AHCA CONTRACT NO. FA521 AMENDMENT NO. 9
Exhibit
10.3
AHCA
CONTRACT NO. FA521 AMENDMENT NO. 9
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", 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
$835,063,844.00
(an
increase of $1,513,414.00), subject to availability of funds.
2.
Attachment I, Section 10.5, Optional Services, is hereby deleted in its entirety
and replaced with the following:
10.5
Optional Services
The
Plan
shall offer the following services within all applicable Medicaid
guidelines:
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Covered
|
Not
Covered
|
|
|
Dental
Services
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____________
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___________
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|
Transportation
Services
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_______X___
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___________
|
|
Frail/Elderly
Program (in
accordance with Exhibit 110.4 of this contract)
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____________
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_________
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3.
Attachment I, Section 10.8.14, Transportation Services (optional), is hereby
deleted in its entirety and replaced with the following:
10.8.14
Transportation Services (optional)
a.
Transportation Services are the arrangement and provision of an appropriate
mode
of transportation for Enrollees to receive medical care services. The Plan
shall
comply with the limitations and exclusions in the Medicaid Transportation
Coverage, Limitations & Reimbursement Handbook (the "Transportation
Handbook") except where compliance conflicts with the terms of this Contract.
In
no instance may the limitations or exclusions imposed by the Plan be more
stringent than those specified in the Transportation Handbook. The Plan
shall
AHCA
Contract No. FA521, Amendment No. 9, Page 1 of 30
offer
Transportation Services free of charge and shall not charge Enrollees a co-pay
for use of the Transportation Services. In providing Transportation Services,
the Plan:
1.
Shall
assure that providers of transportation are appropriately licensed and insured
in accordance with the provisions of the Transportation Handbook;
2.
Must
provide Transportation Services for all Enrollees seeking necessary Medicaid
services;
3.
Shall
be responsible for the cost of transporting an Enrollee from a nonparticipating
facility or hospital to a Participating Facility or Hospital if the reason
for
transport is solely for the Plan's convenience, regardless of whether the
Plan
covers Medicaid Transportation Services; and
4.
Shall
pay Transportation Services providers in accordance with the requirements
set
forth in this Contract,
b.
The
Plan may delegate the provision of Transportation Services to a third
party.
1.
The
Plan shall provide a copy of the model Participating Transportation Subcontract
to the Bureau of Managed Health Care in compliance with Section 70.0 of the
Contract.
2.
The
Plan may subcontract with more than one Transportation Services
provider.
3.
The
Plan shall maintain oversight of any third party providing Transportation
Services on the Plan's behalf.
c.
The
Plan shall provide the following non-emergency transportation, at a minimum,
as
part of its line of Transportation Services:*
1.
Ambulatory transportation;
2.
Long
haul ambulatory transportation;
3.
Wheelchair transportation;
4.
Stretcher transportation;
5.
Multiload transportation;
6.
Mass
transit transportation;
'
As
defined in the Transportation Handbook.
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Contract No. FA521, Amendment No. 9, Page 2 of 30
7.
Over-the-road bus;
8.
Over-the-road train;
9.
Private volunteer transportation;
10.
Escort services (including medical escort); and
11.
Commercial air carrier transportation.
d.
The
Plan shall provide the following encounter data on a quarterly
basis:
1.
A call
log broken down by month that includes the following information:
(a)
Number of calls received;
(b)
Average time required to answer a call;
(c)
Number of abandoned calls;
(d)
Percentage of calls that are abandoned;
(e)
Average abandonment time; and
(f)
Average call time.
2.
A
listing of the total number of reservations of Transportation Services by
month,
level of service and percentage of level of service utilized, to include,
but
not be limited to, the following:
(a)
Ambulatory transportation;
(b)
Long
haul ambulatory transportation;
(c)
Wheelchair transportation;
(d)
Stretcher transportation;
(e)
Ambulatory multiload transportation;
(f)
Wheelchair multiload transportation;
(g)
Mass
transit pending transportation;
(h)
Mass
transit transportation;
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Contract No. FA521, Amendment No. 9, Page 3 of 30
(i)
Mass
transit transportation (Enrollee has pass); and
(j)
Mass
transit transportation (sent pass to Enrollee).
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3.
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A
listing of the total number of authorized uses of Transportation
Services,
by month, level of service and percentage of level of service utilized,
to
include, but not be limited to, the
following:
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(a)
Ambulatory transportation;
(b)
Long
haul ambulatory transportation;
(c)
Wheelchair transportation;
(d)
Stretcher transportation;
(e)
Ambulatory multiload transportation;
(f)
Wheelchair multiload transportation;
(g)
Mass
transit pending transportation;
(h)
Mass
transit transportation;
(i)
Mass
transit transportation (Enrollee has pass); and
(j)
Mass
transit transportation (sent pass to Enrollee).
4. A
listing
of the total number of canceled trips, by month, level of service and percentage
of level of service utilized, to include, but not be limited to, the
following:
(a)
Ambulatory transportation;
(b)
Long
haul ambulatory transportation;
(c)
Wheelchair transportation;
(d)
Stretcher transportation;
(e)
Ambulatory multiload transportation;
(f)
Wheelchair multiload transportation;
(g)
Mass
transit pending transportation;
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Contract No. FA521, Amendment No. 9, Page 4 of 30
(h)
Mass
transit transportation;
(i)
Mass
transit transportation (Enrollee has pass); and
(j)
Mass
transit transportation (sent pass to Enrollee).
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5.
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A
listing of the total number of denied Transportation Services,
by month,
and a detailed description of why the Plan denied the Transportation
Service request.
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6.
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A
listing of the total number of authorized trips, by facility type,
for
each month and level of service.
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7.
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A
listing of the total number of Transportation Service claims and
payments,
by facility type, for each month and level of
service.
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e. Before
providing Transportation Services, the Plan shall provide to the Bureau of
Managed Health Care a copy of its policies and procedures relating to the
following:
1.
How
the Plan will determine eligibility for each Enrollee;
2.
The
Plan's course of action as to how it will determine what type of
transportation
to provide to a particular Enrollee;
3.
The
Plan's procedure for providing prior authorization to Enrollees requesting
Transportation Services;
4.
The
Plan's comprehensive employee training program to investigate potential
fraud;
5.
How
the Plan will review Participating Transportation Providers who demonstrate
a
pattern or practice of:
(a)
Falsified encounter or service reports;
(b)
Overstated reports or up-coded levels of service; and/or
(c)
Fraud
or abuse.2
6.
How
the Plan will review Participating Transportation Providers that:
(a)
Alter, falsify or destroy records prior to the end of the five (5) year records
retention benchmark;
2
As
defined in section 409.913, F.S., 2004.
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Contract No. FA521, Amendment No. 9, Page 5 of 30
(b)
Make
false statements about credentials;
(c)
Misrepresent medical information to justify referrals;
(d)
Failed to provide scheduled transportation for Enrollees;
(e)
Charge Enrollees for covered services; and/or
(f)
Have
committed, or been suspected of committing, fraud or abuse
3
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7.
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How
the Plan will provide Transportation Services outside of the Plan's
service area.
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(a)
The
Plan shall state clearly the guidelines it will use in order to control costs
when providing Transportation Services outside of the Plan's service
area.
f.
The
Plan shall report immediately, in writing to the Agency Contract Manager
and the
Medicaid Program Integrity Unit, any aspect of Transportation Service delivery,
by any Transportation Services Provider, any adverse or untoward
incident.4
The Plan
shall also report, immediately upon identification, in writing to the Agency
Contract Manager and the Medicaid Program Integrity Unit, all instances of
suspected Enrollee or Transportation Services Provider fraud or
abuse.5
1.
The
Plan shall file a written report with the Medicaid Program Integrity Unit
and
the Agency Contract Manager immediately upon the detection of a potentially
or
suspected fraudulent or abusive action by a Transportation Services Provider.
At
a minimum, the report must contain the name, tax identification number and
contract information of the Transportation Services Provider and a description
of the suspected fraudulent or abusive act. The report shall be in the form
of a
narrative.
g.
Insurance, Safety Requirements and Standards6
1.
The
Plan shall ensure compliance with the minimum liability insurance requirement
of
$100,000 per person and $200,000 per incident for all transportation services
purchased or provided for the transportation disadvantaged through the
Plan.7
The Plan
shall indemnify and hold harmless the local. State, and federal governments
and
their entities and
3
As
defined in section 409.913, F.S., 2004.
4
See
section 641.55, F.S., 2004.
5
As
defined in section 409.913, F.S., 2004.
6
Including, but not limited to, 41-2, F.A.C., 2004.
7
See
section 768.28(5), F.S., 2004.
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Contract No. FA521, Amendment No. 9, Page 6 of 30
the
Agency from any liabilities arising out of or due to an accident or negligence
on the part of the Plan and/or all Participating Transportation Providers
under
contract to the Plan. The Plan may act as a Participating Transportation
Provider, in which case it must follow all requirements set forth below for
Participating Transportation Providers.
2.
The
Plan, and all Participating Transportation Providers, shall ensure that all
operations and services are in compliance with all federal and State safety
requirements.8
3.
The
Plan, and all Participating Transportation Providers, shall ensure continuing
compliance with all applicable State or federal laws relating to drug
testing.9
4.
The
Plan and all Participating Transportation Providers shall adhere to the
following standards, including, but not limited to, the following:
(a)
Drug
and alcohol testing for safety sensitive job positions relating to the provision
of Transportation Services regarding pre-employment, randomization,
post-accident, and reasonable suspicion as required by the Federal Highway
Administration and the Federal Transit Administration;
(b)
Use
of child safety restraint devices, where the use of such devices would not
interfere with the safety of a child (for example, a child in a
wheelchair);
(c)
Enrollee property that can be carried by the passenger and/or driver, and
can be
stowed safely on the vehicle, shall be transported with the passenger at
no
additional charge. The driver shall provide transportation of the following
items, as applicable, within the capabilities of the vehicle:
(1)
Wheelchairs;
(2)
Child
seats;
(3)
Stretchers;
(4)
Secured oxygen;
(5)
Personal assistive devices; and/or
(6)
Intravenous devices.
8
Including, but not limited to, section 341.061(2)(a), Florida Statutes, and
Chapter 14-90, F.A.C.
9
Including, but not limited to, to section 112.0455, Florida Statutes, 2004,
Chapters 59A-24,41 U.S.C. 701, and 49 C.F.R., Parts 29 and 382.
