THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the “Agency” and AMERIGROUP FLORIDA, INC., hereinafter referred to as the “Vendor”, is hereby amended as follows:
1. Standard Contract, Section II.A, Contract Amount, the first sentence is hereby amended to now read:
To pay for contracted services according to the conditions ofAttachment Iin an amount not to exceed$666,784,520.00(an increase of $3,426,823.00), subject to the availability of funds.
2.
Attachment I, section 90.0, Payment and Authorized Enrollment Levels, Table 2 is hereby amended to now read as follows:
Table 2. Area wide Age-banded Capitation Rates for All Agency Areas of the State other than Areas 5, 6, and 7.
Area 08 General Rates Plan — 015005302(LEE) 015005306(SARASOTA)
<1 year
1-5
6-13
14-20 Male 14-20 Female 21-54 Male
21-54Female
55-64
65+
TANF/FC/SOBRA
296.66
66.37
41.76
46.19
95.19
117.62
179.02
250.96
250.96
SSI/No Medicare
3079.30
371.80
192.49
201.68
201.68
577.71
577.71
557.45
557.45
SSI/Part B
243.56
243.56
243.56
243.56
243.56
243.56
243.56
243.56
243.56
SSI/Part A & B
285.08
285.08
285.08
285.08
285.08
285.08
285.08
285.08
199.47
Area 09 General Rates Plan — 015005310(PALM BEACH)
<1 year
1-5
6-13
14-20 Male 14-20 Female 21-54 Male
21-54Female
55-64
65+
TANF/FC/SOBRA
316.78
70.74
44.52
49.17
101.48
125.24
190.60
266.97
266.97
SSI/No Medicare
3344.05
405.22
211.12
221.15
221.15
633.22
633.22
610.93
610.93
SSI/Part B
267.20
267.20
267.20
267.20
267.20
267.20
267.20
267.20
267.20
SSI/Part A & B
320.32
320.32
320.32
320.32
320.32
320.32
320.32
320.32
224.19
Area 10 General Rates Plan — 015005311(BROWARD)
<1 year
1-5
6-13
14-20 Male 14-20 Female 21-54 Male
21-54Female
55-64
65+
TANF/FC/SOBRA
328.74
73.77
46.68
51.61
105.94
131.31
199.49
280.33
280.33
SSI/No Medicare
4151.82
503.54
263.75
275.32
275.32
788.23
788.23
761.08
761.08
SSI/Part B
287.04
287.04
287.04
287.04
287.04
287.04
287.04
287.04
287.04
SSI/Part A & B
351.55
351.55
351.55
351.55
351.55
351.55
351.55
351.55
245.95
Area 11 General Rates Plan — 015005312(DADE)
<1 year
1-5
6-13
14-20 Male 14-20 Female 21-54 Male
21-54Female
55-64
65+
TANF/FC/SOBRA
409.16
91.08
56.97
62.97
130.55
160.40
244.76
341.98
341.98
SSI/No Medicare
4551.55
550.33
286.57
299.62
299.62
857.90
857.90
827.83
827.83
SSI/Part B
449.17
449.17
449.17
449.17
449.17
449.17
449.17
449.17
449.17
SSI/Part A & B
416.90
416.90
416.90
416.90
416.90
416.90
416.90
416.90
292.00
3.
Attachment I, section 90.0, Payment and Authorized Enrollment Levels, Table 3 is hereby amended to now read as follows:
Table 3 Area
Age-banded Capitation Rates, Including Community Mental Health and Mental Health Targeted Case Management
Table 3. Areas 5, 6, and 7 Age-banded Capitation Rates, Including Community Mental Health and Mental Health Targeted Case Management
Area 06 General Rates plus Mental Health Plan — 015005300(HILLSBOROUGH) 015005307(POLK) 015005318(MANATEE)
<1 year
1-5
6-13
14-20 Male 14-20 Female 21-54 Male
21-54Female
55-64
65+
TANF/FC/SOBRA
330.07
75.91
61.92
67.67
122.23
135.83
204.29
282.98
282.98
SSI/No Medicare
3017.05
371.69
265.72
243.82
243.82
647.81
647.81
587.26
587.26
SSI/Part B
242.29
242.29
242.29
242.29
242.29
242.29
242.29
242.29
242.29
SSI/Part A & B
288.09
288.09
288.09
288.09
288.09
288.09
288.09
288.09
202.64
Area 07 General Rates plus Mental Health Plan — 015005308(ORANGE) 015005313(SEMINOLE) 015005314(OSCEOLA)
<1 year
1-5
6-13
14-20 Male 14-20 Female 21-54 Male
21-54Female
55-64
65+
TANF/FC/SOBRA
337.20
76.92
58.07
59.10
114.69
136.45
206.32
287.87
287.87
SSI/No Medicare
3237.90
406.84
260.45
239.73
239.73
628.24
628.24
594.96
594.96
SSI/Part B
266.03
266.03
266.03
266.03
266.03
266.03
266.03
266.03
266.03
SSI/Part A & B
293.59
293.59
293.59
293.59
293.59
293.59
293.59
293.59
208.25
4.
Attachment I, Section 90.0, Payment and Authorized Enrollment Levels, Table 3, the second paragraph is hereby amended to now read:
Notwithstanding the payment amounts which may be computed with the above rate table, the sum of total capitation payments under this contract shall not exceed the total contract amount of$666,784,520.00(an increase of $3,426,823.00), expressed on page seven of this contract.
5.
This amendment shall begin on April 1, 2005, or the date on which the amendment has been signed by both parties, 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 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 2 page amendment (including all attachments) to be executed by their officials thereunto duly authorized.
AMERIGROUP FLORIDA, INC. STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED BY: /s/ Don Gilmore
SIGNED BY:
NAME: Don Gilmore TITLE: CEO
NAME: Alan Levine TITLE: Secretary
DATE: 3/31/05
DATE:
THE REMAINDER OF THIS PAGE LEFT BLANK INTENTIONALLY
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