AHCA CONTRACT NO. FA619 AMENDMENT NO. 2
Exhibit
10.1
HealthEase
of Florida,
Inc.
AHCA
CONTRACT NO. FA619
AMENDMENT
NO. 2
THIS
CONTRACT, entered into
between the STATE OF FLORIDA,
AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the
"Agency" and HEALTHEASE OF
FLORIDA, INC., hereinafter referred to as the "Vendor" or “Health Plan”,
is hereby amended as follows:
|
1.
|
Effective
September 1, 2007, Attachment I, Scope of Services, is hereby amended
to
include Exhibit III-B, September 1, 2007- August 31, 2008 Medicaid
Non-Reform HMO Capitation Rates, attached hereto and made a part
of the
Contract. All references in the Contract to Exhibit III-A, September
1,
2007 – August 31, 2008 Medicaid Non-Reform HMO Capitation Rates, shall
hereinafter instead refer to Exhibit III-B, September 1, 2007- August
31,
2008 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.
IN
WITNESS WHEREOF, the parties hereto
have caused this six (6) page Amendment (which includes all attachments hereto)
to be executed by their officials thereunto duly authorized.
|
HEALTHEASE
OF FLORIDA, INC.
|
STATE
OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
|
|
|
SIGNED
BY: /s/ ▇▇▇▇
▇. ▇▇▇▇▇
|
SIGNED
BY: /s/ ▇▇▇▇▇▇
▇. ▇▇▇▇▇▇▇▇
|
|
|
NAME:
▇▇▇▇ ▇.
▇▇▇▇▇
|
NAME: ▇▇▇▇▇▇
▇. ▇▇▇▇▇▇▇▇,
M.D.
|
|
|
TITLE:
President
and
CEO
|
TITLE:
Secretary
|
|
|
DATE: 12/7/07
|
DATE:
12/10/07
|
|
|
List
of attachments included as part of this Amendment:
|
||
|
Specify
Type
|
Letter/
Number
|
Description
|
|
Exhibit
|
III-B
|
September
1, 2007- August 31, 2008 Medicaid Non-Reform HMO Capitation Rates
(5
Pages)
|
REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
AHCA
Contract No. FA619, Amendment No. 2, Page 1 of 1
|
ATTACHMENT
III-B
|
|
September
1, 2007- August 31,
2008
|
|
MEDICAID
Non-Reform HMO CAPITATION
RATES
|
|
By
Area , Age and Eligibility
Category
Estimated
Health Plan Rates (Not for use unless approved by
CMS)
|
|
TABLE
1
|
||||||||||||||||||||||
|
General
Rates:
|
||||||||||||||||||||||
| TANF | SSI-N |
|
SSI-B
|
SSI-AB
|
||||||||||||||||||
|
Area
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
||||||
|
Female
|
Male
|
Female
|
Male
|
|||||||||||||||||||
|
01
|
1,131.99
|
202.30
|
105.58
|
66.22
|
135.19
|
72.29
|
265.45
|
167.89
|
347.47
|
10,081.87
|
1,458.88
|
435.95
|
201.26
|
222.08
|
716.10
|
703.88
|
270.84
|
98.28
|
80.72
|
|||
|
02
|
1,131.99
|
202.30
|
105.58
|
66.22
|
135.19
|
72.29
|
265.45
|
167.89
|
347.47
|
10,081.87
|
1,458.88
|
435.95
|
201.26
|
222.08
|
716.10
|
703.88
|
270.84
|
98.28
|
80.72
|
|||
|
03
|
1,296.42
|
233.58
|
122.13
|
77.48
|
156.47
|
84.50
|
308.68
|
196.24
|
408.68
|
11,326.29
|
1,656.79
|
495.12
|
233.33
|
256.55
|
826.59
|
816.63
|
272.62
|
91.40
|
75.41
|
|||
|
04
|
1,128.87
|
203.75
|
106.78
|
67.92
|
136.68
|
74.01
|
269.88
|
171.79
|
358.59
|
10,675.98
|
1,563.58
|
467.86
|
220.87
|
