.22
|
128.61
|
104.55
|
|
11
|
1,428.21
|
256.94
|
136.08
|
96.15
|
179.96
|
100.55
|
341.69
|
217.91
|
449.71
|
14,187.41
|
2,095.37
|
631.78
|
334.99
|
350.10
|
1,080.40
|
1,052.54
|
341.70
|
177.46
|
144.14
|
AHCA Contract No. FA619,
Exhibit III-C, Page 2 of 5
|
EXHIBIT
III-C
|
|||||||||||||||||||
|
January
1, 2008 - August 31, 2008
|
|||||||||||||||||||
|
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+)
|
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
|
1,118.73
|
200.31
|
104.69
|
65.63
|
134.85
|
72.34
|
264.10
|
167.45
|
344.87
|
9,957.83
|
1,462.32
|
434.29
|
200.38
|
224.42
|
723.91
|
708.47
|
273.02
|
110.17
|
87.99
|
|
02
|
1,118.73
|
200.31
|
104.69
|
65.63
|
134.85
|
72.34
|
264.10
|
167.45
|
344.87
|
9,957.83
|
1,462.32
|
434.29
|
200.38
|
224.42
|
723.91
|
708.47
|
273.02
|
110.17
|
87.99
|
|
03
|
1,281.57
|
231.38
|
121.13
|
76.81
|
156.15
|
84.60
|
307.25
|
195.82
|
405.70
|
11,192.87
|
1,664.19
|
493.94
|
232.55
|
259.91
|
837.75
|
823.63
|
276.59
|
109.40
|
86.61
|
|
04
|
1,115.14
|
201.60
|
105.78
|
67.25
|
136.13
|
73.93
|
268.15
|
171.07
|
355.49
|
10,543.05
|
1,565.88
|
465.78
|
219.70
|
244.51
|
789.03
|
775.91
|
330.95
|
108.15
|
86.27
|
|
05
|
1,243.78
|
224.93
|
117.75
|
75.09
|
151.49
|
82.18
|
298.73
|
190.41
|
396.04
|
11,614.48
|
1,714.94
|
510.93
|
239.94
|
267.03
|
859.23
|
845.41
|
230.62
|
100.71
|
81.25
|
|
06
|
1,097.23
|
199.53
|
104.90
|
67.33
|
134.74
|
73.70
|
266.82
|
170.68
|
356.65
|
10,687.16
|
1,586.13
|
472.54
|
224.12
|
248.58
|
801.65
|
789.96
|
284.05
|
95.45
|
76.82
|
|
07
|
1,114.98
|
202.02
|
105.93
|
67.63
|
136.17
|
74.06
|
268.75
|
171.58
|
357.29
|
11,015.82
|
1,637.26
|
487.45
|
231.91
|
257.04
|
827.79
|
816.32
|
326.49
|
99.37
|
80.16
|
|
08
|
1,047.91
|
190.55
|
100.00
|
64.18
|
128.91
|
70.49
|
254.70
|
162.91
|
339.83
|
9,374.95
|
1,392.05
|
414.02
|
195.32
|
217.57
|
701.39
|
689.54
|
193.77
|
97.58
|
77.96
|
|
09
|
1,085.93
|
196.00
|
102.74
|
65.32
|
132.20
|
71.63
|
260.47
|
166.09
|
344.30
|
10,464.45
|
1,558.24
|
463.42
|
220.18
|
244.53
|
788.61
|
776.47
|
208.11
|
105.83
|
84.69
|
|
10
|
1,104.66
|
200.57
|
105.33
|
67.54
|
135.23
|
73.85
|
267.68
|
170.94
|
357.01
|
13,554.20
|
2,019.83
|
601.62
|
288.13
|
319.30
|
1,027.52
|
1,014.54
|
258.48
|
120.69
|
96.63
|
|
11
|
1,428.19
|
256.92
|
134.49
|
85.05
|
172.60
|
93.19
|
339.82
|
216.04
|
448.09
|
14,187.33
|
2,095.29
|
624.92
|
295.86
|
327.65
|
1,054.24
|
1,040.19
|
334.59
|
