Exhibit 10.4
HealthEase of Florida, Inc.
Medicaid Reform HMO Contract
AHCA CONTRACT NO. FAR001
AMENDMENT NO. 8
THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the "Agency" and HEALTHEASE OF FLORIDA, INC., hereinafter referred to as the "Vendor", is hereby amended as follows:
1. | Effective January 1, 2008, Standard Contract, Section II, Item A, Contract Amount, the first sentence is hereby revised to now read as follows: |
To pay for contracted services according to the conditions of Attachment I in an amount not to exceed $382,047,581.00 (a decrease of $28,281,601.00), subject to availability of funds. |
2. | Effective January 1, 2008, Attachment I, Section C, Method of Payment, Item 1, General, the first paragraph is hereby revised to now read as follows: |
Notwithstanding the payment amounts which may be computed with the rate tables specified in Tables 2 thru 8, the sum of total capitation payments under this Contract shall not exceed the total Contract amount of $382,047,581.00 (a decrease of $28,281,601.00). |
3. | Effective January 1, 2008, Attachment I, Scope of Services, is hereby amended to include Exhibits 3-B, 5-C, 6-C, and 9-B, attached hereto and made a part of the Contract. All references in the Contract to Exhibits 3-A, 5-B, 6-B, and 9-A, shall hereinafter instead refer to Exhibits 3-B, 5-C, 6-C, and 9-B. |
4. | This Amendment shall have an effective date of January 1, 2008, or the date on which other parties execute the Amendment which ever 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.
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AHCA Contract No. FAR001, Amendment No. 8, Page 1 of 2
HealthEase of Florida, Inc.
Medicaid Reform HMO Contract
IN WITNESS WHEREOF, the parties hereto have caused this seven (7) page amendment (which includes all attachments hereto) to be executed by their officials thereunto duly authorized.
HEALTHEASE OF FLORIDA, INC | STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION |
SIGNED BY: /s/ Todd S. Farha | SIGNED BY: /s/ Illegible |
NAME: Todd S. Farha | (for) NAME: Andrew C. Agwunobi, M.D. |
TITLE: President and CEO | TITLE: Secretary |
DATE:1/2/08 | DATE: 1/3/08 |
List of Attachments/Exhibits included as part of this Amendment:
Specify Type | Letter/ Number | Description |
Exhibit | 3-B | Comprehensive and Catostrophic Component Captation Rates (2 Pages) |
Exhibit | 5-C | Capitation Rates SSI Medicare Part B Only and SSI Medicare Parts A & B Enrollees for All Medicaid Reform Counties (1 Page) |
Exhibit | 6-C | Capitation Rates for HIV/AIDS Populations for Each Medicaid Reform County (1 Page) |
Exhibit | 9-B | Kick Payment Amounts for Covered Obstetrical Delivery Services (1 Page) |
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AHCA Contract No. FAR001, Amendment No. 8, Page 2 of 2
EXHIBIT 3-B
COMPREHENSIVE COMPONENT AND CATASTROPHIC COMPONENT CAPITATION RATES
TABLE 2
Jan 1, 2008
Area: 10 County: Broward
Age Range | FY0708 Discounted Reform rates Under Current Methodology | Percentage of Current Methodology | 50% of Current Methodology | Preliminary FY0708 Base rates for Risk Adjusted Methodology | Budget Neutrality Factor | FY0708 Base rates for Risk Adjusted Methodology after Budget Neutrality | Percentage of Risk Adjusted Methodology | 50% of Risk Adjusted Methodology | Final Rates (with Enhanced Benefit Adjustment) | |||||||||||||||||||||||||||||
a | b | c | d | e | f | g | h | i | j | |||||||||||||||||||||||||||||
Eligibility Category: | Children and Family | |||||||||||||||||||||||||||||||||||||
