WellCare Health Plans 8-K Entry into a Material Definitive Agreement

Back to 8-k  Exhibit 10.4

AHCA CONTRACT NO. FA972

AMENDMENT NO. 1

THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the "Agency" and WELLCARE OF FLORIDA, INC., D/B/A HEALTHEASE, hereinafter referred to as the "Vendor," or “Health Plan,” is hereby amended as follows:

1. Standard Contract, Section III., Item A., Termination, sub-item 3., Termination for Breach, first paragraph, the third sentence is hereby amended to now read as follows:

If applicable, the Agency may employ the default provisions in Rule 60A-1.006(3), Florida Administrative Code.

2. Effective September 1, 2012, Attachment I, Scope of Services, Capitated Health Plans, Exhibit 2-NR, Medicaid Non-Reform Capitation Rates, Effective September 1, 2011, is hereby deleted in its entirety and replaced with Exhibit 2-NR, Medicaid Non-Reform HMO Capitation Rates, September 1, 2012 – August 31, 2013 (90112), attached hereto and made a part of this Contract.

3. Effective January 1, 2013, Attachment II, Core Contract Provisions, Section V, Covered Services, Item H., Coverage Provisions is hereby amended to include sub-item 23. as follows:

23. Primary Care Services

The Health Plan shall process claims for and, if capitated or are approved by the Agency to subcapitate for certain covered services, pay certain physicians who provide Florida Medicaid-covered eligible primary care services in accordance with the Affordable Care Act and 42 CFR sections 438 and 447, for the period January 1, 2013, through December 31, 2014. Health Plans that are approved by the Agency to subcapitate for services shall also pay in accordance with such requirements

Unless otherwise stated, this amendment shall be effective upon execution by both Parties.

All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in this Contract.

This amendment, and all its attachments, are hereby made part of this Contract.

This amendment cannot be executed unless all previous amendments to this Contract have been fully executed.

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FA972, Amendment No. 1, Page  1 of 2

IN WITNESS WHEREOF, the Parties hereto have caused this seven (7) page amendment (including all attachments) to be executed by their officials thereunto duly authorized.

WELLCARE OF FLORIDA, INC.,   D/B/A STAYWELL HEALTH PLAN OF     FLORIDA		STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION
SIGNED BY:	/s/ Christina Cooper	SIGNED BY:	/s/Elizabeth Dudek
NAME:	Christina Cooper	NAME:	Elizabeth Dudek
TITLE:	President, FL and HI Division	TITLE:	Secretary
DATE:	1/3/13	DATE:	1/10/13

List of Attachments/Exhibits included as part of this amendment:

Specify Type Number Description

Attachment I Exhibit 2-NR Medicaid Non-Reform HMO Capitation Rates, September 1, 2012 – August 31, 2013 (90112) (5 Pages)

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FA972, Amendment No. 1, Page  2 of 2

EXHIBIT 2 - NR

ESTIMATED HEALTH PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS

(MEDICAID Non-Reform HMO CAPITATION RATES)

September 1, 2012 - August 31, 2013 (90112)