169.54
|
136.22
|
|
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+)
|
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
|
1,113.28
|
198.96
|
105.90
|
69.37
|
137.36
|
74.81
|
262.87
|
166.72
|
345.09
|
9,915.13
|
1,434.76
|
430.91
|
201.70
|
221.68
|
707.07
|
695.60
|
266.85
|
98.94
|
80.83
|
|
02
|
1,113.28
|
198.96
|
105.90
|
69.37
|
137.36
|
74.81
|
262.87
|
166.72
|
345.09
|
9,915.13
|
1,434.76
|
430.91
|
201.70
|
221.68
|
707.07
|
695.60
|
266.85
|
98.94
|
80.83
|
|
03
|
1,274.98
|
229.74
|
123.14
|
82.43
|
160.34
|
88.57
|
306.54
|
195.62
|
407.38
|
11,138.98
|
1,629.41
|
490.26
|
235.23
|
257.33
|
816.42
|
807.29
|
268.64
|
92.92
|
76.10
|
|
04
|
1,110.21
|
200.38
|
107.02
|
70.94
|
138.73
|
76.45
|
268.17
|
171.40
|
357.75
|
10,499.42
|
1,537.72
|
462.28
|
220.97
|
241.64
|
772.18
|
763.20
|
326.07
|
95.66
|
78.31
|
|
05
|
1,239.66
|
223.92
|
120.51
|
81.73
|
157.37
|
87.40
|
303.51
|
194.92
|
406.75
|
11,579.77
|
1,692.56
|
511.26
|
246.34
|
269.46
|
850.66
|
841.05
|
229.20
|
95.12
|
77.71
|
|
06
|
1,093.26
|
198.55
|
106.88
|
72.32
|
138.92
|
77.49
|
268.17
|
172.13
|
360.94
|
10,652.91
|
1,564.03
|
471.20
|
227.57
|
248.47
|
790.23
|
782.13
|
280.63
|
88.73
|
72.56
|
|
07
|
1,111.12
|
201.06
|
107.45
|
71.64
|
139.38
|
77.02
|
269.09
|
172.13
|
359.67
|
10,979.12
|
1,613.57
|
485.74
|
235.12
|
256.49
|
813.94
|
806.02
|
322.54
|
90.55
|
74.54
|
|
08
|
1,042.43
|
189.19
|
102.13
|
69.82
|
133.38
|
74.62
|
254.62
|
163.19
|
342.16
|
9,334.29
|
1,365.82
|
411.80
|
198.31
|
216.48
|
686.21
|
678.30
|
189.24
|
86.12
|
70.66
|
|
09
|
1,080.65
|
194.69
|
104.80
|
70.76
|
136.53
|
75.62
|
259.25
|
165.35
|
344.43
|
10,421.98
|
1,530.83
|
460.58
|
222.40
|
242.60
|
770.72
|
762.30
|
202.02
|
92.09
|
75.93
|
|
10
|
1,100.95
|
199.65
|
107.56
|
72.98
|
139.94
|
78.07
|
267.41
|
170.94
|
358.19
|
13,515.73
|
1,995.00
|
600.30
|
292.31
|
319.43
|
1,011.86
|
1,002.38
|
253.31
|
105.84
|
87.17
|
|
11
|
1,425.00
|
256.13
|
137.72
|
92.41
|
179.45
|
99.17
|
339.63
|
216.07
|
449.20
|
14,158.44
|
2,076.65
|
625.41
|
301.55
|
329.99
|
1,044.51
|
1,033.47
|
334.07
|
161.23
|
130.93
|
AHCA Contract No. FA619,
Exhibit III-C, Page 3 of 5
|
EXHIBIT
III-C
|
|||||||||||||||||||
|
January
1, 2008 - August 31, 2008
|
|||||||||||||||||||
|
MEDICAID
Non-Reform HMO CAPITATION RATES
|
|||||||||||||||||||
|
By
Area , Age and Eligibility
Category
|
|
TABLE
7
|
|||||||||||||||||||
|
General