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Contract No. FA521, Amendment No. 9, Page 7 of 30
(d)
Vehicle transfer points shall provide shelter, security, and safety of
Enrollees;
(e)
Maintain inside all vehicles copies of the Plan's toll free phone number
for
Enrollee complaints;
(f)
The
interior of all vehicles shall be free from dirt, grime, oil, trash, torn
upholstery, damaged or broken seats, protruding metal or other objects or
materials which could soil items placed in the vehicle or provide discomfort
for
Enrollees;
(g)
Maintain a passenger/trip database for each Enrollee transported by the
Plan/Participating Transportation Provider;
(h)
Ensure adequate seating for paratransit services for each Enrollee and escort,
child, or personal care attendant, and shall ensure that the vehicle does
not
transport more passengers than the registered passenger seating capacity
in a
vehicle at any time;
(i)
Ensure adequate seating space for transit services for each Enrollee and
escort,
child, or personal care attendant, and shall ensure that transit vehicles
provide adequate seating or standing space to each rider, and shall ensure
that
the vehicle does not transport more passengers than the registered passenger
seating or standing capacity in a vehicle at any time;
(j)
Drivers for paratransit services shall identify themselves by name and company
in a manner that is conducive to communications with the specific passenger,
upon pickup of each Enrollee, group of Enrollees, or representative, guardian,
or associate of the Enrollee, except in situations where the driver regularly
transports the Enrollee on a recurring basis;
(k)
Each
driver must have photo identification that is viewable by the passenger.
Name
patches, inscriptions or badges that affix to driver clothing are acceptable.
For transit services, the driver photo identification shall be in a conspicuous
location in the vehicle;
(1)
The
paratransit driver shall provide the Enrollee with boarding assistance, if
necessary or requested, to the seating portion of the vehicle. The boarding
assistance shall include, but not be limited to, opening the vehicle door,
fastening the seat belt or utilization of wheel chair securement devices,
storage of mobility assistive devices and closing the vehicle door. In the
door-through-door
AHCA
Contract No. FA521, Amendment No. 9, Page 8 of 30
paratransit
service category, the driver shall open and close doors to buildings, except
in
situations in which assistance in opening and/or closing building doors would
not be safe for passengers remaining on the vehicle. The driver shall provide
assisted access in a dignified manner. Drivers may not assist wheelchair
passengers up or down more than one (1) step, unless it can be performed
safely
as determined by the Enrollee, guardian, and driver;
(m)
Smoking, eating and drinking are prohibited in any vehicle, except in cases
in
which, as a Medical Necessity, the Enrollee requires fluids or sustenance
during
transport;
(n)
Ensure that all vehicles are equipped with two-way communications, in good
working order and audible to the driver at all times, by which to communicate
with the Transportation Services hub or base of operations;
(o)
Ensure that all vehicles have working air conditioners and heaters. The Plan
shall ensure that all vehicles that do not have a working air conditioner
or
heater are removed from the vehicle pool and scheduled for repair or
replacement;
(p)
Develop and implement a first aid policy and cardiopulmonary resuscitation
policy;
(q)
Ensure that all drivers providing Transportation Services undergo a background
screening;
(r)
Establish Enrollee pick-up windows and communicate these windows to
Participating Transportation Providers and Enrollees;
(s)
Establish a minimum 24-hour advanced notification policy to obtain
Transportation Services. The Plan shall communicate said policy to Participating
Transportation Providers and Enrollees;
(t)
Establish a performance measure to evaluate the safety of the Transportation
Services provided by Participating Transportation Providers. The Plan shall
report the results of the evaluation to the Agency on August 15th
of each
year;
(u)
Establish a performance measure to evaluate the reliability of the vehicles
utilized by Participating Transportation Providers. The Plan shall report
the
results of the evaluation to the Agency on August 15th
of each
year; and
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Contract No. FA521, Amendment No. 9, Page 9 of 30
(v)
Establish a performance measure to evaluate the quality of service provided
by a
Participating Transportation Provider. The Plan shall report the results
of the
evaluation to the Agency on August 15th
of each
year.
(h.)
Operational Standards10
- Each
Plan shall implement, or ensure that each Participating Transportation Provider
has implemented, policies and procedures that, at a minimum, comply with
the
following:
1.
Address the following safety elements and requirements:
(a)
Safety policies and responsibilities;
(b)
Vehicle and equipment standards and procurement criteria;
(c)
Operational standards and procedures;
(d)
Vehicle driver and employee selection;
(e)
Driving requirements;
(f)
Vehicle driver and employee training;
(g)
Vehicle maintenance;
(h)
Investigations of events described under Section 10.8-14.h-7, Transportation
Services, below;
(i)
Hazard identification and resolution;
(j)
Equipment for transporting wheelchairs;
(k)
Safety data acquisition and analysis;
(1)
Safety standards for private contract vehicle transit system(s) that provide(s)
transportation services for compensation as a result of a contractual agreement
with the vehicle transit system.
2.
Shall
submit an annual safety certification to the Agency verifying the
following:
(a)
Adoption of policies and procedures that, at a minimum, establish standard
set
forth in this Section; and
10
For
reference, see 14-90, F.A.C., 2004.
AHCA
Contract No. FA521, Amendment No. 9, Page 10 of 30
Medicaid
HMO Contract
(b)
The
Plan/Participating Transportation Provider is in full compliance with the
policies and procedures relating to Transportation Services, and that it
has
performed annual safety inspections on all vehicles operated by the
Plan/Participating Transportation Provider, by persons meeting the requirements
set forth in Section 10.8.14.h.6, below.
3.
The
Plan shall suspend immediately a Participating Transportation Provider if,
at
any time, continued use of that Participating Transportation Provider, is
unsafe
for passenger service or poses a potential danger to public safety.
4.
Address the following security requirements:
(a)
Security policies, goals, and objectives;
(b)
Organization, roles, and responsibilities;
(c)
Emergency management processes and procedures for mitigation,
preparedness,
response, and recovery;
(d)
Procedures for investigation of any event involving a vehicle, or taking
place
on vehicle transit system controlled property, resulting in a fatality, injury,
or property damage as discussed in Section 10.8.14.h.7, below;
(e)
Procedures for the establishment of interfaces with emergency response
organizations;
(f)
Employee security and threat awareness training programs;
(g)
Conduct and participate in emergency preparedness drills and exercises;
and
(h)
Security requirements for Participating Transportation Providers that provide
Transportation Services for compensation as a result of a contractual agreement
with the Plan/Participating Transportation Provider.
5.
Shall
establish criteria and procedures for selection, qualification, and training
of
all drivers. The criteria shall include, at a minimum, the
following:
(a)
Driver qualifications and background checks with minimum hiring
standards;
AHCA
Contract No. FA521, Amendment No. 9, Page 11 of 30
Medicaid
HMO Contract
(b)
Driving and criminal background checks for all new drivers;
(c)
Verification and documentation of valid driver licenses for all employees
who
drive vehicles;
(d)
Training and testing to demonstrate and ensure adequate skills and capabilities
to safely operate each type of vehicle or vehicle combination before driving
unsupervised;
(e)
At a
minimum, drivers shall be given explicit instructional and procedural training
and testing in the following areas:
(1)
Plans/Participating Transportation Provider safety and operational policies
and
procedures;
(2)
Operational vehicle and equipment inspections;
(3)
Vehicle equipment familiarization;
(4)
Basic
operations and maneuvering;
(5)
Boarding and alighting passengers;
(6)
Operation of wheelchair lift and other special equipment and driving
conditions;
(7)
Defensive driving;
(8)
Passenger assistance and securement;
(9)
Handling of emergencies and security threats; and
(10)
Security and threat awareness.
(f)
Shall
provide written operational and safety procedures to all vehicle drivers
before
the drivers are allowed to drive unsupervised. These procedures and instructions
shall address, at a minimum, the following:
(1)
Communication and handling of unsafe conditions, security threats, and
emergencies;
(2)
Familiarization and operation of safety and emergency equipment, wheelchair
lift
equipment, and restraining devices;
and
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Contract No. FA521, Amendment No. 9, Page 12 of 30
Medicaid
HMO Contract
(3)
Application and compliance with applicable federal and State rules and
regulations.l}
(g)
Shall
maintain the following records for at least five (5) years:
(1)
Records of vehicle driver background checks and qualifications;
(2)
Detailed descriptions of training administered and completed by each vehicle
driver;
(3)
A
record of each vehicle driver's duty status, which shall include total days
worked, on-duty hours, driving hours and time of reporting on- and off-duty
each
day; and
(4)
Any
documents required to be prepared by this Contract.
(h)
Shall
establish a drug-free workplace policy statement12
and a
substance abuse management and testing program;13
and
(i)
Shall
require that drivers write and submit a daily vehicle inspection report,
i
6.
Shall
establish a maintenance policy and procedures for preventative and routine
maintenance for all vehicles. The maintenance policy and procedures shall
ensure, at a minimum, that:
(a)
All
vehicles, all parts and accessories on such vehicles, and any additional
parts
and accessories which may affect the safety of vehicle operation, including
frame and frame assemblies, suspension systems, axles and attaching parts,
wheels and rims, and steering systems, are regularly and systematically
inspected, maintained and lubricated in accordance with the standards developed
and established according to the vehicle manufacturer's recommendations and
requirements;
(b)
That
a recording and tracking system is established for the types of inspections,
maintenance, and lubrication intervals, including the date or mileage when
these
services are due. Required maintenance inspections shall be more comprehensive
than daily inspections performed by the driver;
"
The
provisions in Sections !0.8.14.h.5(e) and (f), above, shall not apply to
personnel licensed and authorized by the Plan/Participating
Transportation
Provider to drive, move, or road test a vehicle in order to perform repairs
or
maintenance services where it has been determined
that
such
temporary operation does not create an unsafe operating condition or create
a
hazard to public safety.
12
In
accordance with 49 C.F.R. Part 29.
11
In
accordance with 49 C.F.R. Parts 40 and 655, October 1,2004.
14
Pursuant
to Rule 14-90.006, F.A.C.
AHCA
Contract No. FA521, Amendment No. 9, Page 13 of 30
Medicaid
HMO Contract
(c)
That
proper preventive maintenance is performed when on all
vehicles;
and
(d)
That
the Plan/Participating Transportation Provider maintain and provide written
documentation of preventive maintenance, regular maintenance, inspections,
lubrication, and repairs performed for each vehicle under their control.
Such
records shall be maintained by the Plan/Participating Transportation Provider
for at least five (5) years and include, at a minimum, the following
information:
(1)
Identification of the vehicle, including make, model, and license number
or
other means of positive identification and ownership;
(2)
Date,
mileage, and type of inspection, maintenance, lubrication, or repair
performed;
(3)
Date,
mileage, and description of each inspection, maintenance, and lubrication
intervals performed;
(4)
If
not owned by the Plan/Participating Transportation Provider, the name of
any
person or lessor furnishing any vehicle; and
(5)
The
name and address of any entity or contractor performing an inspection,
maintenance, lubrication, or repair.
7.
The
Plan/Participating Transportation Provider shall investigate, or cause to
be
investigated, any event involving a vehicle or taking place on
Plan/Participating Transportation Provider controlled property resulting
in a
fatality, injury, or property damage as follows:
(a)
A
fatality, where an individual is confirmed dead, within three (3) days of
a
Transportation Services related event, excluding suicides and deaths from
illnesses. The Plan must file detailed report of the incident with the Agency
within ten (10) days of the event;15
(b)
Injuries requiring immediate medical attention away from the scene for two
(2)
or more individuals;
(c)
Property damage to Plan/Participating Transportation Provider vehicles, other
Plan/Participating Transportation Provider property or facilities, or any
other
property, except the Plan/Participating
15
See
section 641.55(6), F.S., 2004.