242.36
|
781.86
|
772.10
|
329.54
|
94.19
|
77.67
|
|||
|
05
|
1,260.50
|
227.66
|
119.09
|
75.94
|
152.59
|
82.61
|
301.42
|
191.81
|
400.30
|
11,774.49
|
1,721.01
|
514.94
|
241.96
|
266.53
|
857.42
|
846.21
|
228.63
|
88.38
|
73.66
|
|||
|
06
|
1,111.64
|
201.87
|
106.04
|
68.10
|
135.60
|
74.02
|
269.07
|
171.81
|
360.32
|
10,832.05
|
1,590.31
|
475.95
|
225.91
|
247.84
|
799.09
|
790.01
|
283.50
|
85.45
|
70.71
|
|||
|
07
|
1,129.81
|
204.44
|
107.10
|
68.40
|
137.11
|
74.43
|
271.08
|
172.77
|
361.05
|
11,163.75
|
1,640.70
|
490.80
|
233.68
|
256.10
|
824.52
|
815.86
|
326.33
|
88.91
|
73.77
|
|||
|
08
|
1,059.95
|
192.36
|
100.83
|
64.75
|
129.15
|
70.40
|
255.88
|
163.25
|
342.35
|
9,491.26
|
1,388.78
|
415.62
|
196.24
|
215.38
|
694.16
|
685.42
|
190.94
|
84.41
|
69.83
|
|||
|
09
|
1,098.82
|
197.96
|
103.63
|
65.91
|
132.56
|
71.62
|
261.85
|
166.57
|
346.99
|
10,597.24
|
1,556.56
|
465.60
|
221.41
|
242.54
|
781.98
|
773.10
|
204.68
|
91.80
|
76.03
|
|||
|
10
|
1,119.46
|
203.01
|
106.51
|
68.32
|
136.20
|
74.23
|
270.06
|
172.18
|
360.84
|
13,743.01
|
2,028.53
|
606.68
|
290.75
|
319.15
|
1,026.77
|
1,016.73
|
255.52
|
105.04
|
86.99
|
|||
|
11
|
1,448.96
|
260.41
|
136.24
|
86.18
|
174.38
|
94.02
|
343.72
|
218.26
|
453.77
|
14,396.52
|
2,111.55
|
631.62
|
299.15
|
329.01
|
1,058.44
|
1,046.51
|
335.29
|
159.90
|
130.52
|
|||
|
TABLE
2
|
||||||||||||||||||||||
|
General
+ Mental Health
Rates:
|
||||||||||||||||||||||
|
TANF
|
SSI-N
|
SSI-B
|
SSI-AB | |||||||||||||||||||
|
Area
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
||||||
|
Female
|
Male
|
Female
|
Male
|
|||||||||||||||||||
|
01
|
1,132.01
|
202.32
|
107.22
|
77.91
|
146.11
|
83.21
|
269.89
|
172.33
|
351.22
|
10,081.95
|
1,458.96
|
443.39
|
249.30
|
266.06
|
797.48
|
734.86
|
271.05
|
109.93
|
92.37
|
|||
|
02
|
1,132.02
|
202.33
|
108.49
|
86.47
|
148.60
|
85.70
|
268.86
|
171.30
|
350.43
|
10,082.03
|
1,459.04
|
449.74
|
280.06
|
267.29
|
768.77
|
728.75
|
291.04
|
113.28
|
95.72
|
|||
|
03
|
1,296.43
|
233.59
|
123.45
|
86.66
|
162.55
|
90.58
|
310.23
|
197.79
|
410.02
|
11,326.36
|
1,656.86
|
501.38
|
269.08
|
277.06
|
850.48
|
827.91
|
279.47
|
100.38
|
84.39
|
|||
|
04
|
1,128.88
|
203.76
|
108.15
|
77.48
|
143.01
|
80.34
|
271.49
|
173.40
|
359.98
|
10,676.09
|
1,563.69
|
477.61
|
276.60
|
274.33
|
819.11
|
789.69
|
354.09
|
110.96
|
94.44
|
|||
|
05
|
1,260.51
|
227.67
|
120.30
|
84.61
|
160.70
|
90.72
|
304.71
|
195.10
|
403.08
|
11,774.54
|
1,721.06
|
519.96
|
274.37
|
296.20
|
912.32
|
867.11
|
231.36
|
101.19
|
86.47
|
|||
|
06
|
1,111.66
|
201.89
|
107.89
|
81.34
|
147.98
|
86.40
|
274.10
|
176.84
|
364.57
|
10,832.12
|
1,590.38
|
482.47
|
268.01
|
286.38
|
870.40
|
817.15
|
284.81
|
89.33
|
74.59
|
|||
|
07
|
1,129.83
|
204.46
|
108.88
|
81.08
|
148.96
|
86.28
|
275.90
|
177.59
|
365.12
|
11,163.81
|
1,640.76
