SEVENTH AMENDMENT TO MANAGED CARE ALLIANCE AGREEMENT

Exhibit 10.1

SEVENTH AMENDMENT TO

MANAGED CARE ALLIANCE AGREEMENT

THIS AMENDMENT (the “Amendment”) is entered into this 25^th day of January, 2007 by and between CIGNA Health Corporation, for and on behalf of its CIGNA Affiliates (individually and collectively, “CIGNA”) and Gentiva CareCentrix, Inc. (“MCA”).

WITNESSETH

WHEREAS, CIGNA and MCA entered into a Managed Care Alliance Agreement which became effective January 1, 2004, as amended from time to time, (the “Agreement”) whereby MCA agreed to provide or arrange for the provision of certain home health care services to Participants, as that term is defined in the Agreement;

WHEREAS, the parties wish to amend the Agreement to change the capitation and fee for service rates effective February 1, 2007.

NOW THEREFORE, CIGNA and MCA agree to amend the Agreement as follows:

1. This Amendment shall be effective on February 1, 2007.

2. The definition for the term Home Setting is replaced in its entirety with the following:

Home Setting means the Participant’s primary place of residence or the residence (including Skilled Nursing Facility) where the Participant is receiving Home Care Services.

3. Exhibit A HMO Program Attachment – Fee for Service Reimbursement For Other Services is hereby deleted and replaced with a new Exhibit A HMO Program Attachment – Fee for Service Reimbursement For Other Services attached hereto.

4. Exhibit A PPO & Indemnity Program Attachment – Fee for Service Reimbursement For Other Services is hereby deleted and replaced with a new Exhibit A PPO & Indemnity Program Attachment Reimbursement For Other Services attached hereto.

5. Exhibit A Gatekeeper Program Attachment – Fee for Service Reimbursement For Other Services is hereby deleted and replaced with a new Exhibit A Gatekeeper Program Attachment – Fee for Service Reimbursement For Other Services attached hereto.

6. Exhibit A HMO Program Attachment – Capitation Schedule of Capitation Rates is hereby deleted and replaced with a new Exhibit A HMO Program Attachment – Capitation Schedule of Capitation Rates attached hereto.

7. Exhibit A Gatekeeper Program Attachment – Capitation Schedule of Capitation Rates is hereby deleted and replaced with a new Exhibit A Gatekeeper Program Attachment – Capitation Schedule of Capitation Rates attached hereto.

8. To the extent that the provisions in the Agreement, including any prior amendments, conflict with the terms of this Amendment (including the exhibits and schedules hereto), the terms in this Amendment shall supersede and control. All other terms and conditions of the Agreement, including the Program Attachments and the Exhibits attached thereto, shall remain the same and in full force and effect. Capitalized terms not defined herein but defined in the Agreement shall have the same meaning as defined in the Agreement.

IN WITNESS WHEREOF, CIGNA and MCA have caused their duly authorized representatives to execute this Amendment as of the date first written above.

CIGNA HEALTH CORPORATION
By:						/s/ Xxxxx X. Xxxxxxx
Its:						Vice President, Network Performance Management
Dated:						2/1/07
GENTIVA CARECENTRIX, INC.
By:						/s/ Xxxxxx Xxxxxxx
Its:						Senior Vice President
Dated:						1/25/07

EXHIBIT A

HMO PROGRAM ATTACHMENT - FEE FOR SERVICE

REIMBURSEMENT FOR OTHER SERVICES

RATE AREA DESIGNATIONS:

STATE		RATE AREA		RATE DESIGNATION
Alabama		*		*
Alaska		*		*
Arizona		*		*
Arkansas		*		*
California		*		*
Colorado		*		*
Connecticut		*		*
Delaware		*		*
District of Columbia		*		*
Florida		*		*
Georgia		*		*
Hawaii		*		*
Idaho		*		*
Illinois		*		*
Indiana		*		*
Iowa		*		*
Kansas		*		*
Kentucky		*		*
Louisiana		*		*
Maine		*		*
Maryland		*		*
Massachusetts		*		*
Michigan		*		*
Minnesota		*		*
Mississippi		*		*
Missouri		*		*
Montana		*		*
Nebraska		*		*
Nevada		*		*
New Hampshire		*		*
New Jersey		*		*
New Mexico		*		*
New York		*		*
North Carolina		*		*
North Dakota		*		*
Ohio		*		*
Oklahoma		*		*
Oregon		*		*
Pennsylvania		*		*
Rhode Island		*		*
South Carolina		*		*
South Dakota		*		*
Tennessee		*		*
Texas		*		*
Utah		*		*
Vermont		*		*
Virginia		*		*
Washington		*		*
West Virginia		*		*
Wisconsin		*		*
Wyoming		*		*

* Confidential Treatment Requested.

TRADITIONAL HOME HEALTH FEE-FOR-SERVICE RATE

HMO RATES EFFECTIVE FEBRUARY 1, 2007 - JANUARY 31. 2008

The following Traditional Home Health Services have both Visit and Hourly rates.

Notes 1, 2, 3, 4, 5 and 6 apply

Area 1

Area 2

Area 3

Visit

Hour

Visit

Hour

Visit

Hour

CERTIFIED NURSES AIDE

*

*

*

*

*

*

HOME HEALTH AIDE

*

*

*

*

*

*

LVN/LPN

*

*

*

*

*

*

LVN/LPN - HIGH TECH

*

*

*

*

*

*

PEDIATRIC HIGH TECH LVN/LPN

*

*

*

*

*

*

PEDIATRIC HIGH TECH RN

*

*

*

*

*

*

PEDIATRIC LVN/LPN

*

*

*

*

*

*

PEDIATRIC RN

*

*

*

*

*

*

RN

*

*

*

*

*

*

RN HIGH TECH INFUSION

*

*

*

*

*

*

RN HIGH TECH OTHER

*

*

*

*

*

*

The following Traditional Home Health Services have Visit only rates.

