AHCA CONTRACT NO. FA614 AMENDMENT NO. 13

Exhibit 10.2



Amerigroup Florida, Inc. d/b/a Amerigroup Community Care		Medicaid HMO Contract

AHCA CONTRACT NO. FA614
AMENDMENT NO. 13

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

Standard Contract, Section III, Item C., Contract Managers, sub-item 1, is hereby amended to now read as follows:

1. The Agency’s Contract Manager’s name, address and telephone number for this Contract is as follows:

Xxxxxxx Xxxxxxxx
Agency for Health Care Administration
0000 Xxxxx Xxxxx, XX#00
Xxxxxxxxxxx, XX 00000
(000) 000-0000

2.		Effective March 1, 2009, Attachment I, Scope of Services, is hereby amended to include Exhibit I-E, Fifth Revised Maximum Enrollment Levels, attached hereto and made a part of the Contract. All references in the Contract to Exhibit I-D, Fourth Revised Maximum Enrollment Levels, shall hereinafter also refer to Exhibit I-E, Fifth Revised Maximum Enrollment Levels, as appropriate.

3.		Effective March 1, 2009, Attachment I, Scope of Services, is hereby amended to include Exhibit III-F, March 1, 2009 — August 31, 2009 Medicaid Non-Reform HMO Capitation Rates, attached hereto and made a part of the Contract. All references in the Contract to Exhibit III-E, February 1, 2009 — August 31, 2009 Medicaid Non-Reform HMO Capitation Rates, shall hereinafter also refer to Exhibit III-F, March 1, 2009 — August 31, 2009 Medicaid Non-Reform HMO Capitation Rates, as appropriate.

All provisions in the Contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to conform with this Amendment.

All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in the Contract.

This Amendment and all its attachments are hereby made a part of the Contract.

This Amendment cannot be executed unless all previous amendments to this Contract have been fully executed.

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FA614, Amendment No. 13, Page 1 of 2


Amerigroup Florida, Inc. d/b/a Amerigroup Community Care		Medicaid HMO Contract

IN WITNESS WHEREOF, the parties hereto have caused this eight (8) page Amendment (which includes all attachments hereto) to be executed by their officials thereunto duly authorized.

AMERIGROUP FLORIDA, INC.
D/B/A/ AMERIGROUP COMMUNITY CARE

STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION

Signed By:

/s/ Xxxxxxx X. XxXxxx

Signed By:

/s/ Xxxxx Xxxxxx

NAME:

Xxxxxxx X. XxXxxx

NAME:

Xxxxx Xxxxxx

TITLE:

CEO

TITLE:

Secretary

DATE:

3/20/09

DATE:

3/26/09

List of Attachments/Exhibits included as part of this Amendment:


Specify	Letter/
Type	Number	Description
Exhibit	I-E	Fifth Revised Maximum Enrollment Levels (1 Page)
Exhibit	III- F	March 1, 2009 — August 31, 2009 Medicaid Non-Reform HMO Capitation RatesS (5 Pages)

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FA614, Amendment No. 13, Page 2 of 2


Amerigroup Florida, Inc. d/b/a Amerigroup Community Care		Medicaid HMO Contract

EXHIBIT I-E

FIFTH REVISED MAXIMUM ENROLLMENT LEVELS

TABLE 1
FOURTH REVISED ENROLLMENT LEVELS


County	Maximum Enrollment Level
Brevard		8,000
Broward		14,000
Miami-Dade		25,000
Hernando		8,000
Hillsborough		40,000
Lake		8,000
Xxx		18,000
Manatee		8,000
Orange		30,000
Osceola		8,500
Pasco		15,000
Pinellas		25,000
Polk		30,000
Sarasota		8,000
Seminole		8,000
Volusia		8,000

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FA614, Exhibit I-E, Page 1 of 1


Amerigroup Florida, Inc. d/b/a Amerigroup Community Care		Medicaid HMO Contract

EXHIBIT III-F
March 1, 2009 — August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area , Age and Eligibility Category
Revised on February 16, 2009

TABLE 1

General Rates:

TANF

AGE (14-20)

AGE (21-54)

XXX-X

XXX-XX

Xxxx

XXXX0x0X0

0X0.00XX

AGE (1-5)

AGE (6-13)

Female

Male

Female

Male

AGE (55+)

