Amerigroup Florida, Inc. Medicaid HMO Contract d/b/a Amerigroup Community Care
AHCA CONTRACT NO. FA614
AMENDMENT NO. 6
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 CARE,hereinafter referred to as the “Vendor” or “Health Plan”, is hereby amended as follows:
1. Effective September 1, 2007,Attachment I, Scope of Services, is hereby amended to include Exhibit III-B, September 1, 2007-August 31, 2008 Medicaid Non-Reform HMO Capitation Rates, attached hereto and made a part of the Contract. All references in the Contract to Exhibit III-A, September 1, 2007 — August 31, 2008 Medicaid Non-Reform HMO Rates, shall hereinafter instead refer to Exhibit III-B, September 1, 2007- August 31, 2008 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 eight (8) page Amendment (which includes all attachments hereto) to be executed by their officials thereunto duly authorized.
AMERIGROUP FLORIDA, INC.STATE OF FLORIDA, AGENCY FOR
D/B/A/ AMERIGROUP COMMUNITY CAREHEALTH CARE ADMINISTRATION
SIGNED BY:
SIGNED BY:
NAME:William McHugh .......................
NAME:Andrew C. Agwunobi, M.D
TITLE: CEO
TITLE:Secretary
DATE:
DATE:
List of attachments included as part of this Amendment:
Specify Type
Letter/Number .............
Description
Exhibit
III-B
September 1, 2007- August 31, 2008 Medicaid Non-Reform HMO
AHCA Contract No. FA614, Exhibit III-B, Page 1 of 5
EXHIBIT III-A September 1, 2007- August 31, 2008 Medicaid Non-Reform HMO Capitation Rates By Area , Age and Eligibility Category ESTIMATEDHEALTHPLAN RATES (NOT FOR USE UNLESSAPPROVED BYCMS)
TABLE 1
General Rates:
TANF
SSI-N
SSI-B
SSI-AB
Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21.54) AGE (55+) BTHMO+2M0 3M0-11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)
Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21.54) AGE (55+) BTHMO+2M0 3M0-11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)
AHCA Contract No. FA614, Exhibit III-B, Page 2 of 5
EXHIBIT III-A
September 1, 2007- August 31, 2008
Medicaid Non-Reform HMO Capitation Rates
By Area , Age and Eligibility Category
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
TABLE 3
General + MH + Dental Rates:
TANF
SSI-N
SSI-B
SSI-AB
Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21.54) AGE (55+) BTHMO+2M0 3M0-11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)
Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) BTHMO+2M0 3M0-11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)
AHCA Contract No. FA614, Exhibit III-B, Page 3 of 5
EXHIBIT III-A September 1, 2007- August 31, 2008 Medicaid Non-Reform HMO Capitation Rates By Area , Age and Eligibility Category ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESSAPPROVEDBY CMS)
TABLE 5
General + Transportation Rates:
TANF
SSI-N
SSI-B
SSI-AB
Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21.54) AGE (55+) BTHMO+2M0 3M0-11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)
Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) BTHMO+2M0 3M0-11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)
AHCA Contract No. FA614, Exhibit III-B, Page 4 of 5
EXHIBIT III-A September 1, 2007- August 31, 2008 Medicaid Non-Reform HMO Capitation Rates By Area , Age and Eligibility Category ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESSAPPROVEDBY CMS)
TABLE 7
General + Dental + Transportation Rates:
TANF
SSI-N
SSI-B
SSI-AB
Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21.54) AGE (55+) BTHMO+2M0 3M0-11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)
TABLE 8 General + Mental Health + Dental + Transportation Rates:
TANF
SSI-N
SSI-B
SSI-AB
Area BTHM0+2M0 3M0.11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) BTHMO+2M0 3M0-11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) AGE (65-) AGE (65+)
EXHIBIT III-A September 1, 2007- August 31, 2008 Medicaid Non-Reform HMO Capitation Rates By Area , Age and Eligibility Category
Area Area 1 Area 2 Area 3 Area 4 Area 5 Area 6 Area 7 Area 8 Area 9 Area 10 Area 11
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Corresponding Counties Escambia, Okaloosa, Santa Rosa, Walton Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Washington, Wakulla Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamiliton, Hemando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, Union Baker, Clay, Duval, Flagler, Nassau, St. Johns, Volusia Pasco, Pinellas Hardee, Highlands, Hillsborough, Manatee, Polk Brevard, Orange, Osceola, Seminole Charlotte, Collier, De Soto, Glades, Hendry, Lee, Sarasota Indian River, Okeechobee, St. Lucie, Martin, Palm Beach Broward Dade, Monroe
Created on August 10, 2007 AHCA Contract No. FA614, Exhibit III-B, Page 5 of 5
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