AHCA CONTRACT NO. FAR001 AMENDMENT NO. 4
Exhibit
10.1
AMENDMENT
NO. 4
THIS
CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH
CARE ADMINISTRATION, hereinafter referred to as the “Agency,” and
HEALTHEASE HEALTH PLAN OF FLORIDA, INC., hereinafter referred
to as the “Vendor,” is hereby amended as follows:
|
1.
|
All
references in the Contract to the Vendor’s company name are hereby changed
from HealthEase Health Plan of Florida, Inc. to HealthEase of Florida,
Inc. d/b/a HealthEase. The Vendor’s contact information,
including names, addresses and telephone numbers and the Vendor’s XXXX
number remain unchanged.
|
|
2.
|
Effective
September 1, 2007, Standard Contract, Section II., Item A., Contract
Amount, the first sentence, is hereby revised to change the total
amount
of the Contract from $399,853,991.00 to $410,329,182.00 (an increase
of
$10,475,191.00).
|
|
3.
|
Effective
September 1, 2007, Attachment I, Scope of Services, Section C.,
Method of
Payment, Item 1., General, the first paragraph is hereby revised
to now
read as follows:
|
|
|
Notwithstanding
the payment amounts which may be computed with the rate tables
specified
in Tables 2 thru 8, the sum of total capitation payments under
this
Contract shall not exceed the total Contract amount of $410,329,182.00.00
(an increase of $10,475,191.00).
|
|
|
4.
|
Effective
September 1, 2007, Attachment I, Scope of Services, Xxxxxxxx 0-X,
0-X,
0-X, 0-X, 0-X, 0-X, 8-A and 9-A, are hereby included and made a
part of
the Contract. All references in the Contract to Exhibits 1, 3,
4, 5, 6, 7, 8 and 9, shall hereinafter refer respectively to Xxxxxxxx
0-X,
0-X, 0-X, 0-X, 0-X, 0-X, 8-A and
9-A.
|
|
|
5.
|
Effective
September 1, 2007, Attachment II, Medicaid Reform Health Plan Model
Contract, Section XIII, Method of Payment, Section B, Capitation
Rate
Payments, is hereby revised as
follows:
|
-- Sub-item
1.b.(1)(b), is hereby amended to include the following:
Contract
Year 2007-2008 Medicaid Reform rates under current Capitation Rate
methodology.
-- Sub-item
1.b.(1)(i), the first paragraph is hereby amended to now read as
follows:
|
|
(i)
|
50%
of Risk Adjusted Methodology: The capitation amount based on the
percentage of Risk-Adjusted methodology (h) multiplied by the Base
Rates
column for Risk-Adjusted methodology after budget neutrality factor
(g).
|
-- Sub-item
1.b.(1)(j), the first sentence is hereby amended to now read as
follows:
|
|
(j)
|
Final
Rate (with Enhanced Benefit Adjustment): The current methodology
capitation amount (d) added to the 50% of Risk-Adjusted methodology
amount
(i).
|
|
|
6.
|
This
Amendment shall be effective upon execution by both parties or
July 1,
2007, whichever is later.
|
All
provisions in the Contract and any attachments thereto in conflict with this
Amendment shall be and are hereby changed to conform with this
Amendment.
All
provisions not in conflict with
this Amendment are still in effect and are to be performed at the level
specified in the Contract
This
Amendment, and all its
attachments, is hereby made 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 fourteen (14) page Amendment (including all attachments)
to be
executed by their officials thereunto duly authorized.