BTHMO+2M0

3M0-11MO

AGE (1-5)

AGE (6-13)

AGE (14-20)

AGE (21-54)

AGE (55+)

SSI-B

AGE (65-)

AGE (65+)

1,094.22

184.16

99.63

60.40

127.26

68.32

250.84

150.73

313.03

10,249.54

1,491.48

438.21

195.46

209.48

684.74

688.27

300.62

93.17

84.30

1,094.22

184.16

99.63

60.40

127.26

68.32

250.84

150.73

313.03

10,249.54

1,491.48

438.21

195.46

209.48

684.74

688.27

300.62

93.17

84.30

1,196.62

202.96

110.34

67.92

140.84

76.51

278.65

168.47

353.53

11,246.01

1,651.16

486.56

222.16

237.31

773.96

781.87

334.70

88.46

80.57

1,049.14

178.79

97.34

60.45

124.13

68.04

246.51

149.64

315.69

10,783.85

1,587.50

468.19

215.03

229.34

748.28

757.29

292.70

88.80

80.98

1,194.06

202.97

110.37

68.18

140.78

76.87

279.19

169.16

355.65

12,038.26

1,765.98

519.70

236.81

252.51

825.86

834.51

221.32

79.80

74.00

1,038.39

178.07

97.17

60.92

124.01

68.48

247.03

150.57

319.86

10,970.19

1,617.13

476.72

220.10

233.82

764.56

774.50

270.21

77.95

71.38

1,074.14

183.63

100.12

62.40

127.54

70.12

253.83

154.32

326.38

11,607.26

1,714.80

505.56

234.47

249.97

814.51

826.24

367.55

83.10

76.28

1,015.73

174.04

95.01

59.33

121.03

66.85

241.01

146.72

311.46

10,344.94

1,523.63

449.17

206.42

220.49

718.78

727.41

251.83

77.41

70.98

1,049.42

178.45

97.12

60.00

123.89

67.48

245.50

148.81

312.90

10,887.75

1,607.33

473.84

219.83

233.26

762.25

772.33

215.52

82.97

75.87

1,064.83

182.89

99.98

62.78

127.46

70.63

254.09

155.07

330.14

14,097.57

2,095.67

618.54

292.06

308.77

1,009.40

1,026.88

316.67

92.40

84.73

1,348.59

228.59

124.07

76.21

158.52

85.96

313.61

189.56

397.28

14,238.94

2,095.21

617.24

284.21

302.64

987.26

998.51

364.12

137.86

124.45

6B*

1,038.25

178.05

97.16

60.91

123.99

68.47

247.00

150.55

319.81

10,969.70

1,617.05

476.70

220.09

233.81

764.51

774.47

270.21

77.95

71.38

TABLE 2

General + Mental Health Rates:

TANF

AGE (14-20)

AGE (21-54)

XXX-X

XXX-XX

Xxxx

XXXX0x0X0

0X0.00XX

AGE (1-5)

AGE (6-13)

Female

Male

Female

Male

AGE (55+)

BTHMO+2M0

3M0-11MO

AGE (1-5)

AGE (6-13)

AGE (14-20)

AGE (21-54)

AGE (55+)

SSI-B

AGE (65-)

AGE (65+)