By Area , Age and Eligibility Category

TABLE 1

General Rates:
									TANF														SSI-N								SSI-B		SSI-AB
									AGE (14-20)			AGE (21-54)
Area	BTHMO+2MO		3MO-11MO		AGE (1-5)		AGE (6-13)		Female                  Male			Female                  Male			AGE (55+)		BTHMO+2MO		3MO-11MO		AGE (1-5)		AGE (6-13)		AGE (14-20)		AGE (21-54)		AGE (55+)				AGE (65-)		AGE(65+)
01		1,044.10		176.87		97.38		60.25		120.03	62.88		275.12	123.66		286.22		23,175.16		2,589.79		260.75		143.76		178.78		725.48		788.53		353.96		99.74		79.65
02		962.26		163.01		90.13		57.49		112.56	59.89		255.25	115.67		264.90		21,691.74		2,423.90		237.61		117.79		152.73		651.93		728.05		353.96		93.24		74.33
03		1,132.49		191.85		106.18		68.14		132.95	70.97		300.83	136.55		312.05		23,983.47		2,680.18		273.22		157.59		192.69		765.02		821.29		353.96		92.76		73.94
04		1,224.06		207.35		113.91		69.29		139.40	72.40		321.40	143.83		334.79		26,645.33		2,977.63		302.25		171.70		211.14		844.47		910.43		353.96		88.79		70.69
05		1,314.12		222.62		123.01		78.07		153.29	81.36		348.21	157.58		361.52		26,552.12		2,967.14		297.54		161.57		202.09		826.11		901.56		353.96		78.87		62.58
06		1,233.32		208.96		116.42		78.18		148.71	81.20		331.03	152.13		342.09		25,907.64		2,895.25		297.29		175.80		213.01		835.41		890.51		353.96		78.53		62.31
07		1,189.59		201.49		110.21		64.80		132.98	67.86		310.16	137.59		323.92		27,626.61		3,087.18		308.28		164.73		207.33		854.09		936.03		353.96		77.12		61.15
09		1,228.70		208.14		114.67		71.23		141.58	74.33		324.06	145.83		337.02		28,336.53		3,166.45		312.52		159.40		204.33		860.57		954.38		353.96		87.68		69.78
10		1,087.72		184.27		101.80		64.51		126.76	67.23		288.12	130.34		299.17		29,961.41		3,348.10		334.98		180.35		226.33		929.01		1,016.15		353.96		91.91		73.25
11		1,365.87		231.40		128.48		84.35		162.48	87.72		364.68	166.55		377.59		26,428.69		2,953.34		295.73		159.73		200.21		820.51		896.71		353.96		104.17		83.26
6B		1,232.80		208.88		116.40		78.35		148.84	81.36		331.06	152.23		342.07		25,906.00		2,895.07		297.32		175.93		213.11		835.58		890.53		353.96		78.53		62.31
8A		1,220.23		206.73		114.76		75.21		145.02	78.23		325.67	148.67		337.25		27,586.10		3,082.83		316.74		187.71		227.26		890.38		948.50		353.96		88.70		70.62
8B		1,111.87		188.36		104.24		66.89		130.51	69.65		295.33	134.05		306.36		25,996.71		2,905.10		292.67		161.74		200.96		814.57		884.82		353.96		85.56		68.05

TABLE 2

General + Mental Health Rates:
									TANF																SSI-N						SSI-B		SSI-AB
									AGE (14-20)			AGE (21-54)
Area	BTHMO+2MO		3MO-11MO		AGE (1-5)		AGE (6-13)		Female                 Male			Female                  Male			AGE (55+)		BTHMO+2MO		3MO-11MO		AGE (1-5)		AGE (6-13)		AGE (14-20)		AGE (21-54)		AGE (55+)				AGE (65-)		AGE(65+)
01		1,044.18		176.95		99.62		71.64		131.27	74.12		284.95	133.49		292.73		23,175.56		2,590.19		279.12		191.60		220.46		802.81		817.07		371.28		109.99		89.90
02		962.32		163.07		91.81		66.02		120.98	68.31		262.61	123.03		269.78		21,692.25		2,424.41		261.25		179.34		206.35		751.43		764.78		371.28		103.49		84.58
03		1,132.56		191.92		108.06		77.70		142.38	80.40		309.07	144.79		317.51		23,983.81		2,680.52		288.85		198.29		228.15		830.81		845.57		371.28		103.01		84.19
04		1,224.16		207.45		116.80		83.98		153.90	86.90		334.07	156.50		343.19		26,645.73		2,978.03		320.91		220.29		253.47		923.02		939.42		371.28		99.04		80.94
05		1,314.20		222.70		125.39		90.16		165.22	93.29		358.64	168.01		368.43		26,552.60		2,967.62		319.79		219.52		252.58		919.79		936.13		371.28		89.12		72.83
06		1,233.37		209.01		117.68		84.62		155.06	87.55		336.58	157.68		345.77		25,907.96		2,895.57		312.03		214.19		246.45		897.46		913.41		371.28		88.78		72.56
07		1,189.71		201.61		113.51		81.62		149.57	84.45		324.67	152.10		333.53		27,627.14		3,087.71		332.73		228.41		262.80		957.02		974.02		371.28		87.37		71.40
09		1,228.79		208.23		117.24		84.30		154.48	87.23		335.33	157.10		344.49		28,337.15		3,167.07		341.28		234.28		269.56		981.61		999.05		371.28		97.93		80.03
10		1,087.79		184.34		103.79		74.63		136.75	77.22		296.85	139.07		304.96		29,961.97		3,348.66		360.85		247.71		285.01		1,037.89		1,056.34		371.28		102.16		83.50
11		1,365.94		231.47		130.32		93.71		171.72	96.96		372.76	174.63		382.94		26,429.18		2,953.83		318.30		218.50		251.41		915.52		931.78		371.28		114.42		93.51
6B		1,232.84		208.92		117.63		84.58		154.99	87.51		336.44	157.61		345.63		25,906.32		2,895.39		312.01		214.18		246.43		897.41		913.35		371.28		88.78		72.56
8A		1,220.29		206.79		116.43		83.72		153.41	86.62		333.01	156.01		342.11		27,586.43		3,083.16		332.24		228.07		262.42		955.61		972.58		371.28		98.95		80.87
8B		1,111.94		188.43		106.09		76.29		139.79	78.93		303.44	142.16		311.73		25,997.15		2,905.54		313.10		214.93		247.30		900.55		916.55		371.28		95.81		78.30