Notes 1, 3, 4, 5, 7 and 8 apply

Area 1

Area 2

Area 3

Visit

Hour

Visit

Hour

Visit

Hour

DIABETIC NURSE

*

N/A

*

N/A

*

N/A

DIETITIAN

*

N/A

*

N/A

*

N/A

ENTEROSTOMAL THERAPIST

*

N/A

*

N/A

*

N/A

MATERNAL CHILD HEALTH

*

N/A

*

N/A

*

N/A

MEDICAL SOCIAL WORKER

*

N/A

*

N/A

*

N/A

OCCUPATIONAL THERAPIST

*

N/A

*

N/A

*

N/A

OCCUPATIONAL THERAPIST ASSISTANT

*

N/A

*

N/A

*

N/A

PHLEBOTOMIST

*

N/A

*

N/A

*

N/A

PHOTOTHERAPY PACKAGE SERVICE

*

N/A

*

N/A

*

N/A

PHYSICAL THERAPIST

*

N/A

*

N/A

*

N/A

PHYSICAL THERAPIST ASSISTANT

*

N/A

*

N/A

*

N/A

PSYCHIATRIC NURSE

*

N/A

*

N/A

*

N/A

REHABILITATION NURSE

*

N/A

*

N/A

*

N/A

RESPIRATORY THERAPIST

*

N/A

*

N/A

*

N/A

RN ASSESSMENT, INITIAL

*

N/A

*

N/A

*

N/A

RN SKILLED NURSING VISIT-EXTENSIVE

*

N/A

*

N/A

*

N/A

SPEECH THERAPIST

*

N/A

*

N/A

*

N/A

The following Traditional Home Health Service has Hourly only rates.

Notes 3, 4 and 5 apply

Area 1

Area 2

Area 3

Visit

Hour

Visit

Hour

Visit

Hour

HOMEMAKER

N/A

*

N/A

*

N/A

*

The following Traditional Home Health Service is priced on a Per Diem basis.

Notes 3, 4 and 5 apply

Xxxx 0

Xxxx 0

Xxxx 0

Per Diem

Per Diem

Per Diem

COMPANION/LIVE IN

*

*

*

NOTES:

1. Visits are defined as two (2) hours or less in duration (EXCEPT MATERNAL CHILD HEALTH VISITS, which have no maximum duration).

2. Hourly rate for visits exceeding two (2) hours in duration, starting with hour 3.

3. CIGNA does not reimburse for travel time, weekend, holiday or evening differentials.

4. Above prices have no exclusions.

5. All services not listed above will be billed at * until rates are mutually established and become part of the fee schedule.

6. RN High Tech Infusion visit and hourly utilization/costs to be reported with HIT.

7. Respiratory Therapist visit utilization/costs to be reported with HME/RT.

8. Diabetic Nurse, Psychiatric Nurse and Rehabilitation Nurse assume specialty certification which is not readily available in the home care environment. Use requires special coordination.

9. There shall a ceiling for annual inflation increases in Home Health Services of *.

* Confidential Treatment Requested.

HOME INFUSION RATES

HMO RATES EFFECTIVE FEBRUARY 1, 2007 - JANUARY 31. 2008

The following Home Infusion Therapy service rates EXCLUDE drugs. Drugs are priced as a percentage discount off AWP (if applicable), and there is NO price difference between primary and multiple therapies
		Primary or Multiple Therapy Per Diem		Primary or Multiple Therapy Dispensing Fee		Primary or Multiple Therapy Drug Discount off AWP
Ancillary Drugs				*		*
Biological Response Modifiers				*		*
Cardiac (Inotropic) Therapy		*				*
Chelation Therapy		*				*
Chemotherapy		*				*
Enteral Therapy		*				*
Enzyme Therapy		*				*
Growth Hormone				*		*
IV Immune Globulin		*				*
Other Injectable Therapies				*		*
Other Infusion Therapies		*				*
Pain Management Therapy		*				*
Steroid Therapy		*				*
Thrombolytic (Anticoagulation) Therapy		*				*
Synagis				*		*
Remodulin Therapy		*				*
The following Home Infusion Therapy service rates EXCLUDE drugs. Drugs are priced as a percentage discount off AWP, and there IS a price difference between primary and multiple anti-infective therapies
		Per Diem				Drug Discount Off AWP
Anti-Infectives - Primary Anti-Infective		*				*
Anti-Infectives - Multiple Anti-Infective		*				*
The following Home Infusion Therapy service rate EXCLUDES drugs. Drugs are priced per vial, and there is NO price difference between primary and multiple anti-infective therapies
		Primary or Multiple Therapy Per Diem				Cost of Drug
Flolan Therapy		*
Flolan 0.5 mg vial						*
Flolan 1.5 mg vial						*
Flolan diluent vial						*
The following Home Infusion Therapy service rates INCLUDE drugs, and there is NO price difference between primary and multiple therapies
		Primary or Multiple Therapy Per Diem
Enteral Therapy		*
Hydration Therapy		*
Total Parenteral Nutrition		*
SCHEDULE 2A, PAGE 2: HOME INFUSION HMO/FLEX FEE-FOR-SERVICE THERAPY RATES
NOTES:
1.      Per Diems EXCLUDING drugs include all costs related to the therapy except the cost of drugs, including but not limited to facility overhead, supplies, delivery, professional labor including compounding and monitoring, all nursing required, maintenance of specialized catheters, equipment/patient supplies, disposables, pumps, general and administrative expenses, etc. 2.      Per Diems INCLUDING drugs include ALL costs - including but not limited to cost of drugs, facility overhead, supplies, delivery, professional labor including compounding and monitoring, all nursing required, maintenance of specialized catheters, equipment/patient supplies, disposables, pumps, general and administrative expenses, etc. 3.      "DISPENSING FEE" is defined as per each time the drug is dispensed by the home infusion provider. 4.      "PER DIEM" costs are the same for primary or multiple treatments for all drug categories, except ANTI-INFECTIVES. 5.      The per diem rate shall only be charged for those days the Participant receives medication. 6.      For home infusion pharmaceuticals not listed on fee schedule, * will apply. 7.      There shall be a ceiling for annual inflation increases in Home Infusion Therapy of *. 8.      There shall be a ceiling for annual inflation increases in Medications under CAP of *. 9.      All Medications are subject to MAC pricing, where applicable.
The following are for the stated item ONLY. Unless otherwise noted, nursing, supplies, etc. are NOT included.
Blood Transfusion per Unit (Tubing, Filters)						*
Catheter Care Per Diem						*
Midline Insertion (Catheter & Supplies)						*
PICC Line Insertion (Catheter & Supplies)						*
Blood Product						*
SCHEDULE 2A, PAGE 3: HOME INFUSION THERAPY HMO/FLEX FEE-FOR-SERVICE RATES
Factor Concentrates
				Vial price		Unit Price
Factor VII
Novoseven 1200MCG Vial				*
Novoseven 4800MCG Vial				*
Novoseven in 1200MCG or 4800MCG QTY						*
Factor VIII (Recombinant)
Recombinate						*
Kogenate or Helixate						*
Bioclate						*
Helixate FS						*
Kogenate FS						*
Refacto						*
Advate						*
Factor VIII (Monoclonal)
Hemofil-M or A. R. C. Method M						*
Monoclate P						*
Monarc-M						*
Factor VIII (Other)
Koate						*
Humate						*
Alphanate SDHT						*
Factor IX (Recombinant)
BeneFix						*
Factor IX (Monoclonal/High Purity)
Mononine						*
Alphanine						*
Factor IX (Other)
Konyne - 80						*
Proplex T						*
Bebulin						*
Profilnine SD						*
Anti-Inhibitor Complex
Autoplex-T						*
Feiba-VH						*
Hyate-C						*
HEMOSTATIC AGENTS
DDAVP - 10ml vial						*
Stimate - 2.5xx xxxx						*
Above rates include all necessary ancillary supplies and waste disposal unit; 24-hour on-call clinical support; home infusion monitoring system; product delivery nationwide; patient training, education, and evaluation

* Confidential Treatment Requested.