Month 0-2 All | $ | 892.28 | ||||||||||||||||||||||||||||||||||||
Month 3-11 All | $ | 205.04 | ||||||||||||||||||||||||||||||||||||
1-5 All | $ | 106.14 | 50 | % | $ | 53.07 | $ | 117.69 | 1.07460 | $ | 126.47 | 50 | % | $ | 63.23 | $ | 112.09 | |||||||||||||||||||||
6-13 All | $ | 82.94 | 50 | % | $ | 41.47 | $ | 117.69 | 1.07460 | $ | 126.47 | 50 | % | $ | 63.23 | $ | 100.91 | |||||||||||||||||||||
14-20 Female | $ | 115.00 | 50 | % | $ | 57.50 | $ | 117.69 | 1.07460 | $ | 126.47 | 50 | % | $ | 63.23 | $ | 116.36 | |||||||||||||||||||||
14-20 Male | $ | 79.98 | 50 | % | $ | 39.99 | $ | 117.69 | 1.07460 | $ | 126.47 | 50 | % | $ | 63.23 | $ | 99.49 | |||||||||||||||||||||
21-54 Female | $ | 202.08 | 50 | % | $ | 101.04 | $ | 117.69 | 1.07460 | $ | 126.47 | 50 | % | $ | 63.23 | $ | 158.33 | |||||||||||||||||||||
21-54 Male | $ | 146.71 | 50 | % | $ | 73.35 | $ | 117.69 | 1.07460 | $ | 126.47 | 50 | % | $ | 63.23 | $ | 131.64 | |||||||||||||||||||||
55+ All | $ | 325.58 | 50 | % | $ | 162.79 | $ | 117.69 | 1.07460 | $ | 126.47 | 50 | % | $ | 63.23 | $ | 217.84 | |||||||||||||||||||||
Composite Based on Total Casemonths | $ | 108.91 | $ | 126.47 | $ | 0.00 | $ | 113.43 | ||||||||||||||||||||||||||||||
Eligibility Category: | Aged and Disabled | |||||||||||||||||||||||||||||||||||||
Month 0-2 All | $ | 17,528.17 | ||||||||||||||||||||||||||||||||||||
Month 3-11 All | $ | 3,534.94 | ||||||||||||||||||||||||||||||||||||
1-5 All | $ | 631.27 | 50 | % | $ | 315.63 | $ | 813.28 | 1.06682 | $ | 867.63 | 50 | % | $ | 433.81 | $ | 722.31 | |||||||||||||||||||||
6-13 All | $ | 355.68 | 50 | % | $ | 177.84 | $ | 813.28 | 1.06682 | $ | 867.63 | 50 | % | $ | 433.81 | $ | 589.51 | |||||||||||||||||||||
14-20 All | $ | 343.79 | 50 | % | $ | 171.90 | $ | 813.28 | 1.06682 | $ | 867.63 | 50 | % | $ | 433.81 | $ | 583.78 | |||||||||||||||||||||
21-54 All | $ | 930.27 | 50 | % | $ | 465.13 | $ | 813.28 | 1.06682 | $ | 867.63 | 50 | % | $ | 433.81 | $ | 866.40 | |||||||||||||||||||||
55+ All | $ | 965.71 | 50 | % | $ | 482.85 | $ | 813.28 | 1.06682 | $ | 867.63 | 50 | % | $ | 433.81 | $ | 883.48 | |||||||||||||||||||||
Composite Based on Total Casemonths | $ | 758.94 | $ | 867.63 | $ | 0.00 | $ | 783.84 |
AHCA Contract No. FAR001, Exhibit 3-B, Page 1 of 2
EXHIBIT 3-B
COMPREHENSIVE COMPONENT AND CATASTROPHIC COMPONENT CAPITATION RATES
TABLE 2
Jan 1, 2008
Area: 4 County: Duval, Baker, Clay, Nassau
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
Age Range | FY0708 Discounted Reform rates Under Current Methodology | Percentage of Current Methodology | 50% of Current Methodology | Preliminary FY0708 Base rates for Risk Adjusted Methodology | Budget Neutrality Factor | FY0708 Base rates for Risk Adjusted Methodology after Budget Neutrality | Percentage of Risk Adjusted Methodology | 50% of Risk Adjusted Methodology | Final Rates (with Enhanced Benefit Adjustment) |
a | b | c | d | e | f | g | h | I | j |
Eligibility Category: | Children and Family | ||||||||
Month 0-2 All | $ 926.73 | ||||||||
Month 3-11 All | $ 215.12 | ||||||||
1-5 All | $113.17 | 50% | $56.58 | $124.53 | 1.04120 | $129.66 | 50% | $64.83 | $ 117.02 |
6-13 All | $82.75 | 50% | $41.37 | $124.53 | 1.04120 | $129.66 | 50% | $64.83 | $ 102.36 |
14-20 Female | $119.81 | 50% | $59.91 | $124.53 | 1.04120 | $129.66 | 50% | $64.83 | $ 120.22 |
14-20 Male | $81.70 | 50% | $40.85 | $124.53 | 1.04120 | $129.66 | 50% | $64.83 | $ 101.85 |
21-54 Female | $218.13 | 50% | $109.06 | $124.53 | 1.04120 | $129.66 | 50% | $64.83 | $ 167.60 |