|
HEALTHEASE
OF FLORIDA, INC. D/B/A
HEALTHEASE
|
STATE
OF FLORIDA, AGENCY FOR HEALTH CARE
ADMINISTRATION
|
|
SIGNED BY: /s/ Xxxx
Xxxxx
|
SIGNED
BY: /s/ Xxxxxx Xxxxxxxx
|
|
NAME: Xxxx
X. Xxxxx
|
NAME: Xxxxxx
X. Xxxxxxxx, M.D.
|
|
TITLE:
President and
CEO
|
TITLE:
Secretary
|
|
DATE:
6/29/2007
|
DATE: 6/29/07
|
List
of
Attachments/Exhibits included as part of this Amendment:
|
Specify
Type
|
Letter/
Number
|
Description
|
|
Exhibit
|
1-A
|
Benefit
Grid Effective September 1, 2007 (4 Pages)
|
|
Exhibit
|
3-A
|
Comprehensive
Component and Catastrophic Component Capitation Rates (2
Pages)
|
|
Exhibit
|
4-A
|
Comprehensive
Component Only (1 Page)
|
|
Exhibit
|
5-A
|
Capitation
Rates SSI Medicare Part B Only and SSI Medicare Parts A and B Enrollees
for All Medicaid Reform Counties (1 Page)
|
|
Exhibit
|
6-A
|
Capitation
Rates for HIV/AIDS Populations for Each Medicaid Reform County
(1
Page)
|
|
Exhibit
|
7-A
|
Capitation
Rates for Children with Chronic Conditions for All Medicaid Reform
Counties (1 Page)
|
|
Exhibit
|
8-A
|
Kick
Payment Amounts for Covered Transplant Services (1
Page)
|
|
Exhibit
|
9-A
|
Kick
Payment Amounts for Covered Obstetrical Delivery Services (1
Page)
|
REMAINDER
OF THIS PAGE INTENTIONALLY LEFT BLANK
EXHIBIT
1-A
Benefit
Grid
Effective
September 1, 2007
(i) Area
10 Broward- Children and Families
*IF
ADDITIONAL SERVICES ARE NEEDED THEY MUST BE PRIOR AUTHORIZED.
|
Enhanced
benefits
|
|
(Circumcision,
boys up to one year)
|
|
($25
OTC, per household per month)
|
|
(Adult
Dental – Adult Dental – Exams / X-rays / Two Annual Standard
Cleanings)
|
(ii) Area
10 Broward- Aged and Disabled
*IF
ADDITIONAL SERVICES ARE NEEDED THEY MUST BE PRIOR AUTHORIZED.
|
Enhanced
benefits
|
|
(Circumcision,
boys up to one year)
|
|
($25
OTC, per household per month)
|
|
(Meals
on Wheels – Home delivery up to 10 meals post
discharge)
|
|
(Expanded
dental services – Exams/Xrays / Deep Cleaning/ Clear and Silver Fillings/
Crown (limited)
Flouride/Periodontal
Scaling and root planing)
|
|
(Respite
Events - up to 1 per
month)
|
(i) Area
4 Xxxxx- Children and Families
*IF
ADDITIONAL SERVICES ARE NEEDED THEY MUST BE PRIOR AUTHORIZED.
|
Enhanced
benefits
|
|
(Circumcision,
boys up to one year)
|
|
($25
OTC, per household per month)
|
|
(Adult
Dental Exams / X-rays / Deep Cleaning / Unlimited Silver Fillings
/ Two
Annual Standard
Cleanings)
|
(ii) Area
4 Xxxxx- Aged and Disabled
*IF
ADDITIONAL SERVICES ARE NEEDED THEY MUST BE PRIOR AUTHORIZED.
