AHCA CONTRACT NO. FAR009 AMENDMENT NO. 5
Exhibit
10.4
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,” is hereby amended as
follows:
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1.
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Attachment
I, Exhibit 6-A, is hereby deleted in its entirety and replaced with
Exhibit 6-B, attached hereto and made a part of the
Contract. All references in the Contract to Exhibit 6-A shall
hereinafter refer to Exhibit 6-B.
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This
Amendment shall have an effective
date of September 1, 2007, or the date on which both parties execute the
Amendment, whichever is later.
All
provisions in the Contract and any
attachments thereto in conflict with this Amendment shall be and are hereby
changed to conform with this Amendment.
All
provisions not in conflict with
this Amendment are still in effect and are to be performed at the level
specified in the Contract
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 two (2) page Amendment (including all attachments) 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,
INC.
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STATE
OF FLORIDA, AGENCY FOR HEALTH CARE
ADMINISTRATION
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SIGNED
BY: /s/ Xxxx X. Xxxxx
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SIGNED
BY: /s/ Xxxxxx Xxxxxxxx
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NAME: Xxxx
X. Xxxxx
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NAME: Xxxxxx
X. Xxxxxxxx, M.D.
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TITLE: CEO
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TITLE: Secretary
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DATE: 9/4/07
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DATE: 9/6/07
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List
of Attachments/Exhibits 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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6-B
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Capitation
Rates for HIV/AIDS Populations for each
Medicaid
Reform County (1 page)
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EXHIBIT
6-B
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CAPTITATION
RATES FOR HIV/AIDS POPULATIONS FOR EACH MEDICAID REFORM
COUNTY
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TABLE
5
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Area: 4
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County:
Duval, Baker, Clay, and Nassau
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ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
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Capitation
Rate
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HIV
(no medicare)
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$1,216.29
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AIDS
(no medicare)
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$2,394.42
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HIV-SSI/Parts
A & B, SSI Part B Only
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$ 199.19
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AIDS-SSI/Parts
A & B, SSI Part B Only
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$ 425.36
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Area: 10
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County: Broward
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ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
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Capitation
Rate
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HIV
(no medicare)
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$1,966.44
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AIDS
(no medicare)
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$3,690.26
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HIV-SSI/Parts
A & B, SSI Part B Only
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$ 331.60
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AIDS-SSI/Parts
A & B, SSI Part B Only
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$ 708.10
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REMAINDER
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