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Contract No. FA521, Amendment No. 9, Page 14 of 30
Medicaid
HMO Contract
Transportation
Provider shall have the discretion to investigate events resulting in property
damage totaling less than $1,000;
(d)
Evacuation of a vehicle due where there is imminent danger to passengers
on the
vehicle, excluding evacuations due to vehicle operation issues;
(e)
Each
investigation shall be documented in a final report that includes a description
of investigation activities, identified causal factors and a corrective action
plan;
(1)
Each
corrective action plan shall identify the action to be taken by the
Plan/Participating Transportation Provider and the schedule for its
implementation; and
(2)
The
Plan/Participating Transportation Provider must monitor and track the
implementation of each corrective action plan.
(f)
The
Plan/Participating Transportation Provider shall maintain all investigation
reports, corrective action plans, and related supporting documentation for
a
minimum of five (5) years from the date of completion of the
investigation.
i.
Medical Examinations for Drivers - The Plan/Participating Transportation
Provider shall establish medical examination requirements for all applicants
for
driver positions and for existing drivers. The medical examination requirements
shall include a pre-employment examination for applicants, an examination
at
least once every two (2) years for existing drivers, and a return to duty
examination for any driver prior to returning to duty after having been off
duty
for thirty (30) or more days due to an illness, medical condition, or
injury.
1.
Medical examinations may be
performed and recorded according to qualification standards adopted by the
Plan/Participating Transportation Provider, provided the medical examination
qualification standards adopted by the Plan/Participating Transportation
Provider meet or exceed those provided in Department Form Number 000-000-00,
Medical Examination Report for Bus Transit System Driver, Rev. 07/05, hereby
incorporated by reference.16
2.
Medical examinations shall be performed by a Doctor of Medicine or Osteopathy,
a
PA or ARNP licensed or certified by the State of Florida. The examination
shall
be conducted in person, and not via the Internet. If medical examinations
are
performed by a PA or ARNP, they must be
16
Copies
of Form Number 000-000-00 are available from the Florida Department of
Transportation, Public Transit Office, 605 Suwannee Street, Mail Station
26,
Xxxxxxxxxxx, Xxxxxxx 00000-0000 or on-line at
xxx.xxx.xxxxx.xx.xx/xxxxxxx.
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Contract No. FA521, Amendment No. 9, Page 15 of 30
Medicaid
HMO Contract
performed
under the supervision or review of a Doctor of Medicine or
Osteopathy.
(a)
An
ophthalmologist or optometrist licensed by the State of Florida may perform
as
much of the examination as pertains to visual acuity, field of vision and
color
recognition.
(b)
Upon
completion of the examination, the examining medical professional shall
complete, sign, and date the medical examination report.
3.
The
Plan/Participating Transportation Provider shall have on file proof of medical
examination, i.e., a completed and signed medical examination report for
each
driver, dated within the past 24 months. Medical examination reports of employee
drivers shall be maintained by the Plan/Participating Transportation Provider
for a minimum of five (5) years from the date of the examination.
j.
Operational and Driving Requirements
1.
The
Plan/Participating Transportation Provider shall not permit a driver to drive
a
vehicle when such driver's license has been suspended, canceled or revoked.
The
Plan/Participating Transportation Provider shall require a driver who receives
a
notice that his or her license to operate a motor vehicle has been suspended,
canceled, or revoked notify his or her employer of the contents of the notice
immediately, and no later than the end of the business day following the
day he
or she received the notice.
2.
At all
times, the Plan/Participating Transportation Provider shall operate vehicles
in
compliance with applicable traffic regulations, ordinances and laws of the
jurisdiction in which they are being operated.
3.
The
Plan/Participating Transportation Provider shall not permit or require a
driver
to drive more than twelve (12) hours in any one 24-hour period, or drive
after
having been on duty for sixteen (16) hours in any one 24-hour period. The
Plan/Participating Transportation Provider shall not permit a driver to drive
until the driver fulfills the requirement of a minimum eight (8) consecutive
hours off-duty. A driver's work period shall begin from the time he or she
first
reports for duty to his or her employer. A driver is permitted to exceed
his or
her regulated hours in order to reach a regularly established relief or dispatch
point, provided the additional driving time does not exceed one (1)
hour.
4.
The
Plan/Participating Transportation Provider shall not permit or require a
driver
to be on duty more than 72 hours in any period of seven (7) consecutive days;
however, 24 consecutive hours off-duty shall constitute
AHCA
Contract No. FA521, Amendment No. 9, Page 16 of 30
Medicaid
HMO Contract
the
end
of any such period of seven (7) consecutive days. The Plan/Participating
Transportation Provider shall ensure that a driver who has reached the maximum
72 hours of on-duty time during the seven (7) consecutive days has a minimum
of
24 consecutive hours off-duty before returning to on-duty status.
5.
A
driver is permitted to drive for more than the regulated hours for safety
and
protection of the public due to conditions such as adverse weather, disaster,
security threat, a road or traffic condition, medical emergency or an
accident.
6.
The
Plan/Participating Transportation Provider shall not permit or require any
driver to drive when his or her ability is impaired, or likely to be impaired,
by fatigue, illness, or other causes, as to make it unsafe for the driver
to
begin or continue driving.
7.
The
Plan/Participating Transportation Provider shall require pre-operational
or
daily inspection of all vehicles and reporting of all defects and deficiencies
likely to affect safe operation or cause mechanical malfunctions.
(a)
The
Plan/Participating Transportation Provider shall maintain a log detailing
a
daily inspection or test of the following parts and devices to ascertain
that
they are in safe condition and in good working order:
(1)
Service brakes;
(2)
Parking brakes;
(3)
Tires
and wheels;
(4)
Steering;
(5)
Horn;
(6)
Lighting devices;
(7)
Windshield wipers;
(8)
Rear
vision mirrors;
(9)
Passenger doors and seats;
(10)
Exhaust system;
AHCA
Contract No. FA521, Amendment No. 9, Page 17 of 30
Medicaid
HMO Contract
(11)
Equipment for transporting wheelchairs; and
(12)
Safety, security, and emergency equipment.
(b)
The
Plan/Participating Transportation Provider shall review daily inspection
reports
and document corrective actions taken as a result of any deficiencies identified
by any inspections.
(c)
The
Plan/Participating Transportation Provider shall retain records of all
inspections and any corrective action documentation for five (5)
years.
8.
The
driver shall not operate a vehicle with passenger doors in the open position
when passengers are aboard. The driver shall not open the vehicle's doors
until
the vehicle comes to a complete stop. The Plan/Participating Transportation
Provider shall not operate a vehicle with inoperable passenger doors with
passengers aboard, except to move the vehicle to a safe location.
9.
During
darkness, interior lighting and lighting in stepwells on vehicles shall be
sufficient for passengers to enter and exit safely.
10.
Passenger(s) shall not be permitted in the stepwell(s) of any vehicle, while
the
vehicle is in motion, or to occupy an area forward of the standee
line.
11.
Passenger(s) shall not be permitted to stand on or in vehicles not designed
and
constructed for that purpose.
12.
The
Plan/Participating Transportation Provider shall not refuel vehicles in a
closed
building. The Plan/Participating Transportation Provider shall minimize the
number of times a vehicle shall refuel when passengers are onboard.
13.
The
Plan/Participating Transportation Provider shall require the driver to be
properly secured to the driver's seat with a restraining belt at all times
while
the vehicle is in motion.
14.
The
driver shall not leave vehicles unattended with passenger(s) aboard for longer
than five (5) minutes. The Plan/Participating Transportation Provider shall
ensure that the driver sets the parking or holding brake any time the vehicle
is
left unattended.
15.
The
Plan/Participating Transportation Provider shall not leave vehicles unattended
in an unsafe condition with passenger(s) aboard at any time.
k.
Vehicle Equipment Standards and Procurement
Criteria
AHCA
Contract No. FA521, Amendment No. 9, Page 18 of 30
Medicaid
HMO Contract
1.
The
Plan/Participating Transportation Provider shall ensure that vehicles procured
and operated meet the following requirements, at a minimum:
(a)
The
capability and strength to carry the maximum allowed load and not exceed
the
manufacturer's gross vehicle weight rating (GVWR), gross axle weighting,
or tire
rating;
(b)
Structural integrity that mitigates or minimizes the adverse effects of
collisions; and
(c)
Federal Motor Vehicle Safety Standards (FMVSS), 49 C.F.R. Part 571, Sections
102, 103, 104, 105, 108, 207, 209, 210, 217, 220, 221, 225, 302, 403, and
404,
October 1, 2004, are hereby incorporated by reference.
2.
Proof
of strength and structural integrity tests on new vehicles procured shall
be
submitted by manufacturers or the Plan/Participating Transportation Providers
to
the Department of Transportation.17
3.
The
Plan/Participating Transportation Provider shall ensure that every vehicle
operated in this State in connection with this Contract shall be equipped
as
follows:
(a)
Mirrors - There must be at least two (2) exterior rear vision mirrors, one
(1)
at each side. The mirrors shall be firmly attached to the outside of the
vehicle
and so located as to reflect to the driver a view to the rear along both
sides
of the vehicle.
(1)
Each
exterior rear vision mirror, on Type I buses shall have a minimum reflective
surface of 50 square inches and the right (curbside) mirror shall be located
on
the bus so that the lowest part of the mirror and its mounting is a minimum
80
inches above the ground. All Type I buses shall be equipped with an inside
rear
vision mirror capable of giving the driver a clear view of seated or standing
passengers. Buses having a passenger exit door that is located inconveniently
for the driver's visual control shall be equipped with additional interior
mirror(s), enabling the driver to view the passenger exit door. The exterior
right (curbside) rear vision mirror and its mounting on Type I buses may
be
located lower than 80 inches from the ground, provided such buses are used
exclusively for paratransit services.
AHCA
Contract No. FA521, Amendment No. 9, Page 19 of 30
Medicaid
HMO Contract
(2)
In
lieu of interior mirrors, trailer buses and articulated buses may be equipped
with closed circuit video systems or adult monitors in voice control with
the
driver.
(b)
Wiring and Battery - Electrical wiring shall be maintained so as not to come
in
contact with moving parts, or heated surfaces, or be subject to chafing or
abrasion which may cause insulation to become worn.
(1)
Every
Type I bus manufactured on or after February 7, 1988, shall be equipped with
a
storage battery(ies) electrical power main disconnect switch. The disconnect
switch shall be practicably located in an accessible location adjacent to
or
near to the battery(ies) and be legibly and permanently marked for
identification.
(2)
Every
storage battery on each public-sector bus shall be mounted with proper
retainment devices in a compartment which provides adequate ventilation and
drainage.
