AHCA CONTRACT NO. FA523 AMENDMENT NO. 8

AMERIGROUP FLORIDA, INC. Medicaid HMO Contract

AHCA CONTRACT NO. FA523
AMENDMENT NO. 8

THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the “Agency” and AMERIGROUP FLORIDA, INC., hereinafter referred to as the “Vendor”, is hereby amended as follows:

1. Standard Contract, Section II .A, Contract Amount, the first sentence is hereby amended to now read:

To pay for contracted services according to the conditions of Attachment I in an amount not to exceed $680,379,083.00, (an increase of $10,560,000.00), subject to the availability of funds.

Attachment I, Section 90.0, Payment and Authorized Enrollment Levels, Table 1 is hereby amended to now read:

Table 1 Projected Enrollment


County	Maximum Enrollment Level
BREVARD		8,000

BROWARD		14,000

_DADE DADE		25,000

HILLSBOROUGH		40,000

XXX		18,000

MANATEE		3,500

ORANGE		30,000

OSCEOLA		8,500

PALM BEACH		12,000

PASCO		15,000

-PINELLAS		25,000

POLK		30,000

SARASOTA		8,000

SEMINOLELE		8,000

Attachment I, Section 90.0, Payment and Authorized Enrollment Levels, Table 3, is hereby amended to now read:

Table 3 Area

Age-banded Capitation Rates, Including Community Mental Health and Mental Health Targeted Case Management

Table 3.
Areas 5, 6, 7, 8, 9, 10, and 11 Age-banded Capitation Rates, Including Community Mental Health and Mental Health Targeted Case Management Area 05 General Rates plus Mental Health Plan - 015005304(PASCO) 015005305(PINELLAS)


	<1 year		1-5	6-13		14-20 Male 14-20 Female 21-54 Male			21-54Female		55-64	65+
TANF/FC/SOBRA		345.77	79.28	51.94	57.32		114,31	139.01		210.44	291.84	291,84
SSI/NO Medicare		3265.63	429.24	240.86	235.59		235.59	628.37		628.37	594.95	594.95
SSI/Part B		266.87	266.81	266.87	266.87		266.87	266.87		266.87	266.87	266.87
SSI/Part A 6 B		310.72	318.72	318.12	318.72		318.72	318.72		318,72	318.72	225,77

Area 06 General Rates plus Mental Health Plan — 015005300(HILLSBOROUGH) 015005307(POLK) 015005318 (MANATEE)

<1 year

-5

6-13

14-20 Male 14-20 Female 21-54 Male 21-54 Female

55-64

65+

TANF/FC/SOBRA

330.07

7591

61.92

61.67

122.23

135.83

204.29

282.98

SS1/No Medicare

3017.05

37169

265.72

243.82

243,82

647.81

587,26

587.26

SSI/Part B

242.29

24229

242.29

242,29

242.29

SSI/Part A 6 B

288.09

288,09

288.09

202.64

AHCA Contract No. FA523, Amendment No. 8, Page 1 of 3

AHCA Form 2100-0002 (Rev. NOV03)

AMERIGROUP FLORIDA, INC. Medicaid HMO Contract

Area 07 General Rates plus Mental Health Plan — 015005308 (ORANGE) 015005313(SEMINOLE) 015005314(OSCEOLA) 015005336(BREVARD)


	<1 year		1-:		6-13		14-20 Male 14-20 Female 21-54 Male			21-54Female		55-64	65+
TANF/FC/SOBRA		337.20	76.9	)	58.07	59.10		114.69	136.45		206.32	287.87	287.87
SSI/No Medicare		3217.90	406,81		260.45	239.73		239.73	628.24		628.24	594.96	594.96
SSI/Part B		266.03	266.0		266.03	266.03		266.03	266.03		266.03	266.03	266.03
SSI/Part A & B		293.59	293.59		293.59	293.59		293.59	293.59		293.59	293.59	208.25

Xxxx 00 General Rates plus Mental Health Plan — 015005302 (XXX) 015005306(SARASOTA)


