AHCA CONTRACT NO. FA615 AMENDMENT NO. 5
Exhibit
10.2
WellCare
of Florida, Inc. d/b/a
Staywell Health Plan of Florida
AHCA
CONTRACT NO. FA615
AMENDMENT
NO. 5
THIS CONTRACT,
entered into between the STATE OF FLORIDA,
AGENCY FOR HEALTH CARE ADMINISTRATION,
hereinafter referred to as the "Agency" and WELLCARE OF FLORIDA,
INC. D/B/A STAYWELL
HEALTH PLAN OF FLORIDA, hereinafter referred to as the "Vendor" or
"Health Plan", is
hereby amended as follows:
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1.
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Attachment
I, Scope of Services, is hereby amended to include Exhibit II-C, Third
Revised Capitation Rates, attached hereto and made a part of the Contract.
All references in the Contract to Exhibit II-B, Second Revised Capitation
Rates, shall hereinafter also refer to Exhibit II-C, Third Revised
Capitation Rates, as appropriate.
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2.
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Attachment
II, Medicaid Prepaid Health Plan Model Contract, Section V, Covered
Services, Item B, Optional Services, is hereby deleted in its entirety and
replaced with the following:
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B.
Optional Services
1.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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X
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Transportation
Services
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X
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3. Attachment
II, Medicaid Prepaid Health Plan Model Contract, Section V, Covered Services,
Item C,
Expanded Services, sub-item 2 is hereby deleted in its entirety and replaced
with the following:
2.The
following is a list of the Health Plan's Expanded Services:
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a.
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Annual
comprehensive oral exam, x-rays (one (1) per year), two (2) cleanings per
year, silver amalgam fillings, one periodontic deep cleaning per year, two
(2) periodontic scaling and root planing per
year.
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b.
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Up
to $25 credit per household each month for selected over the counter drugs
and/or health supplies.
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c.
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Unlimited
eye exams and eyeglasses, if medically
necessary.
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d.
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Circumcision
up to one (1) year.
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4.
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This
Amendment shall have an effective date of March 1, 2008, or the date on
which both parties execute
the Amendment, whichever is
later.
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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. FA615, Amendment No. 5, Page 1 of
2
Wellcare
of Florida, Inc. d/b/a Staywell Health Plan of
Florida
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.
IN
WITNESS WHEREOF, the parties hereto have caused this two (2) page Amendment
(which includes all attachments hereto) to be executed by their officials
thereunto duly authorized.
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WELLCARE
OF FLORIDA, INC. D/B/A STAYWELL HEALTH PLAN OF FLORIDA
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STATE
OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION
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SIGNED BY: /s/ Xxxxx
Xxxxxxxxx
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SIGNED
BY: /s/ Illegible
for
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NAME: Xxxxx
Xxxxxxxxx
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NAME:
Xxxxx Xxxxxx
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TITLE: President and
CEO
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TITLE:
Secretary
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DATE: 3/27/08
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Date:
4/2/08
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List of
attachments included as part of this Amendment:
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Specify
Type
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Letter/Number
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Description
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Exhibit
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11-C
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Third
Revised Capitation Rates (1 Page)
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REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
AHCA Contract No. FA615, Amendment No. 5, Page 2 of
2
EXHIBIT
II-C
THIRD
REVISED CAPITATION RATES
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A.
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Table
2 - General Capitation Rates plus Mental Health
Rates:
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Area
3 Counties:
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County
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Provider
Number
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Hernando
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015016901
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Sumter
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015016916
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Area
5 Counties:
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County
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Provider
Number
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Pasco
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015016903
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Pinellas
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015016904
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Area
6 Counties:
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County
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Provider
Number
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Hillsborough
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015016902
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Manatee
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015016912
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Polk
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015016905
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Area
7 Counties:
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County
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Provider
Number
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Orange
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015016906
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Seminole
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015016908
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Osceola
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015016907
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Xxxxxxx
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000000000
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Xxxx
0 Xxxxxxxx:
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Xxxxxx
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Provider
Number
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Xxx
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015016911
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Sarasota
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015016914
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Area
9 Counties:
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County
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Provider
Number
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Palm
Beach
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015016910
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St.
Lucie
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015016915
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Area
10 Counties:
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County
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Provider
Number
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Broward
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015016900
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Area
11 Counties:
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County
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Provider
Number
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Miami-Date
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015016909
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AHCA
Contract No. FA615, Exhibit 11-C, Page 1 of 1