AHCA Contract No. FA972, Attachment I, Exhibit 2-NR, Page 1 of 5

EXHIBIT 2 - NR

ESTIMATED HEALTH PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS

(MEDICAID Non-Reform HMO CAPITATION RATES)

September 1, 2012 - August 31, 2013 (90112)

By Area , Age and Eligibility Category

TABLE 3

General + MH + Dental Rates:
	TANF																				SSI-N												SSI-B		SSI-AB
Area	BTHMO+2MO		3MO-11MO		AGE (1-5)		AGE (6-13)		AGE (14-20)		AGE (21-54)						AGE (55+)		BTHMO+2MO		3MO-11MO		AGE (1-5)		AGE (6-13)		AGE (14-20)		AGE (21-54)		AGE (55+)				AGE (65-)		AGE (65+)
									Female		Male		Female		Male
01		1,044.18		176.96		101.49		74.61		134.03		77.30		286.70		135.13		295.93		23,175.56		2,590.20		281.06		194.04		222.64		804.38		819.27		373.69		110.98		90.72
02		962.33		163.09		95.76		72.29		126.81		75.04		266.15		126.34		276.24		21,692.26		2,424.43		265.21		184.33		210.80		753.49		767.67		373.69		104.93		85.77
03		1,132.58		191.95		114.35		87.70		151.68		91.12		312.29		147.80		323.38		23,983.82		2,680.55		295.56		206.73		235.69		833.00		848.62		373.69		104.94		85.78
04		1,224.17		207.47		120.41		89.72		159.24		93.05		337.91		160.09		350.20		26,645.74		2,978.05		324.64		224.98		257.66		925.96		943.53		373.69		101.15		82.68
05		1,314.22		222.73		132.37		101.25		175.54		105.18		362.92		172.02		376.25		26,552.61		2,967.65		326.50		227.96		260.12		922.47		939.88		373.69		91.44		74.74
06		1,233.38		209.04		123.44		93.77		163.57		97.37		338.87		159.82		349.94		25,907.97		2,895.59		317.31		220.83		252.38		899.06		915.65		373.69		90.36		73.86
07		1,189.73		201.64		120.12		92.13		159.35		95.73		327.55		154.80		338.79		27,627.15		3,087.74		339.32		236.70		270.20		959.00		976.79		373.69		89.18		72.89
09		1,228.81		208.27		125.84		97.98		167.20		101.90		338.50		160.06		350.27		28,337.16		3,167.10		349.01		244.00		278.24		983.98		1,002.36		373.69		99.99		81.73
10		1,087.80		184.36		108.23		81.68		143.31		84.78		298.21		140.34		307.44		29,961.98		3,348.68		366.05		254.26		290.86		1,039.64		1,058.79		373.69		103.56		84.65
11		1,366.02		231.55		139.28		108.79		184.83		110.07		374.98		176.70		386.98		26,429.18		2,953.83		329.16		230.76		260.96		918.53		935.98		373.69		117.45		96.01
6B		1,232.85		208.95		123.39		93.73		163.50		97.33		338.73		159.75		349.80		25,906.33		2,895.41		317.29		220.82		252.36		899.01		915.59		373.69		90.36		73.86
8A		1,220.32		206.84		127.98		102.09		170.49		106.32		336.78		159.53		348.99		27,586.45		3,083.20		342.39		240.83		273.82		958.31		976.35		373.69		101.47		82.95
8B		1,111.97		188.48		116.21		92.38		154.76		96.19		306.24		144.78		316.84		25,997.16		2,905.57		321.27		225.21		256.48		902.57		919.37		373.69		97.46		79.66

