AHCA CONTRACT NO. FA522 AMENDMENT NO. 10
Exhibit
10.2
AHCA
CONTRACT NO. FA522 AMENDMENT NO. 10
THIS
CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE
ADMINISTRATION, hereinafter referred to as the "Agency" and WELL CARE HMO,
INC.
D/B/A STAYWELL HEALTH PLAN OF FLORIDA, 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
$665,594,194.00
(an
increase of $1,836,972.00), 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
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Not
Covered
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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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___________
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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
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AHCA
Contract No. FA522, Amendment No. 10, Page 1 of 29
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
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.
AHCA
Contract No. FA522, Amendment No. 10, Page 2 of 29
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;
AHCA
Contract No. FA522, Amendment No. 10, Page 3 of 29
(i) Mass
transit transportation (Enrollee has pass); and
(j) Mass
transit transportation (sent pass to Enrollee).
3. 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:
(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. FA522, Amendment No. 10, Page 4 of 29
(h) Mass
transit transportation;
(i) Mass
transit transportation (Enrollee has pass); and
(j) Mass
transit transportation (sent pass to Enrollee).
5. 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.
6. A
listing
of the total number of authorized trips, by facility type, for each month
and
level of service.
7. A
listing
of the total number of Transportation Service claims and payments, by facility
type, for each month and level of service.
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.
AHCA
Contract No. FA522, Amendment No. 10, Page 5 of 29
(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.1
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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/
The
Plan shall indemnify and hold harmless the local, State, and federal governments
and their entities and
_________________________
3As
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.
'
Including, but not limited to, 41-2, F.A.C., 2004.
7
See
section 768.28(5), F.S., 2004.
AHCA
Contract No. FA522, Amendment No. 10, Page 6 of 29
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.
AHCA
Contract No. FA522, Amendment No. 10, Page 7 of 29
(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. FA522, Amendment No. 10, Page 8 of 29
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;
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(m)
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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;
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(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 151
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. FA522, Amendment No. 10, Page 9 of 29
(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:
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(a)
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Adoption
of policies and procedures that, at a minimum, establish standard
set
forth in this Section; and
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___________________________
3
For
reference, see 14-90, F.A.C., 2004.
AHCA
Contract No. FA522, Amendment No. 10, Page 10 of 29
Medicaid
HMO Contract
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(b)
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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.
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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.
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5.
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Shall
establish criteria and procedures for selection, qualification,
and
training of all drivers. The criteria shall include, at a minimum,
the
following:
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(a) Driver
qualifications and background checks with minimum hiring
standards;
AHCA
Contract No. FA522, Amendment No. 10, Page 11 of 29
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
AHCA
Contract No. FA522, Amendment No. 10, Page 12 of 29
Medicaid
HMO Contract
(3)
Application and compliance with applicable federal and State rules and
regulations.''
(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.14
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6.
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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:
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(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 10.8.14.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.
13
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. FA522, Amendment No. 10, Page 13 of 29
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.
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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:
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|
(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
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|
(b)
|
Injuries
requiring immediate medical attention away from the scene for two
(2) or
more individuals;
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|
(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
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15
See
section 641.55(6), F.S., 2004.
AHCA
Contract No. FA522, Amendment No. 10, Page 14 of 29
Medicaid
HMO Contract
Transportation
Provider shall have the discretion to investigate events resulting in property
damage totaling less than $1,000;
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(d)
|
Evacuation
of a vehicle due where there is imminent danger to passengers on
the
vehicle, excluding evacuations due to vehicle operation
issues;
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(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
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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
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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.
AHCA
Contract No. FA522, Amendment No. 10, Page 15 of 29
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. FA522, Amendment No. 10, Page 16 of 29
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. FA522, Amendment No. 10, Page 17 of 29
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. FA522, Amendment No. 10, Page 18 of 29
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 services2 .
AHCA
Contract No. FA522, Amendment No. 10, Page 19 of 29
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. FA522, Amendment No. 10, Page 20 of 29
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. FA522, Amendment No. 10, Page 21 of 29
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 of FMVSS 209, "Seat Belt
Assemblies"19
and
FMVSS 210, "Seat Belt Assembly Anchorages."20
19
See 49
C.F.R. 571.209,2004.
20
See 49
C.F.R. 571.210,2004.
AHCA
Contract No. FA522, Amendment No. 10, Page 22 of 29
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 31/2 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. FA522, Amendment No. 10, Page 23 of 29
Medicaid
HMD 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. FA522, Amendment No. 10, Page 24 of 29
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. FA522, Amendment No. 10, Page 25 of 29
Medicaid
HMO 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:
(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
(3) The
operating financial statistics for the previous fiscal year.
22
As
defined in the Transportation Handbook.