1,094.24

184.16

101.24

71.89

138.00

79.06

255.20

155.09

316.71

10,249.62

1,491.56

445.52

242.68

252.71

764.74

718.72

300.83

104.62

95.75

1,094.25

184.16

102.49

80.31

140.45

81.51

254.19

154.08

315.93

10,249.69

1,491.63

451.77

272.92

253.92

736.51

712.72

320.48

107.92

99.05

1,196.63

202.96

111.64

76.94

146.82

82.49

280.17

169.99

354.85

11,246.08

1,651.23

492.71

257.30

257.47

797.45

791.96

341.43

97.29

89.40

1,049.15

178.79

98.69

69.84

130.36

74.27

248.09

151.22

317.06

10,783.96

1,587.61

477.78

269.81

260.77

784.90

774.58

316.83

105.28

97.45

1,194.07

202.97

111.56

76.71

148.75

84.84

282.43

172.40

358.38

12,038.31

1,766.03

524.64

268.67

281.68

879.83

855.05

224.00

92.40

86.60

1,038.41

178.07

98.99

73.94

136.17

80.64

251.97

155.51

324.03

10,970.26

1,617.20

483.13

261.48

271.70

834.66

801.18

271.50

81.77

75.20

1,074.16

183.63

101.87

74.87

139.19

81.77

258.57

159.06

330.38

11,607.32

1,714.86

511.58

273.30

285.42

880.29

851.28

370.10

93.44

86.62

1,015.74

174.04

96.25

67.97

126.75

72.57

242.47

148.18

312.72

10,345.01

1,523.70

455.07

240.11

239.83

741.30

738.04

258.56

90.40

83.97

1,049.44

178.47

98.64

70.62

130.92

74.51

247.29

150.60

314.45

10,887.82

1,607.40

480.06

255.35

253.65

785.99

783.54

222.25

92.39

85.29

1,064.85

182.91

101.87

75.91

136.16

79.33

256.30

157.28

332.60

14,097.66

2,095.76

626.75

338.95

335.68

1,040.74

1,041.68

323.40

100.32

92.65

1,348.61

228.61

125.66

87.31

165.88

93.32

315.48

191.43

398.90

14,239.02

2,095.29

624.09

323.33

325.08

1,013.40

1,010.85

371.22

145.78

132.37

6B*

1,038.27

178.07

98.88

73.21

135.48

79.96

251.67

155.22

323.75

10,969.77

1,617.72

483.09

261.35

271.58

834.41

801.07

271.50

81.77

75.20

AHCA Contract No. FA614, Exhibit III-F, Page 1 of 1

EXHIBIT III-F
March 1, 2009 — August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area , Age and Eligibility Category
Revised on February 16, 2009

TABLE 3

General + MH + Dental Rates:

TANF

AGE (14-20)

AGE (21.54)

XXX-X

XXX-XX

Xxxx

XXXX0x0X0

0X0.00XX

AGE (1-5)

AGE (6-13)

Female

Male

Female

Male

AGE (55+)

BTHMO+2M0

3M0-11MO

AGE (1-5)

AGE (6-13)

AGE (14-20)

AGE (21-54)

AGE (55+)

SSI-B

AGE (65-)

AGE (65+)

1,094.24

184.19

102.89

74.95

141.13

81.70

256.40

156.33

319.45

10,249.62

1,491.56

447.11

245.04

254.73

766.05

720.55

301.27

105.72

96.60

1,094.25

184.20

104.14

83.37

143.58

84.15

256.39

155.32

318.67

10,249.69

1,491.63

453.36

275.28

255.94

737.82

714.55

320.92

109.02

99.90

1,196.64

202.99

114.64

82.50

152.49

87.29

281.88

171.74

358.75

11,246.08

1,651.24

495.79

261.86

261.39

799.30

795.56

342.44

98.91

90.64

1,049.16

178.81

100.50

73.20

133.80

77.17

249.73

152.91

320.81

10,783.96

1,587.61

479.53

272.40

263.00

786.75

777.17

318.97

106.84

98.65

1,194.08

203.00

114.91

82.93

155.11

90.22

285.78

175.85

366.04

12,038.32

1,766.04

528.79

274.83

286.97

883.47

860.16

227.60

96.12

89.44

1,038.42

178.10

101.61

78.81

141.14

84.85

253.82

157.42

328.26

10,970.26

1,617.21

486.12

265.90

275.50

837.12

804.63

273.23

83.98

76.88

1,074.17

183.66

104.23

79.24

143.65

85.54

259.88

160.40

333.37

11,607.32

1,714.87

514.53

277.66

289.17

881.81

853.42

370.57

94.93

87.76

1,015.75

174.07

99.83

74.59

133.52

78.30

244.46

150.21

317.24

10,345.01

1,523.71

458.43

245.10

244.12

743.54

741.18

260.07

92.04

85.22

1,049.45

178.49

101.52

75.97

136.38

79.13

248.23

151.66

316.60

10,887.82

1,607.41

482.61

259.13

256.90

787.15

785.16

224.05

93.44

86.09

1,064.86

182.92

104.26

80.34

140.69

83.16

257.02

158.02

333.69

14,097.66

2,095.77

629.49

343.02

339.18

1,041.67

1,042.99

324.21

101.60

93.61

1,348.62

228.62

129.33

94.86

173.71

99.92

316.33

192.29

400.83

14,239.03

2,095.31

628.29

330.59

331.44

1,015.15

1,013.31

374.50

147.90

133.99

6B*

1,038.28

178.08

101.50

78.08

140.45

84.17

251.67

155.22

323.75

10,969.77

1,617.13

486.08

265.77

275.38

834.41

801.07

273.23

83.98

76.88

TABLE 4

General + Mental Health + Transportation Rates:

TANF

AGE (14-20)

AGE (21-54)

XXX-X

XXX-XX

Xxxx

XXXX0x0X0

0X0.00XX

AGE (1-5)

AGE (6-13)

Female

Male

Female

Male

AGE (55+)

BTHMO+2M0

3M0-11MO

AGE (1-5)

AGE (6-13)

AGE (14-20)

AGE (21-54)

AGE (55+)

SSI-B

AGE (65-)

AGE (65+)

1,099.50

185.53

102.06

72.38

140.00

80.38

258.44

157.56

320.16

10,288.04

1,516.79

450.72

245.07

258.73

784.45

735.36

308.17

118.10

104.44

1,099.51

185.54

103.31

80.80

142.45

82.83

257.43

156.55

319.38

10,288.11

1,516.86

456.97

275.31

259.94

756.22

729.36

327.82

121.40

107.74

1,202.95

204.60

112.62

77.53

149.22

84.07

284.07

172.96

359.00

11,294.54

1,683.05

499.28

260.32

265.06

822.32

813.95

349.99

116.72

101.92

1,053.64

179.96

99.39

70.26

132.07

75.40

250.86

153.32

320.01

10,821.63

1,612.34

482.87

272.15

266.67

804.22

790.89

323.89

120.86

107.50

1,197.87

203.96

112.15

77.06

160.19

85.79

284.77

174.18

360.87

12,069.58

1,786.55

528.88

270.62

286.57

895.87

868.59

230.44

106.24

95.51

1,042.14

179.05

99.57

74.29

137.59

81.57

254.28

157.27

326.48

11,001.22

1,637.53

487.33

263.40

276.55

850.54

814.59

277.11

93.13

82.52

1,078.12

184.66

102.49

75.24

140.69

82.77

261.02

160.93

332.97

11,641.47

1,737.28

516.20

275.41

290.77

897.81

866.07

375.39

105.36

94.30

1,020.94

175.39

97.07

68.46

128.74

73.88

245.67

150.62

316.13

10,382.57

1,548.36

460.15

242.45

245.71

760.56

754.32

264.39

104.94

93.33

1,054.46

179.77

99.43

71.09

132.83

75.77

250.39

152.96

317.74

10,926.48

1,632.80

485.30

257.76

259.70

805.82

800.29

228.70

107.92

95.29

1,067.79

183.68

102.33

76.19

137.28

80.07

258.11

158.66

333.99

14,123.46

2,112.70

630.24

340.55

339.72

1,053.97

1,052.85

328.61

112.45

100.46

1,351.65

229.39

126.13

87.60

167.04

94.09

317.36

192.86

400.90

14,265.93

2,112.95

627.73

325.00

329.30

1,027.20

1,022.51

376.25

158.01

140.24

6B*

1,042.00

179.03

99.46

73.56

136.90

80.89

253.98

156.98

326.20

11,000.73

1,637.45

487.29

263.27

276.43

850.29

814.48

277.11

93.13

82.52

AHCA Contract No. FA614, Exhibit III-F, Page 2 of 5

EXHIBIT III-F
March 1, 2009 — August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area , Age and Eligibility Category
Revised on February 16, 2009

TABLE 5

General + Transportation Rates:

TANF

AGE (14-20)

AGE (21.54)

XXX-X

XXX-XX

Xxxx

XXXX0x0X0

0X0.00XX

AGE (1-5)

AGE (6-13)

Female

Male

Female

Male

AGE (55+)

BTHMO+2M0

3M0-11MO

AGE (1-5)

AGE (6-13)

AGE (14-20)

AGE (21-54)

AGE (55+)

SSI-B

AGE (65-)

AGE (65+)