|
Enhanced
benefits
|
|
(Circumcision,
boys up to one year)
|
|
($25
OTC, per household per month)
|
|
(Meals
on Wheels)
|
|
(Adult
Dental – Exams / X-rays / Deep Cleaning / Clear and Silver Fillings /
Crown (limited) / Fluoride / Periodontal Scaling and Root
Planing)
|
|
(Respite
Events - up to 1 per
month)
|
EXHIBIT
3-A
COMPREHENSIVE
COMPONENT AND CATASTROPHIC COMPONENT CAPITATION
RATES
|
TABLE
2
|
||
|
Area: 4
|
County: Duval,
Clay, Xxxxx and Nassau
|
September
1, 2007
|
ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY
CMS)
|
Age
Range
|
|
FY0708
Discounted Reform rates Under Current Methodology
|
Percentage
of Current Methodology
|
50%
of Current Methodology
|
Preliminary
FY0708 Base rates for Risk Adjusted Methodology
|
Budget
Neutrality Factor
|
FY0708
Base rates for Risk Adjusted Methodology after Budget
Neutrality
|
Percentage
of Risk Adjusted Methodology
|
50%
of Risk Adjusted Methodology
|
Final
Rates (with Enhanced Benefit Adjustment)
|
||||||||||||||||||||||||||||
|
|
a
|
|
|
b
|
c
|
d
|
e
|
f
|
g
|
h
|
i
|
j
|
||||||||||||||||||||||||||
|
Eligibility
Category:
|
|
Children
and Family
|
||||||||||||||||||||||||||||||||||||
|
Month
0-2 All
|
$ |
942.31
|
||||||||||||||||||||||||||||||||||||
|
Month
3-11 All
|
$ |
218.74
|
||||||||||||||||||||||||||||||||||||
|
1-5
All
|
$ |
113.17
|
50
|
% | $ |
56.58
|
$ |
124.53
|
1.04120
|
$ |
129.66
|
50
|
% | $ |
64.83
|
$ |
118.98
|
|||||||||||||||||||||
|
6-13
All
|
$ |
82.75
|
50
|
% | $ |
41.37
|
$ |
124.53
|
1.04120
|
$ |
129.66
|
50
|
% | $ |
64.83
|
$ |
104.08
|
|||||||||||||||||||||
|
14-20
Female
|
$ |
119.81
|
50
|
% | $ |
59.91
|
$ |
124.53
|
1.04120
|
$ |
129.66
|
50
|
% | $ |
64.83
|
$ |
122.24
|
|||||||||||||||||||||
|
14-20
Male
|
$ |
81.70
|
50
|
% | $ |
40.85
|
$ |
124.53
|
1.04120
|
$ |
129.66
|
50
|
% | $ |
64.83
|
$ |
103.56
|
|||||||||||||||||||||
|
21-54
Female
|
$ |
218.13
|
50
|
% | $ |
109.06
|
$ |
124.53
|
1.04120
|
$ |
129.66
|
50
|
% | $ |
64.83
|
$ |
170.41
|
|||||||||||||||||||||
|
21-54
Male
|
$ |
158.54
|
50
|
% | $ |
79.27
|
$ |
124.53
|
1.04120
|
$ |
129.66
|
50
|
% | $ |
64.83
|
$ |
141.22
|
|||||||||||||||||||||
|
55+
All
|
$ |
350.55
|
50
|
% | $ |
175.28
|
$ |
124.53
|
1.04120
|
$ |
129.66
|
50
|
% | $ |
64.83
|
$ |
235.30
|
|||||||||||||||||||||
|
|
|
|||||||||||||||||||||||||||||||||||||
|
Composite
Based on Total Casemonths
|
$ |
119.40
|
$ |
129.66
|
$ |
0.00
|
$ |
122.04
|
||||||||||||||||||||||||||||||
|
|
||||||||||||||||||||||||||||||||||||||
|
Eligibility
Category:
|
Aged
and Disabled
|
|||||||||||||||||||||||||||||||||||||
|
|
||||||||||||||||||||||||||||||||||||||
|
Month
0-2 All
|
|
$ |
14,803.79
|
|||||||||||||||||||||||||||||||||||
|
Month
3-11 All
|
|
$ |
3,019.63
|
|||||||||||||||||||||||||||||||||||
|
1-5
All
|
$ |