+ Dental + 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+)
|
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
|
1,118.74
|
200.32
|
106.75
|
69.88
|
139.25
|
76.05
|
265.91
|
169.06
|
348.22
|
9,957.83
|
1,462.33
|
436.46
|
204.14
|
227.70
|
726.73
|
711.83
|
273.51
|
112.44
|
89.44
|
|
02
|
1,118.74
|
200.32
|
106.75
|
69.88
|
139.25
|
76.05
|
265.91
|
169.06
|
348.22
|
9,957.83
|
1,462.33
|
436.46
|
204.14
|
227.70
|
726.73
|
711.83
|
273.51
|
112.44
|
89.44
|
|
03
|
1,281.58
|
231.39
|
124.16
|
83.05
|
162.62
|
90.06
|
310.21
|
198.45
|
411.16
|
11,192.88
|
1,664.21
|
497.26
|
238.30
|
264.93
|
841.25
|
827.80
|
277.12
|
112.43
|
88.55
|
|
04
|
1,115.15
|
201.61
|
107.79
|
71.40
|
140.44
|
77.57
|
270.91
|
173.52
|
360.59
|
10,543.05
|
1,565.89
|
467.95
|
223.46
|
247.80
|
792.28
|
779.79
|
332.92
|
111.18
|
88.21
|
|
05
|
1,243.79
|
224.95
|
121.15
|
82.12
|
158.79
|
88.33
|
305.81
|
196.70
|
409.11
|
11,614.49
|
1,714.96
|
515.77
|
248.32
|
274.36
|
866.65
|
854.25
|
234.98
|
108.92
|
86.51
|
|
06
|
1,097.24
|
199.54
|
107.50
|
72.69
|
140.30
|
78.39
|
270.38
|
173.84
|
363.22
|
10,687.16
|
1,586.14
|
475.66
|
229.53
|
253.31
|
806.00
|
795.15
|
285.86
|
100.15
|
79.84
|
|
07
|
1,114.99
|
202.03
|
108.05
|
72.01
|
140.71
|
77.89
|
271.24
|
173.79
|
361.89
|
11,015.82
|
1,637.27
|
490.51
|
237.21
|
261.67
|
830.85
|
819.97
|
328.09
|
102.48
|
82.16
|
|
08
|
1,047.92
|
190.56
|
102.98
|
70.33
|
135.28
|
75.86
|
257.67
|
165.54
|
345.30
|
9,374.95
|
1,392.06
|
417.09
|
200.64
|
222.22
|
704.93
|
693.76
|
195.22
|
100.68
|
79.95
|
|
09
|
1,085.94
|
196.01
|
105.62
|
71.26
|
138.36
|
76.82
|
262.19
|
167.62
|
347.47
|
10,464.45
|
1,558.25
|
466.11
|
224.83
|
248.60
|
790.27
|
778.45
|
208.82
|
107.64
|
85.85
|
|
10
|
1,104.67
|
200.58
|
108.13
|
73.33
|
141.23
|
78.91
|
269.48
|
172.54
|
360.32
|
13,554.21
|
2,019.85
|
605.30
|
294.51
|
324.87
|
1,029.59
|
1,017.01
|
260.50
|
123.21
|
98.25
|
|
11
|
1,428.20
|
256.93
|
138.21
|
92.71
|
180.55
|
99.89
|
341.41
|
217.45
|
451.03
|
14,187.34
|
2,095.31
|
629.16
|
303.20
|
334.07
|
1,057.82
|
1,044.45
|
338.91
|
173.53
|
138.78
|
|
TABLE
8
|
|||||||||||||||||||
|
General
+ Mental Health + Dental +
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+)
|
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
|
1,118.76
|
200.34
|
108.36
|
81.37
|
149.99
|
86.79
|
270.28
|
173.43
|
351.90
|
9,957.91
|
1,462.41
|
443.78
|
251.39
|
270.95
|
806.77
|
742.30
|
273.72
|
123.90
|
100.90
|
|
02
|
