Exhibit 10.26.3.7
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Amerigroup Florida, Inc. d/b/a Amerigroup Community Care | | Medicaid HMO Contract |
AHCA CONTRACT NO. FA614
AMENDMENT NO. 11
THIS CONTRACT,entered into between theSTATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,hereinafter referred to as the “Agency” andAMERIGROUP FLORIDA, INC. D/B/A AMERIGROUP COMMUNITY CAREhereinafter referred to as the “Vendor” or “Health Plan”, is hereby amended as follows:
1. | | Effective February 1, 2009, Attachment I, Scope of Services, is hereby amended to include Exhibit III-E, February 1, 2009 - August 31, 2009 Medicaid Non-Reform HMO Capitation Rates, attached hereto and made a part of the Contract. All references in the Contract to Exhibit III-D, September 1, 2008 - August 31, 2009 Medicaid Non-Reform HMO Capitation Rates, shall hereinafter also refer to Exhibit III-E, February 1, 2009 - - August 31, 2009 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.
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AMERIGROUP FLORIDA INC. D/B/A AMERIGROUP COMMUNITY CARE | | | | STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION | | |
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SIGNED | | | | | | SIGNED | | | | |
BY: | | /s/ William L. McHugh | | | | BY: | | /s/ Holly Benson | | |
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NAME: | | William L. McHugh | | | | NAME: | | Holly Benson | | |
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TITLE: | | CEO | | | | TITLE: | | Secretary | | |
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DATE: | | | | | | DATE: | | | | |
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List of Attachments/Exhibits included as part of this Amendment:
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Specify | | Letter/ | | |
Type | | Number | | Description |
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Exhibit | | III-E | | February 1, 2009 - August 31, 2009 Medicaid Non-Reform HMO Capitation Rates (5 pages) |
AHCA Contract No. FA614, Amendment No. 11, Page 1 of 1
EXHIBIT III-E
February 1, 2009 - August 31, 2009 HMO RATES
(MEDICAID Non-Reform HMO CAPITATION RATES)
By Area, Age and Eligibility Category
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 | | | 1,113.37 | | | | 187.38 | | | | 101.38 | | | | 61.45 | | | | 129.49 | | | | 69.52 | | | | 255.23 | | | | 153.37 | | | | 318.51 | | | | 10,428.92 | | | | 1,517.58 | | | | 445.88 | | | | 198.88 | | | | 213.14 | | | | 696.73 | | | | 700.31 | | | | 305.88 | | | | 94.80 | | | | 85.77 | |
02 | | | 1,113.37 | | | | 187.38 | | | | 101.38 | | | | 61.45 | | | | 129.49 | | | | 69.52 | | | | 255.23 | | | | 153.37 | | | | 318.51 | | | | 10,428.92 | | | | 1,517.58 | | | | 445.88 | | | | 198.88 | | | | 213.14 | | | | 696.73 | | | | 700.31 | | | | 305.88 | | | | 94.80 | | | | 85.77 | |
03 | | | 1,217.67 | | | | 206.51 | | | | 112.28 | | | | 69.11 | | | | 143.30 | | | | 77.85 | | | | 283.53 | | | | 171.42 | | | | 359.72 | | | | 11,442.82 | | | | 1,680.06 | | | | 495.07 | | | | 226.05 | | | | 241.47 | | | | 787.51 | | | | 795.55 | | | | 340.56 | | | | 90.01 | | | | 81.98 | |
04 | | | 1,067.51 | | | | 181.92 | | | | 99.04 | | | | 61.51 | | | | 126.30 | | | | 69.23 | | | | 250.83 | | | | 152.26 | | | | 321.21 | | | | 10,972.58 | | | | 1,615.28 | | | | 476.38 | | | | 218.79 | | | | 233.36 | | | | 761.37 | | | | 770.55 | | | | 297.82 | | | | 90.35 | | | | 82.40 | |
05 | | | 1,214.96 | | | | 206.53 | | | | 112.30 | | | | 69.38 | | | | 143.25 | | | | 78.21 | | | | 284.08 | | | | 172.12 | | | | 361.87 | | | | 12,248.94 | | | | 1,796.88 | | | | 528.79 | | | | 240.95 | | | | 256.93 | | | | 840.31 | | | | 849.11 | | | | 225.19 | | | | 81.19 | | | | 75.29 | |
06 | | | 1,056.56 | | | | 181.19 | | | | 98.87 | | | | 61.99 | | | | 126.18 | | | | 69.68 | | | | 251.35 | | | | 153.20 | | | | 325.45 | | | | 11,162.18 | | | | 1,645.44 | | | | 485.06 | | | | 223.95 | | | | 237.92 | | | | 777.94 | | | | 788.05 | | | | 274.94 | | | | 79.31 | | | | 72.63 | |
