Back to Form 8-K
Exhibit
10.4
HealthEase
of Florida, Inc.
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", is hereby amended
as follows:
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1.
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Effective
January 1, 2008, Standard Contract, Section II, Item A, Contract
Amount,
the first sentence is hereby revised to now read as follows:
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To
pay for contracted services according to the conditions of Attachment
I in
an amount not to exceed $382,047,581.00 (a decrease of $28,281,601.00),
subject to availability of funds.
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2.
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Effective
January 1, 2008, Attachment I, Section C, Method of Payment, Item
1,
General, the first paragraph is hereby revised to now read as follows:
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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 $382,047,581.00
(a
decrease of $28,281,601.00).
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3.
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Effective
January 1, 2008, Attachment I, Scope of Services, is hereby amended
to
include Exhibits 3-B, 5-C, 6-C, and 9-B, attached hereto and made
a part
of the Contract. All references in the Contract to Exhibits 3-A,
5-B, 6-B,
and 9-A, shall hereinafter instead refer to Exhibits 3-B, 5-C,
6-C, and
9-B.
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4.
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This
Amendment shall have an effective date of January 1, 2008, or the
date on
which other parties execute the Amendment which ever 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.
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. FAR001, Amendment No. 8, Page 1 of 2
HealthEase
of Florida, Inc.
IN
WITNESS WHEREOF, the parties hereto have caused this seven (7) page
amendment (which includes all attachments hereto) to be executed by their
officials thereunto duly authorized.
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HEALTHEASE
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/ Illegible
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NAME:
Xxxx X. Xxxxx
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(for)
NAME: Xxxxxx
X. Xxxxxxxx, M.D.
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TITLE:
President and CEO
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TITLE: Secretary
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DATE:1/2/08
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DATE:
1/3/08
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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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3-B
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Comprehensive
and Catostrophic Component Captation Rates (2 Pages)
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Exhibit
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5-C
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Capitation
Rates SSI Medicare Part B Only and SSI Medicare Parts A & B Enrollees
for All Medicaid Reform Counties (1 Page)
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Exhibit
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6-C
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Capitation
Rates for HIV/AIDS Populations for Each Medicaid Reform County
(1
Page)
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Exhibit
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9-B
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Kick
Payment Amounts for Covered Obstetrical Delivery Services (1
Page)
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REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
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AHCA
Contract No. FAR001, Amendment No. 8, Page 2 of 2
EXHIBIT
3-B
COMPREHENSIVE
COMPONENT AND
CATASTROPHIC COMPONENT CAPITATION RATES
TABLE
2
Jan
1, 2008
Area:
10
County: Broward
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Age
Range
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FY0708
Discounted
Reform
rates
Under
Current Methodology
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Percentage
of Current Methodology
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50%
of Current Methodology
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Preliminary
FY0708 Base rates for Risk Adjusted Methodology
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Budget
Neutrality Factor
|
FY0708
Base rates for Risk Adjusted Methodology after Budget
Neutrality
|
Percentage
of Risk Adjusted Methodology
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50%
of Risk Adjusted Methodology
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Final
Rates (with Enhanced Benefit Adjustment)
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|||||||||||||||||||||||||||||
| a | b | c | d | e | f | g | h | i | j | |||||||||||||||||||||||||||||
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Eligibility
Category:
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Children
and Family
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|||||||||||||||||||||||||||||||||||||
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Month
0-2 All
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$ | 892.28 | ||||||||||||||||||||||||||||||||||||
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Month
3-11 All
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$ | 205.04 | ||||||||||||||||||||||||||||||||||||
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1-5
All
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$ | 106.14 | 50 | % | $ | 53.07 | $ | 117.69 | 1.07460 | $ | 126.47 | 50 | % | $ | 63.23 | $ | 112.09 | |||||||||||||||||||||
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6-13
All
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$ | 82.94 | 50 | % | $ | 41.47 | $ | 117.69 | 1.07460 | $ | 126.47 | 50 | % | $ | 63.23 | $ | 100.91 | |||||||||||||||||||||
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14-20
Female
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$ | 115.00 | 50 | % | $ | 57.50 | $ | 117.69 | 1.07460 | $ | 126.47 | 50 | % | $ | 63.23 | $ | 116.36 | |||||||||||||||||||||
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14-20
Male
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$ | 79.98 | 50 | % | $ | 39.99 | $ | 117.69 | 1.07460 | $ | 126.47 | 50 | % | $ | 63.23 | $ | 99.49 | |||||||||||||||||||||
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21-54
Female
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$ | 202.08 | 50 | % | $ | 101.04 | $ | 117.69 | 1.07460 | $ | 126.47 | 50 | % | $ | 63.23 | $ | 158.33 | |||||||||||||||||||||
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21-54
Male
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$ | 146.71 | 50 | % | $ | 73.35 | $ | 117.69 | 1.07460 | $ | 126.47 | 50 | % | $ | 63.23 | $ | 131.64 | |||||||||||||||||||||
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55+
All
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$ | 325.58 | 50 | % | $ | 162.79 | $ | 117.69 | 1.07460 | $ | 126.47 | 50 | % | $ | 63.23 | $ | 217.84 | |||||||||||||||||||||
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Composite
Based on Total Casemonths
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$ | 108.91 | $ | 126.47 | $ | 0.00 | $ | 113.43 | ||||||||||||||||||||||||||||||
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Eligibility
Category:
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Aged
and Disabled
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|||||||||||||||||||||||||||||||||||||
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Month
0-2 All
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$ | 17,528.17 | ||||||||||||||||||||||||||||||||||||
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Month
3-11 All
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$ | 3,534.94 | ||||||||||||||||||||||||||||||||||||
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1-5
All
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$ | 631.27 | 50 | % | $ | 315.63 | $ | 813.28 | 1.06682 | $ | 867.63 | 50 | % | $ | 433.81 | $ | 722.31 | |||||||||||||||||||||
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6-13
All
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$ | 355.68 | 50 | % | $ | 177.84 | $ | 813.28 | 1.06682 | $ | 867.63 | 50 | % | $ | 433.81 | $ | 589.51 | |||||||||||||||||||||