|
496.92
|
273.18
|
292.26
|
891.44
|
841.33
|
328.92
|
99.42
|
84.28
|
|||
|
08
|
1,059.96
|
192.37
|
102.09
|
73.55
|
134.98
|
76.23
|
257.36
|
164.73
|
343.63
|
9,491.33
|
1,388.85
|
421.62
|
230.52
|
235.05
|
717.07
|
696.24
|
197.79
|
97.63
|
83.05
|
|||
|
09
|
1,098.84
|
197.98
|
105.18
|
76.72
|
139.72
|
78.78
|
263.67
|
168.39
|
348.57
|
10,597.31
|
1,556.63
|
471.93
|
257.55
|
263.28
|
806.13
|
784.51
|
211.53
|
101.39
|
85.62
|
|||
|
10
|
1,119.48
|
203.03
|
108.43
|
81.68
|
145.05
|
83.08
|
272.31
|
174.43
|
362.79
|
13,743.10
|
2,028.62
|
615.03
|
338.45
|
346.52
|
1,058.65
|
1,031.78
|
262.37
|
113.09
|
95.04
|
|||
|
11
|
1,448.98
|
260.43
|
137.86
|
97.47
|
181.86
|
101.50
|
345.62
|
220.16
|
455.42
|
14,396.60
|
2,111.63
|
638.59
|
338.94
|
351.84
|
1,085.04
|
1,059.07
|
342.52
|
167.95
|
138.57
|
|||
AHCA
Contract No. FA619,
Attachment III-B, Page 1 of 5
|
ATTACHMENT
III-B
|
|
September
1, 2007- August 31,
2008
|
|
MEDICAID
Non-Reform HMO CAPITATION
RATES
|
|
By
Area , Age and Eligibility
Category
Estimated
Health Plan Rates (Not for use unless approved by
CMS)
|
|
TABLE
3
|
||||||||||||||||||||||
|
General
+ MH + Dental
Rates:
|
||||||||||||||||||||||
|
TANF
|
SSI-N |
SSI-B
|
SSI-AB
|
|||||||||||||||||||
|
Area
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
||||||
|
Female
|
Male
|
Female
|
Male
|
|||||||||||||||||||
|
01
|
1,132.02
|
202.33
|
109.31
|
82.23
|
150.59
|
86.99
|
271.74
|
173.97
|
354.63
|
10,081.95
|
1,458.97
|
445.59
|
253.12
|
269.40
|
800.35
|
738.28
|
271.55
|
112.24
|
93.85
|
|||
|
02
|
1,132.03
|
202.34
|
110.58
|
90.79
|
153.08
|
89.48
|
270.71
|
172.94
|
353.84
|
10,082.03
|
1,459.05
|
451.94
|
283.88
|
270.63
|
771.64
|
732.17
|
291.54
|
115.59
|
97.20
|
|||
|
03
|
1,296.44
|
233.60
|
126.52
|
93.00
|
169.14
|
96.13
|
313.24
|
200.46
|
415.57
|
11,326.37
|
1,656.88
|
504.76
|
274.93
|
282.17
|
854.04
|
832.15
|
280.01
|
103.46
|
86.37
|
|||
|
04
|
1,128.89
|
203.77
|
110.20
|
81.71
|
147.39
|
84.03
|
274.30
|
175.89
|
365.17
|
10,676.09
|
1,563.70
|
479.82
|
280.43
|
277.68
|
822.42
|
793.64
|
356.10
|
114.04
|
96.42
|
|||
|
05
|
1,260.52
|
227.69
|
123.77
|
91.76
|
168.12
|
96.98
|
311.90
|
201.49
|
416.36
|
11,774.55
|
1,721.08
|
524.88
|
282.89
|
303.65
|
919.87
|
876.10
|
235.79
|
109.53
|
91.82
|
|||
|
06
|
1,111.67
|
201.90
|
110.53
|
86.79
|
153.63
|
91.17
|
277.72
|
180.05
|
371.26
|
10,832.13
|
1,590.40
|
485.64
|
273.51
|
291.19
|
874.82
|
822.42
|
286.65
|
94.11
|
77.66
|
|||
|
07
|
1,129.84
|
204.47
|
111.04
|
85.54
|
153.58
|
90.17
|
278.43
|
179.84
|
369.79
|
11,163.81
|
1,640.77
|
500.03
|
278.58
|
296.97
|
894.55
|
845.04
|
330.54
|
102.58
|
86.31
|
|||
|
08
|
1,059.97
|
192.38
|
105.11
|
79.80
|
141.46
|
81.69
|
260.37
|
167.40
|
349.19
|
9,491.34
|
1,388.87
|
424.74
|
235.93
|
239.77
|
720.67
|
700.54
|
199.27
|
100.78
|
85.06
|