DME / HME RESPIRATORY RATES:

HMO RATES EFFECTIVE FEBRUARY 1, 2006 - JANUARY 31. 2009

CAT

TYPE

HCPCS CODE

CHC CODE

CareCentrix Code

DESCRIPTION

PURCHASE PRICE

RENTAL PRICE

DAILY PRICE

HME

A4230

A4230

Infusion set for external insulin pump, non-needle cannula Type

*

HME

A4231

A4231

Infusion set for external insulin pump, needle type

*

HME

A4232

A4232

Reservoir/Syringe with needle for external insulin pump

*

HME

A4632

A4632

Replacement battery for external insulin pump, any type, each

*

HME

A5119

A5119

Skin Barrier, wipes, box per 50

*

HME

A6257

A6257

Transparent film/dressing

*

HME

INSULPP

E0784

E0784

2158

PUMP (E0784), EXT AMBULATORY INFUSION, MINIMED, INSULIN

*

HME

INSULPP

E0784

E0784

6771

PUMP (E0784), INSULIN EXT INFUSION DISETRONICS OR OTHER

*

HME

INSULPP

E0784

E0784

7704

PUMP, EXT INFUSION, XXXX DIABECARE, INSULIN (E0784)

*

HME

INSULPP

E0784

E0784

7731

PUMP, EXT INFUSION, ANIMAS, INSULIN (E0784)

*

HME

INSULPP

E0784

E0784

7773

PUMP (E0784), EXT AMBULATORY INFUSION, DELTEC, INSULIN

*

HME

OTHER

E0746

DM570

2109

ELECTROMYOGRAPHY (EMG) (E0746), BIOFEEDBACK DEVICE

*

*

HME

OTHER

E0935

E0935

2125

PASSIVE MOTION (E0935) EXERCISE DEVICE

*

HME

OTHER

E0935

E0935

2857

PASSIVE MOTION (E0935) EXERCISE DEVICE, HAND

*

HME

OTHER

E0935

E0935

2858

PASSIVE MOTION (E0935) EXERCISE DEVICE, SHOULDER

*

HME

OTHER

E0935

E0935

2859

PASSIVE MOTION (E0935) EXERCISE DEVICE, ANKLE

*

HME

OTHER

E0935

E0935

2860

PASSIVE MOTION (E0935) EXERCISE DEVICE, ELBOW

*

HME

OTHER

E0935

E0935

2861

PASSIVE MOTION (E0935) EXERCISE DEVICE, WRIST

*

HME

OTHER

E1300

DM570

2062

WHIRLPOOL (E1300), PORT (OVERTUB TYPE)

*

HME

OTHER

E1310

DM570

2061

WHIRLPOOL (E1399), NON-PORT (BUILT-IN TYPE)

*

HME

OTHER

E1399

E1399

2327

DURABLE MEDICAL EQUIP (E1399), MISCELLANEOUS

*

HME

STIM_BO

E0747

DM570

6875

STIMULATOR, OSTEOGENIC, ULTRASOUND

*

HME

STIM_BO

E0747

DM570

8386

STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, EBI

*

HME

STIM_BO

E0747

DM570

8387

STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, ORTHOFIX

*

HME

STIM_BO

E0747

DM570

8388

STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, ORTHOLOGIC

*

HME

STIM_BO

E0748

DM570

2124

STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL APPLICATIONS

*

HME

STIM_BO

E0748

DM570

8389

STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, EBI

*

HME

STIM_BO

E0748

DM570

8390

STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, ORTHOFIX

*

HME

STIM_BO

E0748

DM570

8391

STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, ORTHOLOGIC

*

HME

WDSUCT

K0538

DM570

6873

WOUND SUCTION DEVICE (K0538)

*

HME

WDSUCT

K0539

DM570

7914

DRESSING SET, FOR WOUND SUCTION DEVICE (K0539)

*

HME

WDSUCT

K0540

DM570

7915

CANISTER SET, FOR WOUND SUCTION DEVICE (K0540)

*

The following may be charged under extraordinary circumstances:

HME

SUP

E1399

E1399

4551

LABOR/SERVICE/SHIPPING CHARGES

*

HME

SUP

E1399

E1399

2731

SHIPPING AND HANDLING FEES

*

The following may be charged if over and above routine on rental equipment:

RESP

EQUIP

E1350

E1350

2382

REPAIR OR NON-ROUTINE (E1350) SERVICE REQUIRING SKILL OF A TECH

*

HME

SUP

E1399

E1399

4552

MISCELLANEOUS SUPPLIES

*

*

NOTES:

1. Whether rental or purchase, rates include all shipping, labor and set-up.

2. If item is rented, rates include all supplies to enable the equipment to function effectively with the exception Suction and CPM. Such exception supplies will be billed at *.

3. If item is rented, rates include repair and maintenance costs.

* Confidential Treatment Requested.

EXHIBIT A

PPO & INDEMNITY PROGRAM ATTACHMENT - FEE FOR SERVICE

REIMBURSEMENT FOR OTHER SERVICES

RATE AREA DESIGNATIONS:

STATE		RATE AREA		RATE DESIGNATION
Alabama		*		*
Alaska		*		*
Arizona		*		*
Arkansas		*		*
California		*		*
Colorado		*		*
Connecticut		*		*
Delaware		*		*
District of Columbia		*		*
Florida		*		*
Georgia		*		*
Hawaii		*		*
Idaho		*		*
Illinois		*		*
Indiana		*		*
Iowa		*		*
Kansas		*		*
Kentucky		*		*
Louisiana		*		*
Maine		*		*
Maryland		*		*
Massachusetts		*		*
Michigan		*		*
Minnesota		*		*
Mississippi		*		*
Missouri		*		*
Montana		*		*
Nebraska		*		*
Nevada		*		*
New Hampshire		*		*
New Jersey		*		*
New Mexico		*		*
New York		*		*
North Carolina		*		*
North Dakota		*		*
Ohio		*		*
Oklahoma		*		*
Oregon		*		*
Pennsylvania		*		*
Rhode Island		*		*
South Carolina		*		*
South Dakota		*		*
Tennessee		*		*
Texas		*		*
Utah		*		*
Vermont		*		*
Virginia		*		*
Washington		*		*
West Virginia		*		*
Wisconsin		*		*
Wyoming		*		*

* Confidential Treatment Requested.