07 | | | 1,092.94 | | | | 186.84 | | | | 101.87 | | | | 63.49 | | | | 129.77 | | | | 71.35 | | | | 258.27 | | | | 157.02 | | | | 332.09 | | | | 11,810.40 | | | | 1,744.81 | | | | 514.41 | | | | 238.57 | | | | 254.24 | | | | 828.77 | | | | 840.70 | | | | 373.98 | | | | 84.56 | | | | 77.61 | |
08 | | | 1,033.51 | | | | 177.08 | | | | 96.67 | | | | 60.37 | | | | 123.15 | | | | 68.03 | | | | 245.23 | | | | 149.29 | | | | 316.91 | | | | 10,525.98 | | | | 1,550.30 | | | | 457.03 | | | | 210.03 | | | | 224.35 | | | | 731.36 | | | | 740.14 | | | | 256.24 | | | | 78.77 | | | | 72.23 | |
09 | | | 1,067.78 | | | | 181.58 | | | | 98.82 | | | | 61.05 | | | | 126.06 | | | | 68.67 | | | | 249.80 | | | | 151.41 | | | | 318.38 | | | | 11,078.29 | | | | 1,635.46 | | | | 482.13 | | | | 223.68 | | | | 237.34 | | | | 775.59 | | | | 785.85 | | | | 219.29 | | | | 84.42 | | | | 77.20 | |
10 | | | 1,083.46 | | | | 186.09 | | | | 101.73 | | | | 63.88 | | | | 129.70 | | | | 71.87 | | | | 258.53 | | | | 157.78 | | | | 335.92 | | | | 14,344.29 | | | | 2,132.34 | | | | 629.36 | | | | 297.17 | | | | 314.18 | | | | 1,027.07 | | | | 1,044.85 | | | | 322.21 | | | | 94.02 | | | | 86.21 | |
11 | | | 1,372.19 | | | | 232.59 | | | | 126.24 | | | | 77.54 | | | | 161.30 | | | | 87.46 | | | | 319.10 | | | | 192.88 | | | | 404.23 | | | | 14,488.14 | | | | 2,131.88 | | | | 628.05 | | | | 289.19 | | | | 307.93 | | | | 1,004.54 | | | | 1,015.98 | | | | 370.49 | | | | 140.27 | | | | 126.63 | |
6B* | | | 1,056.42 | | | | 181.17 | | | | 98.86 | | | | 61.98 | | | | 126.16 | | | | 69.67 | | | | 251.32 | | | | 153.18 | | | | 325.40 | | | | 11,161.68 | | | | 1,645.35 | | | | 485.04 | | | | 223.94 | | | | 237.91 | | | | 777.89 | | | | 788.02 | | | | 274.94 | | | | 79.31 | | | | 72.63 | |
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 | | | 1,113.39 | | | | 187.40 | | | | 103.02 | | | | 73.14 | | | | 140.42 | | | | 80.45 | | | | 259.67 | | | | 157.81 | | | | 322.25 | | | | 10,429.00 | | | | 1,517.66 | | | | 453.32 | | | | 246.93 | | | | 257.13 | | | | 778.13 | | | | 731.29 | | | | 306.09 | | | | 106.45 | | | | 97.42 | |
02 | | | 1,113.40 | | | | 187.41 | | | | 104.29 | | | | 81.71 | | | | 142.91 | | | | 82.94 | | | | 258.64 | | | | 156.78 | | | | 321.46 | | | | 10,429.08 | | | | 1,517.74 | | | | 459.67 | | | | 277.70 | | | | 258.36 | | | | 749.41 | | | | 725.19 | | | | 326.08 | | | | 109.81 | | | | 100.78 | |
03 | | | 1,217.58 | | | | 206.52 | | | | 113.60 | | | | 78.29 | | | | 149.38 | | | | 83.93 | | | | 285.07 | | | | 172.96 | | | | 361.06 | | | | 11,442.89 | | | | 1,680.13 | | | | 501.33 | | | | 261.81 | | | | 261.99 | | | | 811.41 | | | | 806.83 | | | | 347.41 | | | | 98.99 | | | | 90.96 | |
04 | | | 1,067.52 | | | | 181.93 | | | | 100.42 | | | | 71.07 | | | | 132.64 | | | | 75.57 | | | | 252.44 | | | | 153.87 | | | | 322.61 | | | | 10,972.69 | | | | 1,615.39 | | | | 486.14 | | | | 274.53 | | | | 265.34 | | | | 798.63 | | | | 788.14 | | | | 322.37 | | | | 107.12 | | | | 99.17 | |
05 | | | 1,214.97 | | | | 206.54 | | | | 113.51 | | | | 78.06 | | | | 151.36 | | | | 85.32 | | | | 287.37 | | | | 175.41 | | | | 364.65 | | | | 12,248.99 | | | | 1,796.93 | | | | 533.81 | | | | 273.37 | | | | 286.61 | | | | 895.23 | | | | 870.01 | | | | 227.92 | | | | 94.01 | | | | 88.11 | |
06 | | | 1,056.58 | | | | 181.21 | | | | 100.72 | | | | 75.24 | | | | 138.56 | | | | 82.06 | | | | 256.38 | | | | 158.23 | | | | 329.70 | | | | 11,162.25 | | | | 1,645.51 | | | | 491.58 | | | | 266.06 | | | | 276.46 | | | | 849.27 | | | | 815.20 | | | | 276.25 | | | | 83.20 | | | | 76.52 | |
07 | | | 1,092.96 | | | | 186.86 | | | | 103.65 | | | | 76.18 | | | | 141.63 | | | | 83.21 | | | | 263.09 | | | | 161.84 | | | | 336.16 | | | | 11,810.46 | | | | 1,744.87 | | | | 520.53 | | | | 278.08 | | | | 290.41 | | | | 895.70 | | | | 866.18 | | | | 376.57 | | | | 95.08 | | | | 88.13 | |