|||
|
09
|
1,098.85
|
197.99
|
108.10
|
82.75
|
145.98
|
84.06
|
265.42
|
169.94
|
351.80
|
10,597.31
|
1,556.64
|
474.66
|
262.28
|
267.41
|
807.81
|
786.52
|
212.26
|
103.23
|
86.80
|
|||
|
10
|
1,119.49
|
203.04
|
111.29
|
87.56
|
151.15
|
88.23
|
274.13
|
176.05
|
366.16
|
13,743.11
|
2,028.64
|
618.77
|
344.93
|
352.19
|
1,060.76
|
1,034.30
|
264.42
|
115.66
|
96.69
|
|||
|
11
|
1,448.99
|
260.44
|
141.58
|
105.13
|
189.81
|
108.20
|
347.23
|
221.59
|
458.40
|
14,396.61
|
2,111.65
|
642.83
|
346.28
|
358.26
|
1,088.67
|
1,063.40
|
346.92
|
172.01
|
141.17
|
|||
|
TABLE
4
|
||||||||||||||||||||||
|
General
+ MH + Transportation
Rates:
|
||||||||||||||||||||||
|
TANF
|
SSI-N
|
SSI-B
|
SSI-AB
|
|||||||||||||||||||
|
Area
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
||||||
|
Female
|
Male
|
Female
|
Male
|
|||||||||||||||||||
|
01
|
1,137.56
|
203.71
|
108.08
|
78.43
|
148.03
|
84.47
|
272.98
|
174.71
|
354.40
|
10,125.36
|
1,486.99
|
449.03
|
251.78
|
272.18
|
817.47
|
751.37
|
277.82
|
123.66
|
101.13
|
|||
|
02
|
1,137.57
|
203.72
|
109.35
|
86.99
|
150.52
|
86.96
|
271.95
|
173.68
|
353.61
|
10,125.44
|
1,487.07
|
455.38
|
282.54
|
273.41
|
788.76
|
745.26
|
297.81
|
127.01
|
104.48
|
|||
|
03
|
1,303.13
|
235.26
|
124.49
|
87.29
|
164.87
|
92.09
|
313.95
|
200.67
|
413.86
|
11,381.17
|
1,692.25
|
508.50
|
272.20
|
284.79
|
875.73
|
848.76
|
288.09
|
120.22
|
97.05
|
|||
|
04
|
1,133.91
|
205.01
|
108.93
|
77.95
|
144.75
|
81.48
|
274.28
|
175.56
|
362.87
|
10,720.46
|
1,592.34
|
483.38
|
279.13
|
280.59
|
839.55
|
806.56
|
361.06
|
126.74
|
104.50
|
|||
|
05
|
1,264.71
|
228.72
|
120.95
|
85.01
|
162.15
|
91.67
|
307.04
|
196.90
|
405.49
|
11,809.84
|
1,743.85
|
524.54
|
276.38
|
301.18
|
928.58
|
880.53
|
237.24
|
115.22
|
95.42
|
|||
|
06
|
1,115.71
|
202.90
|
108.52
|
81.72
|
149.38
|
87.31
|
276.35
|
178.58
|
366.89
|
10,866.95
|
1,612.87
|
487.00
|
270.00
|
291.30
|
886.44
|
830.40
|
290.13
|
100.93
|
81.99
|
|||
|
07
|
1,133.77
|
205.44
|
109.49
|
81.45
|
150.32
|
87.17
|
278.09
|
179.28
|
367.38
|
11,201.13
|
1,664.85
|
501.77
|
275.30
|
297.53
|
908.63
|
855.51
|
334.56
|
111.55
|
92.03
|
|||
|
08
|
1,065.54
|
193.77
|
102.95
|
74.07
|
136.91
|
77.49
|
260.46
|
167.12
|
346.83
|
9,532.67
|
1,415.54
|
427.00
|
232.88
|
240.88
|
736.11
|
711.96
|
203.87
|
112.43
|
92.50
|
|||
|
09
|
1,104.22
|
199.32
|
106.02
|
77.23
|
141.58
|
79.99
|
266.66
|
170.70
|
351.65
|
10,640.50
|
1,584.51
|
477.55
|
260.02
|
269.38
|
826.01
|
800.93
|
218.45
|
117.20
|
95.70
|
|||
|
10
|
1,123.27
|
203.97
|
109.01
|
82.04
|
146.35
|
83.94
|
274.42
|
176.05
|
364.96
|
13,782.23
|
2,053.89
|
620.11
|
340.69
|
352.05
|
1,076.67
|
1,046.66
|
269.67
|
130.75
|
106.30
|
|||
|
11
|
1,452.24
|
261.24
|
138.36
|
97.78
|
182.98
|
102.24
|
347.43
|
221.56
|
457.29
|
14,425.98
|
2,130.60
|
642.40
|
340.62
|
355.99
