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 toasthe “Vendor”, is hereby amended as follows:
Section III, Item C.1. of the Standard Contract is hereby amended as follows:
The Agency’s Contract Manager’s name, address and telephone number for this Contract is as follows:
G. Douglas Harper Agency for Health Care Administration Building #3, Mail Stop #50 2727 Mahan Drive Tallahassee, Florida 32308 Telephone - (850) 488-9287 Facsimile — (850) 410-1676
2.
Attachment I, Section 90.0, Payment and Authorized Enrollment Levels, is hereby deleted in its entirety and replaced with the following:
90.0 PAYMENT AND AUTHORIZED ENROLLMENT LEVELS
a.
The Agency assigns the Plan an authorized maximum enrollment level for each operational county, and the Agency shall pay the Plan capitation payments for each Agency operational area, in accordance with the following table. The Agency shall pay the Plan capitation payments based on the Agency operational area (or rate zone) age group, and gender, in accordance with Table 2. Where the Plan has implemented behavioral health care, the Agency shall pay the Plan in accordance with Table 3.
b.
The authorized maximum enrollment level is in effective as of July I, 2005, or upon Contract execution, whichever is later. The Agency must approve in writing any increase in the Plan’s maximum enrollment level for each operational county. Such approval shall not be unreasonably withheld, and shall be based on the Plan’s satisfactory performance of terms of the Contract and approval of the Plan’s administrative and service resources, as specified in this Contract, in support of each enrollment level.
c.
The Agency has developed estimated rates, for examination and evaluation by its actuary, Milliman and Co., to be paid to the Plan for services provided in Fiscal Year 2005 — 2006. These estimated rates represent the Agency’s best efforts to develop accurate rates. They are included as Attachment Viii; entitled “ESTIMATED 2005 — 2006 HMO RATES; NOT FOR USE UNLESS APPROVED BY CMS.” The Agency may use, or may amend and use, these estimated rates only after certification by its actuary and approval by the Centers for Medicare and Medicaid Services, and by notice in a Contract amendment to the Plan. Inclusion of these estimated rates is not intended to convey or imply any rights, duties or obligations of either party, nor is it intended to restrict, restrain or control the rights of either party that may have existed independently of this section of the Contract. By signature of this document, the parties explicitly agree that this section shall not independently convey any inherent rights, responsibilities or obligations of either party, relative to these rates, and shall not itself be the basis for any cause of administrative, legal or equitable action brought by either party.
In the event the rates certified by the actuary and approved by CMS are different from the Agency’s estimated rates, the Contractor agrees to accept a reconciliation performed by the Agency to bring payments to the Contractor in line with the approved rates.
e.
Upon receipt of CMS approval of 2005 - 2006 capitation rates, the Agency shall amend this Contract to reflect accepted capitation rates effective July 1, 2005.
f. Table l provides the Plan’s Contract enrollment levels.
g.
Table 2 provides capitation rates for all Agency areas, except for areas where behavioral health care has been implemented.
h.
Table 3 provides capitation rates for Agency areas where behavioral health care has been implemented, including community mental health and mental health targeted case management.
Table1
Enrollment Levels
County
Maximum Enrollment Level
BREVARD
8,000
BROWARID
14,000
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
SEMINOLE
8,000
Amendment No. 9, Page 2 of 4
AHCA Form 2100-0002 (Rev. NOV03)
2
AMERIGROUP FLORIDA, INC. Medicaid HMO Contract
Table2.
Area wideAge-bandedCapitation Rates forallagency areas of the state other than Area 6 and AreaI.