21-54 Male | $158.54 | 50% | $79.27 | $124.53 | 1.04120 | $129.66 | 50% | $64.83 | $ 138.88 |
55+ All | $350.55 | 50% | $175.28 | $124.53 | 1.04120 | $129.66 | 50% | $64.83 | $ 231.41 |
Composite Based on Total Casemonths | $119.40 | $129.66 | $0.00 | $ 120.02 | |||||
Eligibility Category: | Aged and Disabled | ||||||||
Month 0-2 All | $ 14,558.96 | ||||||||
Month 3-11 All | $ 2,969.69 | ||||||||
1-5 All | $537.41 | 50% | $268.70 | $657.05 | 1.05080 | $690.42 | 50% | $345.21 | $ 591.69 |
6-13 All | $312.13 | 50% | $156.06 | $657.05 | 1.05080 | $690.42 | 50% | $345.21 | $ 483.13 |
14-20 All | $296.53 | 50% | $148.27 | $657.05 | 1.05080 | $690.42 | 50% | $345.21 | $ 475.61 |
21-54 All | $790.16 | 50% | $395.08 | $657.05 | 1.05080 | $690.42 | 50% | $345.21 | $ 713.49 |
55+ All | $809.32 | 50% | $404.66 | $657.05 | 1.05080 | $690.42 | 50% | $345.21 | $ 722.72 |
Composite Based on Total Casemonths | $623.67 | $690.42 | $0.00 | $ 633.26 |
AHCA Contract No. FAR001, Exhibit 3-B, Page 2 of 2
EXHIBIT 5-C
CAPITATION RATES
SSI MEDICARE PART B ONLY
AND
SSI MEDICARE PARTS A AND B ENROLLEES
FOR ALL MEDICAID REFORM COUNTIES
TABLE 4
Area: 10 County: Broward
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
Under Age 65 | Age 65 & Over | |
SSI/Parts A & B | $149.01 | $100.91 |
SSI/Part B Only | $244.40 | $244.40 |
Area: 4 County: Duval, Baker, Clay, and Nassau
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
Under Age 65 | Age 65 & Over | |
SSI/Parts A & B | $156.46 | $105.72 |
SSI/Part B Only | $362.68 | $362.68 |
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AHCA Contract No. FAR001, Exhibit 5-C, Page 1 of 1
EXHIBIT 6-C
CAPITATION RATES FOR HIV/AIDS POPULATIONS FOR EACH MEDICAID REFORM COUNTY
TABLE 5 |
Area: 10 | County: Broward |
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
Capitation Rate | |
HIV (no medicare) | $1,933.92 |
AIDS (no medicare) | $3,629.23 |
HIV-SSI/Parts A & B, SSI Part B Only | $ 271.50 |
AIDS-SSI/Parts A & B, SSI Part B Only | $ 579.63 |
Area: 4 | County: Duval, Baker, Clay, and Nassau |
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
Capitation Rate | |
HIV (no medicare) | $1,196.17 |
AIDS (no medicare) | $2,354.82 |
HIV-SSI/Parts A & B, SSI Part B Only | $ 162.15 |
AIDS-SSI/Parts A & B, SSI Part B Only | $ 346.18 |
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AHCA Contract No. FAR001, Exhibit 6-C, Page 1 of 1
EXHIBIT 9-B
KICK PAYMENT AMOUNTS FOR COVERED OBSTETRICAL DELIVERY SERVICES
TABLE 8
Area: 10 | County: Broward |
CPT Code | Obstetrical Delivery CPT Code Description | Payment Amount |
59409 | Vaginal delivery only | $3,950.67 |
59410 | Vaginal delivery including postpartum care | |
59515 | Cesarean delivery including postpartum care | |
59612 | Vaginal delivery only, after previous cesarean delivery | |
59614 | Vaginal delivery only, after previous cesarean delivery including postpartum care | |
59622 | Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery including postpartum care |
Area: 04 | County: Duval, Baker, Clay, Nassau |
CPT Code | Obstetrical Delivery CPT Code Description | Payment Amount |
59409 | Vaginal delivery only | $3,936.56 |
59410 | Vaginal delivery including postpartum care | |
59515 | Cesarean delivery including postpartum care | |
59612 | Vaginal delivery only, after previous cesarean delivery | |
59614 | Vaginal delivery only, after previous cesarean delivery including postpartum care | |
59622 | Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery including postpartum care |
AHCA Contract No. FAR001, Exhibit 9-B, Page 1 of 1