TABLE 4

General + MH + Transportation Rates:
									TANF																SSI-N								SSI-B		SSI-AB
									AGE (14-20)				AGE (21-54)
Area	BTHMO+2MO		3MO-11MO		AGE (1-5)		AGE (6-13)		Female		Male		Female		Male		AGE (55+)		BTHMO+2MO		3MO-11MO		AGE (1-5)		AGE (6-13)		AGE (14-20)		AGE (21-54)		AGE (55+)				AGE (65-)		AGE (65+)
01		1,050.20		178.92		100.80		72.42		132.86		76.58		287.64		137.29		296.27		23,220.19		2,624.21		287.27		197.37		229.60		827.01		838.17		374.89		114.19		93.11
02		967.80		164.86		92.88		66.73		122.43		70.55		265.06		126.49		273.00		21,732.42		2,455.03		268.58		184.53		214.57		773.21		783.77		374.89		107.00		87.26
03		1,138.56		193.89		109.23		78.48		143.97		82.85		311.76		148.58		321.04		24,023.02		2,710.41		296.01		203.36		236.18		852.07		864.10		374.89		107.41		87.55
04		1,229.96		209.35		117.94		84.73		155.43		89.27		336.66		160.16		346.61		26,691.49		3,012.91		329.26		226.20		262.84		947.83		961.05		374.89		104.55		85.15
05		1,318.77		224.20		126.29		90.75		166.43		95.16		360.69		170.90		371.12		26,589.93		2,996.07		326.60		224.34		260.22		940.03		953.77		374.89		93.73		76.35
06		1,238.15		210.58		118.62		85.24		156.32		89.50		338.72		160.70		348.59		25,947.17		2,925.46		319.19		219.26		254.48		918.72		931.95		374.89		92.87		75.68
07		1,194.72		203.25		114.49		82.27		150.89		86.49		326.91		155.26		336.48		27,668.14		3,118.96		340.22		233.71		271.19		979.25		993.40		374.89		90.67		73.92
09		1,234.50		210.10		118.36		85.04		155.99		89.56		337.89		160.71		347.85		28,377.81		3,198.06		348.70		239.54		277.88		1,003.65		1,018.27		374.89		102.51		83.53
10		1,093.71		186.28		104.95		75.40		138.31		79.64		299.50		142.81		308.45		30,012.86		3,387.45		370.14		254.29		295.43		1,065.48		1,080.39		374.89		106.75		87.00
11		1,370.41		232.93		131.19		94.29		172.90		98.78		374.76		177.45		385.57		26,466.18		2,982.03		325.06		223.28		258.98		935.58		949.27		374.89		117.89		96.16
6B		1,237.62		210.49		118.57		85.20		156.25		89.46		338.58		160.63		348.45		25,945.53		2,925.28		319.17		219.25		254.46		918.67		931.89		374.89		92.87		75.68
8A		1,226.17		208.72		117.58		84.48		154.96		89.02		335.64		159.72		345.57		27,626.55		3,113.74		339.56		233.26		270.63		977.36		991.54		374.89		101.08		82.50
8B		1,117.96		190.40		107.27		77.07		141.38		81.39		306.13		145.96		315.27		26,035.24		2,934.58		320.06		219.85		255.10		921.20		934.56		374.89		99.43		81.07

  AHCA Contract No. FA972, Attachment I, Exhibit 2-NR, Page 2 of 5   

EXHIBIT 2 - NR

ESTIMATED HEALTH PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS

(MEDICAID Non-Reform HMO CAPITATION RATES)

September 1, 2012 - August 31, 2013 (90112)