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14-20
All
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$ | 343.79 | 50 | % | $ | 171.90 | $ | 813.28 | 1.06682 | $ | 867.63 | 50 | % | $ | 433.81 | $ | 583.78 | |||||||||||||||||||||
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21-54
All
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$ | 930.27 | 50 | % | $ | 465.13 | $ | 813.28 | 1.06682 | $ | 867.63 | 50 | % | $ | 433.81 | $ | 866.40 | |||||||||||||||||||||
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55+
All
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$ | 965.71 | 50 | % | $ | 482.85 | $ | 813.28 | 1.06682 | $ | 867.63 | 50 | % | $ | 433.81 | $ | 883.48 | |||||||||||||||||||||
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Composite
Based on Total Casemonths
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$ | 758.94 | $ | 867.63 | $ | 0.00 | $ | 783.84 | ||||||||||||||||||||||||||||||
AHCA
Contract No. FAR001, Exhibit 3-B, Page 1 of 2
EXHIBIT
3-B
COMPREHENSIVE
COMPONENT AND
CATASTROPHIC COMPONENT CAPITATION RATES
TABLE
2
Jan
1,
2008
Area:
4
County: Duval, Baker,
Clay, Nassau
ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
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Age
Range
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FY0708
Discounted Reform rates Under Current Methodology
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Percentage
of Current Methodology
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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
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50%
of Risk Adjusted Methodology
|
Final
Rates (with Enhanced Benefit Adjustment)
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a
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b
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c
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d
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e
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f
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g
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h
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I
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j
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Eligibility
Category:
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Children
and Family
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||||||||
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Month
0-2 All
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$
926.73
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Month
3-11 All
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$
215.12
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1-5
All
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$113.17
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50%
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$56.58
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$124.53
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1.04120
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$129.66
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50%
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$64.83
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$
117.02
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6-13
All
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$82.75
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50%
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$41.37
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$124.53
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1.04120
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$129.66
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50%
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$64.83
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$
102.36
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14-20
Female
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$119.81
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50%
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$59.91
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$124.53
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1.04120
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$129.66
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50%
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$64.83
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$
120.22
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14-20
Male
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$81.70
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50%
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$40.85
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$124.53
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1.04120
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$129.66
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50%
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$64.83
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$
101.85
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21-54
Female
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$218.13
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50%
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$109.06
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$124.53
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1.04120
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$129.66
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50%
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$64.83
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$
167.60
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21-54
Male
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$158.54
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50%
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$79.27
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$124.53
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1.04120
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$129.66
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50%
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$64.83
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$
138.88
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55+
All
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$350.55
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50%
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$175.28
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$124.53
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1.04120
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$129.66
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50%
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$64.83
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$
231.41
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Composite
Based on Total Casemonths
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$119.40
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$129.66
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$0.00
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$
120.02
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|||||
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Eligibility
Category:
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Aged
and Disabled
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||||||||
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Month
0-2 All
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$
14,558.96
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||||||||
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Month
3-11 All
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$
2,969.69
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||||||||
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1-5
All
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$537.41
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50%
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$268.70
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$657.05
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1.05080
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$690.42
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50%
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$345.21
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$
591.69
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6-13
All