1,099.48

185.51

100.45

60.89

129.26

69.64

254.08

153.20

316.48

10,287.96

1,516.71

443.41

197.85

215.50

704.45

704.91

307.96

106.65

92.99

1,099.48

185.51

100.45

60.89

129.26

69.64

254.08

153.20

316.48

10,287.96

1,516.71

443.41

197.85

215.50

704.45

704.91

307.96

106.65

92.99

1,202.94

204.59

111.32

68.51

143.24

78.09

282.55

171.44

357.68

11,294.47

1,682.98

493.13

225.18

244.90

798.83

802.86

343.26

107.89

93.09

1,053.63

179.95

98.04

60.87

125.84

69.17

249.28

151.74

318.64

10,821.52

1,612.23

473.28

217.37

235.24

767.60

773.60

299.76

104.38

91.02

1,197.86

203.95

110.96

68.53

142.22

77.82

281.53

170.94

358.14

12,069.53

1,786.50

523.94

238.76

257.40

841.90

848.05

227.76

93.64

82.91

1,042.12

179.03

97.75

61.27

125.43

69.41

249.34

152.33

322.31

11,001.15

1,637.46

480.92

222.02

238.67

780.44

787.91

275.82

89.31

78.70

1,078.10

184.64

100.74

62.77

129.04

71.12

256.28

156.19

328.97

11,641.41

1,737.22

510.18

236.58

255.22

832.03

841.03

372.84

95.02

83.96

1,020.93

175.38

95.83

59.82

123.02

68.16

244.21

149.16

314.87

10,382.50

1,548.29

454.25

208.76

226.37

738.04

743.69

257.66

91.95

80.34

1,054.44

179.75

97.91

60.47

125.80

68.74

248.60

151.17

316.19

10,926.41

1,632.73

479.08

222.24

239.31

782.08

789.08

221.97

98.50

85.87

1,067.77

183.66

100.44

63.06

128.58

71.37

255.90

156.45

332.07

14,123.37

2,112.61

622.03

293.66

312.81

1,022.63

1,038.05

321.88

104.53

92.54

1,351.63

229.37

124.54

76.50

159.68

86.73

315.49

190.99

399.28

14,265.85

2,112.87

620.88

285.88

306.86

1,001.06

1,010.17

369.15

150.09

132.32

6B*

1,041.98

179.01

97.74

61.26

125.41

69.40

249.31

152.31

322.26

11,000.66

1,637.38

480.90

222.01

238.66

780.39

787.88

275.82

89.31

78.70

TABLE 6

General + Dental Rates:

TANF

AGE (14-20)

AGE (21-54)

XXX-X

XXX-XX

Xxxx

XXXX0x0X0

0X0.00XX

AGE (1-5)

AGE (6-13)

Female

Male

Female

Male

AGE (55+)

BTHMO+2M0

3M0-11MO

AGE (1-5)

AGE (6-13)

AGE (14-20)

AGE (21-54)

AGE (55+)

SSI-B

AGE (65-)

AGE (65+)