Area 05
<1 year
1-5
6-13
14-20 Male
14-20 Female
21-54 Male
21-54 Female
55-64
65+
TANF/FC/SOBRA
344.75
77.20
47.92
53.39
110.51
134.26
206.44
287.43
287.43
SSI/No Medicare
3312.84
399.97
207.73
217.58
217.58
622.27
622.27
600.49
600.49
SSI/PartB
262.11
262.1I
262.11
262.11
262.11
262.11
262.11
262.11
262.11
SSI/Part A & B
279.92
279.92
279.92
279.92
279.92
279.92
279.92
279.92
240.03
Area07
<1year
1-5
6-13
14-20Male
14-20Female
21-54 Male
21-54 Female
55-64
65+
TANF/FC/SOBRA
336.57
75.50
47.25
52.60
108.28
132.13
202.76
283.08
283.08
SSI/NoMedicare
3320.10
402.55
211.07
220.72
220.72
631.77
631.77
609.58
609.58
SSI/Part B
261.32
261.32
261.32
261.32
261.32
261.32
261.32
261.32
261.32
5SI/Part A &B
251.20
251.20
251.20
251.20
251.20
251.20
25I.20
25I.20
217.86
Area08
<1year
1-5
6-I3
14-20Male
14-20 Female
21-54 Male
2I-54Female
55-64
65+
TANF/FC/SOBRA
295.59
66.21
41.16
45.89
94.88
115.33
177.31
247.08
247.08
SSI/NoMedicare
3101.85
374.62
194.07
203.31
203.31
582.39
582.39
561.96
561.96
SSI/PartB
239.50
239.50
239.50
239.50
239.50
239.50
239.50
239.50
239.50
SSI/PartA &B
253.8I
253.81
253.81
253.81
253.81
253.81
253.81
253.81
219.39
Area 09
<I year
1-5
6-13
14-20 Male
14-20Female
21-54Male
21-54 Female
55-64
65+
TANF/FC/SOBRA
315.38
70.51
43.83
48.82
10I.05
122.63
I88.58
262.53
262.53
SSI/NoMedicare
3369.20
408.36
212.88
222.97
222.97
638.43
638.43
615.96
6I5.96
SSI/PartB
262.75
262.75
262.75
262.75
262.75
262.75
262.75
262.75
262.75
SSI/Part A &B
285.85
285.85
285.85
285.85
285.85
285.85
285.85
285.85
244.68
Area10
<1year
1-5
6-13
I4-20 Male
14-20 Female
21-54Male
21-54 Female
55-64
65+
TANF/FC/SOBRA
327.60
73.59
46.05
51.31
105.60
128.95
197.71
276.31
276.31
SSI/No Medicare
4270.73
518.41
272.09
283.90
283.90
812.87
812.87
784.90
784.90
SSI/PartB
282.31
282.31
282.31
282.31
282.31
282.31
282.31
282.31
282.3I
SSI/PartA &B
307.18
307.18
307.18
307.18
307.18
307.18
307.I8
307.18
266.50
Area11
<1year
1-5
6-13
14-20Male
I4-20Female
21-54 Male
21-54 Female
55-64
65+
TANF/FC/S0BRA
408.42
91.09
56.29
62.75
130.48
157.53
243.00
337.44
337.44
SSI/NoMedicare
4662.01
564.13
294.32
307.60
307.60
880.79
880.79
849.95
849.95
SSI/PartB
441.72
441.72
44I.72
441.72
441.72
441.72
441.72
441.72
441.72
SSI/PartA & B
325.70
325.70
325.70
325.70
325.70
325.70
325.70
325.70
303.69
Table3.
Area 6 or Area1Age-banded Capitation Rates,IncludingCommunityMentalHealth andMental Health TargetedCase Management.
Area06
<1year
1-5
6-13
14-20Male
14-20 Female
21-54 Male
21-54 Female
55-64
65+
TANF/FC/SOBRA
329.30
75.87
61.50
67.73
122.33
133.79
202.90
279.50
279.50
SSI/No Medicare
3062.53
377.38
271.33
247.10
247.10
657.23
657.23
596.37
596.37
SSI/PartB
238.I6
238.18
238.18
238.18
238.18
238.18
238.I8
238.18
238.18
SSI/PartA& B
255.15
255.15
255.15
255.15
255.15
255.15
255.15
255.15
222.29
For Plans participating in the frail/elderly program, the community rate shall be paid for all members in each eligibility category except for those SSI members determined by the Comprehensive Assessment and Review for Long Term Care (CARES) Unit to be at risk of nursing home institutionalization. Evidence of such assessments shall be provided to the Agency by the Plan prior to authorization by the Agency of payment of the institutional rates. Payment of institutional rates for any eligible enrollee shall continue only so long as the enrollee meets the level of care requirements for institutionalization, otherwise, the community capitation rate applies.
j.
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$680,379,083.00as expressed in this Contract.