|
1,098.57
|
1,070.25
|
347.44
|
180.46
|
146.55
|
|||
AHCA Contract No. FA619, Attachment
III-B, Page 2 of 5
|
ATTACHMENT
III-B
|
|
September
1, 2007- August 31,
2008
|
|
MEDICAID
Non-Reform HMO CAPITATION
RATES
|
|
By
Area , Age and Eligibility
Category
Estimated
Health Plan Rates (Not for use unless approved by
CMS)
|
|
TABLE
5
|
||||||||||||||||||||||
|
General
+ Transportation
Rates:
|
||||||||||||||||||||||
|
TANF
|
SSI-N
|
SSI-B
|
SSI-AB
|
|||||||||||||||||||
|
Area
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
||||||
|
Female
|
Male
|
Female
|
Male
|
|||||||||||||||||||
|
01
|
1,137.54
|
203.69
|
106.44
|
66.74
|
137.11
|
73.55
|
268.54
|
170.27
|
350.65
|
10,125.28
|
1,486.91
|
441.59
|
203.74
|
228.20
|
736.09
|
720.39
|
277.61
|
112.01
|
89.48
|
|||
|
02
|
1,137.54
|
203.69
|
106.44
|
66.74
|
137.11
|
73.55
|
268.54
|
170.27
|
350.65
|
10,125.28
|
1,486.91
|
441.59
|
203.74
|
228.20
|
736.09
|
720.39
|
277.61
|
112.01
|
89.48
|
|||
|
03
|
1,303.12
|
235.25
|
123.17
|
78.11
|
158.79
|
86.01
|
312.40
|
199.12
|
412.52
|
11,381.10
|
1,692.18
|
502.24
|
236.45
|
264.28
|
851.84
|
837.48
|
281.24
|
111.24
|
88.07
|
|||
|
04
|
1,133.90
|
205.00
|
107.56
|
68.39
|
138.42
|
75.15
|
272.67
|
173.95
|
361.48
|
10,720.35
|
1,592.23
|
473.63
|
223.40
|
248.62
|
802.30
|
788.97
|
336.51
|
109.97
|
87.73
|
|||
|
05
|
1,264.70
|
228.71
|
119.74
|
76.34
|
154.04
|
83.56
|
303.75
|
193.61
|
402.71
|
11,809.79
|
1,743.80
|
519.52
|
243.97
|
271.51
|
873.68
|
859.63
|
234.51
|
102.41
|
82.61
|
|||
|
06
|
1,115.69
|
202.88
|
106.67
|
68.48
|
137.00
|
74.93
|
271.32
|
173.55
|
362.64
|
10,866.88
|
1,612.80
|
480.48
|
227.90
|
252.76
|
815.13
|
803.26
|
288.82
|
97.05
|
78.11
|
|||
|
07
|
1,133.75
|
205.42
|
107.71
|
68.77
|
138.47
|
75.32
|
273.27
|
174.46
|
363.31
|
11,201.07
|
1,664.79
|
495.65
|
235.80
|
261.37
|
841.71
|
830.04
|
331.97
|
101.04
|
81.52
|
|||
|
08
|
1,065.53
|
193.76
|
101.69
|
65.27
|
131.08
|
71.66
|
258.98
|
165.64
|
345.55
|
9,532.60
|
1,415.47
|
421.00
|
198.60
|
221.21
|
713.20
|
701.14
|
197.02
|
99.21
|
79.28
|
|||
|
09
|
1,104.20
|
199.30
|
104.47
|
66.42
|
134.42
|
72.83
|
264.84
|
168.88
|
350.07
|
10,640.43
|
1,584.44
|
471.22
|
223.88
|
248.64
|
801.86
|
789.52
|
211.60
|
107.61
|
86.11
|
|||
|
10
|
1,123.25
|
203.95
|
107.09
|
68.68
|
137.50
|
75.09
|
272.17
|
173.80
|
363.01
|
13,782.14
|
2,053.80
|
611.76
|
292.99
|
324.68
|
1,044.79
|
1,031.61
|
262.82
|
122.70
|
98.25
|
|||
|
11
|
1,452.22
|
261.22
|
136.74
|
86.49
|
175.50
|
94.76
|
345.53
|
219.66
|
455.64
|
14,425.90
|
2,130.52
|
635.43
|
300.83
|
333.16
|
1,071.97
|
1,057.69
|
340.21
|
172.41
|
138.50
|
|||
|
TABLE
6
|
||||||||||||||||||||||
|
General
+ Dental
Rates:
|
||||||||||||||||||||||
|
TANF
|
SSI-N
|
SSI-B
|
SSI-AB
|
|||||||||||||||||||
|
Area
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