TRADITIONAL HOME HEALTH FEE-FOR-SERVICE RATE

PPO AND INDEMNITY RATES EFFECTIVE FEBRUARY 1, 2007 - JANUARY 31. 2008

The following Traditional Home Health Services have both Visit and Hourly rates.

Notes 1, 2, 3, 4, 5 and 6 apply

Area 1

Area 2

Area 3

Visit

Hour

Visit

Hour

Visit

Hour

CERTIFIED NURSES AIDE

*

*

*

*

*

*

HOME HEALTH AIDE

*

*

*

*

*

*

LVN/LPN

*

*

*

*

*

*

LVN/LPN - HIGH TECH

*

*

*

*

*

*

PEDIATRIC HIGH TECH LVN/LPN

*

*

*

*

*

*

PEDIATRIC HIGH TECH RN

*

*

*

*

*

*

PEDIATRIC LVN/LPN

*

*

*

*

*

*

PEDIATRIC RN

*

*

*

*

*

*

RN

*

*

*

*

*

*

RN HIGH TECH INFUSION

*

*

*

*

*

*

RN HIGH TECH OTHER

*

*

*

*

*

*

The following Traditional Home Health Services have Visit only rates.

Notes 1, 3, 4, 5, 7 and 8 apply

Area 1

Area 2

Area 3

Visit

Hour

Visit

Hour

Visit

Hour

DIABETIC NURSE

*

N/A

*

N/A

*

N/A

DIETITIAN

*

N/A

*

N/A

*

N/A

ENTEROSTOMAL THERAPIST

*

N/A

*

N/A

*

N/A

MATERNAL CHILD HEALTH

*

N/A

*

N/A

*

N/A

MEDICAL SOCIAL WORKER

*

N/A

*

N/A

*

N/A

OCCUPATIONAL THERAPIST

*

N/A

*

N/A

*

N/A

OCCUPATIONAL THERAPIST ASSISTANT

*

N/A

*

N/A

*

N/A

PHLEBOTOMIST

*

N/A

*

N/A

*

N/A

PHOTOTHERAPY PACKAGE SERVICE

*

N/A

*

N/A

*

N/A

PHYSICAL THERAPIST

*

N/A

*

N/A

*

N/A

PHYSICAL THERAPIST ASSISTANT

*

N/A

*

N/A

*

N/A

PSYCHIATRIC NURSE

*

N/A

*

N/A

*

N/A

REHABILITATION NURSE

*

N/A

*

N/A

*

N/A

RESPIRATORY THERAPIST

*

N/A

*

N/A

*

N/A

RESPIRATORY THERAPIST - CPAP clinic

*

N/A

*

N/A

*

N/A

RN ASSESSMENT, INITIAL

*

N/A

*

N/A

*

N/A

RN SKILLED NURSING VISIT-EXTENSIVE

*

N/A

*

N/A

*

N/A

SPEECH THERAPIST

*

N/A

*

N/A

*

N/A

The following Traditional Home Health Service has Hourly only rates.

Notes 3, 4 and 5 apply

Area 1

Area 2

Area 3

Visit

Hour

Visit

Hour

Visit

Hour

HOMEMAKER

N/A

*

N/A

*

N/A

*

The following Traditional Home Health Service is priced on a Per Diem basis.

Notes 3, 4 and 5 apply

Xxxx 0

Xxxx 0

Xxxx 0

Per Diem

Per Diem

Per Diem

COMPANION/LIVE IN

*

*

*

NOTES:

1. Visits are defined as two (2) hours or less in duration (EXCEPT MATERNAL CHILD HEALTH VISITS, which have no maximum duration).

2. Hourly rate for visits exceeding two (2) hours in duration, starting with hour 3.

3. CIGNA does not reimburse for travel time, weekend, holiday or evening differentials.

4. Above prices have no exclusions.

5. All services not listed above will be billed at * until rates are mutually established and become part of the fee schedule.

6. RN High Tech Infusion visit and hourly utilization/costs to be reported with HIT.

7. Respiratory Therapist visit utilization/costs to be reported with HME/RT.

8. Diabetic Nurse, Psychiatric Nurse and Rehabilitation Nurse assume specialty certification which is not readily available in the home care environment. Use requires special coordination.

9. There shall be a ceiling for annual inflation increases in Home Health Services of *.

* Confidential Treatment Requested.

HOME INFUSION RATES

PPO AND INDEMNITY RATES EFFECTIVE FEBRUARY 1, 2007 - JANUARY 31. 2008

The following Home Infusion Therapy service rates EXCLUDE drugs. Drugs are priced as a percentage discount off AWP (if applicable), and there is NO price difference between primary and multiple therapies