By Area , Age and Eligibility Category

TABLE 5

General + Transportation Rates:
	TANF																				SSI-N											SSI-B		SSI-AB
Area	BTHMO+2MO		3MO-11MO		AGE (1-5)		AGE (6-13)		AGE (14-20)				AGE (21-54)				AGE (55+)		BTHMO+2MO		3MO-11MO		AGE (1-5)		AGE (6-13)		AGE (14-20) AGE (21-54)			AGE (55+)				AGE (65-)		AGE(65+)
									Female		Male		Female		Male
01		1,050.12		178.84		98.56		61.03		121.62		65.34		277.81		127.46		289.76		23,219.79		2,623.81		268.90		149.53		187.92	749.68		809.63		357.57		103.94		82.86
02		967.74		164.80		91.20		58.20		114.01		62.13		257.70		119.13		268.12		21,731.91		2,454.52		244.94		122.98		160.95	673.71		747.04		357.57		96.75		77.01
03		1,138.49		193.82		107.35		68.92		134.54		73.42		303.52		140.34		315.58		24,022.68		2,710.07		280.38		162.66		200.72	786.28		839.82		357.57		97.16		77.30
04		1,229.86		209.25		115.05		70.04		140.93		74.77		323.99		147.49		338.21		26,691.09		3,012.51		310.60		177.61		220.51	869.28		932.06		357.57		94.30		74.90
05		1,318.69		224.12		123.91		78.66		154.50		83.23		350.26		160.47		364.21		26,589.45		2,995.59		304.35		166.39		209.73	846.35		919.20		357.57		83.48		66.10
06		1,238.10		210.53		117.36		78.80		149.97		83.15		333.17		155.15		344.91		25,946.85		2,925.14		304.45		180.87		221.04	856.67		909.05		357.57		82.62		65.43
07		1,194.60		203.13		111.19		65.45		134.30		69.90		312.40		140.75		326.87		27,667.61		3,118.43		315.77		170.03		215.72	876.32		955.41		357.57		80.42		63.67
09		1,234.41		210.01		115.79		71.97		143.09		76.66		326.62		149.44		340.38		28,377.19		3,197.44		319.94		164.66		212.65	882.61		973.60		357.57		92.26		73.28
10		1,093.64		186.21		102.96		65.28		128.32		69.65		290.77		134.08		302.66		30,012.30		3,386.89		344.27		186.93		236.75	956.60		1,040.20		357.57		96.50		76.75
11		1,370.34		232.86		129.35		84.93		163.66		89.54		366.68		169.37		380.22		26,465.69		2,981.54		302.49		164.51		207.78	840.57		914.20		357.57		107.64		85.91
6B		1,237.58		210.45		117.34		78.97		150.10		83.31		333.20		155.25		344.89		25,945.21		2,924.96		304.48		181.00		221.14	856.84		909.07		357.57		82.62		65.43
8A		1,226.11		208.66		115.91		75.97		146.57		80.63		328.30		152.38		340.71		27,626.22		3,113.41		324.06		192.90		235.47	912.13		967.46		357.57		90.83		72.25
8B		1,117.89		190.33		105.42		67.67		132.10		72.11		298.02		137.85		309.90		26,034.80		2,934.14		299.63		166.66		208.76	835.22		902.83		357.57		89.18		70.82