537.41
|
50
|
%
|
$ |
268.70
|
$ |
657.05
|
1.05080
|
$ |
690.42
|
50
|
% | $ |
345.21
|
$ |
601.64
|
|||||||||||||||||||||
|
6-13
All
|
$ |
312.13
|
50
|
% | $ |
156.06
|
$ |
657.05
|
1.05080
|
$ |
690.42
|
50
|
% | $ |
345.21
|
$ |
491.25
|
|||||||||||||||||||||
|
14-20
All
|
$ |
296.53
|
50
|
% | $ |
148.27
|
$ |
657.05
|
1.05080
|
$ |
690.42
|
50
|
% | $ |
345.21
|
$ |
483.61
|
|||||||||||||||||||||
|
21-54
All
|
$ |
790.16
|
50
|
% | $ |
395.08
|
$ |
657.05
|
1.05080
|
$ |
690.42
|
50
|
% | $ |
345.21
|
$ |
725.49
|
|||||||||||||||||||||
|
55+
All
|
$ |
809.32
|
50
|
% | $ |
404.66
|
$ |
657.05
|
1.05080
|
$ |
690.42
|
50
|
% | $ |
345.21
|
$ |
734.88
|
|||||||||||||||||||||
|
Composite
Based on Total Casemonths
|
$ |
623.67
|
$ |
690.42
|
$ |
0.00
|
$ |
643.91
|
||||||||||||||||||||||||||||||
EXHIBIT
3-A
COMPREHENSIVE
COMPONENT AND CATASTROPHIC COMPONENT CAPITATION
RATES
|
TABLE
2
|
||
|
Area: 10
|
County: Broward
|
September
1, 2007
|
ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
|
Age
Range
|
FY0708
Discounted
Reform
rates
Under
Current Methodology
|
Percentage
of Current Methodology
|
50%
of Current Methodology
|
Preliminary
FY0708 Base rates for Risk Adjusted Methodology
|
Budget
Neutrality Factor
|
FY0708
Base rates for Risk Adjusted Methodology after Budget
Neutrality
|
Percentage
of Risk Adjusted Methodology
|
50%
of Risk Adjusted Methodology
|
Final
Rates (with Enhanced Benefit Adjustment)
|
|||||||||||||||||||||||||||||
|
a
|
b
|
c
|
d
|
e
|
f
|
g
|
h
|
i
|
j
|
|||||||||||||||||||||||||||||
|
Eligibility
Category:
|
Children
and Family
|
|||||||||||||||||||||||||||||||||||||
|
Month
0-2 All
|
$ |
907.28
|
||||||||||||||||||||||||||||||||||||
|
Month
3-11 All
|
$ |
208.49
|
||||||||||||||||||||||||||||||||||||
|
1-5
All
|
$ |
106.14
|
50
|
% | $ |
53.07
|
$ |
117.69
|
1.07460
|
$ |
126.47
|
50
|
% | $ |
63.23
|
$ |
113.98
|
|||||||||||||||||||||
|
6-13
All
|
$ |
82.94
|
50
|
% | $ |
41.47
|
$ |
117.69
|
1.07460
|
$ |
126.47
|
50
|
% | $ |
63.23
|
$ |
102.61
|
|||||||||||||||||||||
|
14-20
Female
|
$ |
115.00
|
50
|
% | $ |
57.50
|
$ |
117.69
|
1.07460
|
$ |
126.47
|
50
|
% | $ |
63.23
|
$ |
118.32
|
|||||||||||||||||||||
|
14-20
Male
|
$ |
79.98
|
50
|
% | $ |
39.99
|
$ |
117.69
|
1.07460
|
$ |
126.47
|
50
|
% | $ |
63.23
|
$ |
101.16
|
|||||||||||||||||||||
|
21-54
Female
|
$ |
202.08
|
50
|
% | $ |
101.04
|
$ |
117.69
|
1.07460
|
$ |
126.47
|
50
|
% | $ |
63.23
|
$ |
160.99
|
|||||||||||||||||||||
|
21-54
Male
|
$ |
146.71
|
50
|
% | $ |
73.35
|
$ |
117.69
|
1.07460
|
$ |
126.47
|
50
|
% | $ |
63.23
|
$ |
133.86
|
|||||||||||||||||||||
|
55+
All
|
$ |
325.58
|
50
|
% | $ |
162.79
|
$ |
117.69
|
1.07460
|
$ |
126.47
|
50
|
% | $ |
63.23
|
$ |
221.50
|
|||||||||||||||||||||
|
|
|
|
|
|||||||||||||||||||||||||||||||||||