		Primary or Multiple Therapy Per Diem		Primary or Multiple Therapy Dispensing Fee		Primary or Multiple Therapy Drug Discount off AWP
Ancillary Drugs				*		*
Biological Response Modifiers				*		*
Cardiac (Inotropic) Therapy		*				*
Chelation Therapy		*				*
Chemotherapy		*				*
Enteral Therapy		*				*
Enzyme Therapy		*				*
Growth Hormone				*		*
IV Immune Globulin		*				*
Other Injectable Therapies				*		*
Other Infusion Therapies		*				*
Pain Management Therapy		*				*
Steroid Therapy		*				*
Thrombolytic (Anticoagulation) Therapy		*				*
Synagis				*		*
Remodulin Therapy		*				*
The following Home Infusion Therapy service rates EXCLUDE drugs. Drugs are priced as a percentage discount off AWP, and there IS a price difference between primary and multiple anti-infective therapies
		Per Diem				Drug Discount Off AWP
Anti-Infectives - Primary Anti-Infective		*				*
Anti-Infectives - Multiple Anti-Infective		*				*
The following Home Infusion Therapy service rate EXCLUDES drugs. Drugs are priced per vial, and there is NO price difference between primary and multiple anti-infective therapies
		Primary or Multiple Therapy Per Diem				Cost of Drug
Flolan Therapy		*
Flolan 0.5 mg vial						*
Flolan 1.5 mg vial						*
Flolan diluent vial						*
The following Home Infusion Therapy service rates INCLUDE drugs, and there is NO price difference between primary and multiple therapies
		Primary or Multiple Therapy Per Diem
Enteral Therapy		*
Hydration Therapy		*
Total Parenteral Nutrition		*
SCHEDULE 2A, PAGE 2: HOME INFUSION PPO & INDEMNITY FEE-FOR-SERVICE THERAPY RATES
NOTES: 1.      Per Diems EXCLUDING drugs include all costs related to the therapy except the cost of drugs, including but not limited to facility overhead, supplies, delivery, professional labor including compounding and monitoring, all nursing required, maintenance of specialized catheters, equipment/patient supplies, disposables, pumps, general and administrative expenses, etc. 2.      Per Diems INCLUDING drugs include ALL costs - including but not limited to cost of drugs, facility overhead, supplies, delivery, professional labor including compounding and monitoring, all nursing required, maintenance of specialized catheters, equipment/patient supplies, disposables, pumps, general and administrative expenses, etc. 3.      "DISPENSING FEE" is defined as per each time the drug is dispensed by the home infusion provider. 4.      "PER DIEM" costs are the same for primary or multiple treatments for all drug categories, except ANTI-INFECTIVES. 5.      The per diem rate shall only be charged for those days the Participant receives medication. 6.      For home infusion pharmaceuticals not listed on fee schedule, * will apply. 7.      There shall be a ceiling for annual inflation increases in Home Infusion Therapy of *. 8.      There shall be a ceiling for annual inflation increases in Medications under CAP of *. 9.      All Medications are subject to MAC pricing, where applicable.
The following are for the stated item ONLY. Unless otherwise noted, nursing, supplies, etc. are NOT included.
Blood Transfusion per Unit (Tubing, Filters)						*
Catheter Care Per Diem						*
Midline Insertion (Catheter & Supplies)						*
PICC Line Insertion (Catheter & Supplies)						*
Blood Product						*
SCHEDULE 2A, PAGE 3: HOME INFUSION THERAPY PPO & INDEMNITY FEE-FOR-SERVICE RATES
Factor Concentrates
				Vial price		Unit Price
Factor VII
Novoseven 1200MCG Vial				*
Novoseven 4800MCG Vial				*
Novoseven in 1200MCG or 4800MCG QTY						*
Factor VIII (Recombinant)
Recombinate						*
Kogenate or Helixate						*
Bioclate						*
Helixate FS						*
Kogenate FS						*
Refacto						*
Advate						*
Factor VIII (Monoclonal)
Hemofil-M or A. R. C. Method M						*
Monoclate P						*
Monarc-M						*
Factor VIII (Other)
Koate						*
Humate						*
Alphanate SDHT						*
Factor IX (Recombinant)
BeneFix						*
Factor IX (Monoclonal/High Purity)
Mononine						*
Alphanine						*
Factor IX (Other)
Konyne—80						*
Proplex T						*
Bebulin						*
Profilnine SD						*
Anti-Inhibitor Complex
Autoplex-T						*
Feiba-VH						*
Hyate-C						*
HEMOSTATIC AGENTS
DDAVP - 10ml vial						*
Stimate - 2.5xx xxxx						*
Above rates include all necessary ancillary supplies and waste disposal unit; 24-hour on-call clinical support; home infusion monitoring system; product delivery nationwide; patient training, education, and evaluation

* Confidential Treatment Requested.

DME / HME RESPIRATORY RATES:

PPO and INDEMNITY RATES EFFECTIVE FEBRUARY 1, 2006 - JANUARY 31. 2009

CAT

TYPE

HCPCS CODE

CHC CODE

CareCentrix Code

DESCRIPTION

PURCHASE PRICE

RENTAL PRICE

DAILY PRICE

HME

A4230

A4230

Infusion set for external insulin pump, non-needle cannula Type

*

HME

A4231

A4231

Infusion set for external insulin pump, needle type

*

HME

A4232

A4232

Reservoir/Syringe with needle for external insulin pump

*

HME

A4632

A4632

Replacement battery for external insulin pump, any type, each

*

HME

A5119

A5119

Skin Barrier, wipes, box per 50

*

HME

A6257

A6257

Transparent film/dressing

*

HME

INSULPP

E0784

E0784

2158

PUMP (E0784), EXT AMBULATORY INFUSION, MINIMED, INSULIN

*

HME

INSULPP

E0784

E0784

6771

PUMP (E0784), INSULIN EXT INFUSION DISETRONICS OR OTHER

*

HME

INSULPP

E0784

E0784

7704

PUMP, EXT INFUSION, XXXX DIABECARE, INSULIN (E0784)

*

HME

INSULPP

E0784

E0784

7731

PUMP, EXT INFUSION, ANIMAS, INSULIN (E0784)

*

HME

INSULPP

E0784

E0784

7773

PUMP (E0784), EXT AMBULATORY INFUSION, DELTEC, INSULIN

*

HME

OTHER

E0746

DM570

2109

ELECTROMYOGRAPHY (EMG) (E0746), BIOFEEDBACK DEVICE

*

*

HME

OTHER

E0935

E0935

2125

PASSIVE MOTION (E0935) EXERCISE DEVICE

*

HME

OTHER

E0935

E0935

2857

PASSIVE MOTION (E0935) EXERCISE DEVICE, HAND

*

HME

OTHER

E0935

E0935

2858

PASSIVE MOTION (E0935) EXERCISE DEVICE, SHOULDER

*

HME

OTHER

E0935

E0935

2859

PASSIVE MOTION (E0935) EXERCISE DEVICE, ANKLE

*

HME

OTHER

E0935

E0935

2860

PASSIVE MOTION (E0935) EXERCISE DEVICE, ELBOW

*

HME

OTHER

E0935

E0935

2861

PASSIVE MOTION (E0935) EXERCISE DEVICE, WRIST

*

HME

OTHER

E1300

DM570

2062

WHIRLPOOL (E1300), PORT (OVERTUB TYPE)

*

HME

OTHER

E1310

DM570

2061

WHIRLPOOL (E1399), NON-PORT (BUILT-IN TYPE)

*

HME

OTHER

E1399

E1399

2327

DURABLE MEDICAL EQUIP (E1399), MISCELLANEOUS

*

HME

STIM_BO

E0747

DM570

6875

STIMULATOR, OSTEOGENIC, ULTRASOUND

*

HME

STIM_BO

E0747

DM570

8386

STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, EBI

*

HME

STIM_BO

E0747

DM570

8387

STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, ORTHOFIX

*

HME

STIM_BO

E0747

DM570

8388

STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, ORTHOLOGIC

*

HME

STIM_BO

E0748

DM570

2124

STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL APPLICATIONS

*

HME

STIM_BO

E0748

DM570

8389

STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, EBI

*

HME

STIM_BO

E0748

DM570

8390

STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, ORTHOFIX

*

HME

STIM_BO

E0748

DM570

8391

STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, ORTHOLOGIC

*

HME

WDSUCT

K0538

DM570

6873

WOUND SUCTION DEVICE (K0538)