TABLE 6

General + Dental Rates:
	TANF																				SSI-N											SSI-B		SSI-AB
Area	BTHMO+2MO		3MO-11MO		AGE (1-5)		AGE (6-13)		AGE (14-20)				AGE (21-54)				AGE (55+)		BTHMO+2MO		3MO-11MO		AGE (1-5)		AGE (6-13)		AGE (14-20) AGE (21-54)			AGE (55+)				AGE (65-)		AGE (65+)
									Female		Male		Female		Male
01		1,044.10		176.88		99.25		63.22		122.79		66.06		276.87		125.30		289.42		23,175.16		2,589.80		262.69		146.20		180.96	727.05		790.73		356.37		100.73		80.47
02		962.27		163.03		94.08		63.76		118.39		66.62		258.79		118.98		271.36		21,691.75		2,423.92		241.57		122.78		157.18	653.99		730.94		356.37		94.68		75.52
03		1,132.51		191.88		112.47		78.14		142.25		81.69		304.05		139.56		317.92		23,983.48		2,680.21		279.93		166.03		200.23	767.21		824.34		356.37		94.69		75.53
04		1,224.07		207.37		117.52		75.03		144.74		78.55		325.24		147.42		341.80		26,645.34		2,977.65		305.98		176.39		215.33	847.41		914.54		356.37		90.90		72.43
05		1,314.14		222.65		129.99		89.16		163.61		93.25		352.49		161.59		369.34		26,552.13		2,967.17		304.25		170.01		209.63	828.79		905.31		356.37		81.19		64.49
06		1,233.33		208.99		122.18		87.33		157.22		91.02		333.32		154.27		346.26		25,907.65		2,895.27		302.57		182.44		218.94	837.01		892.75		356.37		80.11		63.61
07		1,189.61		201.52		116.82		75.31		142.76		79.14		313.04		140.29		329.18		27,626.62		3,087.21		314.87		173.02		214.73	856.07		938.80		356.37		78.93		62.64
09		1,228.72		208.18		123.27		84.91		154.30		89.00		327.23		148.79		342.80		28,336.54		3,166.48		320.25		169.12		213.01	862.94		957.69		356.37		89.74		71.48
10		1,087.73		184.29		106.24		71.56		133.32		74.79		289.48		131.61		301.65		29,961.42		3,348.12		340.18		186.90		232.18	930.76		1,018.60		356.37		93.31		74.40
11		1,365.95		231.48		137.44		99.43		175.59		100.83		366.90		168.62		381.63		26,428.69		2,953.34		306.59		171.99		209.76	823.52		900.91		356.37		107.20		85.76
6B		1,232.81		208.91		122.16		87.50		157.35		91.18		333.35		154.37		346.24		25,906.01		2,895.09		302.60		182.57		219.04	837.18		892.77		356.37		80.11		63.61
8A		1,220.26		206.78		126.31		93.58		162.10		97.93		329.44		152.19		344.13		27,586.12		3,082.87		326.89		200.47		238.66	893.08		952.27		356.37		91.22		72.70
8B		1,111.90		188.41		114.36		82.98		145.48		86.91		298.13		136.67		311.47		25,996.72		2,905.13		300.84		172.02		210.14	816.59		887.64		356.37		87.21		69.41

AHCA Contract No. FA972, Attachment I, Exhibit 2-NR, Page 3 of 5   

EXHIBIT 2 - NR

ESTIMATED HEALTH PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS

(MEDICAID Non-Reform HMO CAPITATION RATES)

September 1, 2012 - August 31, 2013 (90112)

By Area , Age and Eligibility Category

TABLE 7

General + Dental + Transportation Rates:
	TANF																				SSI-N												SSI-B		SSI-AB
Area	BTHMO+2MO		3MO-11MO		AGE (1-5)		AGE (6-13)		AGE (14-20)				AGE (21-54)				AGE (55+)		BTHMO+2MO		3MO-11MO		AGE (1-5)		AGE (6-13)		AGE (14-20)		AGE (21-54)		AGE (55+)				AGE (65-)		AGE (65+)
									Female		Male		Female		Male
01		1,050.12		178.85		100.43		64.00		124.38		68.52		279.56		129.10		292.96		23,219.79		2,623.82		270.84		151.97		190.10		751.25		811.83		359.98		104.93		83.68
02		967.75		164.82		95.15		64.47		119.84		68.86		261.24		122.44		274.58		21,731.92		2,454.54		248.90		127.97		165.40		675.77		749.93		359.98		98.19		78.20
03		1,138.51		193.85		113.64		78.92		143.84		84.14		306.74		143.35		321.45		24,022.69		2,710.10		287.09		171.10		208.26		788.47		842.87		359.98		99.09		78.89
04		1,229.87		209.27		118.66		75.78		146.27		80.92		327.83		151.08		345.22		26,691.10		3,012.53		314.33		182.30		224.70		872.22		936.17		359.98		96.41		76.64
05		1,318.71		224.15		130.89		89.75		164.82		95.12		354.54		164.48		372.03		26,589.46		2,995.62		311.06		174.83		217.27		849.03		922.95		359.98		85.80		68.01
06		1,238.11		210.56		123.12		87.95		158.48		92.97		335.46		157.29		349.08		25,946.86		2,925.16		309.73		187.51		226.97		858.27		911.29		359.98		84.20		66.73
07		1,194.62		203.16		117.80		75.96		144.08		81.18		315.28		143.45		332.13		27,667.62		3,118.46		322.36		178.32		223.12		878.30		958.18		359.98		82.23		65.16
09		1,234.43		210.05		124.39		85.65		155.81		91.33		329.79		152.40		346.16		28,377.20		3,197.47		327.67		174.38		221.33		884.98		976.91		359.98		94.32		74.98
10		1,093.65		186.23		107.40		72.33		134.88		77.21		292.13		135.35		305.14		30,012.31		3,386.91		349.47		193.48		242.60		958.35		1,042.65		359.98		97.90		77.90
11		1,370.42		232.94		138.31		100.01		176.77		102.65		368.90		171.44		384.26		26,465.69		2,981.54		313.35		176.77		217.33		843.58		918.40		359.98		110.67		88.41
6B		1,237.59		210.48		123.10		88.12		158.61		93.13		335.49		157.39		349.06		25,945.22		2,924.98		309.76		187.64		227.07		858.44		911.31		359.98		84.20		66.73
8A		1,226.14		208.71		127.46		94.34		163.65		100.33		332.07		155.90		347.59		27,626.24		3,113.45		334.21		205.66		246.87		914.83		971.23		359.98		93.35		74.33
8B		1,117.92		190.38		115.54		83.76		147.07		89.37		300.82		140.47		315.01		26,034.81		2,934.17		307.80		176.94		217.94		837.24		905.65		359.98		90.83		72.18