08 | | | 1,033.52 | | | | 177.09 | | | | 97.93 | | | | 69.15 | | | | 128.97 | | | | 73.85 | | | | 246.72 | | | | 150.78 | | | | 318.20 | | | | 10,526.05 | | | | 1,560.37 | | | | 463.03 | | | | 244.31 | | | | 244.03 | | | | 754.27 | | | | 750.96 | | | | 263.09 | | | | 91.99 | | | | 85.45 | |
09 | | | 1,067.80 | | | | 181.60 | | | | 100.37 | | | | 71.86 | | | | 133.22 | | | | 75.83 | | | | 251.62 | | | | 153.23 | | | | 319.95 | | | | 11,078.36 | | | | 1,635.53 | | | | 488.46 | | | | 259.82 | | | | 258.08 | | | | 799.75 | | | | 797.26 | | | | 226.14 | | | | 94.01 | | | | 86.79 | |
10 | | | 1,083.48 | | | | 186.11 | | | | 103.65 | | | | 77.24 | | | | 138.55 | | | | 80.72 | | | | 260.78 | | | | 160.03 | | | | 337.87 | | | | 14,344.39 | | | | 2,132.44 | | | | 637.71 | | | | 344.88 | | | | 341.56 | | | | 1,058.95 | | | | 1,059.91 | | | | 329.06 | | | | 102.08 | | | | 94.27 | |
11 | | | 1,372.21 | | | | 232.61 | | | | 127.86 | | | | 88.83 | | | | 168.79 | | | | 94.95 | | | | 321.01 | | | | 194.79 | | | | 405.88 | | | | 14,488.22 | | | | 2,131.96 | | | | 635.02 | | | | 328.99 | | | | 330.76 | | | | 1,031.14 | | | | 1,028.54 | | | | 377.72 | | | | 148.33 | | | | 134.69 | |
6B* | | | 1,056.44 | | | | 181.19 | | | | 100.61 | | | | 74.50 | | | | 137.86 | | | | 81.37 | | | | 256.07 | | | | 157.93 | | | | 329.41 | | | | 11,161.75 | | | | 1,645.42 | | | | 491.54 | | | | 265.93 | | | | 276.34 | | | | 849.01 | | | | 815.09 | | | | 276.25 | | | | 83.20 | | | | 76.52 | |
AHCA Contract No. FA614, Exhibit III-E, 1 of 5
EXHIBIT III-E
February 1, 2009 -August 31, 2009 HMO RATES
(MEDICAID Non-Reform HMO CAPITATION RATES)
By Area, Age and Eligibility Category
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 | | | 1,113.39 | | | | 187.41 | | | | 104.70 | | | | 76.25 | | | | 143.60 | | | | 83.14 | | | | 260.89 | | | | 159.07 | | | | 325.04 | | | | 10,429.00 | | | | 1,517.66 | | | | 454.94 | | | | 249.33 | | | | 259.19 | | | | 779.46 | | | | 733.15 | | | | 306.54 | | | | 107.57 | | | | 98.28 | |
02 | | | 1,113.40 | | | | 187.42 | | | | 105.97 | | | | 84.82 | | | | 146.09 | | | | 85.63 | | | | 259.86 | | | | 158.04 | | | | 324.25 | | | | 10,429.08 | | | | 1,517.74 | | | | 461.29 | | | | 280.10 | | | | 260.42 | | | | 750.74 | | | | 727.05 | | | | 326.53 | | | | 110.93 | | | | 101.64 | |
03 | | | 1,217.59 | | | | 206.54 | | | | 116.65 | | | | 83.95 | | | | 155.15 | | | | 88.81 | | | | 286.81 | | | | 174.74 | | | | 365.03 | | | | 11,442.89 | | | | 1,680.14 | | | | 504.46 | | | | 266.45 | | | | 265.98 | | | | 813.29 | | | | 809.48 | | | | 348.44 | | | | 100.64 | | | | 92.22 | |
04 | | | 1,067.53 | | | | 181.94 | | | | 102.26 | | | | 74.49 | | | | 136.14 | | | | 78.52 | | | | 254.11 | | | | 155.59 | | | | 326.43 | | | | 10,972.69 | | | | 1,615.39 | | | | 487.92 | | | | 277.17 | | | | 267.61 | | | | 800.51 | | | | 790.78 | | | | 324.55 | | | | 108.71 | | | | 100.38 | |
05 | | | 1,214.98 | | | | 206.56 | | | | 116.92 | | | | 84.39 | | | | 157.83 | | | | 91.79 | | | | 290.78 | | | | 178.92 | | | | 372.44 | | | | 12,249.00 | | | | 1,796.94 | | | | 538.03 | | | | 279.64 | | | | 291.99 | | | | 898.93 | | | | 875.21 | | | | 231.58 | | | | 97.80 | | | | 91.00 | |
06 | | | 1,056.59 | | | | 181.22 | | | | 103.39 | | | | 80.20 | | | | 143.62 | | | | 86.34 | | | | 258.26 | | | | 160.17 | | | | 334.00 | | | | 11,162.25 | | | | 1,645.52 | | | | 494.62 | | | | 270.56 | | | | 280.33 | | | | 851.77 | | | | 818.71 | | | | 278.01 | | | | 85.45 | | | | 78.23 | |
07 | | | 1,092.97 | | | | 186.87 | | | | 106.05 | | | | 80.63 | | | | 146.17 | | | | 87.05 | | | | 264.42 | | | | 163.20 | | | | 339.20 | | | | 11,810.46 | | | | 1,744.88 | | | | 523.53 | | | | 282.52 | | | | 294.23 | | | | 897.25 | | | | 868.36 | | | | 377.05 | | | | 96.60 | | | | 89.29 | |
08 | | | 1,033.53 | | | | 177.11 | | | | 101.57 | | | | 75.90 | | | | 135.86 | | | | 79.68 | | | | 248.74 | | | | 152.85 | | | | 322.80 | | | | 10,526.05 | | | | 1,550.38 | | | | 466.45 | | | | 249.39 | | | | 248.39 | | | | 756.55 | | | | 754.16 | | | | 264.63 | | | | 93.66 | | | | 86.72 | |