1,094.22

184.17

101.28

63.46

130.39

70.96

252.04

151.97

315.77

10,249.54

1,491.48

439.80

197.82

211.50

686.05

690.10

301.06

94.27

85.15

1,094.22

184.17

101.28

63.46

130.39

70.96

252.04

151.97

315.77

10,249.54

1,491.48

439.80

197.82

211.50

686.05

690.10

301.06

94.27

85.15

1,196.63

202.98

113.34

73.48

146.51

81.31

280.36

170.22

357.43

11,246.01

1,651.17

489.64

226.72

241.23

775.81

784.47

335.71

90.08

81.81

1,049.15

178.80

99.15

63.81

127.57

70.94

248.15

151.33

319.44

10,783.85

1,587.50

469.94

217.62

231.57

750.13

759.88

294.84

90.36

82.17

1,194.07

202.99

113.72

74.40

147.14

82.25

282.54

172.61

363.31

12,038.27

1,765.99

523.85

242.97

257.80

829.50

839.62

224.92

83.52

76.84

1,038.40

178.08

99.79

65.79

128.98

72.69

248.88

152.48

324.09

10,970.19

1,617.14

479.71

224.52

237.62

767.02

777.95

271.94

80.16

73.06

1,074.15

183.64

102.48

66.77

132.00

73.89

255.14

155.66

329.37

11,607.26

1,714.81

508.51

238.83

253.62

816.03

828.38

368.02

84.59

77.42

1,015.74

174.06

98.59

65.95

127.80

72.58

243.00

148.75

315.98

10,344.94

1,523.64

452.53

211.41

224.78

721.02

730.55

253.34

79.05

72.23

1,049.43

178.47

100.00

65.35

129.35

72.10

246.44

149.77

315.05

10,887.75

1,607.34

476.39

223.61

236.51

763.41

773.95

217.32

84.02

76.67

1,064.84

182.90

102.37

67.21

131.99

74.46

254.81

155.81

331.77

14,097.57

2,095.68

621.28

296.13

312.27

1,010.33

1,028.19

317.48

93.68

85.69

1,348.60

228.60

127.74

83.76

166.35

92.56

314.46

190.42

399.21

14,238.95

2,095.23

621.44

291.47

309.00

989.01

1,000.97

367.40

139.98

126.07

6B*

1,038.26

178.06

99.78

65.78

128.96

72.68

247.00

150.55

319.81

10,969.71

1,617.06

479.69

224.51

237.61

764.51

774.47

271.94

80.16

73.06

AHCA Contract No. FA614, Exhibit III-F, Page 3 of 5

EXHIBIT III-F
March 1, 2009 — August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area , Age and Eligibility Category
Revised on February 16, 2009

TABLE 7

General + Dental + Transportation Rates:

TANF

AGE (14-20)

AGE (21.54)

SSI-N

SSI-AB

Area

BTHM0+2M0

3M0.11MO

AGE (1-5)

AGE (6-13)

Female

Male

Female

Male

AGE (55+)

BTHMO+2M0

3M0-11MO

AGE (1-5)

AGE (6-13)

AGE (14-20)

AGE (21-54)

AGE (55+)

SSI-B

AGE (65-)

AGE (65+)

1,099.48

185.52

102.10

63.95

132.39

72.28

255.28

154.44

319.22

10,287.96

1,516.71

445.00

200.21

217.52

705.76

706.74

308.40

107.75

93.84

1,099.48

185.52

102.10

63.95

132.39

72.28

255.28

154.44

319.22

10,287.96

1,516.71

445.00

200.21

217.52

705.76

706.74

308.40

107.75

93.84

1,202.95

204.61

114.32

74.07

148.91

82.89

284.26

173.19

361.58

11,294.47

1,682.99

496.21

229.74

248.82

800.68

805.46

344.27

109.51

94.33

1,053.64

179.96

99.85

64.23

129.28

72.07

250.92

153.43

322.39

10,821.52

1,612.23

475.03

219.96

237.47

769.45

776.19

301.90

105.94

92.21

1,197.87

203.97

114.31

74.75

148.58

83.20

284.88

174.39

365.80

12,069.54

1,786.51

528.09

244.92

262.69

845.54

853.16

231.36

97.36

85.75

1,042.13

179.04

100.37

66.14

130.40

73.62

251.19

154.24

326.54

11,001.15

1,637.47

483.91

226.44

242.47

782.90

791.36

277.55

91.52

80.38

1,078.11

184.65

103.10

67.14

133.50

74.89

257.59

157.53

331.96

11,641.41

1,737.23

513.13

240.94

258.97

833.55

843.17

373.31

96.51

85.10

1,020.94

175.40

99.41

66.44

129.79

73.89

246.20

151.19

319.39

10,382.50

1,548.30

457.61

213.75

230.66

740.28

746.83

259.17

93.59

81.59

1,054.45

179.77

100.79

65.82

131.26

73.36

249.54

152.13

318.34

10,926.41

1,632.74

481.63

226.02

242.56

783.24

790.70

223.77

99.55

86.67

1,067.78

183.67

102.83

67.49

133.11

75.20

256.62

157.19

333.70

14,123.37

2,112.62

624.77

297.73

316.31

1,023.56

1,039.36

322.69

105.81

93.50

1,351.64

229.38

128.21

84.05

167.51

93.33

316.34

191.85

401.21

14,265.86

2,112.89

625.08

293.14

313.22

1,002.81

1,012.63

372.43

152.21

133.94

6B*

1,041.99

179.02

100.36

66.13

130.38

73.61

249.31

152.31

322.26

11,000.66

1,637.39

483.89

226.43

242.46

780.39

787.88

277.55

91.52

80.38

TABLE 8

General + Mental Health + Dental + Transportation Rates:

TANF

AGE (14-20)

AGE (21-54)

SSI-N

SSI-AB

Area

BTHM0+2M0

3M0.11MO

AGE (1-5)

AGE (6-13)

Female

Male

Female

Male

AGE (55+)

BTHMO+2M0

3M0-11MO

AGE (1-5)

AGE (6-13)

AGE (14-20)

AGE (21-54)

AGE (55+)

SSI-B

AGE (65-)

AGE (65+)

1,099.50

185.54

103.71

75.44

143.13

83.02

259.64

158.80

322.90

10,288.04

1,516.79

452.31

247.43

260.75

785.76

737.19

308.61

119.20

105.29

1,099.51

185.55

104.96

83.86

145.58

85.47

258.63

157.79

322.12

10,288.11

1,516.86

458.56

277.67

261.96

787.53

731.19

328.26

122.50

108.59

1,202.96

204.62

115.62

83.09

154.89

88.87

285.78

174.71

362.90

11,294.54

1,683.06

502.36

264.88

268.98

824.17

816.55

351.00

118.34

103.16

1,053.65

179.97

101.20

73.62

135.51

78.30

252.50

155.01

323.76

10,821.63

1,612.34

484.62

274.74

268.90

806.07

793.48

326.03

122.42

108.69

1,197.88

203.98

115.50

83.28

156.55

91.17

288.12

177.63

368.53

12,069.59

1,786.56

533.03

276.78

291.86

899.51

873.70

234.04

109.96

98.35

1,042.15

179.06

102.19

79.16

142.56

85.78

256.13

159.18

330.71

11,001.22

1,637.54

490.32

267.82

280.35

853.00

818.04

278.84

95.34

84.20

1,078.13

184.67

104.85

79.61

145.15

86.54

262.33

162.27

335.96

11,641.47

1,737.29

519.15

279.77

294.52

899.33

868.21

375.86

106.85

95.44

1,020.95

175.41

100.65

75.08

135.51

79.61

247.66

152.65

320.65

10,382.57

1,548.37

463.51

247.44

250.00

762.80

757.46

265.90

106.58

94.58

1,054.47

179.79

102.31

76.44

138.29

80.39

251.33

153.92

319.89

10,926.48

1,632.81

487.85

261.54

262.95

806.98

801.91

230.50

108.97

96.09

1,067.80

183.69

104.72

80.62

141.81

83.90

258.83

159.40

335.62

14,123.46

2,112.71

632.98

344.62

343.22

1,054.90

1,054.16

329.42

113.73

101.42

1,351.66

229.40

129.80

95.15

174.87

100.69

318.21

193.72

402.83

14,265.94

2,112.97

631.93

322.26

335.66

1,028.95

1,024.97

379.53

160.13

141.86

6B*

1,042.01

179.04

102.08

78.43

141.87

85.10

253.98

156.98

326.20

11,000.73

1,637.46

490.28

267.69

280.23

850.29

814.48

278.84

95.34

84.20

AHCA Contract No. FA614, Exhibit III-F, Page 4 of 5

EXHIBIT III-F
March 1, 2009 — August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area , Age and Eligibility Category
Revised on February 16, 2009


Area		Corresponding Counties

Area 1		Escambia, Okaloosa, Santa Rosa, Walton

Area 2		Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Xxxxxxxxx, Xxxx, Liberty, Madison, Taylor, Washington, Wakulla

Area 3		Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Xxxx, Xxxxxx, Putnam, Sumter, Suwannee, Union

Area 4		Baker, Clay, Duval, Flagler, Nassau, St. Xxxxx, Volusia

Area 5		Pasco, Pinellas

Area 6		Xxxxxx, Highlands, Hillsborough, Manatee, Polk

Area 7		Brevard, Orange, Osceola, Seminole

Area 8		Charlotte, Xxxxxxx, De Xxxx, Glades, Hendry, Lee, Sarasota

Area 9		Indian River, Okeechobee, St. Lucie, Martin, Palm Beach

Area 10		Xxxxxxx

Xxxx 00		Xxxx, Xxxxxx

AHCA Contract No. FA614, Exhibit III-F, Page 5 of 5

Document Metadata

AHCA CONTRACT NO. FA614 AMENDMENT NO. 13

Document Metadata