	<1 year		1-3	6-13		14-20 Male 14-20 Female 21-54 Male			21-54Female		55-64	65+
TANF/FC/SOBRA		296.69	67.7⁷	46,25	49.88		98.88	119,48		180.88	251.72	251.72
SSI/No Medicare		3079.31	393.43	223.95	221.50		221.50	594.93		594,93	563.76	563,76
SSI/Part B		243.57	243.51	243.57	243.57		243.57	243.57		243.57	243.57	243.57
SSI/Part A 6 B		292.10	292.30	292.10	292.10		292.10	292.10		292.10	292.10	206.49

Xxxx 00 General Rates plus Mental Health Plan — 015005310(PALM BEACH)


	<1 year		1-5	6-13		14-20 Male 14-20 Female 21-54 Male			21-54Female		55-64	65+
TANF/FC/SOBRA		316.80	71.49	49.26	52.54		104,85	126.25		191.61	270.11	270.11
SSI/No Medicare		3344.06	424,:3	246.02	236.61		236.61	650.12		650,12	614.45	614,45
SSI/Part B		267.44	267.+4	267,44	267.44		267.44	267.44		267.44	267.44	267.44
SSI/Part A & B		331.80	331.10	331.80	331.80		331.00	331.80		331.80	331,80	235.67

Xxxx 00 General Rates plus Mental Health Plan — 015005311(BROWARD)


	<1 year		1^.5	6-13		14-20 Male 14-20 Female 21-54 Male 21-54 Female				55-64	65+
TANF/FC/SOBRA		328.75	75.⁷4	60.81	58.42		112.75	132.87	201.05	203.53	283.53
SSI/No Medicare		4151.83	510.2	323.61	304.08		304.08	801.75	801.75	764.03	764.03
SSI/Part B		290.18	290..0	290.18	290,16		290.18	290.18	290.18	290.18	290.18
SSI/Part A & B		354.95	354.15	354.95	354.95		354.95	354.95	354,95	354.95	249.35

Area 11 General Rates plus Mental ‘]Health Plan - 015005312(DADE)

<1 year

1^.5

6-13

14-20 Male 14-20 Female 21-54 Male 21-54 Female

55-64

65+

TANF/FC/SOBRA

409.17

92.¹6

69.70

69.26

136.84

161.91

246.27

343.39

SSI/No Medicare

4551.56

561.11

358.04

331.22

B76.41

876.41

832.73

SSI/Part B

451.58

451,58

451.58

451.50

451.58

451,58

SSI/Part A & B

420.30

420.10

420.30

420,30

420.30

295.40

Attachment I, Section 90.0, Payment and Authorized Enrollment Levels, Table 3, the second paragraph is hereby amended to now read^:

Notwithstanding the payment amounts which may be computed with the above rate table, the sum of total capitation payments under this contract shall not exceed the total contract amount of $680,379,083.00, (an increase of $10,560,000.00), expressed on page seven of this contract.

This amendment shall begin on July 1, 2005, or the date on which the amendment has been signed by both parties, whichever is after.

All provisions in the Contract and any attachments thereto in conflict with this amendment shall be and are hereby changed to con form 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 cam tot be executed unless all previous amendments to this Contract have been fully executed.

No. 8, Page 2 of 3

AHCA Form 2100-0002 (Rev. NOV03)

AMERIGROUP FLORIDA, INC. Medicaid HMO Contract

IN WITNESS WHEREOF, the parties hereto have caused this 3 page amendment (including all attachments) to be executed by their officials thereunto duly authorized.

AMERIGROUP FLORIDA, MC.

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION

S.CONT


NAME: Xxx Xxxxxxx		NAME: Xxxx Xxxxxx



TITLE: CEO		TITLE: Secretary


DATE:	/s/ 6/21/05	DATE:_, /S/ 6/27/05

THE REMAINDER OF THIS PAGE LEFT BLANK INTENTIONALLY

AHCA Contract No. FA523, Amendment No. 8, Page 3 of 3

AHCA Form 2100-0002 (Rev. NOV03 )

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AHCA CONTRACT NO. FA523 AMENDMENT NO. 8

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