09 | | | 1,067.81 | | | | 181.62 | | | | 103.30 | | | | 77.30 | | | | 138.78 | | | | 80.53 | | | | 252.58 | | | | 154.21 | | | | 322.14 | | | | 11,078.36 | | | | 1,635.54 | | | | 491.05 | | | | 263.67 | | | | 261.39 | | | | 800.93 | | | | 798.91 | | | | 227.97 | | | | 95.08 | | | | 87.60 | |
10 | | | 1,083.49 | | | | 186.12 | | | | 106.08 | | | | 81.75 | | | | 143.16 | | | | 84.62 | | | | 261.51 | | | | 160.78 | | | | 339.53 | | | | 14,344.39 | | | | 2,132.45 | | | | 640.50 | | | | 349.02 | | | | 345.12 | | | | 1,059.90 | | | | 1,061.24 | | | | 329.88 | | | | 103.38 | | | | 95.25 | |
11 | | | 1,372.22 | | | | 232.62 | | | | 131.59 | | | | 96.51 | | | | 176.76 | | | | 101.67 | | | | 321.87 | | | | 195.67 | | | | 407.84 | | | | 14,488.23 | | | | 2,131.98 | | | | 639.29 | | | | 336.38 | | | | 337.23 | | | | 1,032.92 | | | | 1,031.04 | | | | 381.06 | | | | 150.49 | | | | 136.34 | |
6B* | | | 1,056.45 | | | | 181.20 | | | | 103.28 | | | | 79.48 | | | | 142.92 | | | | 85.65 | | | | 256.07 | | | | 157.93 | | | | 329.41 | | | | 11,161.75 | | | | 1,645.43 | | | | 494.58 | | | | 270.43 | | | | 280.21 | | | | 849.01 | | | | 815.09 | | | | 278.01 | | | | 85.45 | | | | 78.23 | |
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 | | | 1,118.74 | | | | 188.77 | | | | 103.85 | | | | 73.64 | | | | 142.45 | | | | 81.79 | | | | 262.97 | | | | 160.32 | | | | 325.75 | | | | 10,468.09 | | | | 1,543.33 | | | | 458.61 | | | | 249.36 | | | | 263.26 | | | | 798.19 | | | | 748.22 | | | | 313.56 | | | | 120.17 | | | | 106.26 | |
02 | | | 1,118.75 | | | | 188.78 | | | | 105.12 | | | | 82.21 | | | | 144.94 | | | | 84.28 | | | | 261.94 | | | | 159.29 | | | | 324.97 | | | | 10,468.17 | | | | 1,543.41 | | | | 464.96 | | | | 280.13 | | | | 264.49 | | | | 769.47 | | | | 742.12 | | | | 333.55 | | | | 123.53 | | | | 109.62 | |
03 | | | 1,224.01 | | | | 208.18 | | | | 114.60 | | | | 78.89 | | | | 151.82 | | | | 85.54 | | | | 289.04 | | | | 175.98 | | | | 365.28 | | | | 11,492.20 | | | | 1,712.51 | | | | 508.01 | | | | 264.88 | | | | 269.71 | | | | 836.72 | | | | 828.19 | | | | 356.12 | | | | 118.76 | | | | 103.70 | |
04 | | | 1,072.09 | | | | 183.11 | | | | 101.13 | | | | 71.50 | | | | 134.38 | | | | 76.72 | | | | 256.26 | | | | 156.01 | | | | 325.61 | | | | 11,011.02 | | | | 1,640.55 | | | | 491.32 | | | | 276.91 | | | | 271.34 | | | | 818.29 | | | | 804.74 | | | | 329.55 | | | | 122.97 | | | | 109.39 | |
05 | | | 1,218.84 | | | | 207.54 | | | | 114.11 | | | | 78.42 | | | | 152.83 | | | | 87.29 | | | | 289.75 | | | | 177.22 | | | | 367.18 | | | | 12,280.81 | | | | 1,817.81 | | | | 538.12 | | | | 275.35 | | | | 291.59 | | | | 911.55 | | | | 883.79 | | | | 234.47 | | | | 108.09 | | | | 97.18 | |
06 | | | 1,060.38 | | | | 182.19 | | | | 101.31 | | | | 75.60 | | | | 140.00 | | | | 83.01 | | | | 258.73 | | | | 160.02 | | | | 332.19 | | | | 11,193.75 | | | | 1,666.20 | | | | 495.85 | | | | 268.01 | | | | 281.39 | | | | 865.43 | | | | 828.84 | | | | 281.96 | | | | 94.76 | | | | 83.97 | |
07 | | | 1,096.99 | | | | 187.89 | | | | 104.28 | | | | 76.56 | | | | 143.16 | | | | 84.23 | | | | 265.58 | | | | 163.74 | | | | 338.80 | | | | 11,845.21 | | | | 1,767.68 | | | | 525.23 | | | | 280.23 | | | | 295.85 | | | | 913.53 | | | | 881.23 | | | | 381.95 | | | | 107.21 | | | | 95.94 | |
08 | | | 1,038.81 | | | | 178.45 | | | | 98.76 | | | | 69.66 | | | | 130.99 | | | | 75.18 | | | | 249.98 | | | | 153.26 | | | | 321.67 | | | | 10,564.27 | | | | 1,575.46 | | | | 468.20 | | | | 246.69 | | | | 250.01 | | | | 773.87 | | | | 767.52 | | | | 269.02 | | | | 106.78 | | | | 94.97 | |
09 | | | 1,072.91 | | | | 182.92 | | | | 101.17 | | | | 72.34 | | | | 135.16 | | | | 77.11 | | | | 254.77 | | | | 155.63 | | | | 323.30 | | | | 11,117.70 | | | | 1,661.37 | | | | 493.79 | | | | 262.27 | | | | 264.24 | | | | 819.93 | | | | 814.30 | | | | 232.70 | | | | 109.81 | | | | 96.97 | |