|
Composite
Based on Total Casemonths
|
$ |
108.91
|
$ |
126.47
|
|
$ |
0.00
|
$ |
115.34
|
|||||||||||||||||||||||||||||
|
|
||||||||||||||||||||||||||||||||||||||
|
Eligibility
Category:
|
Aged
and Disabled
|
|||||||||||||||||||||||||||||||||||||
|
Month
0-2 All
|
$ |
17,822.94
|
||||||||||||||||||||||||||||||||||||
|
Month
3-11 All
|
$ |
3,594.38
|
||||||||||||||||||||||||||||||||||||
|
1-5
All
|
$ |
631.27
|
50
|
% | $ |
315.63
|
$ |
813.28
|
1.06682
|
$ |
867.63
|
50
|
% | $ |
433.81
|
$ |
734.46
|
|||||||||||||||||||||
|
6-13
All
|
$ |
355.68
|
50
|
% | $ |
177.84
|
$ |
813.28
|
1.06682
|
$ |
867.63
|
50
|
% | $ |
433.81
|
$ |
599.42
|
|||||||||||||||||||||
|
14-20
All
|
$ |
343.79
|
50
|
% | $ |
171.90
|
$ |
813.28
|
1.06682
|
$ |
867.63
|
50
|
% | $ |
433.81
|
$ |
593.59
|
|||||||||||||||||||||
|
21-54
All
|
$ |
930.27
|
50
|
% | $ |
465.13
|
$ |
813.28
|
1.06682
|
$ |
867.63
|
50
|
% | $ |
433.81
|
$ |
880.97
|
|||||||||||||||||||||
|
55+
All
|
$ |
965.71
|
50
|
% | $ |
482.85
|
$ |
813.28
|
1.06682
|
$ |
867.63
|
50
|
% | $ |
433.81
|
$ |
898.33
|
|||||||||||||||||||||
|
|
||||||||||||||||||||||||||||||||||||||
|
Composite
Based on Total Casemonths
|
$ |
758.94
|
$ |
867.63
|
$ |
0.00
|
$ |
797.02
|
||||||||||||||||||||||||||||||
REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
EXHIBIT
4-A
COMPREHENSIVE
COMPONENT ONLY
|
TABLE
3
|
||
|
Area:
________________
|
County:
_________________
|
September
1, 2007
|
|
ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY
CMS)
|
|
Area
________
|
|||||||||||||||||||||||||||
|
Age
Range
|
FY0607
Discounted Reform rates Under Current Methodology
|
Percentage
of Current
Methodology
|
75%
of Current Methodology
|
FY0607
Base Rates for Risk-Adjusted Methodology
|
Percentage
of Risk-Adjusted
Methodology
|
25%
of Risk-Adjusted Methodology
|
Budget
Neutrality Factor
|
Budget
Adjusted of 25% of Risk Adjusted
Methodology
|
Blended
Rate (Risk = 1.00)
|
Final
Rate (with Enhanced Benefit Adjustment)
|
|||||||||||||||||
|
(a)
|
(b)
|
(c)
|
(d)
|
(e)
|
(f)
|
(g)
|
(h)
|
(i)
|
(j)
|
(k)
|
|||||||||||||||||
|
Eligibility
Category:
|
Children
and Family
|
||||||||||||||||||||||||||
|
Month
0-2 All
|
$ |
75
|
% | $ | $ |
25
|
% | $ | $ | $ | |||||||||||||||||
|
Month
3-11 All
|
$ |
75
|
% | $ | $ |
25
|
% | $ | $ | $ | |||||||||||||||||
|
1-5
All
|
$ |
75
|
% | $ | $ |
25
|
% | $ | $ | $ | |||||||||||||||||
|
6-13
All
|
$ |
75
|
% | $ | $ |
25
|
% | $ | $ | $ | |||||||||||||||||
|
14-20
Female
|
$ |
75
|
% | $ | $ |
25
|
% | $ | $ | $ | |||||||||||||||||
|
14-20
Male
|
$ |
75
|
% | $ | $ |
25
|
% | $ | $ | $ | |||||||||||||||||
|
21-54
Female
|
$ |
75
|
% | $ | $ |
25
|
% | $ | $ | $ | |||||||||||||||||
|
21-54
Male
|
$ |
75
|
% | $ | $ |
25
|
% | $ | $ | $ | |||||||||||||||||
|