*

HME

WDSUCT

K0539

DM570

7914

DRESSING SET, FOR WOUND SUCTION DEVICE (K0539)

*

HME

WDSUCT

K0540

DM570

7915

CANISTER SET, FOR WOUND SUCTION DEVICE (K0540)

*

The following may be charged under extraordinary circumstances:

HME

SUP

E1399

E1399

4551

LABOR/SERVICE/SHIPPING CHARGES

COST+10%

HME

SUP

E1399

E1399

2731

SHIPPING AND HANDLING FEES

COST+10%

The following may be charged if over and above routine on rental equipment:

RESP

EQUIP

E1350

E1350

2382

REPAIR OR NON-ROUTINE (E1350) SERVICE REQUIRING SKILL OF A TECH

*

HME

SUP

E1399

E1399

4552

MISCELLANEOUS SUPPLIES

*

*

NOTES:

1. Whether rental or purchase, rates include all shipping, labor and set-up.

2. If item is rented, rates include all supplies to enable the equipment to function effectively with the exception Suction and CPM. Such exception supplies will be billed at *.

3. If item is rented, rates include repair and maintenance costs.

* Confidential Treatment Requested.

EXHIBIT A

GATEKEEPER PROGRAM ATTACHMENT - FEE FOR SERVICE

REIMBURSEMENT FOR OTHER SERVICES

RATE AREA DESIGNATIONS:

STATE		RATE AREA		RATE DESIGNATION
Alabama		*		*
Alaska		*		*
Arizona		*		*
Arkansas		*		*
California		*		*
Colorado		*		*
Connecticut		*		*
Delaware		*		*
District of Columbia		*		*
Florida		*		*
Georgia		*		*
Hawaii		*		*
Idaho		*		*
Illinois		*		*
Indiana		*		*
Iowa		*		*
Kansas		*		*
Kentucky		*		*
Louisiana		*		*
Maine		*		*
Maryland		*		*
Massachusetts		*		*
Michigan		*		*
Minnesota		*		*
Mississippi		*		*
Missouri		*		*
Montana		*		*
Nebraska		*		*
Nevada		*		*
New Hampshire		*		*
New Jersey		*		*
New Mexico		*		*
New York		*		*
North Carolina		*		*
North Dakota		*		*
Ohio		*		*
Oklahoma		*		*
Oregon		*		*
Pennsylvania		*		*
Rhode Island		*		*
South Carolina		*		*
South Dakota		*		*
Tennessee		*		*
Texas		*		*
Utah		*		*
Vermont		*		*
Virginia		*		*
Washington		*		*
West Virginia		*		*
Wisconsin		*		*
Wyoming		*		*

* Confidential Treatment Requested.

TRADITIONAL HOME HEALTH FEE-FOR-SERVICE RATE

GATEKEEPER RATES EFFECTIVE FEBRUARY 1, 2007 - JANUARY 31. 2008

The following Traditional Home Health Services have both Visit and Hourly rates.

Notes 1, 2, 3, 4, 5 and 6 apply

Area 1

Area 2

Area 3

Visit

Hour

Visit

Hour

Visit

Hour

CERTIFIED NURSES AIDE

*

*

*

*

*

*

HOME HEALTH AIDE

*

*

*

*

*

*

LVN/LPN

*

*

*

*

*

*

LVN/LPN - HIGH TECH

*

*

*

*

*

*

PEDIATRIC HIGH TECH LVN/LPN

*

*

*

*

*

*

PEDIATRIC HIGH TECH RN

*

*

*

*

*

*

PEDIATRIC LVN/LPN

*

*

*

*

*

*

PEDIATRIC RN

*

*

*

*

*

*

RN

*

*

*

*

*

*

RN HIGH TECH INFUSION

*

*

*

*

*

*

RN HIGH TECH OTHER

*

*

*

*

*

*

The following Traditional Home Health Services have Visit only rates.

Notes 1, 3, 4, 5, 7 and 8 apply

Area 1

Area 2

Area 3

Visit

Hour

Visit

Hour

Visit

Hour

DIABETIC NURSE

*

N/A

*

N/A

*

N/A

DIETITIAN

*

N/A

*

N/A

*

N/A

ENTEROSTOMAL THERAPIST

*

N/A

*

N/A

*

N/A

MATERNAL CHILD HEALTH

*

N/A

*

N/A

*

N/A

MEDICAL SOCIAL WORKER

*

N/A

*

N/A

*

N/A

OCCUPATIONAL THERAPIST

*

N/A

*

N/A

*

N/A

OCCUPATIONAL THERAPIST ASSISTANT

*

N/A

*

N/A

*

N/A

PHLEBOTOMIST

*

N/A

*

N/A

*

N/A

PHOTOTHERAPY PACKAGE SERVICE

*

N/A

*

N/A

*

N/A

PHYSICAL THERAPIST

*

N/A

*

N/A

*

N/A

PHYSICAL THERAPIST ASSISTANT

*

N/A

*

N/A

*

N/A

PSYCHIATRIC NURSE

*

N/A

*

N/A

*

N/A

REHABILITATION NURSE

*

N/A

*

N/A

*

N/A

RESPIRATORY THERAPIST

*

N/A

*

N/A

*

N/A

RN ASSESSMENT, INITIAL

*

N/A

*

N/A

*

N/A

RN SKILLED NURSING VISIT-EXTENSIVE

*

N/A

*

N/A

*

N/A

SPEECH THERAPIST

*

N/A

*

N/A

*

N/A

The following Traditional Home Health Service has Hourly only rates.

Notes 3, 4 and 5 apply

Area 1

Area 2

Area 3

Visit

Hour

Visit

Hour

Visit

Hour

HOMEMAKER

N/A

*

N/A

*

N/A

*

* Confidential Treatment Requested.

The following Traditional Home Health Service is priced on a Per Diem basis.

Notes 3, 4 and 5 apply

Xxxx 0

Xxxx 0

Xxxx 0

Per Diem

Per Diem

Per Diem

COMPANION/LIVE IN

*

*

*

NOTES:

1. Visits are defined as two (2) hours or less in duration (EXCEPT MATERNAL CHILD HEALTH VISITS, which have no maximum duration).

2. Hourly rate for visits exceeding two (2) hours in duration, starting with hour 3.

3. CIGNA does not reimburse for travel time, weekend, holiday or evening differentials.

4. Above prices have no exclusions.

5. All services not listed above will be billed at * until rates are mutually established and become part of the fee schedule.

6. RN High Tech Infusion visit and hourly utilization/costs to be reported with HIT.

7. Respiratory Therapist visit utilization/costs to be reported with HME/RT.

8. Diabetic Nurse, Psychiatric Nurse and Rehabilitation Nurse assume specialty certification which is not readily available in the home care environment. Use requires special coordination.