10 | | | 1,086.47 | | | | 186.89 | | | | 104.12 | | | | 77.52 | | | | 139.69 | | | | 81.47 | | | | 262.62 | | | | 161.43 | | | | 339.83 | | | | 14,370.64 | | | | 2,149.68 | | | | 641.26 | | | | 346.51 | | | | 345.67 | | | | 1,072.41 | | | | 1,071.28 | | | | 334.36 | | | | 114.42 | | | | 102.22 | |
11 | | | 1,375.30 | | | | 233.40 | | | | 128.34 | | | | 89.12 | | | | 169.97 | | | | 95.73 | | | | 322.92 | | | | 196.24 | | | | 407.91 | | | | 14,515.60 | | | | 2,149.93 | | | | 638.72 | | | | 330.69 | | | | 335.05 | | | | 1,045.18 | | | | 1,040.40 | | | | 382.84 | | | | 160.77 | | | | 142.70 | |
6B* | | | 1,060.24 | | | | 182.17 | | | | 101.20 | | | | 74.86 | | | | 139.30 | | | | 82.32 | | | | 258.42 | | | | 159.72 | | | | 331.90 | | | | 11,193.25 | | | | 1,666.11 | | | | 495.81 | | | | 267.88 | | | | 281.27 | | | | 865.17 | | | | 828.73 | | | | 281.96 | | | | 94.76 | | | | 83.97 | |
AHCA Contract No. FA614, Exhibit III-E, 2 of 5
EXHIBIT lll-E
February 1, 2009 - August 31, 2009 HMO RATES
(MEDICAID Non-Reform HMO CAPITATION RATES)
By Area, Age and Eligibility Category
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 | | 1,118.72 | | 188.75 | | 102.21 | | 61.95 | | 131.52 | | 70.86 | | 258.53 | | 155.88 | | 322.02 | | 10,468.01 | | 1,543.25 | | 451.17 | | 201.31 | | 219.27 | | 716.79 | | 717.24 | | 313.35 | | 108.52 | | 94.61 |
02 | | 1,118.72 | | 188.75 | | 102.21 | | 61.95 | | 131.52 | | 70.86 | | 258.53 | | 155.88 | | 322.02 | | 10,468.01 | | 1,543.25 | | 451.17 | | 201.31 | | 219.27 | | 716.79 | | 717.24 | | 313.35 | | 108.52 | | 94.61 |
03 | | 1,224.00 | | 208.17 | | 113.28 | | 69.71 | | 145.74 | | 79.46 | | 287.50 | | 174.44 | | 363.94 | | 11,492.13 | | 1,712.44 | | 501.75 | | 229.12 | | 249.19 | | 812.82 | | 816.91 | | 349.27 | | 109.78 | | 94.72 |
04 | | 1,072.08 | | 183.10 | | 99.75 | | 61.94 | | 128.04 | | 70.38 | | 253.65 | | 154.40 | | 324.21 | | 11,010.91 | | 1,640.44 | | 481.56 | | 221.17 | | 239.36 | | 781.03 | | 787.15 | | 305.00 | | 106.20 | | 92.62 |
05 | | 1,218.83 | | 207.53 | | 112.90 | | 69.74 | | 144.72 | | 79.18 | | 286.46 | | 173.93 | | 364.40 | | 12,280.76 | | 1,817.76 | | 533.10 | | 242.93 | | 261.91 | | 856.63 | | 862.89 | | 231.74 | | 95.27 | | 84.36 |
06 | | 1,060.36 | | 182.17 | | 99.46 | | 62.35 | | 127.62 | | 70.63 | | 253.70 | | 154.99 | | 327.94 | | 11,193.68 | | 1,666.13 | | 489.33 | | 225.90 | | 242.85 | | 794.10 | | 801.69 | | 280.65 | | 90.87 | | 80.08 |
07 | | 1,096.97 | | 187.87 | | 102.50 | | 63.87 | | 131.30 | | 72.37 | | 260.76 | | 158.92 | | 334.73 | | 11,845.15 | | 1,767.62 | | 519.11 | | 240.72 | | 259.68 | | 846.60 | | 855.75 | | 379.36 | | 96.69 | | 85.42 |
08 | | 1,038.80 | | 178.44 | | 97.50 | | 60.87 | | 125.17 | | 69.36 | | 248.49 | | 151.77 | | 320.38 | | 10,564.20 | | 1,575.39 | | 462.20 | | 212.41 | | 230.33 | | 750.96 | | 756.70 | | 262.17 | | 93.56 | | 81.75 |
09 | | 1,072.89 | | 182.90 | | 99.62 | | 61.53 | | 128.00 | | 69.95 | | 252.95 | | 153.81 | | 321.73 | | 11,117.63 | | 1,661.30 | | 487.46 | | 226.13 | | 243.50 | | 796.77 | | 802.89 | | 225.85 | | 100.22 | | 87.38 |
10 | | 1,086.45 | | 186.87 | | 102.20 | | 64.16 | | 130.84 | | 72.62 | | 260.37 | | 159.18 | | 337.88 | | 14,370.54 | | 2,149.58 | | 632.91 | | 298.80 | | 318.29 | | 1,040.53 | | 1,056.22 | | 327.51 | | 106.36 | | 94.16 |
11 | | 1,375.28 | | 233.38 | | 126.72 | | 77.83 | | 162.48 | | 88.24 | | 321.01 | | 194.33 | | 406.26 | | 14,515.52 | | 2,149.85 | | 631.75 | | 290.89 | | 312.22 | | 1,018.58 | | 1,027.84 | | 375.61 | | 152.71 | | 134.64 |
6B* | | 1,060.22 | | 182.15 | | 99.45 | | 62.34 | | 127.60 | | 70.62 | | 253.67 | | 154.97 | | 327.89 | | 11,193.18 | | 1,666.04 | | 489.31 | | 225.89 | | 242.84 | | 794.05 | | 801.66 | | 280.65 | | 90.87 | | 80.08 |
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 | | 1,113.37 | | 187.39 | | 103.06 | | 64.56 | | 132.67 | | 72.21 | | 256.45 | | 154.63 | | 321.30 | | 10,428.92 | | 1,517.58 | | 447.50 | | 201.28 | | 215.20 | | 698.06 | | 702.17 | | 306.33 | | 95.92 | | 86.63 |