TABLE 8

General + Mental Health + Dental + Transportation Rates:
	TANF																				SSI-N											SSI-B		SSI-AB
Area	BTHMO+2MO		3MO-11MO		AGE (1-5)		AGE (6-13)		AGE (14-20)				AGE (21-54)				AGE (55+)		BTHMO+2MO		3MO-11MO		AGE (1-5)		AGE (6-13)		AGE (14-20) AGE (21-54)			AGE (55+)				AGE (65-)		AGE (65+)
									Female		Male		Female		Male
01		1,050.20		178.93		102.67		75.39		135.62		79.76		289.39		138.93		299.47		23,220.19		2,624.22		289.21		199.81		231.78	828.58		840.37		377.30		115.18		93.93
02		967.81		164.88		96.83		73.00		128.26		77.28		268.60		129.80		279.46		21,732.43		2,455.05		272.54		189.52		219.02	775.27		786.66		377.30		108.44		88.45
03		1,138.58		193.92		115.52		88.48		153.27		93.57		314.98		151.59		326.91		24,023.03		2,710.44		302.72		211.80		243.72	854.26		867.15		377.30		109.34		89.14
04		1,229.97		209.37		121.55		90.47		160.77		95.42		340.50		163.75		353.62		26,691.50		3,012.93		332.99		230.89		267.03	950.77		965.16		377.30		106.66		86.89
05		1,318.79		224.23		133.27		101.84		176.75		107.05		364.97		174.91		378.94		26,589.94		2,996.10		333.31		232.78		267.76	942.71		957.52		377.30		96.05		78.26
06		1,238.16		210.61		124.38		94.39		164.83		99.32		341.01		162.84		352.76		25,947.18		2,925.48		324.47		225.90		260.41	920.32		934.19		377.30		94.45		76.98
07		1,194.74		203.28		121.10		92.78		160.67		97.77		329.79		157.96		341.74		27,668.15		3,118.99		346.81		242.00		278.59	981.23		996.17		377.30		92.48		75.41
09		1,234.52		210.14		126.96		98.72		168.71		104.23		341.06		163.67		353.63		28,377.82		3,198.09		356.43		249.26		286.56	1,006.02		1,021.58		377.30		104.57		85.23
10		1,093.72		186.30		109.39		82.45		144.87		87.20		300.86		144.08		310.93		30,012.87		3,387.47		375.34		260.84		301.28	1,067.23		1,082.84		377.30		108.15		88.15
11		1,370.49		233.01		140.15		109.37		186.01		111.89		376.98		179.52		389.61		26,466.18		2,982.03		335.92		235.54		268.53	938.59		953.47		377.30		120.92		98.66
6B		1,237.63		210.52		124.33		94.35		164.76		99.28		340.87		162.77		352.62		25,945.54		2,925.30		324.45		225.89		260.39	920.27		934.13		377.30		94.45		76.98
8A		1,226.20		208.77		129.13		102.85		172.04		108.72		339.41		163.24		352.45		27,626.57		3,113.78		349.71		246.02		282.03	980.06		995.31		377.30		103.60		84.58
8B		1,117.99		190.45		117.39		93.16		156.35		98.65		308.93		148.58		320.38		26,035.25		2,934.61		328.23		230.13		264.28	923.22		937.38		377.30		101.08		82.43