(c)
Brake
Interlock Systems - All Type I buses having a rear exit door shall be equipped
with a rear exit door/brake interlock that automatically applies the brake(s)
upon driver activation of the rear exit door to the open position. Interlock
brake application shall remain activated until deactivation by the driver
and
the rear exit door returns to the closed position. The rear exit door interlock
on such buses shall be equipped with an identified override switch enabling
emergency release of the interlock function, which shall not be located within
reach of the seated driver. Air pressure application to the brake(s) during
interlock operation, on buses equipped with rear exit door/brake interlock,
shall be regulated at the original equipment manufacturer's
specifications.
4.
Standee Line and Warning - Every vehicle designed and constructed to allow
standees shall be plainly marked with a line of contrasting color at least
two
(2) inches wide or be equipped with some other means to indicate that any
passenger is prohibited from occupying a space forward of a perpendicular
plane
drawn through the rear of the driver's seat and perpendicular to the
longitudinal axis of the vehicle. A sign shall be posted at or near the front
of
the vehicle stating that it is a violation for a vehicle to be operated with
passengers occupying an area forward of the line.
5.
Handrails and Stanchions - Every vehicle designed and constructed to allow
standees shall be equipped with overhead grab rails for standee passengers.
Overhead grab rails shall be continuous, except for a gap at
AHCA
Contract No. FA521, Amendment No. 9, Page 20 of 30
Medicaid
HMO Contract
the
rear
exit door, and terminate into vertical stanchions or turn up into a
ceiling
fastener.
(a)
Every
Type I and Type II bus designed for carrying more than sixteen (16) passengers
shall be equipped with grab handles, stanchions, or bars at least ten (10)
inches long and installed to permit safe on-board circulation, seating and
standing assistance, and boarding and unloading by elderly and handicapped
persons. Type I buses shall be equipped with a safety bar and panel directly
behind each entry and exit stepwell.
6.
Flooring, Steps, and Thresholds - Flooring, steps, and thresholds on all
vehicles shall have slip resistant surfaces without protruding or sharp edges,
lips, or overhangs, to prevent tripping hazards. All step edges and thresholds
shall have a band of color(s) running the full width of the step or edge
which
contrasts with the step tread and riser, either light-on-dark or
dark-on-light.
7
Doors -
Power activated doors on all vehicles shall be equipped with a manual device
designed to release door closing pressure.
8.
Emergency Exits - All vehicles shall have an emergency exit door, or in lieu
thereof, shall be provided with emergency escape push-out windows. Each
emergency escape window shall be in a form of a parallelogram with dimensions
of
not less than 18" by 24", and each shall contain an area of not less than
432
square inches. There shall be a sufficient number of such push-out or kick-out
windows in each vehicle to provide a total escape area equivalent to 67 square
inches per seat, including the driver's seat.
(a)
No
less than forty percent (40%) of the total escape area shall be on one (1)
side
of the vehicle. Emergency escape kick-out or push-out windows and emergency
exit
doors shall be conspicuously marked by a sign or light and shall always be
kept
in good working order so that they may be readily opened in an
emergency.
(b)
All
such windows and doors shall not be obstructed by bars or other such means
located either inside or outside so as to hinder escape. Vehicles equipped
with
an auxiliary door for emergency exit shall be equipped with an audible alarm
and
light indicating to the driver when a door is ajar or opened while the engine
is
running.
(c)
Supplemental security locks operable by a key are prohibited on emergency
exit
doors unless these security locks are equipped and
AHCA
Contract No. FA521, Amendment No. 9, Page 21 of 30
Medicaid
HMO Contract
connected
with an ignition interlock system or an audio visual alarm located in the
driver's compartment. Any supplemental security lock system used on emergency
exits shall be kept unlocked whenever a vehicle is in operation.
9.
Tires
and Wheels - Tires shall be properly inflated in accordance with
manufacturer's
recommendations.
(a)
No
vehicle shall be operated with a tread groove pattern depth:
(1)
Less
than 4/32 (1/8) of an inch, measured at any point on a major tread groove
for
tires on the steering axle of all vehicles. The measurements shall not be
made
where tie bars, humps, or fillets are located.
(2)
Less
than 2/32 (1/16) of an inch, measured at any point on a major tread groove
for
all other tires of all vehicles. The measurements shall not be made where
tie
bars, humps, or
fillets
are located.
(b)
The
Plan/Participating Transportation Provider shall not operate any vehicle
with
recapped, regrooved, or retreaded tires on the steering axle.
(c)
Wheels shall be visibly free from cracks and distortion and shall not have
missing, cracked, or broken mounting lugs.
10.
Suspension - The suspension system of all vehicles, including springs, air
bags,
and all other suspension parts as applicable, shall be free from cracks,
leaks,
or any other defect which would or may cause its impairment or failure to
function properly.
11.
Steering and Front Axle - The steering system of all vehicles shall have
no
indication of leaks which would or may cause its impairment to-function
properly, and shall be free from cracks and excessive wear of components
that
would or may cause excessive free play or loose motion in the steering system
or
above normal effort in steering control.
12.
Seat
Belts - Every vehicle shall be equipped with an adjustable driver's restraining
belt in compliance with the requirements ofFMVSS 209, "Seat Belt
Assemblies"19
and
FMVSS 210, "Seat Belt Assembly Anchorages."20
"See
49
C.F.R. 571.209,2004. 20
See 49
C.F.R. 571.210,2004.
AHCA
Contract No. FA521, Amendment No. 9, Page 22 of 30
Medicaid
HMO Contract
13.
Safety Equipment - Every vehicle shall be equipped with one (1) fully charged
dry chemical or carbon dioxide fire extinguisher, having at least a 1A:BC
rating
and bearing the label of Underwriter's Laboratory, Inc.
(a)
Each
fire extinguisher shall be securely mounted on the vehicle in a conspicuous
place or a clearly marked compartment and be readily accessible.
(b)
Each
fire extinguisher shall be maintained in efficient operating condition and
equipped with some means of determining if it is fully charged.
(c)
Every
Type I bus shall be equipped with portable red reflector warning
devices.21
14.
Vehicles used for the purpose of transporting individuals with disabilities
shall meet the requirements set forth in 49 C.F.R. Part 38, October 1, 2004,
hereby incorporated by reference, and the following:
(a)
Installation of a wheelchair lift or ramp shall not cause the manufacturer's
GVWR, gross axle weight rating, or tire rating to be exceeded.
(b)
Except in locations within 3 1/2 inches of the vehicle floor, all readily
accessible exposed edges or other hazardous protrusions of parts of wheelchair
lift assemblies or ramps that are located in the passenger compartment shall
be
padded with energy absorbing material to mitigate injury in normal use and
in
case of a collision. This requirement shall also apply to parts of the vehicle
associated with the operation of the lift or ramp.
(c)
The
controls for operating the lift shall be at a location where the driver or
lift
attendant has a full view, unobstructed by passengers, of the lift platform,
its
entrance and exit, and the wheelchair passenger, either directly or with
partial
assistance of-mirrors. Lifts located entirely to the rear of the driver's
seat
shall not be operable from the driver's seat, but shall have an override
control
at the driver's position that can be activated to prevent the lift from being
operated by the other controls (except for emergency manual operation upon
power
failure).
(d)
The
installation of the wheelchair lift or ramp and its controls and the method
of
attachment in the vehicle body or chassis shall not diminish the structural
integrity of the vehicle nor cause a hazardous imbalance of the vehicle.
No part
of the assembly, when installed and stowed, shall extend laterally beyond
the
21
See
section 316.300, F.S., 2004.
AHCA
Contract No. FA521, Amendment No. 9, Page 23 of 30
Medicaid
HMO Contract
normal
side contour of the vehicle or vertically beyond the lowest part of the rim
of
the wheel closest to the lift.
(e)
Each
wheelchair lift or ramp assembly shall be legibly and permanently marked
by the
manufacturer or installer with the following minimum information:
(1)
The
manufacturer's name and address;
(2)
The
month and year of manufacture; and
(3)
A
certificate that the wheelchair lift or ramp securement devices, and their
installation, conform to State of Florida requirements applicable to accessible
vehicles.
15.
Wheelchair lifts, ramps, securement devices, and restraints shall be inspected
and maintained as required in this Section, above. Instructions for normal
and
emergency operation of the lift or ramp shall be carried or displayed in
every
vehicle.
1.
Vehicle Safety Inspections
1.
The
Plan/Participating Transportation Provider shall require that all vehicles
be
inspected in accordance with the vehicle inspection procedures set forth
above.
2.
It is
the Plan's/Participating Transportation Provider's responsibility to ensure
that
each individual performing a vehicle safety inspection is qualified as
follows:
(a)
Understands the requirements set forth in 14-90, F.A.C., 2004 and can identify
defective components;
(b)
Is
knowledgeable of, and has mastered the methods, procedures, tools, and equipment
used when performing an inspection; and
(c)
Has
at least one (1) year of training and/or experience as a mechanic or inspector
in a vehicle maintenance program and has sufficient general knowledge of
vehicles owned and operated by the Plan/Participating Transportation Provider
to
recognize deficiencies or mechanical defects.
3.
The
Plan/Participating Transportation Provider shall ensure that each vehicle
receiving a safety inspection is checked for compliance with the safety devices
and equipment requirements as referenced or specified above. Specific operable
equipment and devices include the following:
(a) Horn;
AHCA
Contract No. FA521, Amendment No. 9, Page 24 of 30
Medicaid
HMO Contract
(b)
Windshield wipers;
(c)
Mirrors;
(d)
Wiring and battery(ies);
(e)
Service and parking brakes;
(f)
Warning devices;
(g)
Directional signals;
(h)
Hazard warning signals;
(i)
Lighting systems and signaling devices;
(j)
Handrails and stanchions;
(k)
Standee line and warning;
(1)
Doors
and interlock devices;
(m)
Stepwells and flooring;
(n)
Emergency exits;
(o)
Tires
and wheels;
(p)
Suspension system;
(q)
Steering system;
(r)
Exhaust system;
(s)
Seat
belts;
(t)
Safety equipment; and (u) Equipment for transporting wheelchairs.
4.
A
safety inspection report shall be prepared by the individual(s) performing
the
inspection which shall include the following:
(a)
Identification of the individual(s) performing the inspection;
(b)
Identification of the Plan/Participating Transportation Provider operating
the
vehicle;
AHCA
Contract No. FA521, Amendment No. 9, Page 25 of 30
Medicaid
HMD Contract
(c)
The
date of the inspection;
(d)
Identification of the vehicle inspected;
(e)
Identification of the equipment and devices inspected including the
identification of equipment and devices found deficient or defective;
and
(f)
Identification of corrective action(s) for deficient or defective items and
date(s) of completion of corrective action(s).
5.
Records of annual safety inspections and documentation of any required
corrective actions shall be retained for compliance review a minimum of five
(5)
years by the Plan/Participating Transportation Provider.
m.