55+
All
|
$ |
75
|
% | $ | $ |
25
|
% | $ | $ | $ | |||||||||||||||||
|
Composite
|
|
|
$ | $ | |||||||||||||||||||||||
|
|
|
||||||||||||||||||||||||||
|
Eligibility
Category:
|
Aged
and Disabled
|
|
|
||||||||||||||||||||||||
|
Month
0-2 All
|
$ |
75
|
% | $ | $ |
25
|
% | $ | $ | $ | |||||||||||||||||
|
Month
3-11 All
|
$ |
75
|
% | $ | $ |
25
|
% | $ | $ | $ | |||||||||||||||||
|
1-5
All
|
$ |
75
|
% | $ | $ |
25
|
% | $ | $ | $ | |||||||||||||||||
|
6-13
All
|
$ |
75
|
% | $ | $ |
25
|
% | $ | $ | $ | |||||||||||||||||
|
14-20
All
|
$ |
75
|
% | $ | $ |
25
|
% | $ | $ | $ | |||||||||||||||||
|
21-54
All
|
$ |
75
|
% | $ | $ |
25
|
% | $ | $ | $ | |||||||||||||||||
|
55+
All
|
$ |
75
|
% | $ | $ |
25
|
% | $ | $ | $ | |||||||||||||||||
|
Composite
|
$ | ||||||||||||||||||||||||||
REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
AHCA
Contract No. FAR001, Exhibit 4-A, Page 1 of 1
EXHIBIT
5-A
CAPITATION
RATES
SSI
MEDICARE PART B ONLY
AND
SSI
MEDICARE PARTS A AND B ENROLLEES
FOR
ALL MEDICAID REFORM COUNTIES
|
|
TABLE
4
|
|
Area:
|
4
|
County:
|
Duval,
Baker, Clay and Nassau
|
ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
|
Under
Age 65
|
Age
65 & Over
|
|
|
SSI/Parts
A & B
|
$200.51
|
$135.15
|
|
SSI/Part
B Only
|
$369.64
|
$369.64
|
Area: 10 County: Broward
ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
|
Under
Age 65
|
Age
65 & Over
|
|
|
SSI/Parts
A & B
|
$192.29
|
$129.85
|
|
SSI/Part
B Only
|
$249.37
|
$249.37
|
REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
EXHIBIT
6-A
CAPITATION
RATES FOR HIV/AIDS POPULATIONS FOR EACH MEDICAID REFORM
COUNTY
|
|
TABLE
5
|
|
Area:
|
4
|
County:
|
Duval,
Baker, Clay and Nassau
|
ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
|
Capitation
Rate
|
|
|
HIV
(no medicare)
|
$1,216.29
|
|
AIDS
(no medicare)
|
$2,394.42
|
|
HIV-SSI/Parts
A & B, SSI Part B Only
|
$ 294.90
|
|
AIDS-SSI/Parts
A & B, SSI Part B Only
|
$ 291.91
|
|
Area:
|
10
|
County:
|
Broward
|
ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
|
Capitation
Rate
|
|
|
HIV
(no medicare)
|
$1,966.44
|
|
AIDS
(no medicare)
|
$3,690.27
|
|
HIV-SSI/Parts
A & B, SSI Part B Only
|
$ 331.60
|
|
AIDS-SSI/Parts
A & B, SSI Part B Only
|
$ 708.10
|
REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
EXHIBIT
7-A
CAPITATION
RATES FOR CHILDREN WITH CHRONIC CONDITIONS FOR ALL MEDICAID REFORM
COUNTIES
|
|
TABLE
6
|
|
Area:
|
County:
____________________
|
|
ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
|
|
Age
<
1 Yr
|
Age
1 Yr
|
Age
2 - 20 Yrs
|
|
|
Children
with Chronic Conditions
|
$
|
$
|
$
|
REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
EXHIBIT
8-A
KICK
PAYMENT AMOUNTS FOR COVERED
TRANSPLANT
SERVICES
|
|
TABLE
7
|
|
Area:
|
4
|
County:
|
Duval,
Baker, Clay and Nassau
|
|
Area:
|
10
|