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$312.13
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50%
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$156.06
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$657.05
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1.05080
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$690.42
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50%
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$345.21
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$
483.13
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14-20
All
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$296.53
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50%
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$148.27
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$657.05
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1.05080
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$690.42
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50%
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$345.21
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$
475.61
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21-54
All
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$790.16
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50%
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$395.08
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$657.05
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1.05080
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$690.42
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50%
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$345.21
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$
713.49
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55+
All
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$809.32
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50%
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$404.66
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$657.05
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1.05080
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$690.42
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50%
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$345.21
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$
722.72
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Composite
Based on Total Casemonths
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$623.67
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$690.42
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$0.00
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$
633.26
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AHCA
Contract No. FAR001, Exhibit 3-B, Page 2 of
2
EXHIBIT
5-C
CAPITATION
RATES
SSI
MEDICARE PART B ONLY
AND
SSI
MEDICARE PARTS A AND B ENROLLEES
FOR
ALL
MEDICAID REFORM COUNTIES
TABLE
4
Area:
10
County: Broward
ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
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Under
Age 65
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Age
65 & Over
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SSI/Parts
A & B
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$149.01
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$100.91
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SSI/Part
B Only
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$244.40
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$244.40
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Area: 4 County:
Duval,
Baker, Clay, and
Nassau
ESTIMATED
HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
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Under
Age 65
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Age
65 & Over
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SSI/Parts
A & B
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$156.46
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$105.72
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SSI/Part
B Only
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$362.68
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$362.68
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REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
AHCA
Contract No. FAR001, Exhibit 5-C, Page 1 of 1
EXHIBIT
6-C
CAPITATION
RATES FOR HIV/AIDS POPULATIONS FOR EACH MEDICAID REFORM COUNTY
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TABLE
5
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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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$1,933.92
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AIDS
(no medicare)
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$3,629.23
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HIV-SSI/Parts
A & B, SSI Part B Only
|
$ 271.50
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AIDS-SSI/Parts
A & B, SSI Part B Only
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$ 579.63
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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)
|
Capitation
Rate
|
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HIV
(no medicare)
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$1,196.17
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AIDS
(no medicare)
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$2,354.82
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HIV-SSI/Parts
A & B, SSI Part B Only
|
$ 162.15
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AIDS-SSI/Parts
A & B, SSI Part B Only
|
$ 346.18
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REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK
AHCA
Contract No. FAR001, Exhibit 6-C, Page 1 of 1
EXHIBIT
9-B
KICK
PAYMENT AMOUNTS FOR COVERED OBSTETRICAL DELIVERY SERVICES
TABLE
8
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Area:
10
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County:
Broward
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CPT
Code
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Obstetrical
Delivery CPT Code Description
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Payment
Amount
|
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59409
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Vaginal
delivery only
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$3,950.67
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59410
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Vaginal
delivery including postpartum care
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59515
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Cesarean
delivery including postpartum care
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59612
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Vaginal
delivery only, after previous cesarean delivery
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59614
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Vaginal
delivery only, after previous cesarean delivery including postpartum
care
|
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59622
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Cesarean
delivery only, following attempted vaginal delivery after previous
cesarean delivery including postpartum
care
|
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Area:
04
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County:
Duval,
Baker, Clay, Nassau
|
|
CPT
Code
|
Obstetrical
Delivery CPT Code Description
|
Payment
Amount
|
|
59409
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Vaginal
delivery only
|
$3,936.56
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|
59410
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Vaginal
delivery including postpartum care
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59515
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Cesarean
delivery including postpartum care
|
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59612
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Vaginal
delivery only, after previous cesarean delivery
|
|
|
59614
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Vaginal
delivery only, after previous cesarean delivery including postpartum
care
|
|
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59622
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Cesarean
delivery only, following attempted vaginal delivery after previous
cesarean delivery including postpartum
care
|
AHCA
Contract No. FAR001, Exhibit 9-B, Page 1 of 1