Certification - Each Plan/Participating Transportation Provider shall submit
to
the Bureau of Managed Health Care an annual safety and security certification
in
accordance with 14-90.10, F.A.C., 2004 and shall submit in the format set
forth
in 14-90.10 and 14-90.12, F.A.C., 2004.
n.
The
Plan shall report the following by August 15th
of each
year:
(1)
The
estimated number of one-way passenger trips to be provided during the coming
fiscal year in the following categories:22
(a)
Ambulatory transportation;
(b)
Long
haul ambulatory transportation;
(c)
Wheelchair transportation;
(d)
Stretcher transportation;
(e)
Ambulatory multiload transportation;
(f)
Wheelchair multiload transportation;
(g)
Mass
transit pending transportation;
(h)
Mass
transit transportation;
(i)
Mass
transit transportation (Enrollee has pass); and
(j)
Mass
transit transportation (sent pass to Enrollee).
(2)
The
actual amount of funds expended and the total number of trips provided during
the previous fiscal year; and
22
As
defined in the Transportation Handbook.
AHCA
Contract No. FA521, Amendment No. 9, Page 26 of 30
Medicaid
HMO Contract
(3)
The
operating financial statistics for the previous fiscal year.
o.
Shall
provide the total number of vehicles in each category, other than public
transportation, that will serve each County as well as a provider directory
for
all Transportation Services."
4.
Attachment VIII, Estimated 2005-2006 Rates; Not for use unless approved by
CMS,
is hereby deleted in its entirety and replaced with Attachment VIII-A, 2005/2006
Medicaid HMO Capitation Rates.
5.
Attachment I, Section 90.0, Payment and Authorized Enrollment Levels, Tables
2
and 3, are hereby deleted in their entirety and replaced with the
following:
Capitation
Rates
A.
General Capitation Rates (Attachment VIII-A, Table I):
Area
1 Counties: Escambia, Santa Xxxx
County Provider
Number
Escambia 015019314
Santa Xxxx 015019331
Area
4 Counties: Xxxxx, Volusia
County Provider
Number
Volusia
015019335
Area
9 Counties: Xxxxxx, Palm Beach
County Provider
Number
Xxxxxx 015019324
Palm Beach 015019339
Area
10 Counties: Broward
County Provider
Number
Broward
015019337
B.
General Capitation Rates plus Mental Health Rates (Attachment VIII-A, Table
4):
Area
2 Counties: Madison, Wakulla, Xxxxxxx, Liberty, Xxxxxxx,
Xxxx,
Xxxxxxxxx
County Provider
Number
Jefferson 015019318
Madison 015019322
AHCA
Contract No. FA521, Amendment No. 9, Page 27 of 30
Medicaid
HMO Contract
Wakulla 015019336
Xxxxxxx 015019340
Liberty 015019342
Gadsden 015019315
Xxxx 015019320
Area
3 Counties: Citrus, Xxxx, Xxxxxx, Xxxxxx
County Provider
Number
Citrus 015019309
Lake 015019319
Xxxxxx 015019323
Xxxxxx 015019329
Area
5 Counties: Pasco, Pinellas
County
Provider
Number
Pasco
015019302
Pinellas 015019303
Area
6 Counties: Xxxxxxx, Xxxx, Xxxxxxxxx
Xxxxxx Provider
Number
Manatee
015019301
Polk 015019304
Highlands 015019317
Area
7 Counties: Brevard
County Provider
Number
Brevard
015019308
Area
8 Counties: Sarasota
County Provider
Number
Sarasota
015019332
Area
11 Counties: Dade
County Provider
Number
Dade
015019338
REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
AHCA
Contract No. FA521, Amendment No. 9, Page 28 of 30
Medicaid
HMO Contract
C.
General Capitation Rates plus Mental Health Rates and Transportation Rates
(Attachment VIII-A, Table 6):
Xxxx
0 Counties: Xxxxx
County Provider
Number
Xxxxx
015019313
Area
6 Counties: Hillsborough
County
Provider
Number
Hillsborough
015019300
Area
7 Counties: Orange, Osceola, Seminole
County Provider
Number
Orange
015019327
Osceola 015019328
Seminole 015019333
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
$835,063,844.00
(an
increase of $1,513,414.00), expressed on page seven of this
contract.
6.
This
Amendment shall have an effective date of December 1, 2005, 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 part of the
Contract.
This
Amendment can not be executed unless all previous amendments to this Contract
have been fully executed.
REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
AHCA
Contract No. FA521, Amendment No. 9, Page 29 of 30
Medicaid
HMD Contract
IN
WITNESS WHEREOF,
the
Parties have caused this 33 page Amendment (including all attachments, if
any)
to be executed by their duly authorized officials.
|
WELL
CARE HMO, INC. D/B/A STAYWELL HEALTH PLAN OF FLORIDA
SIGNED
BY:/s/
Xxxx X. Xxxxx
NAME:
Xxxx
X. Xxxxx
TITLE:
President
& CEO
DATE:
12/2/05
|
STATE
OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION
SIGNED
BY:
[ILLEGIBLE]
NAME:
Xxxx
Xxxxxx
TITLE:
Secretary
DATE:12/6/05
|
List
of
attachments included as part of this Amendment:
Specify
Type_______ Number Description ____________
Attachment VIII-A 2005/2006
Medicaid HMO Capitation Rates (3 pages)
REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
AHCA
Contract No. FA521, Amendment No. 9, Page 30 of 30
ATTACHMENT
VIII-A 2005/2006 MEDICAID HMO CAPITATION RATES
By
Area , Age and Eligibility Category Effective from July 1, 2005 thru June
30,
2006
|
TABLE
1
|
||||||||||||||||||||||||||||||||||
|
General
Rates: Effect from July 1, 05 - Dec 31, 05
|
Effect
from Jan 1, 06 - June 30, 06
|
|||||||||||||||||||||||||||||||||
|
TANF
|
SSI-NO
MEDICARE
|
SSI-B
|
SSI-AB
|
SSI-B
|
SSI-AB
|
|||||||||||||||||||||||||||||
|
Area
|
THMO
+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+)
|
AGE
(65-)
|
AGE
(65+)
|
||||||||||||||||
|
Female
|
Male
|
Female
|
Male
|
|||||||||||||||||||||||||||||||
|
01
|
856.85
|
169.63
|
82.99
|
52.45
|
116.16
|
58.88
|
223.51
|
144.11
|
299.66
|
8,379.19
|
1,456.18
|
373.32
|
192.70
|
211.00
|
636.93
|
598.84
|
359.76
|
314.95
|
219.52
|
213.89
|
77.80
|
67.94
|
||||||||||||
|
02
|
856.85
|
169.63
|
82.99
|
52.45
|
116.16
|
58.88
|
223.51
|
144.11
|
299.66
|
8,379.19
|
1,456.18
|
373.32
|
192.70
|
211.00
|
636.93
|
598.84
|
359.76
|
314.95
|
219.52
|
213.89
|
77.80
|
67.94
|
||||||||||||
|
03
|
956.50
|
190.36
|
93.47
|
59.66
|
130.82
|
66.71
|
252.75
|
163.57
|
340.95
|
8,796.55
|
1,536.62
|
394.23
|
205.64
|
225.15
|
679.21
|
639.39
|
347.95
|
292.11
|
203.81
|
229.06
|
75.70
|
66.16
|
||||||||||||
|
04
|
877.98
|
175.54
|
86.37
|
55.47
|
120.97
|
62.05
|
234,40
|
152.22
|
317.36
|
8,571.85
|
1,495.58
|
383.99
|
199.57
|
218.39
|
659.82
|
620.93
|
333.59
|
294.49
|
205.57
|
207.10
|
77.20
|
67.39
|
||||||||||||
|
05
|
919.97
|
183.42
|
90.13
|
57.68
|
126.15
|
64.46
|
244.02
|
158.18
|
329.69
|
9,248.01
|
1,615.40
|
414.34
|
216.54
|
236.27
|
713.54
|
671.88
|
327.76
|
311,44
|
217.30
|
209.72
|
74.11
|
64.73
|
||||||||||||
|
06
|
839.89
|
168.12
|
82.82
|
53.24
|
115.99
|
59.56
|
224.94
|
146.07
|
305.02
|
8,536.48
|
1,494.27
|
383.60
|
201.12
|
219.94
|
663,51
|
624.96
|
318.14
|
283,93
|
198.16
|
200.02
|
68.93
|
60.15
|
||||||||||||
|
07
|
894.04
|
178.56
|
87.80
|
56.33
|
122.97
|
63.04
|
238.18
|
154.51
|
322.34
|
8,976.51
|
1,573.97
|
404.51
|
212.74
|
232.25
|
701.12
|
661.11
|
308.90
|
284.51
|
198.54
|
199.32
|
72.42
|
63.26
|
||||||||||||
|
08
|
785.52
|
156.85
|
77.12
|
49.44
|
107.94
|
55.29
|
209.14
|
135.62
|
282.90
|
8,247.93
|
1440.20
|
369.54
|
192.51
|
211.13
|
636.41
|