County:
|
|
Broward |
|
CPT
Code
|
Transplant
CPT Code Description
|
Children/Adolescents
or Adult
|
Payment
Amount
|
|
32851
|
lung
single, without bypass
|
Children/Adolescents
|
$320,800.00
|
|
32851
|
lung
single, without bypass
|
Adult
|
$238,000.00
|
|
32852
|
lung
single, with bypass
|
Children/Adolescents
|
$320,800.00
|
|
32852
|
lung
single, with bypass
|
Adult
|
$238,000.00
|
|
32853
|
lung
double, without bypass
|
Children/Adolescents
|
$320,800.00
|
|
32853
|
lung
double, without bypass
|
Adult
|
$238,000.00
|
|
32854
|
lung
double, with bypass
|
Children/Adolescents
|
$320,800.00
|
|
32854
|
lung
double, with bypass
|
Adult
|
$238,000.00
|
|
33945
|
heart
transplant with or without recipient cardiectomy
|
Children/Adolescents
|
$162,000.00
|
|
33945
|
heart
transplant with or without recipient cardiectomy
|
Adult
|
$162,000.00
|
|
47135
|
liver,
allotransplation, orthotopic, partial or whole from cadaver
or living
donor
|
Children/Adolescents
|
$122,600.00
|
|
47135
|
liver,
allotransplation, orthotopic, partial or whole from cadaver
or living
donor
|
Adult
|
$122,600.00
|
|
47136
|
liver,
heterotopic, partial or whole from cadaver or living donor
any
age
|
Children/Adolescents
|
$122,600.00
|
|
47136
|
liver,
heterotopic, partial or whole from cadaver or living donor
any
age
|
Adult
|
$122,600.00
|
REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
AHCA
Contract No. FAR001, Exhibit 8-A, Page 1 of
1
EXHIBIT
9-A
KICK
PAYMENT AMOUNTS FOR COVERED
OBSTETRICAL
DELIVERY SERVICES
TABLE
8
Area: 4 County: Duval,
Baker, Clay &
Nassau
|
CPT
Code
|
Obstetrical
Delivery CPT Code Description
|
Payment
Amount
|
|
59409
|
Vaginal
delivery only
|
$3,982.26
|
|
59410
|
Vaginal
delivery including postpartum care
|
|
|
59515
|
Cesarean
delivery including postpartum care
|
|
|
59612
|
Vaginal
delivery only, after previous cesarean delivery
|
|
|
59614
|
Vaginal
delivery only, after previous cesarean delivery including postpartum
care
|
|
|
59622
|
Cesarean
delivery only, following attempted vaginal delivery after previous
cesarean delivery including postpartum
care
|
|
Area:
|
10
|
County:
|
Broward
|
|
CPT
Code
|
Obstetrical
Delivery CPT Code Description
|
Payment
Amount
|
|
59409
|
Vaginal
delivery only
|
$3,997.99
|
|
59410
|
Vaginal
delivery including postpartum care
|
|
|
59515
|
Cesarean
delivery including postpartum care
|
|
|
59612
|
Vaginal
delivery only, after previous cesarean delivery
|
|
|
59614
|
Vaginal
delivery only, after previous cesarean delivery including postpartum
care
|
|
|
59622
|
Cesarean
delivery only, following attempted vaginal delivery after previous
cesarean delivery including postpartum
care
|
REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
AHCA
Contract No. FAR001, Exhibit 9-A, Page 1 of 1