9. There shall a ceiling for annual inflation increases in Home Health Services of *.

* Confidential Treatment Requested.

HOME INFUSION RATES

GATEKEEPER RATES EFFECTIVE FEBRUARY 1, 2007 - JANUARY 31. 2008

The following Home Infusion Therapy service rates EXCLUDE drugs. Drugs are priced as a percentage discount off AWP (if applicable), and there is NO price difference between primary and multiple therapies

		Primary or Multiple Therapy Per Diem		Primary or Multiple Therapy Dispensing Fee		Primary or Multiple Therapy Drug Discount off AWP
Ancillary Drugs				*		*
Biological Response Modifiers				*		*
Cardiac (Inotropic) Therapy		*				*
Chelation Therapy		*				*
Chemotherapy		*				*
Enteral Therapy		*				*
Enzyme Therapy		*				*
Growth Hormone				*		*
IV Immune Globulin		*				*
Other Injectable Therapies				*		*
Other Infusion Therapies		*				*
Pain Management Therapy		*				*
Steroid Therapy		*				*
Thrombolytic (Anticoagulation) Therapy		*				*
Synagis				*		*
Remodulin Therapy						*
The following Home Infusion Therapy service rates EXCLUDE drugs. Drugs are priced as a percentage discount off AWP, and there IS a price difference between primary and multiple anti-infective therapies
		Per Diem				Drug Discount Off AWP
Anti-Infectives - Primary Anti-Infective		*				*
Anti-Infectives - Multiple Anti-Infective		*				*
The following Home Infusion Therapy service rate EXCLUDES drugs. Drugs are priced per vial, and there is NO price difference between primary and multiple anti-infective therapies
		Primary or Multiple Therapy Per Diem				Cost of Drug
Flolan Therapy		*
Flolan 0.5 mg vial						*
Flolan 1.5 mg vial						*
Flolan diluent vial						*
The following Home Infusion Therapy service rates INCLUDE drugs, and there is NO price difference between primary and multiple therapies
		Primary or Multiple Therapy Per Diem
Enteral Therapy		*
Hydration Therapy		*
Total Parenteral Nutrition		*
SCHEDULE 2A, PAGE 2: HOME INFUSION HMO/FLEX FEE-FOR-SERVICE THERAPY RATES
NOTES: 1.      Per Diems EXCLUDING drugs include all costs related to the therapy except the cost of drugs, including but not limited to facility overhead, supplies, delivery, professional labor including compounding and monitoring, all nursing required, maintenance of specialized catheters, equipment/patient supplies, disposables, pumps, general and administrative expenses, etc. 2.      Per Diems INCLUDING drugs include ALL costs - including but not limited to cost of drugs, facility overhead, supplies, delivery, professional labor including compounding and monitoring, all nursing required, maintenance of specialized catheters, equipment/patient supplies, disposables, pumps, general and administrative expenses, etc. 3.      "DISPENSING FEE" is defined as per each time the drug is dispensed by the home infusion provider. 4.      "PER DIEM" costs are the same for primary or multiple treatments for all drug categories, except ANTI-INFECTIVES. 5.      The per diem rate shall only be charged for those days the Participant receives medication. 6.      For home infusion pharmaceuticals not listed on fee schedule, * will apply. 7.      There shall be a ceiling for annual inflation increases in Home Infusion Therapy of *. 8.      There shall be a ceiling for annual inflation increases in Medications under *. 9.      All Medications are subject to MAC pricing, where applicable.
The following are for the stated item ONLY. Unless otherwise noted, nursing, supplies, etc. are NOT included.
Blood Transfusion per Unit (Tubing, Filters)						*
Catheter Care Per Diem						*
Midline Insertion (Catheter & Supplies)						*
PICC Line Insertion (Catheter & Supplies)						*
Blood Product						*
SCHEDULE 2A, PAGE 3: HOME INFUSION THERAPY HMO/FLEX FEE-FOR-SERVICE RATES
Factor Concentrates
				Vial price		Unit Price
Factor VII
Novoseven 1200MCG Vial				*
Novoseven 4800MCG Vial				*
Novoseven in 1200MCG or 4800MCG QTY						*
Factor VIII (Recombinant)
Recombinate						*
Kogenate or Helixate						*
Bioclate						*
Helixate FS						*
Kogenate FS						*
Refacto						*
Advate						*
Factor VIII (Monoclonal)
Hemofil-M or A. R. C. Method M						*
Monoclate P						*
Monarc-M						*
Factor VIII (Other)
Koate						*
Humate						*
Alphanate SDHT						*
Factor IX (Recombinant)
BeneFix						*
Factor IX (Monoclonal/High Purity)
Mononine						*
Alphanine						*
Factor IX (Other)
Konyne - 80						*
Proplex T						*
Bebulin						*
Profilnine SD						*
Anti-Inhibitor Complex
Autoplex-T						*
Feiba-VH						*
Hyate-C						*
HEMOSTATIC AGENTS
DDAVP - 10ml vial						*
Stimate - 2.5xx xxxx						*
Above rates include all necessary ancillary supplies and waste disposal unit; 24-hour on-call clinical support; home infusion monitoring system; product delivery nationwide; patient training, education, and evaluation

* Confidential Treatment Requested.

DME / HME RESPIRATORY RATES:

GATEKEEPER RATES EFFECTIVE FEBRUARY 1, 2006 - JANUARY 31. 2009

CAT

TYPE

HCPCS CODE

CHC CODE

CareCentrix Code

DESCRIPTION

PURCHASE PRICE

RENTAL PRICE

DAILY PRICE

HME

A4230

A4230

Infusion set for external insulin pump, non-needle cannula Type

*

HME

A4231

A4231

Infusion set for external insulin pump, needle type

*

HME

A4232

A4232

Reservoir/Syringe with needle for external insulin pump

*

HME

A4632

A4632

Replacement battery for external insulin pump, any type, each

*

HME

A5119

A5119

Skin Barrier, wipes, box per 50

*

HME

A6257

A6257

Transparent film/dressing

*

HME

INSULPP

E0784

E0784

2158

PUMP (E0784), EXT AMBULATORY INFUSION, MINIMED, INSULIN

*

HME

INSULPP

E0784

E0784

6771

PUMP (E0784), INSULIN EXT INFUSION DISETRONICS OR OTHER

*

HME

INSULPP

E0784

E0784

7704

PUMP, EXT INFUSION, XXXX DIABECARE, INSULIN (E0784)

*

HME

INSULPP

E0784

E0784

7731

PUMP, EXT INFUSION, ANIMAS, INSULIN (E0784)