02 | | 1,113.37 | | 187.39 | | 103.06 | | 64.56 | | 132.67 | | 72.21 | | 256.45 | | 154.63 | | 321.30 | | 10,428.92 | | 1,517.58 | | 447.50 | | 201.28 | | 215.20 | | 698.06 | | 702.17 | | 306.33 | | 95.92 | | 86.63 |
03 | | 1,217.58 | | 206.53 | | 115.33 | | 74.77 | | 149.07 | | 82.73 | | 285.27 | | 173.20 | | 363.69 | | 11,442.82 | | 1,680.07 | | 498.20 | | 230.69 | | 245.46 | | 789.39 | | 798.20 | | 341.69 | | 91.66 | | 83.24 |
04 | | 1,067.52 | | 181.93 | | 100.88 | | 64.93 | | 129.80 | | 72.18 | | 252.50 | | 153.98 | | 325.03 | | 10,972.58 | | 1,615.28 | | 478.16 | | 221.43 | | 235.63 | | 763.25 | | 773.19 | | 300.00 | | 91.94 | | 83.61 |
05 | | 1,214.97 | | 206.55 | | 115.71 | | 75.71 | | 149.72 | | 83.68 | | 287.49 | | 176.63 | | 369.66 | | 12,248.95 | | 1,796.89 | | 533.01 | | 247.22 | | 262.31 | | 844.01 | | 854.31 | | 228.85 | | 84.98 | | 78.18 |
06 | | 1,056.57 | | 181.20 | | 101.54 | | 66.95 | | 131.24 | | 73.96 | | 253.23 | | 155.14 | | 329.75 | | 11,162.18 | | 1,845.45 | | 488.10 | | 228.45 | | 241.79 | | 780.44 | | 791.56 | | 276.70 | | 81.56 | | 74.34 |
07 | | 1,092.95 | | 186.85 | | 104.27 | | 67.94 | | 134.31 | | 75.19 | | 259.60 | | 158.38 | | 335.13 | | 11,810.40 | | 1,744.82 | | 517.41 | | 243.01 | | 258.06 | | 830.32 | | 842.88 | | 374.46 | | 86.08 | | 78.77 |
08 | | 1,033.52 | | 177.10 | | 100.31 | | 67.11 | | 130.04 | | 73.86 | | 247.25 | | 151.36 | | 321.51 | | 10,525.98 | | 1,550.31 | | 460.45 | | 215.11 | | 228.71 | | 733.64 | | 743.34 | | 257.78 | | 80.44 | | 73.50 |
09 | | 1,067.79 | | 181.60 | | 101.75 | | 66.49 | | 131.62 | | 73.37 | | 250.76 | | 152.39 | | 320.57 | | 11,078.29 | | 1,635.47 | | 484.72 | | 227.53 | | 240.65 | | 776.77 | | 787.50 | | 221.12 | | 85.49 | | 78.01 |
10 | | 1,083.47 | | 186.10 | | 104.16 | | 68.39 | | 134.31 | | 75.77 | | 259.26 | | 158.53 | | 337.58 | | 14,344.29 | | 2,132.35 | | 632.15 | | 301.31 | | 317.74 | | 1,028.02 | | 1,046.18 | | 323.03 | | 95.32 | | 87.19 |
11 | | 1,372.20 | | 232.60 | | 129.97 | | 85.22 | | 169.27 | | 94.18 | | 319.96 | | 193.76 | | 406.19 | | 14,488.15 | | 2,131.90 | | 632.32 | | 296.58 | | 314.40 | | 1,006.32 | | 1,018.48 | | 373.83 | | 142.43 | | 128.28 |
6B* | | 1,056.43 | | 181.18 | | 101.53 | | 66.94 | | 131.22 | | 73.95 | | 251.32 | | 153.18 | | 325.40 | | 11,161.68 | | 1,645.36 | | 488.08 | | 228.44 | | 241.78 | | 777.89 | | 788.02 | | 276.70 | | 81.56 | | 74.34 |
AHCA Contract No. FA614, Exhibit III-E, 3 of 5
EXHIBIT III-E
February 1, 2009 - August 31, 2009 HMO RATES
(MED1CAID Non-Reform HMO CAPITATION RATES)
By Area, Age and Eligibility Category
TABLE 7
General + Dental+Transportation Rates:
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| | TANF | | | | | | | | | | | | | | AGE (14-20) | | AGE (21-54) | | | | | | | | | | SSI-N | | | | | | | | | | | | | | | | | | | | | | | | | | SSI-AB |
Area | | BTHMO+2MO | | 3MO-11MO | | AGE (1-5) | | AGE (6-13) | | Female | | Male | | Female | | Male | | AGE (55+) | | BTHMO+2MO | | 3MO-11MO | | AGE (1-5) | | AGE (6-13) | | AGE (14-20) | | AGE (21-54) | | AGE (55+) | | SSI-B | | AGE (65-) | | AGE (65+) |
01 | | | 1,118.72 | | | | 188.76 | | | | 103.89 | | | | 65.06 | | | | 134.70 | | | | 73.55 | | | | 259.75 | | | | 157.14 | | | | 324.81 | | | | 10,468.01 | | | | 1,543.25 | | | | 452.79 | | | | 203.71 | | | | 221.33 | | | | 718.12 | | | | 719.10 | | | | 313.80 | | | | 109.64 | | | | 95.47 | |
02 | | | 1,118.72 | | | | 188.76 | | | | 103.89 | | | | 65.06 | | | | 134.70 | | | | 73.55 | | | | 259.75 | | | | 157.14 | | | | 324.81 | | | | 10,468.01 | | | | 1,543.25 | | | | 452.79 | | | | 203.71 | | | | 221.33 | | | | 718.12 | | | | 719.10 | | | | 313.80 | | | | 109.64 | | | | 95.47 | |
03 | | | 1,224.01 | | | | 208.19 | | | | 116.33 | | | | 75.37 | | | | 151.51 | | | | 84.34 | | | | 289.24 | | | | 176.22 | | | | 367.91 | | | | 11,492.13 | | | | 1,712.45 | | | | 504.88 | | | | 233.76 | | | | 253.18 | | | | 814.70 | | | | 819.56 | | | | 350.30 | | | | 111.43 | | | | 95.98 | |
