Exhibit 10.1
WELL CARE HMO, INC., D/B/A STAYWELL Medicaid HMO Contract HEALTH PLAN OF FLORIDA
AHCA CONTRACT NO. FA522
THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the “Agency” and WELL CARE HMO, INC., D/B/A STAYWELL HEALTH PLAN OF FLORIDA, 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 ofAttachment I in an amount not to exceed $663,757,222.00 (an increase of $6,488,350.00), subject to the availability of funds.
2. Attachment I, section 90.0, Payment and Authorized Enrollment Levels, Table 2 is hereby amended to now read as follows:
Table 2 Age-banded Capitation Rates for all Agency Areas of the State.
July 1, 2005 through August 31, 2005 — Estimated HMO rates; not for use unless approved by CMS.
Area 07 General Rates Plan - 015016913 (BREVARD) BTHMO+2MO 3MO-11MO1-56-1314-20 (P)14 -20 (M)21-54 (F) 21-54 (M) 55-64 65+ TANF/FC/SOBRA 894.04 178.5687.80 56.33 122.97 63.04238.18154.51 322.34 322.34 SSI/No Medicare 8976.51 1573.97 404.51 212.74 232.25 232.25701.12701.12 661.11 661.11 SSI/Part B 308.90 308.90 308.90 308.90 308.90 308.90308.90308.90 308.90 308.90 SSI/Part A & B 284.51 284.51284.51 284.51 284.51 284.51284.51284.51 284.51 198.54 Area 09 General Rates Plan - 015016910(PALM BEACH) BTHMO+2MO 3MO-11MO1-56-1314-20(F)14-20(M)21-54(F) 21-54 (M) 55-64 65+ TANF/FC/SOBRA 850.65 169.5683.3253.28116.6359.62225.69 146.30 304.86 304.86 SSI/No Medicare 9123.67 1599.06410.92216.11235.92235.92711.70 711.70 670.95 670.95 SSI/Part B 288.69 288.69288.69288.69288.69288.69288.69 288.69 288.69 288.69 SSI/Part A & B 317.25 317.25317.25317.25317.25317.25317.25 317.25 317.25 221.58 Area 10 General Rates Plan - 015016900(BROWARD) BTHMO+2MO 3MO-11MO1-56-1314-20(F)14-20(M)21-54(F) 21-54 (M) 55-64 65+ TANF/FC/SOBRA 854.17 170.8684.1154.07117.8260.56228.83 148.48 309.80 309.80 SSI/No Medicare11134.67 1955.18502.14264.85289.15289.15873.08 873.08 823.33 823.33 SSI/Part B 316.19 316.19316.19316.19316.19316.19316.19 316.19 316.19 316.19 SSI/Part A & B 341.03 341.03341.03341.03341.03341.03341.03 341.03 341.03 238.56 Area 11 General Rates plus Transportation
Plan - 015016909(DADE) BTHMO+2MO 3MO-11MO 1-5 6-13 14-20(F) 14-20(M) 21-54(P) 21-54(M) 55-64 65+ TANF/FC/SOBRA 1112.08 221.47 108.96 69.38 152.49 77.84 294.30 190.48 396.50 396.50 SSI/No Medicare 12145.44 2131.38 551.08 286.49 314.89 314.89 952.30 952.30 894.10 894.10 SSI/Part B 455.34 455.34 455.34 455.34 455.34 455.34 455.34 455.34 455.34 455.34 SSI/Part A & B 433.96 433.96 433.96 433.96 433.96 433.96 433.96 433.96 433.96 299.72
September 1, 2005 through December 31, 2005 — Estimated HMO rates; not for use unless
Area 09 General Rates Plan - 015016910(PALM BEACH) BTHMO+2MO 3MO-11MO 1-5 6-13 14-20 (P) 14-20(M} 21-54 (P) 21-54 (M) 55-64 65+ TANF/FC/SOBRA 850.65 169.56 83.32 53.28 116.63 59.62 225.69 146.30 304.86 304.86 SSI/No Medicare 9123.67 1599.06 410.92 216.11 235.92 235.92 711.70 711.70 670.95 670.95 SSI/Part B 288.69 288.69 288.69 288.69 288.69 288.69 288.69 288.69 288.69 288.69 SSI/Part A & B 317.25 317.25 317.25 317.25 317.25 317.25 317.25 317.25 317.25 221.58 Area 10 General Rates Plan -
015016900(BROWARD) BTHMO+2MO 3MO-11MO 1-5 6-13 14-20 (F) 14-20 (M) 21-54 (F) 21-54 (M) 55-64 65+ TANF/FC/SOBRA 854.17 170.86 84.11 54.07 117.82 60.56 228.53 148.48 309.80 309.80 SSI/No Medicare 11134.67 1955.18 502.14 264.85 289.15 289.15 873.08 873.08 823.33 823.33 SSI/Part B 316.19 316.19 316.19 316.19 316.19 316.19 316.19 316.19 316.19 316.19 SSI/Part A & B 341.03 341.03 341.03 341.03 341.03 341.03 341.03 341.03 341.03 238.55
AHCA Contract No. FA522, Amendment No. 9, Page 1 of 4
AHCA Form 2100-0002 (Rev. NOV03)
WELL CARE HMO, INC., D/B/A STAYWELL Medicaid HMO Contract HEALTH PLAN OF FLORIDA
January 1, 2006 through June 30, 2006 — Estimated HMO rates; not for use unless approved by CMS.