This amendment shall begin on July 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 6 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
NAME: Don Gilmore NAME: Alan Levine
S.CONTTITLE: .. CEO
DATE:
/s/ 7/05/05
TITLE:
Secretary
DATE: S.CONTList of attachments included as part of this Amendment:
Specify Type
Number ..
Description
Attachment
VIII
ESTIMATED 2005 — 2006 HMO RATES; NOT FOR USE UNLESS APPROVED BY CMS (2 Pages)
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK AHCA Contract No. FA523, Amendment
No. 9, Page 4 of 4
AHCA Form 2100-0002 (Rev. NOV03)
4
ATTACHMENTVIII
ESTIMATED 2005 — 2006 HMO RATES;
NOT FOR USE UNLESS APPROVED BY CMS
AMERIGROUP FLORIDA July 1, 2005 through December 31, 2005
Medicaid HMO Contract contract Number : FA523
Table 3 Area-Wide Age-Banded Capitation Rates for all Agency Areas of the State in Which Behavioral Health has been Implemented Area 05 General Rates plus Mental Health Plan —015005304(PASCO) 015005305(PINELLAS)
BTHMO+2M0
3M0-11M0
1-5
6-13
14-20
(F)
14-20
(M)
21-54
(F)
21-54
(M)
55-64
65+
TANF/FC/SOBRA
9I9.98
183.43
91.15
64.87
13I.62
69.93
245.33
159.49
331.03
331.03
SSI/No Medicare
9248.02
1615.41
420.86
252.27
258.55
258.55
.735.80
735.80
681.19
681.I9
SSI/Part B
332.63
332.63
332.63
332.63
332.63
332.63
332.63
332.63
332.63
332.63
SSI/Part A & B
321.24
321.24
321.24
32I.24
321.24
321.24
321.24
321.24
321.24
227.10
Area 06 General Rates plus Mental Health Plan — 0I5005300(HILLSBOROUGH) 015005307(POLK) 015005318(MANATEE)
BTHM0+2M0
3M0-11M0
1-5
6-13
14-20
(F)
14-20
(M)
21-54
(F)
21-54
(M)
55-64
65+
TANF/FC/SOBRA
839.91
168.14
84.80
67.94
131.59
75.16
230.12
151.25
309.66
309.66
SSI/No Medicare
8536.50
1494.29
393.28
262.75
284.04
284.04
746.59
746.59
653.76
653.76
SSI/Part B
319.38
3I9.3B
319.38
319.38
319.38
319.38
319.38
3I9.38
3I9.38
319.38
SSI/Part A & B
288.23
288.23
288.23
288.23
288.23
288.23
288.23
288.23
288.23
202.46
Area 07 General Rates plus Mental Health Plan —015005308(ORANGE) 0150053I3(SEMINOLE) 015005314(OSCEOLA) 015005336(BREVARD)
BTHM0+2MO
3M0-11MO
1-5
6-13
14-20(F)
14-20(M)
2I-54(F)
21-54(M)
55-64
65+
TANF/FC/SOBRA
894.05
178.57
89.54
68.64
132.32
72.39
240.41
156.74
324.62
324.62
SSI/No Medicare
8976.52
1573.98
414.04
264.97
264.82
264.82
733.66
733.66
674.72
674.72
SSI/Part B
312.78
312.78
312.78
312.78
312.78
312.78
312.78
312.78
3I2.78
3I2.78
SSI/PartA&B
296.22
296.22
296.22
296.22
296.22
296.22
296.22
296.22
296.22
210.25
Area 08 General Rates plus Mental Health Plan — 0I5005302(LEE) 015005306(SARASOTA)
BTHM0+2M0
3M0-11M0
1-5
6-13
14-20(F)
14-20(M)
2I-54(F)
21-54(M)
55-64
65+
TANF/FC/SOBRA
785.53
156.86
78.13
56.61
113.39
60.74
210.44.