||||||
|
Female
|
Male
|
Female
|
Male
|
|||||||||||||||||||
|
01
|
1,132.00
|
202.31
|
107.67
|
70.54
|
139.67
|
76.07
|
267.30
|
169.53
|
350.88
|
10,081.87
|
1,458.89
|
438.15
|
205.08
|
225.42
|
718.97
|
707.30
|
271.34
|
100.59
|
82.20
|
|||
|
02
|
1,132.00
|
202.31
|
107.67
|
70.54
|
139.67
|
76.07
|
267.30
|
169.53
|
350.88
|
10,081.87
|
1,458.89
|
438.15
|
205.08
|
225.42
|
718.97
|
707.30
|
271.34
|
100.59
|
82.20
|
|||
|
03
|
1,296.43
|
233.59
|
125.20
|
83.82
|
163.06
|
90.05
|
311.69
|
198.91
|
414.23
|
11,326.30
|
1,656.81
|
498.50
|
239.18
|
261.66
|
830.15
|
820.87
|
273.16
|
94.48
|
77.39
|
|||
|
04
|
1,128.88
|
203.76
|
108.83
|
72.15
|
141.06
|
77.70
|
272.69
|
174.28
|
363.78
|
10,675.98
|
1,563.59
|
470.07
|
224.70
|
245.71
|
785.17
|
776.05
|
331.55
|
97.27
|
79.65
|
|||
|
05
|
1,260.51
|
227.68
|
122.56
|
83.09
|
160.01
|
88.87
|
308.61
|
198.20
|
413.58
|
11,774.50
|
1,721.03
|
519.86
|
250.48
|
273.98
|
864.97
|
855.20
|
233.06
|
96.72
|
79.01
|
|||
|
06
|
1,111.65
|
201.88
|
108.68
|
73.55
|
141.25
|
78.79
|
272.69
|
175.02
|
367.01
|
10,832.06
|
1,590.33
|
479.12
|
231.41
|
252.65
|
803.51
|
795.28
|
285.34
|
90.23
|
73.78
|
|||
|
07
|
1,129.82
|
204.45
|
109.26
|
72.86
|
141.73
|
78.32
|
273.61
|
175.02
|
365.72
|
11,163.75
|
1,640.71
|
493.91
|
239.08
|
260.81
|
827.63
|
819.57
|
327.95
|
92.07
|
75.80
|
|||
|
08
|
1,059.96
|
192.37
|
103.85
|
71.00
|
135.63
|
75.86
|
258.89
|
165.92
|
347.91
|
9,491.27
|
1,388.80
|
418.74
|
201.65
|
220.10
|
697.76
|
689.72
|
192.42
|
87.56
|
71.84
|
|||
|
09
|
1,098.83
|
197.97
|
106.55
|
71.94
|
138.82
|
76.90
|
263.60
|
168.12
|
350.22
|
10,597.24
|
1,556.57
|
468.33
|
226.14
|
246.67
|
783.66
|
775.11
|
205.41
|
93.64
|
77.21
|
|||
|
10
|
1,119.47
|
203.02
|
109.37
|
74.20
|
142.30
|
79.38
|
271.88
|
173.80
|
364.21
|
13,743.02
|
2,028.55
|
610.42
|
297.23
|
324.82
|
1,028.88
|
1,019.25
|
257.57
|
107.61
|
88.64
|
|||
|
11
|
1,448.97
|
260.42
|
139.96
|
93.84
|
182.33
|
100.72
|
345.33
|
219.69
|
456.75
|
14,396.53
|
2,111.57
|
635.86
|
306.49
|
335.43
|
1,062.07
|
1,050.84
|
339.69
|
163.96
|
133.12
|
|||
AHCA Contract No. FA619, Attachment
III-B, Page 3 of 5
|
ATTACHMENT
III-B
|
|
September
1, 2007- August 31,
2008
|
|
MEDICAID
Non-Reform HMO CAPITATION
RATES
|
|
By
Area , Age and Eligibility
Category
Estimated
Health Plan Rates (Not for use unless approved by
CMS)
|
|
TABLE
7
|
||||||||||||||||||||||
|
General
+ Dental + Transportation
Rates:
|
||||||||||||||||||||||
|
TANF
|
SSI-N
|
SSI-B
|
SSI-AB
|
|||||||||||||||||||
|
Area
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
||||||
|
Female
|
Male
|
Female
|
Male
|
|||||||||||||||||||
|
01
|
1,137.55
|
203.70
|
108.53
|
71.06
|
141.59
|
77.33
|
270.39
|
171.91
|
354.06
|
10,125.28
|
1,486.92
|
443.79
|
207.56
|
231.54
|
738.96
|
723.81
|
278.11
|
114.32
|
90.96
|
|||
|
02
|