1,118.77
|
200.35
|
109.61
|
89.80
|
152.44
|
89.24
|
269.26
|
172.41
|
351.13
|
9,957.99
|
1,462.49
|
450.02
|
281.64
|
272.16
|
778.53
|
736.29
|
293.38
|
127.19
|
104.19
|
|
03
|
1,281.59
|
231.40
|
125.46
|
92.08
|
168.60
|
96.04
|
311.73
|
199.97
|
412.48
|
11,192.95
|
1,664.28
|
503.42
|
273.46
|
285.10
|
864.75
|
838.89
|
283.86
|
121.26
|
97.38
|
|
04
|
1,115.16
|
201.62
|
109.14
|
80.80
|
146.67
|
83.80
|
272.49
|
175.10
|
361.96
|
10,543.16
|
1,566.00
|
477.54
|
278.27
|
279.24
|
828.92
|
797.09
|
357.06
|
127.67
|
104.70
|
|
05
|
1,243.80
|
224.96
|
122.34
|
90.65
|
166.76
|
96.30
|
309.05
|
199.94
|
411.85
|
11,614.54
|
1,715.01
|
520.71
|
280.20
|
303.54
|
920.65
|
874.80
|
237.66
|
121.52
|
99.11
|
|
06
|
1,097.26
|
199.56
|
109.32
|
85.72
|
152.47
|
90.56
|
275.33
|
178.79
|
367.40
|
10,687.23
|
1,586.21
|
482.07
|
270.94
|
291.21
|
876.14
|
821.84
|
287.15
|
103.97
|
83.66
|
|
07
|
1,115.01
|
202.05
|
109.80
|
84.49
|
152.37
|
89.55
|
275.98
|
178.53
|
365.89
|
11,015.88
|
1,637.33
|
496.53
|
276.06
|
297.23
|
896.66
|
845.02
|
330.64
|
112.82
|
92.50
|
|
08
|
1,047.93
|
190.57
|
104.22
|
78.98
|
141.01
|
81.59
|
259.13
|
167.00
|
346.56
|
9,375.02
|
1,392.13
|
422.99
|
234.35
|
241.57
|
727.46
|
704.40
|
201.96
|
113.68
|
92.95
|
|
09
|
1,085.96
|
196.03
|
107.14
|
81.89
|
145.40
|
83.86
|
263.98
|
169.41
|
349.02
|
10,464.52
|
1,558.32
|
472.34
|
260.37
|
269.00
|
814.02
|
789.67
|
215.56
|
117.07
|
95.28
|
|
10
|
1,104.69
|
200.60
|
110.02
|
86.47
|
149.93
|
87.61
|
271.69
|
174.75
|
362.24
|
13,554.30
|
2,019.94
|
613.51
|
341.42
|
351.79
|
1,060.94
|
1,031.81
|
267.24
|
131.13
|
106.17
|
|
11
|
1,428.22
|
256.95
|
139.80
|
103.81
|
187.91
|
107.25
|
343.28
|
219.32
|
452.65
|
14,187.42
|
2,095.39
|
636.02
|
342.33
|
356.52
|
1,083.98
|
1,056.80
|
346.02
|
181.45
|
146.70
|
AHCA Contract No. FA619,
Exhibit III-C, Page 4 of 5
|
EXHIBIT
III-C
|
|||||||||||||||||||
|
January
1, 2008 - August 31, 2008
|
|||||||||||||||||||
|
MEDICAID
Non-Reform HMO CAPITATION RATES
|
|||||||||||||||||||
|
By
Area , Age and Eligibility
Category
|
|
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, 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
00
|
Xxxxxxx
|
||||||||||||||||||
|
Xxxx
00
|
Xxxx,
Xxxxxx
|
||||||||||||||||||
|
created
on August 19,
2006
|
|||||||||||||||||||
|
modified
on September 11, 2006 -
incresing dental
rates.
|
|||||||||||||||||||
AHCA Contract No. FA619,
Exhibit III-C, Page 5 of 5