599.00
|
306.59
|
288.63
|
201.43
|
185.30
|
69.18
|
60.36
|
||||||||||||
|
09
|
850.65
|
169.56
|
83.32
|
53.28
|
116.63
|
59.62
|
225.69
|
146.30
|
304.86
|
9,123.67
|
1,599.06
|
410.92
|
216.11
|
235.92
|
711.70
|
670.95
|
288.69
|
317.25
|
221.58
|
179.44
|
76.11
|
66.48
|
||||||||||||
|
10
|
854.17
|
170.86
|
84.11
|
54.07
|
117.82
|
60.56
|
228.53
|
148.48
|
309.80
|
11,134.67
|
1,955.18
|
502.14
|
264.85
|
289.15
|
873.08
|
823.33
|
316.19
|
341.03
|
238.55
|
205.90
|
81.99
|
71.59
|
||||||||||||
|
11
|
1,110.67
|
220.94
|
108.54
|
69.08
|
151.73
|
77.37
|
293.07
|
189.70
|
395.11
|
12,135.43
|
2,122.04
|
545.24
|
284.82
|
311.87
|
940.58
|
885.79
|
450.68
|
420.85
|
294.28
|
269.25
|
112.55
|
98.31
|
||||||||||||
|
TABLE
2
|
||||||||||||||||||||||||||||||||||
|
General
+ Transportation Rates: Effect from July 1, 05 - Dec 31,
05
|
Effect
from Jan 1, 06 - June 30, 06
|
|||||||||||||||||||||||||||||||||
|
TANF
|
SSI-NO
MEDICARE
|
SSI-B
|
SSI-AB
|
SSI-B
|
SSI-AB
|
|||||||||||||||||||||||||||||
|
Area
|
THMO+2MO
|
3MO-
11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
THMO+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
AGE
(65-)
|
AGE
(65+)
|
||||||||||||||||
|
Female
|
Male
|
Female
|
Male
|
|||||||||||||||||||||||||||||||
|
01
|
859.90
|
170.76
|
83.89
|
53.10
|
117.81
|
59.91
|
226.17
|
145.81
|
302.65
|
8,391.86
|
1,468.01
|
380.72
|
194.81
|
214.04
|
651.77
|
609.36
|
374.05
|
331.44
|
226.36
|
228.18
|
94.29
|
74.78
|
||||||||||||
|
02
|
859.90
|
170.76
|
83.89
|
53.10
|
117.81
|
59.91
|
226.17
|
145.81
|
302.65
|
8,391.86
|
1,468.01
|
380.72
|
194.81
|
214.84
|
651.77
|
609.36
|
374.05
|
331.44
|
226.36
|
228.18
|
94.29
|
74.78
|
||||||||||||
|
03
|
959.98
|
191.66
|
94.50
|
60.41
|
132.70
|
67.88
|
255.80
|
165.52
|
344.37
|
8,811.87
|
1,550.92
|
403.17
|
208.19
|
229.78
|
697.16
|
652.10
|
358.59
|
315.51
|
213.51
|
239.70
|
99.10
|
75.86
|
||||||||||||
|
04
|
880.32
|
176.41
|
87.06
|
55.97
|
122.24
|
62.84
|
236.45
|
153.53
|
319.66
|
8,588.73
|
1,511.34
|
393.86
|
202.38
|
223.50
|
679.61
|
634.95
|
340.18
|
317.93
|
215.29
|
213.69
|
100.64
|
77.11
|
||||||||||||
|
05
|
922.10
|
184.21
|
90.76
|
58.14
|
127.30
|
65.18
|
245.89
|
159.37
|
331.78
|
9,257.23
|
1,624.00
|
419.72
|
218.07
|
239.06
|
724.34
|
679.53
|
333.32
|
325.59
|
223.17
|
215.28
|
88.26
|
70.60
|
||||||||||||
|
06
|
842.31
|
169.02
|
83.53
|
53.75
|
117.30
|
60.38
|
227.06
|
147.42
|
307.40
|
8,546.96
|
1,504.05
|
389.72
|
202.87
|
223.11
|
675.78
|
633.65
|
322.90
|
298.45
|
204.18
|
204.78
|
83.45
|
66.17
|
||||||||||||
|
07
|
895.75
|
179.20
|
88.31
|
56.70
|
123.90
|
63.62
|
239.68
|
155.47
|
324.02
|
8,987.84
|
1,584.55
|
411.12
|
214.63
|
235.67
|
714.39
|
670.51
|
314.35
|
301.66
|
205.65
|
204.77
|
89.57
|
70.37
|
||||||||||||
|
08
|
788.64
|
158.01
|
78.04
|
50.11
|
109.62
|
56.34
|
211.86
|
137.36
|
285.97
|
8.259.67
|
1,451.16
|
376.39
|
194.46
|
214.68
|
650.16
|
608.74
|
316.39
|
304.12
|
207.85
|
195.10
|
84.67
|
66.78
|
||||||||||||
|
09
|
853.54
|
170.64
|
84.18
|
53.90
|
118.18
|
60.59
|
228.21
|
147.91
|
307.69
|
9,136.00
|
1,610.58
|
418.13
|
218.16
|
239.64
|
726.15
|
681.19
|
293.10
|
336.49
|
229.56
|
183.85
|
95.35
|
74.46
|
||||||||||||
|
10
|
856.36
|
171.67
|
84.76
|
54.54
|
119.01
|
61.30
|
230.45
|
149.70
|
311.95
|
11,151.24
|
1,9070.64
|
511.81
|
267.61
|
294.16
|
892.47
|
837.08
|
322.46
|
363.21
|
247.75
|
212.17
|
104.17
|
80.79
|
||||||||||||
|
11
|
1,112.08
|
221.47
|
108.96
|
69.38
|
152.49
|
77.84
|
294.30
|
190.48
|
369.50
|
12,145.44
|
2,131.38
|
551.08
|
286.49
|
314.89
|
952.30
|
894.10
|
455.34
|
433.96
|
299.72
|
273.91
|
125.66
|
103.75
|
||||||||||||
|
TABLE
3
|
||||||||||||||||||||||||||||||||||
|
General
+ Dental Rates: Effect from July 1, 05 - Dec 31, 05 Effect from
Jan 1, 06
- June 30, 06
|
Effect
from Jan 1, 06 - June 30, 06
|
|||||||||||||||||||||||||||||||||
|
TANF
|
SSI-NO
MEDICARE
|
SSI-B
|
SSI-AB
|
SSI-B
|
SSI-AB
|
|||||||||||||||||||||||||||||
|
Area
|
THMO+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
THMO+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
AGE
(65-)
|
AGE
(65+)
|
||||||||||||||||
|
Female
|
Male
|
Female
|
Male
|
|||||||||||||||||||||||||||||||
|
01
|
856.85
|
169.64
|
85.68
|
57.82
|
122.00
|
63.64
|
224.53
|
144.95
|
300.28
|
8,379.19
|
1,456.20
|
375.81
|
196.65
|
214.57
|
636.22
|
599.71
|
359.86
|
315.91
|
219.89
|
213.99
|
78.76
|
68.31
|
||||||||||||
|
02
|
856.85
|
169.64
|
85.68
|
57.82
|
122.00
|
63.64
|
224.53
|
144.95
|
300.28
|
8,379.19
|
1,456.20
|
375.81
|
196.65
|
214.57
|
636.22
|
599.71
|
359.86
|
315.91
|
219.89
|
213.99
|
78.76
|
68.31
|
||||||||||||
|
03
|
956.50
|
190.37
|
96.77
|
66.24
|
137.98
|
72.54
|
256.08
|
166.32
|
342.99
|
8,796.55
|
1.536.65
|
397.67
|
211.11
|
230.10
|
681.91
|
641.21
|
349.31
|
294.26
|
204.63
|
230.42
|
77.85
|
66.98
|
||||||||||||
|
04
|
877.98
|
175.55
|
88.68
|
60.09
|
125.99
|
66.14
|
237.63
|
154.89
|
319.33
|
8,571.85
|
1,495.60
|
386.54
|
203.61
|
222.05
|
662.50
|
622.74
|
334.80
|
296.81
|
206.45
|
208.31
|
79.52
|
68.27
|
||||||||||||
|
05
|
919.98
|
183.44
|
93.94
|
65.28
|
134.42
|
71.19
|
254.18
|
166.58
|
335.91
|
9,248.01
|
1,615.44
|
419.19
|
224.23
|
243.23
|
719.05
|
675.60
|
332.66
|
317.69
|
219.69
|
214.62
|
80.36
|
67.12
|
||||||||||||
|
06
|
839.89
|
168.13
|
85.94
|
59.43
|
122.74
|
65,05
|
231.04
|
151.11
|
308.75
|
8,536.48
|
1,494.30
|
387.15
|
206.75
|
225.03
|
668.52
|
628.34
|
320.73
|
288.82
|
200.03
|
202.61
|
73.82
|
62.02
|
||||||||||||
|
07
|
894.04
|
178.57
|
90.51
|
61.74
|
128.85
|
67.83
|
243.93
|
159.26
|
325.86
|
8,976.51
|
1,574.00
|
407.86
|
218.05
|
237.05
|
704.74
|
663.55
|
310.08
|
287.80
|
199.80
|
200.50
|
75.71
|
64.52
|
||||||||||||
|
08
|
785.52
|
156.86
|
79.85
|
54.89
|
113.87
|
60.13
|
214.88
|
140.36
|
286.42
|
8,247.93
|
1,440.22
|
372.40
|
197.06
|
215.24
|
641.03
|
602.12
|
309.05
|
292.56
|
202.94
|
187.76
|
73.11
|
61.87
|
||||||||||||
|
09
|
850.66
|
169.58
|
86.89
|
60.40
|
124.38
|
65.93
|
229.41
|
149.37
|
307.13
|
9,123.67
|
1,599.08
|
414.10
|
221.16
|
240.49
|
714.60
|
672.91
|
289.96
|
319.90
|
222.59
|
180.71
|
78.76
|
67.49
|
||||||||||||
|
10
|
854.17
|
170.87
|
87.29
|
60.43
|
124.73
|
66.19
|
231.56
|
150.99
|
311.65
|
11,134.67
|
1,955.21
|
506.08
|
271.11
|
294.81
|
876.08
|
825.36
|
317.65
|
344.02
|
239.70
|
207.36
|
84.98
|
72.74
|
||||||||||||
|
11
|
1,110.68
|
220.96
|
112.49
|
76.96
|
160.31
|
84.36
|
296.12
|
192.22
|
396.97
|
12,135.43
|
2,122.07
|
549.62
|
291.76
|
318.15
|
943.63
|
887.85
|
452.12
|
423.86
|
295.43
|
270.69
|
115.56
|
99.46
|
||||||||||||
AHCA
Contract No. FA521, Attachment VIII-A, Page 1 of 3
|
TABLE
4
|
||||||||||||||||||||||||||||||||||
|
General
+ Mental Health Rates: Effect from July 1, 05 - Dec 31,
05
|
Effect
from Jan 1, 06 - June 30, 06
|
|||||||||||||||||||||||||||||||||
|
TANF
|
SSI-NO
MEDICARE
|
SSI-B
|
SSI-AB
|
SSI-B
|
SSI-AB
|
|||||||||||||||||||||||||||||
|
Area
|
THMO
+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+)
|
AGE
(65-)
|
AGE
(65+)
|
||||||||||||||||
|
Female
|
Male
|
Female
|
Male
|
