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 ofAttachmentI in an amount not to exceed $680,379,083.00, (an increase of $10,560,000.00), subject to the availability of funds.
2.
Attachment I, Section 90.0, Payment and Authorized Enrollment Levels, Table 1 is hereby amended to now read:
Table 1 Projected Enrollment
County
Maximum Enrollment Level
BREVARD
8,000
BROWARD
14,000
_DADE DADE
25,000
HILLSBOROUGH
40,000
LEE
18,000
MANATEE
3,500
ORANGE
30,000
OSCEOLA
8,500
PALM BEACH
12,000
PASCO
15,000
-PINELLAS
25,000
POLK
30,000
SARASOTA
8,000
SEMINOLELE
8,000
3.
Attachment I, Section 90.0, Payment and Authorized Enrollment Levels, Table 3, is hereby amended to now read:
Table 3 Area
Age-banded Capitation Rates, Including Community Mental Health and Mental Health Targeted Case Management
Table3. Areas 5, 6, 7,8, 9,10, and 11 Age-banded Capitation Rates, Including Community Mental Health and Mental Health Targeted Case ManagementArea 05 General Rates plus Mental Health Plan - 015005304(PASCO) 015005305(PINELLAS)
<1 year
1-5
6-13
14-20 Male 14-20 Female 21-54 Male
21-54Female
55-64
65+
TANF/FC/SOBRA
345.77
79.28
51.94
57.32
114,31
139.01
210.44
291.84
291,84
SSI/NO Medicare
3265.63
429.24
240.86
235.59
235.59
628.37
628.37
594.95
594.95
SSI/Part B
266.87
266.81
266.87
266.87
266.87
266.87
266.87
266.87
266.87
SSI/PartA 6 B
310.72
318.72
318.12
318.72
318.72
318.72
318,72
318.72
225,77
Area 06 General Rates plus Mental Health Plan — 015005300(HILLSBOROUGH) 015005307(POLK) 015005318 (MANATEE)
<1 year
-5
6-13
14-20 Male 14-20 Female 21-54 Male 21-54 Female
55-64
65+
TANF/FC/SOBRA
330.07
7591
61.92
61.67
122.23
135.83
204.29
282.98
282.98
SS1/No Medicare
3017.05
37169
265.72
243.82
243,82
647.81
647.81
587,26
587.26
SSI/Part B
242.29
24229
242.29
242.29
242.29
242,29
242.29
242.29
242.29
SSI/Part A 6 B
288.09
288.09
288.09
288,09
288.09
288.09
288.09
288.09
202.64
AHCA ContractNo. FA523,Amendment No. 8, Page1 of 3
AHCA Form 2100-0002 (Rev. NOV03)
1
AMERIGROUP FLORIDA, INC. Medicaid HMO Contract
Area 07 General Rates plus Mental Health Plan —015005308 (ORANGE) 015005313(SEMINOLE) 015005314(OSCEOLA)015005336(BREVARD)
<1 year
1-:
6-13
14-20 Male 14-20 Female 21-54 Male
21-54Female
55-64
65+
TANF/FC/SOBRA
337.20
76.9
)
58.07
59.10
114.69
136.45
206.32
287.87
287.87
SSI/No Medicare
3217.90
406,81
260.45
239.73
239.73
628.24
628.24
594.96
594.96
SSI/Part B
266.03
266.0
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
Area08GeneralRatesplus Mental Health Plan —015005302 (LEE)015005306(SARASOTA)
<1 year
1-3
6-13
14-20 Male 14-20 Female 21-54 Male
21-54Female
55-64
65+
TANF/FC/SOBRA
296.69
67.77
46,25
49.88
98.88
119,48
180.88
251.72
251.72
SSI/No Medicare
3079.31
393.43
223.95
221.50
221.50
594.93
594,93
563.76
563,76
SSI/Part B
243.57
243.51
243.57
243.57
243.57
243.57
243.57
243.57
243.57
SSI/Part A 6 B
292.10
292.30
292.10
292.10
292.10
292.10
292.10
292.10
206.49
Area 09 General Rates plus Mental Health 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
316.80
71.49
49.26
52.54
104,85
126.25
191.61
270.11
270.11
SSI/No Medicare
3344.06
424,:3
246.02
236.61
236.61
650.12
650,12
614.45
614,45
SSI/Part B
267.44
267.+4
267,44
267.44
267.44
267.44
267.44
267.44
267.44
SSI/Part A & B
331.80
331.10
331.80
331.80
331.00
331.80
331.80
331,80
235.67
Area 10 General Rates plus Mental Health Plan — 015005311(BROWARD)
<1 year
1.5
6-13
14-20 Male 14-20 Female 21-54 Male 21-54 Female
55-64
65+
TANF/FC/SOBRA
328.75
75.74
60.81
58.42
112.75
132.87
201.05
203.53
283.53
SSI/No Medicare
4151.83
510.2
323.61
304.08
304.08
801.75
801.75
764.03
764.03
SSI/Part B
290.18
290..0
290.18
290,16
290.18
290.18
290.18
290.18
290.18
SSI/Part A & B
354.95
354.15
354.95
354.95
354.95
354.95
354,95
354.95
249.35
Area 11 General Rates plus Mental ‘]Health Plan - 015005312(DADE)
<1 year
1.5
6-13
14-20 Male 14-20 Female 21-54 Male 21-54 Female
55-64
65+
TANF/FC/SOBRA
409.17
92.16
69.70
69.26
136.84
161.91
246.27
343.39
343.39
SSI/No Medicare
4551.56
561.11
358.04
331.22
331.22
B76.41
876.41
832.73
832.73
SSI/PartB
451.58
451,58
451.58
451.58
451.58
451.58
451.50
451.58
451,58
SSI/Part A & B
420.30
420.10
420.30
420.30
420,30
420.30
420.30
420.30
295.40
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 $680,379,083.00, (an increase of $10,560,000.00), expressed on page seven of this contract.
5.
This amendment shall begin on July 1, 2005, or the date on which the amendment has been signed by both parties, whichever is after.
All provisions in the Contract and any attachments thereto in conflict with this amendment shall be and are hereby changed to con form 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 cam tot be executed unless all previous amendments to this Contract have been fully executed.
No. 8, Page 2 of 3
AHCA Form 2100-0002(Rev.NOV03)
AMERIGROUP FLORIDA, INC. Medicaid HMO Contract
IN WITNESS WHEREOF, the parties hereto have caused this 3 page amendment (including all attachments) to be executed by their officials thereunto duly authorized.
AMERIGROUP FLORIDA, MC.
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION
S.CONT
NAME: Don Gilmore
NAME: Alan Levine
TITLE: CEO
TITLE: Secretary
DATE:
/s/ 6/21/05
DATE:,/S/ 6/27/05
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