AHCA Contract No. FA972, Attachment I, Exhibit 2-NR, Page 4 of 5   

EXHIBIT 2 - NR

ESTIMATED HEALTH PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS

(MEDICAID Non-Reform HMO CAPITATION RATES)

September 1, 2012 - August 31, 2013 (90112)

By Area , Age and Eligibility Category

TABLE 9                                                                                                                                                         

Mental Health Rates:
	TANF																				SSI-N											SSI-B		SSI-AB
Area	BTHMO+2MO		3MO-11MO		AGE (1-5)		AGE (6-13)		AGE (14-20)				AGE (21-54)				AGE (55+)		BTHMO+2MO		3MO-11MO		AGE (1-5)		AGE (6-13)             AGE (14-20)			AGE (21-54)		AGE (55+)				AGE (65-)		AGE (65+)
									Female		Male		Female		Male
01		0.08		0.08		2.24		11.39		11.24		11.24		9.83		9.83		6.51		0.40		0.40		18.37		47.84	41.68		77.33		28.54		17.32		10.25		10.25
02		0.06		0.06		1.68		8.53		8.42		8.42		7.36		7.36		4.88		0.51		0.51		23.64		61.55	53.62		99.50		36.73		17.32		10.25		10.25
03		0.07		0.07		1.88		9.56		9.43		9.43		8.24		8.24		5.46		0.34		0.34		15.63		40.70	35.46		65.79		24.28		17.32		10.25		10.25
04		0.10		0.10		2.89		14.69		14.50		14.50		12.67		12.67		8.40		0.40		0.40		18.66		48.59	42.33		78.55		28.99		17.32		10.25		10.25
05		0.08		0.08		2.38		12.09		11.93		11.93		10.43		10.43		6.91		0.48		0.48		22.25		57.95	50.49		93.68		34.57		17.32		10.25		10.25
06		0.05		0.05		1.26		6.44		6.35		6.35		5.55		5.55		3.68		0.32		0.32		14.74		38.39	33.44		62.05		22.90		17.32		10.25		10.25
07		0.12		0.12		3.30		16.82		16.59		16.59		14.51		14.51		9.61		0.53		0.53		24.45		63.68	55.47		102.93		37.99		17.32		10.25		10.25
09		0.09		0.09		2.57		13.07		12.90		12.90		11.27		11.27		7.47		0.62		0.62		28.76		74.88	65.23		121.04		44.67		17.32		10.25		10.25
10		0.07		0.07		1.99		10.12		9.99		9.99		8.73		8.73		5.79		0.56		0.56		25.87		67.36	58.68		108.88		40.19		17.32		10.25		10.25
11		0.07		0.07		1.84		9.36		9.24		9.24		8.08		8.08		5.35		0.49		0.49		22.57		58.77	51.20		95.01		35.07		17.32		10.25		10.25
6B		0.04		0.04		1.23		6.23		6.15		6.15		5.38		5.38		3.56		0.32		0.32		14.69		38.25	33.32		61.83		22.82		17.32		10.25		10.25
8A		0.06		0.06		1.67		8.51		8.39		8.39		7.34		7.34		4.86		0.33		0.33		15.50		40.36	35.16		65.23		24.08		17.32		10.25		10.25
8B		0.07		0.07		1.85		9.40		9.28		9.28		8.11		8.11		5.37		0.44		0.44		20.43		53.19	46.34		85.98		31.73		17.32		10.25		10.25

Area	Corresponding Counties
Area 1	Escambia, Okaloosa, Santa Rosa, Walton
Area 2	Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Washington, Wakulla
Area 3	Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamiliton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, Union
Area 4	Baker, Clay, Duval, Flagler, Nassau, St. Johns, Volusia
Area 5	Pasco, Pinellas
Area 6	Hardee, Highlands, Manatee, Polk
Area 6B	Hillsborough
Area 7	Brevard, Orange, Osceola, Seminole
Area 8A	Lee
Area 8B	Charlotte, Collier, De Soto, Glades, Hendry, Sarasota
Area 9	Indian River, Okeechobee, St. Lucie, Martin, Palm Beach
Area 10	Broward
Area 11	Dade, Monroe

AHCA Contract No. FA972, Attachment I, Exhibit 2-NR, Page 5 of 5