AHCA
Contract No. FA522, Amendment No. 10, Page 26 of 29
Medicaid
HMO Contract
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
9 Counties: Palm Beach
County Provider
Number
Palm
Beach 015016910
Area
10 Counties: Broward
County Provider
Number
Broward 015016900
B. General
Capitation Rates plus Mental Health Rates (Attachment VIII-A, Table
4):
Area
3 Counties: Hernando
County Provider
Number
Hemando 015016901
Area
5 Counties: Pasco, Pinellas
County Provider
Number
Pasco 015016903
Pinellas 015016904
Area
6 Counties: Manatee, Polk
County Provider
Number
Manatee 015016912
Polk 015016905
AHCA
Xxxxxxxx Xx. XX000, Xxxxxxxxx Xx. 00, Page 27 of 29
Medicaid
HMO Contract
Area
7 Counties: Brevard
County Provider
Number
Brevard
015016913
Area
8 Counties:
Sarasota, Xxx
County Provider
Number
Sarasota 015016914
Xxx 015016911
Area
11 Counties: Dade
County Provider
Number
Dade 015016909
C. General
Capitation Rates plus Mental Health Rates and Transportation Rates (Attachment
VIII-A, Table 6):
Area
6 Counties: Hillsborough
County Provider
Number
Hillsborough 015016902
Area
7 Counties: Orange, Osceola, Seminole
County Provider
Number
Orange 015016906
Osceola 015016907
Seminole 015016908
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 $665,594,194.00 (an increase of $1,836,972.00),
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.
AHCA
Contract No. FA522, Amendment No. 10, Page 28 of 29
Medicaid
HMO 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.
IN
WITNESS WHEREOF,
the
Parties have caused this 32 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. FA522, Amendment No. 10, Page 29 of 29
ATTACHMENT
Vlll-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
|
598.64
|
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
|
538.84
|
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
|
1,440.20
|
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
|
316.16
|
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
|
214.84
|
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
|
226.18
|
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
|
1,970.64
|
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
|
919.96
|
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
|
78.73
|
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
|
423.36
|
295.43
|
270.69
|
115.56
|
99.46
|
||||||||||||
AHCA
Contract No. FA522, Attachment Vlll-A, Page 1 of 3
|
TABLE
4
|
||||||||||||||||||||||||||||||||||
|
General
+ Mental Health Rates Effect from July 1, 05 - Dec 31,
05
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
|
169.64
|
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
|
254.46
|
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
|
296.22
|
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
|
84.85
|
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 Rates + Dental Services: 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
|
235.02
|
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
|
327.49
|
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
|
76.32
|
||||||||||||
|
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
|
90.85
|
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
194.54
|
||||||||||||||||||||||||||||||||||
|
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
|
859.91
|
170.77
|
85.48
|
64.88
|
130.31
|
72.41
|
230.32
|
149.96
|
306.37
|
8,391.88
|
1,468.03
|
391.80
|
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
|
942.33
|
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
|
96.44
|
75.55
|
||||||||||||
|
09
|
853.55
|
170.65
|
85.31
|
61.92
|
124.27
|
66.68
|
229.66
|
149.36
|
309.18
|
9,136.01
|
1,610.59424.70
|
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. FA522, Attachment VIII-A, Page 2 of 3
|
TABLE
7
|
|||||||||||||||||||||||||||||||
|
General
+ Dental + Transportation Rates: Effect from July 1, 05 - Dec 31,
05
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
|
859.91
|
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
|
89.37
|
60.59
|
127.26
|
66.93
|
239.68
|
163.20
|
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
|
303.34
|
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
|
309.93
|
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
|
223.48
|
152.21
|
313.80
|
11,151.24
|
1,970.67
|
515.75
|
273.87
|
299.82
|
895.47
|
839.11
|
323.92
|
366.20
|
248.90
|
213.63
|
107.16
|
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
|
859.92
|
170.79
|
88.95
|
75.27
|
136.42
|
77.44
|
230.24
|
149.70
|
306.39
|
8,391.87
|
1,468.04
|
398.83
|
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
|
120.13
|
95.46
|
|||||||||
|
05
|
922.12
|
184.24
|
95.59
|
72.93
|
141.04
|
77.38
|
257.36
|
169.08
|
339.34
|
9,257.25
|
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
|
8,546.98
|
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
|
77.76
|
274.66
|
162.45
|
329.82
|
8,987.85
|
1,584.59
|
424.00
|
272.17
|
273.04
|
750.55
|
626.56
|
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
|
143.10
|
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
|
319.37
|
11,151.25
|
1,970.68
|
523.77
|
317.84
|
327.24
|
922.86
|
850.57
|
327.23
|
372.23
|
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. FA522, Attachment VIII-A, Page 3 of 3
1