04 | | | 1,072.09 | | | | 183.11 | | | | 101.59 | | | | 65.36 | | | | 131.54 | | | | 73.33 | | | | 255.32 | | | | 156.12 | | | | 328.03 | | | | 11,010.91 | | | | 1,640.44 | | | | 483.34 | | | | 223.81 | | | | 241.63 | | | | 782.91 | | | | 789.79 | | | | 307.18 | | | | 107.79 | | | | 93.83 | |
05 | | | 1,218.84 | | | | 207.55 | | | | 116.31 | | | | 76.07 | | | | 151.19 | | | | 84.65 | | | | 289.87 | | | | 177.44 | | | | 372.19 | | | | 12,280.77 | | | | 1,817.77 | | | | 537.32 | | | | 249.20 | | | | 267.29 | | | | 860.33 | | | | 868.09 | | | | 235.40 | | | | 99.06 | | | | 87.25 | |
06 | | | 1,060.37 | | | | 182.18 | | | | 102.13 | | | | 67.31 | | | | 132.68 | | | | 74.91 | | | | 255.58 | | | | 156.93 | | | | 332.24 | | | | 11,193.68 | | | | 1,666.14 | | | | 492.37 | | | | 230.40 | | | | 246.72 | | | | 796.60 | | | | 805.20 | | | | 282.41 | | | | 93.12 | | | | 81.79 | |
07 | | | 1,096.98 | | | | 187.88 | | | | 104.90 | | | | 68.32 | | | | 135.84 | | | | 76.21 | | | | 262.09 | | | | 160.28 | | | | 337.77 | | | | 11,845.15 | | | | 1,767.63 | | | | 522.11 | | | | 245.16 | | | | 263.50 | | | | 848.15 | | | | 857.93 | | | | 379.84 | | | | 98.21 | | | | 86.58 | |
08 | | | 1,038.81 | | | | 178.46 | | | | 101.14 | | | | 67.61 | | | | 132.06 | | | | 76.19 | | | | 250.51 | | | | 153.84 | | | | 324.98 | | | | 10,564.20 | | | | 1,575.40 | | | | 465.62 | | | | 217.49 | | | | 234.69 | | | | 753.24 | | | | 759.90 | | | | 263.71 | | | | 95.23 | | | | 83.02 | |
09 | | | 1,072.90 | | | | 182.92 | | | | 102.55 | | | | 66.97 | | | | 133.56 | | | | 74.65 | | | | 253.91 | | | | 154.79 | | | | 323.92 | | | | 11,117.63 | | | | 1,661.31 | | | | 490.05 | | | | 229.98 | | | | 246.81 | | | | 796.95 | | | | 804.54 | | | | 227.68 | | | | 101.29 | | | | 88.19 | |
10 | | | 1,086.46 | | | | 186.88 | | | | 104.63 | | | | 68.67 | | | | 135.45 | | | | 76.52 | | | | 261.10 | | | | 159.93 | | | | 339.54 | | | | 14,370.54 | | | | 2,149.59 | | | | 635.70 | | | | 302.94 | | | | 321.85 | | | | 1,041.48 | | | | 1,057.55 | | | | 328.33 | | | | 107.66 | | | | 95.14 | |
11 | | | 1,375.29 | | | | 233.39 | | | | 130.45 | | | | 85.51 | | | | 170.45 | | | | 94.96 | | | | 321.87 | | | | 195.21 | | | | 408.22 | | | | 14,515.53 | | | | 2,149.87 | | | | 636.02 | | | | 298.28 | | | | 318.69 | | | | 1,020.36 | | | | 1,030.34 | | | | 378.95 | | | | 154.87 | | | | 136.29 | |
6B* | | | 1,060.23 | | | | 182.16 | | | | 102.12 | | | | 67.30 | | | | 132.66 | | | | 74.90 | | | | 253.67 | | | | 154.97 | | | | 327.89 | | | | 11,193.18 | | | | 1,666.05 | | | | 492.35 | | | | 230.39 | | | | 246.71 | | | | 794.05 | | | | 801.66 | | | | 282.41 | | | | 93.12 | | | | 81.79 | |
Table 8
General+ Mental Health + Dental + Transportation Rates:
| | | | | | | | | | | | | | | | �� | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| | TANF | | | | | | | | | | | | | | AGE (14-20) | | AGE (21-54) | | | | | | | | | | SSI-N | | | | | | | | | | | | | | | | | | | | | | | | | | SSI-AB |
Area | | BTHMO+2MO | | 3MO-11MO | | AGE (1-5) | | AGE (6-13) | | Female | | Male | | Female | | Male | | AGE (55+) | | BTHMO+2MO | | 3MO-11MO | | AGE (1-5) | | AGE (6-13) | | AGE (14-20) | | AGE (21-54) | | AGE (55+) | | SSI-B | | AGE (65-) | | AGE (65+) |
01 | | | 1,118.74 | | | | 188.78 | | | | 105.53 | | | | 76.75 | | | | 145.63 | | | | 84.48 | | | | 264.19 | | | | 161.58 | | | | 328.55 | | | | 10,468.09 | | | | 1,543.33 | | | | 460.23 | | | | 251.76 | | | | 265.32 | | | | 799.52 | | | | 750.08 | | | | 314.01 | | | | 121.29 | | | | 107.12 | |
02 | | | 1,118.75 | | | | 188.79 | | | | 106.80 | | | | 85.32 | | | | 148.12 | | | | 86.97 | | | | 263.16 | | | | 160.55 | | | | 327.76 | | | | 10,468.17 | | | | 1,543.41 | | | | 466.58 | | | | 282.53 | | | | 266.55 | | | | 770.80 | | | | 743.98 | | | | 334.00 | | | | 124.65 | | | | 110.48 | |