*

HME

INSULPP

E0784

E0784

7773

PUMP (E0784), EXT AMBULATORY INFUSION, DELTEC, INSULIN

*

HME

OTHER

E0746

DM570

2109

ELECTROMYOGRAPHY (EMG) (E0746), BIOFEEDBACK DEVICE

*

*

HME

OTHER

E0935

E0935

2125

PASSIVE MOTION (E0935) EXERCISE DEVICE

*

HME

OTHER

E0935

E0935

2857

PASSIVE MOTION (E0935) EXERCISE DEVICE, HAND

*

HME

OTHER

E0935

E0935

2858

PASSIVE MOTION (E0935) EXERCISE DEVICE, SHOULDER

*

HME

OTHER

E0935

E0935

2859

PASSIVE MOTION (E0935) EXERCISE DEVICE, ANKLE

*

HME

OTHER

E0935

E0935

2860

PASSIVE MOTION (E0935) EXERCISE DEVICE, ELBOW

*

HME

OTHER

E0935

E0935

2861

PASSIVE MOTION (E0935) EXERCISE DEVICE, WRIST

*

HME

OTHER

E1300

DM570

2062

WHIRLPOOL (E1300), PORT (OVERTUB TYPE)

*

HME

OTHER

E1310

DM570

2061

WHIRLPOOL (E1399), NON-PORT (BUILT-IN TYPE)

*

HME

OTHER

E1399

E1399

2327

DURABLE MEDICAL EQUIP (E1399), MISCELLANEOUS

*

HME

STIM_BO

E0747

DM570

6875

STIMULATOR, OSTEOGENIC, ULTRASOUND

*

HME

STIM_BO

E0747

DM570

8386

STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, EBI

*

HME

STIM_BO

E0747

DM570

8387

STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, ORTHOFIX

*

HME

STIM_BO

E0747

DM570

8388

STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, ORTHOLOGIC

*

HME

STIM_BO

E0748

DM570

2124

STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL APPLICATIONS

*

HME

STIM_BO

E0748

DM570

8389

STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, EBI

*

HME

STIM_BO

E0748

DM570

8390

STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, ORTHOFIX

*

HME

STIM_BO

E0748

DM570

8391

STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, ORTHOLOGIC

*

HME

WDSUCT

K0538

DM570

6873

WOUND SUCTION DEVICE (K0538)

*

HME

WDSUCT

K0539

DM570

7914

DRESSING SET, FOR WOUND SUCTION DEVICE (K0539)

*

HME

WDSUCT

K0540

DM570

7915

CANISTER SET, FOR WOUND SUCTION DEVICE (K0540)

*

The following may be charged under extraordinary circumstances:

HME

SUP

E1399

E1399

4551

LABOR/SERVICE/SHIPPING CHARGES

*

HME

SUP

E1399

E1399

2731

SHIPPING AND HANDLING FEES

*

The following may be charged if over and above routine on rental equipment:

RESP

EQUIP

E1350

E1350

2382

REPAIR OR NON-ROUTINE (E1350) SERVICE REQUIRING SKILL OF A TECH

*

HME

SUP

E1399

E1399

4552

MISCELLANEOUS SUPPLIES

*

*

NOTES:

1. Whether rental or purchase, rates include all shipping, labor and set-up.

2. If item is rented, rates include all supplies to enable the equipment to function effectively with the exception Suction and CPM. Such exception supplies will be billed at *.

3. If item is rented, rates include repair and maintenance costs.

* Confidential Treatment Requested.

EXHIBIT A

HMO PROGRAM ATTACHMENT - CAPITATION

SCHEDULE OF CAPITATION RATES

CAPITATION RATES EFFECTIVE 2/1/07 - 1/31/08

These are the capitation rates that apply to services rendered to Patient Panel Participants enrolled in HMO Programs. An "HMO Program" means a non-governmental, fully insured HMO or Point of Service product that is underwritten based on a community rating methodology (i.e. community rating, community rating by class, adjusted community rating by class).

		Gentiva HomeHealth, Infusion, DME/HME Capitation Rates PMPM
All Commercial HMO Program Capitated Affiliates		*

Capitation Rate Compensation Terms

The following rates are established for the provision of Home Care Services rendered to Program Participants covered under the HMO and Gatekeeper plans:

February 1, 2006 - January 31, 2007		$ * per member per month
February 1, 2007 - January 31, 2008		$ * per member per month
February 1, 2008 - January 31, 2009		$ * per member per month

The capitation rate listed above will be allocated between HMO and Gatekeeper Program participants in accordance with established business practices. On or about December 1 of each year, the parties shall reconcile the allocation and settle any payment difference no later than December 31 of each calendar year.

If an outlier calculation for * demonstrates a patient per thousand (PPK) increase in excess of *, (* ppk), then MCA reserves the right to propose an * pmpm outlier adjustment. CIGNA may elect to accept this adjustment or * from this agreement.

* Confidential Treatment Requested.

EXHIBIT A

GATEKEEPER PROGRAM ATTACHMENT - CAPITATION

SCHEDULE OF CAPITATION RATES

CAPITATION RATES EFFECTIVE 2/1/07 - 1/31/08

These are the capitation rates that apply to services rendered to Patient Panel Participants enrolled in Gatekeeper Programs. A "Gatekeeper Program" means (i) a product that includes fully insured Standard HMO, Point of Service, or Gatekeeper PPO benefits and which is underwritten by a licensed insurance company based on an experience rating methodology, or (ii) a self funded product which includes Standard HMO, Point of Service, or Gatekeeper PPO benefits. This definition includes, but is not limited to, Participants covered under FlexCare plans insured/administered by Connecticut General Life Insurance Company.

		Gentiva HomeHealth, Infusion, DME/HME Capitation Rates PMPM
All Gatekeeper (FlexCare) Capitated Affiliates		*

Capitation Rate Compensation Terms

The following rates are established for the provision of Home Care Services rendered to Program Participants covered under the HMO and Gatekeeper plans:

February 1, 2006 - January 31, 2007		$ * per member per month
February 1, 2007 - January 31, 2008		$ * per member per month
February 1, 2008 - January 31, 2009		$ * per member per month

The capitation rate listed above will be allocated between HMO and Gatekeeper Program participants in accordance with established business practices. On or about December 1 of each year, the parties shall reconcile the allocation and settle any payment difference no later than December 31 of each calendar year.

If an outlier calculation for * demonstrates a patient per thousand (PPK) increase in excess of *, ( * ppk), then MCA reserves the right to propose an * pmpm outlier adjustment. CIGNA may elect to accept this adjustment or * from this agreement.

* Confidential Treatment Requested.