1,137.55
|
203.70
|
108.53
|
71.06
|
141.59
|
77.33
|
270.39
|
171.91
|
354.06
|
10,125.28
|
1,486.92
|
443.79
|
207.56
|
231.54
|
738.96
|
723.81
|
278.11
|
114.32
|
90.96
|
|||
|
03
|
1,303.13
|
235.26
|
126.24
|
84.45
|
165.38
|
91.56
|
315.41
|
201.79
|
418.07
|
11,381.11
|
1,692.20
|
505.62
|
242.30
|
269.39
|
855.40
|
841.72
|
281.78
|
114.32
|
90.05
|
|||
|
04
|
1,133.91
|
205.01
|
109.61
|
72.62
|
142.80
|
78.84
|
275.48
|
176.44
|
366.67
|
10,720.35
|
1,592.24
|
475.84
|
227.23
|
251.97
|
805.61
|
792.92
|
338.52
|
113.05
|
89.71
|
|||
|
05
|
1,264.71
|
228.73
|
123.21
|
83.49
|
161.46
|
89.82
|
310.94
|
200.00
|
415.99
|
11,809.80
|
1,743.82
|
524.44
|
252.49
|
278.96
|
881.23
|
868.62
|
238.94
|
110.75
|
87.96
|
|||
|
06
|
1,115.70
|
202.89
|
109.31
|
73.93
|
142.65
|
79.70
|
274.94
|
176.76
|
369.33
|
10,866.89
|
1,612.82
|
483.65
|
233.40
|
257.57
|
819.55
|
808.53
|
290.66
|
101.83
|
81.18
|
|||
|
07
|
1,133.76
|
205.43
|
109.87
|
73.23
|
143.09
|
79.21
|
275.80
|
176.71
|
367.98
|
11,201.07
|
1,664.80
|
498.76
|
241.20
|
266.08
|
844.82
|
833.75
|
333.59
|
104.20
|
83.55
|
|||
|
08
|
1,065.54
|
193.77
|
104.71
|
71.52
|
137.56
|
77.12
|
261.99
|
168.31
|
351.11
|
9,532.61
|
1,415.49
|
424.12
|
204.01
|
225.93
|
716.80
|
705.44
|
198.50
|
102.36
|
81.29
|
|||
|
09
|
1,104.21
|
199.31
|
107.39
|
72.45
|
140.68
|
78.11
|
266.59
|
170.43
|
353.30
|
10,640.43
|
1,584.45
|
473.95
|
228.61
|
252.77
|
803.54
|
791.53
|
212.33
|
109.45
|
87.29
|
|||
|
10
|
1,123.26
|
203.96
|
109.95
|
74.56
|
143.60
|
80.24
|
273.99
|
175.42
|
366.38
|
13,782.15
|
2,053.82
|
615.50
|
299.47
|
330.35
|
1,046.90
|
1,034.13
|
264.87
|
125.27
|
99.90
|
|||
|
11
|
1,452.23
|
261.23
|
140.46
|
94.15
|
183.45
|
101.46
|
347.14
|
221.09
|
458.62
|
14,425.91
|
2,130.54
|
639.67
|
308.17
|
339.58
|
1,075.60
|
1,062.02
|
344.61
|
176.47
|
141.10
|
|||
|
TABLE
8
|
||||||||||||||||||||||
|
General
+ Mental Health + Dental +
Transportation Rates:
|
||||||||||||||||||||||
|
TANF
|
SSI-N
|
SSI-B
|
SSI-AB
|
|||||||||||||||||||
|
Area
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
BTHMO
+2MO
|
3MO-11MO
|
AGE
(1-5)
|
AGE
(6-13)
|
AGE
(14-20)
|
AGE
(21-54)
|
AGE
(55+)
|
AGE
(65-)
|
AGE
(65+)
|
||||||
|
Female
|
Male
|
Female
|
Male
|
|||||||||||||||||||
|
01
|
1,137.57
|
203.72
|
110.17
|
82.75
|
152.51
|
88.25
|
274.83
|
176.35
|
357.81
|
10,125.36
|
1,487.00
|
451.23
|
255.60
|
275.52
|
820.34
|
754.79
|
278.32
|
125.97
|
102.61
|
|||
|
02
|
1,137.58
|
203.73
|
111.44
|
91.31
|
155.00
|
90.74
|
273.80
|
175.32
|
357.02
|
10,125.44
|
1,487.08
|
457.58
|
286.36
|
276.75
|
791.63
|
748.68
|
298.31
|
129.32
|
105.96
|
|||
|
03
|
1,303.14
|
235.27
|
127.56
|
93.63
|
171.46
|
97.64
|
316.96
|
203.34
|
419.41
|
11,381.18
|
1,692.27
|
511.88
|
278.05
|
289.90
|
879.29
|
853.00
|
288.63
|
123.30
|
99.03
|
|||
|
04
|
1,133.92
|