I36.92
284.23
284.23
SSI/No Medicare
8247.94
1440.21
376.25
229.28
234.06
234.06
659.32
659.32
608.59
608.59
SSI/Part 8
313.20
313.20
313.20
313.20'
313.20
313.20
313.20
313.20
313.20
313.20
SSI/Part A&B
297.40
297.40
297.40
297.40
297.40
297.40
297.40
297.40
297.40
210.20
Area 09 General Rates plus Mental Health Plan - 015005310(PALM BEACH)
BTHM0+2MO
3M0-11MO
1-5
6-13
14-20
(F)
14-20
(M)
21-54
(F)
21-54
(M)
55-64
65+
TANF/FC/SOBRA
850.66
169.57
84.45
61.30
122.72
65.7I
227.14
147,75
306.35
306.35
SSI/No Medicare
9123.68
1599.07
417.49
252.14
258.39
258.39
734.15
734.15
680.34
680.34
SSI/Part B
292.37
292.37
292.37
292.37
292.37
292.37
292.37
292.37
292.37
292.37
SSI/Part A 6 B
328.87
328.87
328.87
328.87
328.87
328.87
328.87
328.87
328.87
233.20
Area 10 General Rates plus Mental Health Plan - 015005311(BROWARD)
BTHM0+2M0
3M0-11M0
1-5
6-13
14-20
(F)
14-20
(M)
21-54
(F)
21-54
(M)
55-64
65+
TANF/FC/SOBRA
854.19
I70.88
86.07
67.92
128.34
71.08
231.04
150.99
312.37
3I2.37
SSI/No Medicare
11134.68
1955.19
510.16
308.62
316.57
316.57
900.47
900.47
834.79
834.79
SSI/Part B
319.50
319.50
319.50
319.50
319.50
3I9.50
319.50
319.50
319.50
319.50
SSI/Part A & B
346.90
346.90
346.90
346.90
346.90
346.90
346.90
346.90
346.90
244.42
Area 11 General Rates plus Mental Health Plan -015005312(DADE)
BTHMO+2MO
3M0-11MO
I-5
6-13
14-20(F)
I4-20(M)
21-54(F)
21-54(M)
55-64
65+
TANF/FC/SOBRA
1110.68
220.95
I10.34
8I.84
161.42
87.06
295.39
192.02
397.48
397.48
SSI/No Medicare
12135.44
2122.05
554.29
334.42
342.80
342.80
971.48
971.48
898.72
898.72
SSI/Part B
457.65
457.65
457.65
457.65
457.65
457,65
457.65
457.65
457.65
457.65
SSI/Part A & B
426.65
426.65
426.65
426.65
426.65
426.65
426.65
426.65
426.65
300.08
AHCA ContractNo. FA523, AttachmentVIII,Page 1 of 2
AHCA Form 2100-0039 (APR04)
AMERIGROUP FLORIDA January 1, 2006 through June
Medicai 30,2006
d 7840 Contract contract Number
FA523
Table 3. Area-Wide Age-Banded Capitation Rates for all Agency Areas of the State in Which Behavioral Health has been Implemented Area 05 General Rates plus Mental Health Plan —015005304(PASCO) 015005305(PINELLAS)
BTHM0+2M0
3M0-11MO
1-5
6-13
14-20(F)
14-20(M)
21-54(F)
21-54(M)
55-64
65+
TANF/FC/S0BRA
919.98
183.43
91.15
64.87
131.62
69.93
245.33
159.49
331.03
331.03
SSI/No Medicare
9248.02
1615.41
420.86
252.27
258.55
258.55
735.80
735.80
68I.19
681.19
SSI/Part B
2I4.59
214.59
214.59
2I4.59
214.59
214.59
214.59
214.59
214.59
214.59
SSI/PartA&B
83.91
83.91
83.91
83.91
83.91
83.91
83.91
83.91
83.91
��
74.53
Area 06 General Rates plus Mental Health Plan — 015005300(HILLSBOROUGH) 015005307(P0LK) 015005318(MANATEE)
BTHM0+2M0
3MO-11MO
1-5
6-13
14-20
(F)
14-20
(M)
21-54
(F)
21-54
(M)
55-64
65+
TANF/FC/SOBRA
839.91
168.14
84.80
67.94
131.59
75.16
230.12
151.25
309.66
309.66
SSI/No Medicare
8536.50
1494.29.