|||||||||||||||||||||||||||||||
|
01
|
856.86
|
169.64
|
84.58
|
64.23
|
128.66
|
71.38
|
227.66
|
148.26
|
303.38
|
8,379.21
|
1,456.20
|
384.40
|
263.28
|
284.40
|
732.06
|
631.82
|
367.49
|
331.54
|
236.11
|
221.62
|
94.39
|
84.53
|
||||||||||||
|
02
|
856.87
|
169.65
|
85.36
|
69.25
|
128.93
|
71.65
|
226.56
|
147.16
|
302.78
|
8,379.20
|
1,456.19
|
388.93
|
278.27
|
264.36
|
690.25
|
621.15
|
380.79
|
328.39
|
232.96
|
234.92
|
91.24
|
81.38
|
||||||||||||
|
03
|
956.51
|
190.37
|
94.52
|
67.12
|
136.49
|
72.38
|
254.10
|
164.92
|
342.33
|
8,796.56
|
1,536.63
|
401.17
|
243.67
|
248.87
|
702.91
|
649.30
|
356.54
|
299.65
|
211.35
|
237.65
|
83.24
|
73.70
|
||||||||||||
|
04
|
877.99
|
175.55
|
87.56
|
63.92
|
127.39
|
68.47
|
235.93
|
153.75
|
318.93
|
8,571.86
|
1,495.59
|
394.00
|
354.46
|
252.62
|
694.02
|
635.24
|
342.17
|
311.96
|
223.04
|
215.68
|
94.67
|
84.86
|
||||||||||||
|
05
|
919.98
|
183.43
|
91.15
|
64.87
|
131.62
|
69.93
|
245.33
|
159.49
|
331.03
|
9,248.02
|
1,615.41
|
420.86
|
252.27
|
258.55
|
735.80
|
681.19
|
332.63
|
321.24
|
227.10
|
214.59
|
83.91
|
74.53
|
||||||||||||
|
06
|
839.91
|
168.14
|
84.80
|
67.94
|
131.59
|
75.16
|
230.12
|
151.25
|
309.66
|
8,536.50
|
1,494.29
|
393.28
|
262.75
|
284.04
|
746.59
|
653.76
|
319.38
|
288.23
|
202.46
|
201.26
|
73.23
|
64.45
|
||||||||||||
|
07
|
894.05
|
178.57
|
89.54
|
68.64
|
132.32
|
72.39
|
240.41
|
156.74
|
324.62
|
8,976.52
|
1,573.98
|
414.04
|
264.97
|
264.82
|
733.66
|
674.72
|
312.78
|
269.22
|
210.25
|
203.20
|
84.13
|
74.97
|
||||||||||||
|
08
|
785.53
|
156.86
|
78.13
|
56.61
|
113.39
|
60.74
|
210.44
|
136.92
|
284.23
|
8,247.94
|
1,440.21
|
376.25
|
229.28
|
234.06
|
659.32
|
608.59
|
313.20
|
297.40
|
210.20
|
191.91
|
77.95
|
69.13
|
||||||||||||
|
09
|
850.66
|
169.57
|
84.45
|
61.30
|
122.72
|
65.71
|
227.14
|
147.75
|
306.35
|
9,123.68
|
1,599.07
|
417.49
|
252.14
|
258.39
|
734.15
|
680.34
|
292.37
|
328.87
|
233.20
|
183.12
|
87.73
|
78.10
|
||||||||||||
|
10
|
854.19
|
170.88
|
86.07
|
67.92
|
128.34
|
71.08
|
231.04
|
150.99
|
312.37
|
11,134.68
|
1,955.19
|
510.16
|
308.82
|
316.57
|
900.47
|
834.79
|
319.50
|
346.90
|
244.42
|
209.21
|
87.86
|
77.46
|
||||||||||||
|
11
|
1,110.68
|
220.95
|
110.34
|
81.84
|
161.42
|
87.06
|
295.39
|
192.02
|
397.48
|
12,135.44
|
2,122.05
|
554.29
|
334.42
|
342.80
|
971.48
|
898.72
|
457.65
|
426.65
|
300.08
|
276.22
|
118.35
|
104.11
|
||||||||||||
|
TABLE
5
|
||||||||||||||||||||||||||||||||||
|
General
+ Mental Health + Dental Rates: Effect from July 1, 05 - Dec 31,
05
|
Effect
from Jan 1, 06 - June 30, 06
|
|||||||||||||||||||||||||||||||||
|
TANF
|
SSI-NO
MEDICARE
|
SSI-B
|
SSI-AB
|
SSI-B
|
SSI-AB
|
|||||||||||||||||||||||||||||
|
Area
|
THMO+2MO
|
3MO-
11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
THMO+
2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
AGE
(65-)
|
AGE
(65+)
|
||||||||||||||||
|
Female
|
Male
|
Female
|
Male
|
|||||||||||||||||||||||||||||||
|
01
|
856.86
|
169.65
|
87.27
|
69.60
|
134.50
|
76.14
|
228.68
|
149.10
|
304.00
|
8,379.21
|
1,456.22
|
386.89
|
267.23
|
287.97
|
733.35
|
632.69
|
367.59
|
332.50
|
236.48
|
221.72
|
95.35
|
84.90
|
||||||||||||
|
02
|
856.87
|
169.66
|
88.05
|
74.62
|
134.77
|
76.41
|
227.58
|
148.00
|
303.40
|
8,379.20
|
1,456.21
|
391.42
|
282.22
|
267.93
|
691.54
|
622.02
|
380.89
|
329.35
|
233.33
|
235.05
|
92.20
|
81.75
|
||||||||||||
|
03
|
956.51
|
190.38
|
97.82
|
73.70
|
143.65
|
78.21
|
257.43
|
167.67
|
344.37
|
8,796.56
|
1,536.66
|
404.61
|
249.14
|
253.82
|
705.61
|
651.12
|
357.90
|
301.80
|
212.17
|
239.01
|
85.39
|
74.52
|
||||||||||||
|
04
|
877.99
|
175.56
|
89.87
|
68.54
|
132.41
|
72.56
|
239.16
|
156.42
|
320.90
|
8,571.86
|
1,495.61
|
396.55
|
258.50
|
256.28
|
696.70
|
637.05
|
343.38
|
314.28
|
223.92
|
216.89
|
96.99
|
85.74
|
||||||||||||
|
05
|
919.99
|
183.45
|
94.96
|
72.47
|
139.89
|
76.66
|
255.49
|
167.89
|
337.25
|
9,248.02
|
1,615.45
|
425.71
|
259.96
|
265.51
|
741.31
|
684.91
|
337.53
|
927.49
|
229.49
|
219.49
|
90.16
|
76.92
|
||||||||||||
|
06
|
839.91
|
168.15
|
87.92
|
74.13
|
138.34
|
80.65
|
236.22
|
156.29
|
313.39
|
8,536.50
|
1,494.32
|
396.83
|
268.38
|
289.13
|
751.60
|
657.14
|
321.97
|
293.12
|
204.33
|
203.85
|
78.12
|
66.32
|
||||||||||||
|
07
|
894.05
|
178.58
|
92.25
|
74.05
|
138.20
|
77.18
|
246.16
|
161.49
|
328.14
|
8,976.52
|
1,574.01
|
417.39
|
270.28
|
269.62
|
737.28
|
677.16
|
313.96
|
299.51
|
211.51
|
204.38
|
87.42
|
76.23
|
||||||||||||
|
08
|
785.53
|
156.87
|
80.86
|
62.06
|
119.32
|
65.58
|
216.18
|
141.66
|
287.75
|
8,247.94
|
1,440.23
|
379.11
|
233.83
|
238.17
|
663.94
|
611.71
|
315.66
|
301.33
|
211.71
|
194.37
|
81.88
|
70.64
|
||||||||||||
|
09
|
850.67
|
169.59
|
88.02
|
68.42
|
130.47
|
72.02
|
230.86
|
150.82
|
308.62
|
9,123.68
|
1,599.09
|
420.67
|
257.19
|
262.96
|
737.05
|
682.30
|
293.64
|
331.52
|
234.21
|
184.39
|
90.38
|
79.11
|
||||||||||||
|
10
|
854.19
|
170.89
|
89.25
|
74.28
|
135.25
|
76.71
|
234.07
|
153.50
|
314.22
|
11,134.68
|
1,955.22
|
514.10
|
315.08
|
322.23
|
903.47
|
836.82
|
320.96
|
349.89
|
245.57
|
210.67
|
91.85
|
78.61
|
||||||||||||
|
11
|
1,110.69
|
220.97
|
114.29
|
89.72
|
170.00
|
94.05
|
298.44
|
194.54
|
399.34
|
12,135.44
|
2,122.08
|
558.67
|
341.36
|
349.08
|
974.53
|
900.78
|
459.09
|
429.66
|
301.23
|
277.66
|
121.36
|
105.26
|
||||||||||||
|
TABLE
6
|
||||||||||||||||||||||||||||||||||
|
General
+ Mental Health + Transportation Rates: Effect from July 1, 05
- Dec 31,
05 Effect from Jan 1, 06 - June 30, 06
|
Effect
from Jan 1, 06 - June 30, 06
|
|||||||||||||||||||||||||||||||||
|
TANF
|
SSI-NO
MEDICARE
|
SSI-B
|
SSI-AB
|
SSI-B
|
SSI-AB
|
|||||||||||||||||||||||||||||
|
Area
|
THMO+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
THMO+
2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
AGE
(65-)
|
AGE
(65+)
|
||||||||||||||||
|
Female
|
Male
|
Female
|
Male
|
|||||||||||||||||||||||||||||||
|
01
|
859.91
|
170.77
|
85.48
|
64.88
|
130.31
|
72.41
|
230.32
|
149.96
|
306.37
|
8,391.88
|
1,468.03
|
319.80
|
265.39
|
288.24
|
746.90
|
642.34
|
381.78
|
348.03
|
242.95
|
235.91
|
110.88
|
91.37
|
||||||||||||
|
02
|
859.92
|
170.78
|
86.26
|
69.90
|
130.58
|
72.68
|
229.22
|
148.86
|
305.77
|
8,391.87
|
1,468.02
|
396.33
|
280.38
|
268.20
|
705.09
|
631.67
|
395.08
|
344.88
|
239.80
|
249.21
|
107.73
|
88.22
|
||||||||||||
|
03
|
959.99
|
191.67
|
95.55
|
67.87
|
138.37
|
73.55
|
257.15
|
166.87
|
345.75
|
8,811.88
|
1,550.93
|
410.11
|
246.22
|
253.50
|
720.86
|
662.01
|
367.18
|
323.05
|
221.05
|
248.29
|
106.64
|
83.40
|
||||||||||||
|
04
|
880.33
|
176.42
|
88.25
|
64.42
|
128.66
|
69.26
|
237.98
|
155.06
|
321.23
|
8,588.74
|
1,511.35
|
403.87
|
257.27
|
257.73
|
713.81
|
649.26
|
348.76
|
335.40
|
232.76
|
222.27
|
118.11
|
94.58
|
||||||||||||
|
05
|
922.11
|
184.22
|
91.78
|
65.33
|
132.77
|
70.65
|
247.20
|
160.68
|
333.12
|
9,257.24
|
1,624.01
|
426.24
|
253.80
|
261.34
|
746.60
|
688.84
|
338.19
|
335.39
|
232.97
|
220.15
|
98.06
|
80.40
|
||||||||||||
|
06
|
842.33
|
169.04
|
85.51
|
68.45
|
132.90
|
75.98
|
232.24
|