205.02
|
110.98
|
82.18
|
149.13
|
85.17
|
277.09
|
178.05
|
368.06
|
10,720.46
|
1,592.35
|
485.59
|
282.96
|
283.94
|
842.86
|
810.51
|
363.07
|
129.82
|
106.48
|
|||
|
05
|
1,264.72
|
228.74
|
124.42
|
92.16
|
169.57
|
97.93
|
314.23
|
203.29
|
418.77
|
11,809.85
|
1,743.87
|
529.46
|
284.90
|
308.63
|
936.13
|
889.52
|
241.67
|
123.56
|
100.77
|
|||
|
06
|
1,115.72
|
202.91
|
111.16
|
87.17
|
155.03
|
92.08
|
279.97
|
181.79
|
373.58
|
10,866.96
|
1,612.89
|
490.17
|
275.50
|
296.11
|
890.86
|
835.67
|
291.97
|
105.71
|
85.06
|
|||
|
07
|
1,133.78
|
205.45
|
111.65
|
85.91
|
154.94
|
91.06
|
280.62
|
181.53
|
372.05
|
11,201.13
|
1,664.86
|
504.88
|
280.70
|
302.24
|
911.74
|
859.22
|
336.18
|
114.71
|
94.06
|
|||
|
08
|
1,065.55
|
193.78
|
105.97
|
80.32
|
143.39
|
82.95
|
263.47
|
169.79
|
352.39
|
9,532.68
|
1,415.56
|
430.12
|
238.29
|
245.60
|
739.71
|
716.26
|
205.35
|
115.58
|
94.51
|
|||
|
09
|
1,104.23
|
199.33
|
108.94
|
83.26
|
147.84
|
85.27
|
268.41
|
172.25
|
354.88
|
10,640.50
|
1,584.52
|
480.28
|
264.75
|
273.51
|
827.69
|
802.94
|
219.18
|
119.04
|
96.88
|
|||
|
10
|
1,123.28
|
203.98
|
111.87
|
87.92
|
152.45
|
89.09
|
276.24
|
177.67
|
368.33
|
13,782.24
|
2,053.91
|
623.85
|
347.17
|
357.72
|
1,078.78
|
1,049.18
|
271.72
|
133.32
|
107.95
|
|||
|
11
|
1,452.25
|
261.25
|
142.08
|
105.44
|
190.93
|
108.94
|
349.04
|
222.99
|
460.27
|
14,425.99
|
2,130.62
|
646.64
|
347.96
|
362.41
|
1,102.20
|
1,074.58
|
351.84
|
184.52
|
149.15
|
|||
AHCA Contract No. FA619, Attachment
III-B, Page 4 of 5
|
ATTACHMENT
III-B
|
|
September
1, 2007- August 31,
2008
|
|
MEDICAID
Non-Reform HMO CAPITATION
RATES
|
|
By
Area , Age and Eligibility
Category
Estimated
Health Plan Rates (Not for use unless approved by
CMS)
|
|
Area
|
Corresponding
Counties
|
||||||||||||||||||
|
Area
1
|
Escambia,
Okaloosa, Santa Rosa,
Walton
|
||||||||||||||||||
|
Area
2
|
Bay,
Calhoun, Franklin, Gadsden,
Gulf, Holmes, Jackson, ▇▇▇▇▇▇▇▇▇, ▇▇▇▇, Liberty, Madison, Taylor,
Washington, Wakulla
|
||||||||||||||||||
|
Area
3
|
Alachua,
Bradford, Citrus,
Columbia, Dixie, Gilchrist, Hamiliton, Hernando, Lafayette, Lake,
▇▇▇▇,
▇▇▇▇▇▇, Putnam, Sumter, Suwannee, Union
|
||||||||||||||||||
|
Area
4
|
Baker,
Clay, Duval, Flagler,
Nassau, St. ▇▇▇▇▇, Volusia
|
||||||||||||||||||
|
Area
5
|
Pasco,
Pinellas
|
||||||||||||||||||
|
Area
6
|
▇▇▇▇▇▇,
Highlands, Hillsborough,
Manatee, Polk
|
||||||||||||||||||
|
Area
7
|
Brevard,
Orange, Osceola,
Seminole
|
||||||||||||||||||
|
Area
8
|
Charlotte,
▇▇▇▇▇▇▇, De ▇▇▇▇,
Glades, Hendry, Lee, Sarasota
|
||||||||||||||||||
|
Area
9
|
Indian
River, Okeechobee, St.
Lucie, Martin, Palm Beach
|
||||||||||||||||||
|
Area
10
|
Broward
|
||||||||||||||||||
|
Area
11
|
Dade,
Monroe
|
||||||||||||||||||
|
Created
on August 10,
2007
|
|||||||||||||||||||
AHCA Contract No. FA619, Attachment
III-B, Page 5 of 5