393.28
262.75
284.04
284.04
746.59
746.59
653.76
653.76
SSI/Part B
201.26
20I.26
201.26
201.26
201.26
201.26
201.26
201.26
201.26
201.26
SSI/Part A 6 B
73.23
73.23
73.23
73.23
73.23
73.23
73.23
73.23
73.23
64.45
Area 07 General Rates plus Mental Health Plan —015005308(0RANGE) 01SO05313(SEMINOLE) 015005314(OSCEOLA) 015005336(BREVARD)
BTHM0+2M0
3M0-11MO
1-5
6-13
I4-20(F)
I4-20(M)
21-54(F)
21-54(M)
55-64
65+
TANF/FC/SOBRA
894.05
178.57
89.54
68.64
132.32
72.39
240.41
156.74
324.62
324.62
SSI/No Medicare
8976.52
1573.98
414.04
264.97
264.82
264.82
733.66
733.66
674.72
674.72
SSI/Part B
203.20
203.20
203.20
203.20
203.20
203.20
203.20
203.20
203.20
203.20
SSI/Part A6B
84.13
84.13
84.13
84.13
84.I3
84.I3
84.13
84.13
84.13
74.97
Area 08 General Rates plus Mental] Health Plan —015005302(LEE) 015005306(SARAS0TA)
BTHM0+2M0
3M0-11M0
1-5
6-13
14-20(F)
14-20(M)
21-54(F)
21-54((4)
55-64
65+
TANF/FC/SOBRA
785.53
156.86
78.13
56.61
113.39
60.74
210.44
136.92
284.23
284.23
SSI/No Medicare
8247.94
1440.21
376.25
229.28
234.06
234.06
659.32
659.32
608.59
608.59
SSI/Part B
191.91
191.91
191.91
191.9I
191.91
191.91
191.91
191.91
191.91
191.9I
SSI/PartA6B
77.95
77.95
77,95
77.95
77,95
77.95
77.95
77.95
77.95
69.I3
Area 09 General Rates plus Mental Health Plan - 0I5005310(PALM BEACH)
BTHM0+2M0
3M0-11M0
1-5
6-13
14-20
(F)
14-20
(M)
21-54
(F)
21-54
(M)
55-64
65+
TANF/FC/SOBRA
850.66
169.57
84.45
61.30
122.72
65.71
227.14
147.75
306.35
306.35
SSI/No Medicare
9123.68
1599.07
417.49
252.14
258.39
258.39
734.15
734.15
680.34
680.34
SSI/Part B
183.12
183.12
183.12
183.12
I83.12
183.12
183.12
183.12
183.12
183.12
SSI/Part A & B
87.73
87.73
87.73
87.73
87.73
87.73
87.73
87.73
87.73
78.10
Area 10 General Rates plus Mental Health Plan -015005311(BROWARD)
BTHM0+2M0
3M0-11M0
1-5
6-13
14-20
(F)
14-20
(M)
21-54
(F)
21-54
(M)
55-64
65+
TANF/FC/SOBRA
854.19
170.88
86.07
67.92
128.34
71.08
231.04
150.99
312.37
312.37
SSI/No Medicare
11134.68
1955.I9
510.16
308.82
316.57
316.57
900.47
900.47
834.79
834.79
SSI/Part B
209.21
209.21
209.21
209.21
209.21
209.21
209.2I
209.21
209.21
209.2I
SSI/PartA&B
87.86
87.86
87.86
87.86
87.86
87.86
87.86
87.86
87.86
77.46
Area 11 General Rates plus Mental Health Plan - 015005312(DADE)
BTHM0+2M0
3M0-11M0
1-5
6-13
14-20
(F)
14-20
(M)
21-54
(F)
21-54
(M)
55-64
65+
TANF/FC/S0BRA
1110.68
220.95
110.34
81.84
161.42
87.06
295.39
192.02
397.48
397.48
SSI/No Medicare
12I35.44
2122.05
554.29
334.42
342.80
342.80
971.48
971.48
898.72
898.72
SSI/Part B
276.22
276.22
276.22
276.22
276.22
276.22
276.22
276.22
276.22
276.22
SSI/Part A&B
118.35
118.35
118.35
118.35
118.35
118.35
I18.35
118.35
118.35
104.11
AHCA Contract No. FA523,Attachment VIII, Page 2 of 2
AHCA Form 2100-0039 (APR04)
5
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