03 | | | 1,224.02 | | | | 208.20 | | | | 117.65 | | | | 84.55 | | | | 157.59 | | | | 90.42 | | | | 290.78 | | | | 177.76 | | | | 369.25 | | | | 11,492.20 | | | | 1,712.52 | | | | 511.14 | | | | 269.52 | | | | 273.70 | | | | 838.60 | | | | 830.84 | | | | 357.15 | | | | 120.41 | | | | 104.96 | |
04 | | | 1,072.10 | | | | 183.12 | | | | 102.97 | | | | 74.92 | | | | 137.88 | | | | 79.67 | | | | 256.93 | | | | 157.73 | | | | 329.43 | | | | 11,011.02 | | | | 1,640.55 | | | | 493.10 | | | | 279.55 | | | | 273.61 | | | | 820.17 | | | | 807.38 | | | | 331.73 | | | | 124.56 | | | | 110.60 | |
05 | | | 1,218.85 | | | | 207.56 | | | | 117.52 | | | | 84.75 | | | | 159.30 | | | | 92.76 | | | | 293.16 | | | | 180.73 | | | | 374.97 | | | | 12,280.82 | | | | 1,817.82 | | | | 542.34 | | | | 281.62 | | | | 296.97 | | | | 915.25 | | | | 888.99 | | | | 238.13 | | | | 111.88 | | | | 100.07 | |
06 | | | 1,060,39 | | | | 182.20 | | | | 103.98 | | | | 80.56 | | | | 145.06 | | | | 87.29 | | | | 260.61 | | | | 161.96 | | | | 336.49 | | | | 11,193.75 | | | | 1,666.21 | | | | 498.89 | | | | 272.51 | | | | 285.26 | | | | 867.93 | | | | 832.35 | | | | 283.72 | | | | 97.01 | | | | 85.68 | |
07 | | | 1,097.00 | | | | 187.90 | | | | 106.68 | | | | 81.01 | | | | 147.70 | | | | 88.07 | | | | 266.91 | | | | 165.10 | | | | 341.84 | | | | 11,845.21 | | | | 1,767.69 | | | | 528.23 | | | | 284.67 | | | | 299.67 | | | | 915.08 | | | | 883.41 | | | | 382.43 | | | | 108.73 | | | | 97.10 | |
08 | | | 1,038.82 | | | | 178.47 | | | | 102.40 | | | | 76.40 | | | | 137.88 | | | | 81.01 | | | | 252.00 | | | | 155.33 | | | | 326.27 | | | | 10,564.27 | | | | 1,575.47 | | | | 471.62 | | | | 251.77 | | | | 254.37 | | | | 776.15 | | | | 770.72 | | | | 270.56 | | | | 108.45 | | | | 96.24 | |
09 | | | 1,072.92 | | | | 182.94 | | | | 104.10 | | | | 77.78 | | | | 140.72 | | | | 81.81 | | | | 255.73 | | | | 156.61 | | | | 325.49 | | | | 11,117.70 | | | | 1,661.38 | | | | 496.38 | | | | 266.12 | | | | 267.55 | | | | 821.11 | | | | 815.95 | | | | 234.53 | | | | 110.88 | | | | 97.78 | |
10 | | | 1,086.48 | | | | 186.90 | | | | 106.55 | | | | 82.03 | | | | 144.30 | | | | 85.37 | | | | 263.35 | | | | 162.18 | | | | 341.49 | | | | 14,370.64 | | | | 2,149.69 | | | | 644.05 | | | | 350.65 | | | | 349.23 | | | | 1,073.36 | | | | 1,072.61 | | | | 335.18 | | | | 115.72 | | | | 103.20 | |
11 | | | 1,375.31 | | | | 233.41 | | | | 132.07 | | | | 96.80 | | | | 177.94 | | | | 102.45 | | | | 323.78 | | | | 197.12 | | | | 409.87 | | | | 14,515.61 | | | | 2,149.95 | | | | 642.99 | | | | 338.08 | | | | 341.52 | | | | 1,046.96 | | | | 1,042.90 | | | | 386.18 | | | | 162.93 | | | | 144.35 | |
6B* | | | 1,060.25 | | | | 182.18 | | | | 103.87 | | | | 79.82 | | | | 144.36 | | | | 86.60 | | | | 258.42 | | | | 159.72 | | | | 331.90 | | | | 11,193.25 | | | | 1,666.12 | | | | 498.85 | | | | 272.38 | | | | 285.14 | | | | 865.17 | | | | 828.73 | | | | 283.72 | | | | 97.01 | | | | 85.68 | |
AHCA Contract No. FA614, Exhibit III-E, 4 of 5
EXHIBIT III-E
February 1, 2009 - August 31, 2009 HMO RATES
(MEDICAID Non-Reform HMO CAPITATION RATES)
By Area, Age and Eligibility Category
| | |
Area | | Corresponding Counties |
| | |
Area 1 | | Escambia, Okaloosa, Santa Rosa, Walton |
Area 2 | | Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Washington, Wakulla |
Area 3 | | Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamillton, Hemando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, Union |
Area 4 | | Baker, Clay, Duval, Flagler, Nassau, St Johns, Volusia |
Area 5 | | Pasco, Pinellas |
Area 6 | | Hardee, Highlands, Manatee, Polk |
Area 6B * | | Hillsborough |
Area 7 | | Brevard, Orange, Osceola, Seminole |
Area 8 | | Charlotte, Collier, De Soto, Glades, Hendry, Lee, Sarasota |
Area 9 | | Indian River, Okeechobee, St. Lucie, Martin, Palm Beach |
Area 10 | | Broward |
Area 11 | | Dade, Monroe |
AHCA Contract No. FA614, Exhibit III-E, 5 of 5
EXHIBIT III-E
February 1, 2009 - August 31,2009 HMO RATES
(MEDICAID Non-Reform HMO CAPITATION RATES)
By Area, Age and Eligibility Category
AHCA Contract No. FA614, Exhibit III-E, 6 of 5