152.60
|
312.04
|
8,546.98
|
1,504.07
|
399.40
|
264.50
|
287.21
|
758.86
|
662.45
|
324.14
|
302.75
|
208.48
|
206.02
|
87.75
|
70.47
|
||||||||||||
|
07
|
895.76
|
179.21
|
90.05
|
69.01
|
133.25
|
72.97
|
241.91
|
157.70
|
326.30
|
8,987.85
|
1,584.56
|
420.65
|
266.86
|
268.24
|
746.93
|
684.12
|
318.23
|
313.37
|
217.36
|
208.65
|
101.28
|
82.08
|
||||||||||||
|
08
|
788.65
|
158.02
|
79.05
|
57.28
|
115.07
|
61.79
|
213.16
|
138.66
|
287.30
|
8,259.68
|
1,451.17
|
383.10
|
231.23
|
237.61
|
673.07
|
618.33
|
323.00
|
312.89
|
216.62
|
201.71
|
93.44
|
75.55
|
||||||||||||
|
09
|
853.55
|
170.65
|
85.31
|
61.92
|
124.27
|
66.68
|
229.66
|
149.36
|
309.18
|
9,136.01
|
1,610.59
|
424.70
|
254.19
|
262.11
|
748.60
|
690.58
|
296.78
|
348.11
|
241.18
|
187.53
|
106.97
|
86.08
|
||||||||||||
|
10
|
856.38
|
171.69
|
86.72
|
68.39
|
129.53
|
71.82
|
232.96
|
152.21
|
314.52
|
11,151.25
|
1,970.65
|
519.83
|
311.58
|
321.58
|
919.86
|
848.54
|
325.77
|
369.08
|
253.62
|
215.48
|
110.04
|
86.66
|
||||||||||||
|
11
|
1,112.09
|
221.48
|
110.76
|
82.14
|
162.18
|
87.53
|
296.62
|
192.80
|
398.87
|
12,145.45
|
2,131.39
|
560.13
|
336.09
|
345.82
|
983.20
|
907.03
|
462.31
|
439.76
|
305.52
|
280.88
|
131.46
|
109.55
|
||||||||||||
AHCA
Contract No. FA521, Attachment VIII-A, Page 2 of 3
|
TABLE
7
|
|||||||||||||||||||||||||||||||
|
General
+ Dental + Transportation Rates: Effect from July 1, 05 - Dec 31,
05
|
Effect
from Jan 1, 06 - June 30, 06
|
||||||||||||||||||||||||||||||
|
TANF
|
SSI-NO
MEDICARE
|
SSI-B
|
SSI-AB
|
SSI-B
|
SSI-AB
|
||||||||||||||||||||||||||
|
Area
|
THMO
+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+)
|
AGE
(65-)
|
AGE
(65+)
|
|||||||||||||
|
Female
|
Male
|
Female
|
Male
|
||||||||||||||||||||||||||||
|
01
|
859.90
|
170.77
|
86.58
|
58.47
|
123.65
|
64.67
|
227.19
|
146.65
|
303.27
|
8,391.86
|
1,468.03
|
383.21
|
198.76
|
218.41
|
653.06
|
610.23
|
374.15
|
332.40
|
226.73
|
228.28
|
95.25
|
75.15
|
|||||||||
|
02
|
859.90
|
170.77
|
86.58
|
58.47
|
123.65
|
64.67
|
227.19
|
146.65
|
303.27
|
8,391.86
|
1,468.03
|
383.21
|
198.76
|
218.41
|
653.06
|
610.23
|
374.15
|
332.40
|
226.73
|
228.28
|
95.25
|
75.15
|
|||||||||
|
03
|
959.98
|
191.67
|
97.80
|
66.99
|
139.86
|
73.71
|
259.13
|
168.27
|
346.41
|
8,811.87
|
1,550.95
|
406.61
|
213.66
|
234.73
|
699.86
|
653.92
|
359.95
|
317.66
|
214.33
|
241.06
|
101.25
|
76.68
|
|||||||||
|
04
|
880.32
|
176.42
|
86.37
|
60.59
|
127.26
|
66.93
|
239.68
|
156.20
|
321.63
|
8,588.73
|
1,511.36
|
396.41
|
206.42
|
227.16
|
682.29
|
636.76
|
341.39
|
320.25
|
216.17
|
214.90
|
102.96
|
77.99
|
|||||||||
|
05
|
922.11
|
184.23
|
94.57
|
65.74
|
135.57
|
71.91
|
256.05
|
167.77
|
338.00
|
9,257.23
|
1,624.04
|
424.57
|
225.76
|
246.02
|
729.85
|
683.25
|
338.22
|
331.84
|
225.56
|
220.18
|
94.51
|
72.99
|
|||||||||
|
06
|
842.31
|
169.03
|
86.65
|
59.94
|
124.05
|
65.87
|
233.16
|
152.46
|
311.13
|
8,546.96
|
1,504.08
|
393.27
|
208.50
|
228.20
|
680.79
|
637.03
|
325.49
|
303.40
|
206.05
|
207.37
|
88.34
|
68.04
|
|||||||||
|
07
|
895.75
|
179.21
|
91.02
|
62.11
|
129.78
|
68.41
|
245.43
|
160.22
|
327.54
|
8,987.84
|
1,584.58
|
414.47
|
219.94
|
240.47
|
718.01
|
672.95
|
315.53
|
304.95
|
206.91
|
205.95
|
92.86
|
71.63
|
|||||||||
|
08
|
788.64
|
158.02
|
80.77
|
55.56
|
115.55
|
61.18
|
217.60
|
142.10
|
289.49
|
8,259.67
|
1,451.18
|
379.25
|
199.01
|
218.79
|
654.78
|
611.86
|
318.85
|
308.05
|
209.36
|
197.56
|
88.60
|
68.29
|
|||||||||
|
09
|
853.55
|
170.66
|
87.75
|
61.02
|
125.93
|
66.90
|
231.93
|
150.98
|
309.96
|
9,136.00
|
1,610.60
|
421.31
|
223.21
|
244.21
|
729.05
|
683.15
|
294.37
|
339.14
|
230.57
|
185.12
|
98.00
|
75.47
|
|||||||||
|
10
|
856.36
|
171.68
|
87.94
|
60.90
|
125.92
|
66.93
|
233.48
|
152.21
|
313.80
|
11,151.24
|
1,970.67
|
515.75
|
273.87
|
299.82
|
895.47
|
839.11
|
323.92
|
336.20
|
248.90
|
213.63
|
107.18
|
81.94
|
|||||||||
|
11
|
1,112.09
|
221.49
|
112.91
|
77.26
|
161.07
|
84.83
|
297.35
|
193.00
|
398.36
|
12,145.44
|
2,131.41
|
555.46
|
293.43
|
321.17
|
955.35
|
896.16
|
456.78
|
436.97
|
300.87
|
275.35
|
128.67
|
104.90
|
|||||||||
|
TABLE
8
|
|||||||||||||||||||||||||||||||
|
General
+ Mental Health + Transportation + Dental Rates: Effect from July
1, 05 -
Dec 31, 05
|
Effect
from Jan 1, 06 - June 30, 06
|
||||||||||||||||||||||||||||||
|
TANF
|
SSI-NO
MEDICARE
|
SSI-B
|
SSI-AB
|
SSI-B
|
SSI-AB
|
||||||||||||||||||||||||||
|
Area
|
THMO+2MO
|
3MO-
11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
THMO+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
AGE
(65-)
|
AGE
(65+)
|
|||||||||||||
|
Female
|
Male
|
Female
|
Male
|
||||||||||||||||||||||||||||
|
01
|
859.91
|
170.78
|
88.17
|
70.25
|
136.15
|
77.17
|
231.34
|
150.80
|
306.99
|
8,391.88
|
1,468.05
|
394.29
|
269.34
|
291.81
|
748.19
|
643.21
|
381.88
|
348.99
|
243.32
|
236.01
|
111.84
|
91.74
|
|||||||||
|
02
|
859.91
|
170.79
|
88.95
|
75.27
|
136.42
|
77.44
|
230.24
|
149.70
|
306.39
|
8,391.87
|
1,
468.04
|
398.82
|
284.33
|
271.77
|
706.38
|
632.54
|
395.18
|
345.84
|
240.17
|
249.31
|
108.69
|
88.59
|
|||||||||
|
03
|
959.99
|
191.68
|
98.85
|
74.45
|
145.53
|
79.38
|
260.48
|
169.62
|
347.79
|
8,811.88
|
1,550.96
|
413.55
|
251.69
|
258.45
|
723.56
|
663.83
|
368.54
|
325.20
|
221.87
|
249.65
|
108.79
|
84.22
|
|||||||||
|
04
|
880.33
|
176.43
|
90.56
|
69.04
|
133.68
|
73.35
|
241.21
|
157.73
|
323.20
|
8,588.74
|
1,511.37
|
406.42
|
261.31
|
261.39
|
716.49
|
651.07
|
349.97
|
337.72
|
233.64
|
223.48
|
120.43
|
95.46
|
|||||||||
|
05
|
922.12
|
184.24
|
95.59
|
72.93
|
141.04
|
77.38
|
257.36
|
169.08
|
339.34
|
9,257.24
|
1,624.05
|
431.09
|
261.49
|
268.30
|
752.11
|
692.56
|
343.09
|
341.64
|
235.36
|
225.05
|
104.31
|
82.79
|
|||||||||
|
06
|
842.33
|
169.05
|
88.63
|
74.64
|
139.65
|
81.47
|
238.34
|
157.64
|
315.77
|
8,564.98
|
1,504.10
|
402.95
|
270.13
|
292.30
|
763.87
|
665.83
|
326.73
|
307.64
|
210.35
|
208.61
|
92.64
|
72.34
|
|||||||||
|
07
|
895.76
|
179.22
|
92.76
|
74.42
|
139.13
|
77.78
|
247.66
|
162.45
|
329.82
|
8,987.85
|
1,584.59
|
424.00
|
272.17
|
273.04
|
750.55
|
686.56
|
319.41
|
316.66
|
218.62
|
209.83
|
104.57
|
83.34
|
|||||||||
|
08
|
788.65
|
158.03
|
81.78
|
62.73
|
121.00
|
66.63
|
218.90
|
134.40
|
290.82
|
8,259.68
|
1,451.19
|
385.96
|
235.78
|
241.72
|
677.69
|
621.45
|
325.46
|
316.82
|
218.13
|
204.17
|
97.37
|
77.06
|
|||||||||
|
09
|
853.56
|
170.67
|
88.88
|
69.04
|
132.02
|
72.99
|
233.38
|
152.43
|
311.45
|
9,136.01
|
1,610.61
|
427.88
|
259.24
|
266.68
|
751.50
|
692.54
|
298.05
|
350.76
|
242.19
|
188.80
|
109.62
|
87.09
|
|||||||||
|
10
|
856.38
|
171.70
|
89.90
|
74.75
|
136.44
|
77.45
|
235.99
|
154.72
|
316.37
|
11,151.25
|
1,970.68
|
523.77
|
317.84
|
327.24
|
922.86
|
850.57
|
327.23
|
372.07
|
254.77
|
216.94
|
113.03
|
87.81
|
|||||||||
|
11
|
1,112.10
|
221.50
|
114.71
|
90.02
|
170.76
|
94.52
|
299.67
|
195.32
|
400.73
|
12,145.45
|
2,131.42
|
564.51
|
343.03
|
352.10
|
986.25
|
909.09
|
463.75
|
442.77
|
306.67
|
282.32
|
134.47
|
110.70
|
|||||||||
AHCA
Contract No. FA521, Attachment VIII-A, Page 3 of 3