Area 09 General Rates Plan - 015016910(PALM BEACH) BTHM0+2MO 3MO-11MO 1-5 6-13 14-20 (F) 14-20 (M) 21-54 (F) 21-54 (M) 55-64 65+ TANF/FC/SOBRA 850.65 169.56 83.32 53.28 116.63 59.62 225.69 146.30 304.86 304.86 SSI/No Medicare 9123.67 1599.06 410.92 216.11 235.92 235.92 711.70 711.70 670.95 670.95 SSI/Part B 179.44 179.44 179.44 179.44 179.44 179.44 179.44 179.44 179.44 179.44 SSI/Part A & B 76.11 76.11 76.11 76.11 76.11 76.11 76.11 76.11 76.11 66.48 Area 10 General Rates Plan -
015016900(BROWARD) BTHM+2MO 3MO-11MO 1-5 6-13 14-20 (F) 14-20 (M) 21-54 (F) 21-54{M ) 55-64 65+ TANF/FC/SOBRA 854.17 170.86 84.11 54.07 117.82 60.56 228.53 148.48 309.80 309.80 SSI/No Medicare 11134.67 1955.18 502.14 264.85 289.15 289.15 873.08 873.08 823.33 823.33 SSI/Part B 205.90 205.90 205.90 205.90 205.90 205.90 205.90 205.90 205.90 205.90 SSI/Part A & B 81.99 81.99 81.99 81.99 81.99 81.99 81.99 81.99 81.99 71.59
3. Attachment I, section 90.0, Payment and Authorized Enrollment Levels, Table 3 is hereby amended to now read as follows:
Table 3 Age-banded Capitation Rates, Including Community Mental Health and Mental Health Targeted Case Management
July 1, 2005 through August 31, 2005 — Estimated HMO rates; not for use unless approved by CMS.
Area 03 General Rates plus Mental Health Plan — 015016901(HERNADO)
BTHM0+2MO 3MO-11MO 1-5 6-13 14-20 (F) 14-20(M) 21-54(F) 21-54(M) 55-64 65+ TANF/FC/SOBRA 956.51 190.37 94.52 67.12 136.49 72.38 254.10 164.92342.33 342.33 SSI/No Medicare 8796.56 1536.63 401.17 243.67 248.87 248.87 702.91 702.91 649.30 649.30 SSI/Part B 356.54 356.54 356.54 356.54 356.54 356.54 356.54 356.54 356.54 356.54 SSI/Part A & B 299.65 299.65 299.65 299.65 29 9.65 299.65 299.65 299.65 299.65 211.35 Area 05 General Rates plus Mental Health Plan - 015016903(PASCO) 015016904(PINELLAS) BTHMO+2MO 3MO-11MO 1-5 6-13 14-20 (P) 14-20 (M) 21-54 (F) 21-54 (M) 55-64 65+ TANF/FC/SOBRA 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 1615.41 420.86 252.27 258.55 258.55 735.80 738.80 681.19 681.19 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 321.24 321.24 321.24 321.24 321.24 321.24 321.24 321.24 321.24 227.10 Area 06 General Rates plus Mental Health Plan - 015016902(HILLSBOROUGH) 015016905(POLK) 015016912(MANATEE) BTHMO+2MO 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 319.38 319.38 319.38 319.38 319.38 319.38 319.38 319.38 319.38 319.38 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 - 015016906 (ORANGE) 015016907(OSCEOLA) 015016908 (SEMINOLE) BTHM0+2MO 3MO-11MO 1-5 6-13 14-20 (F) 14-20 (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 312.78 312.78 312.78 312.78 312.78 312.78 312.78 312.78 312.78 312.78 SSI/Part A & 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 - 015016911(LEE) 015016914(SARASOTA) BTHMO+2MO 3MO-11MO 1-5 6-13 14-20 (F) 14-20 (M) 21-54 (F) 21-54 (M) 55-64 65+ TANF/FC/SOBRA 785.83 156.86 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 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
September 1, 2005 through December 31, 2005 — Estimated HMO rates; not for use unless approved by CMS.
Area 03 General Rates plus Mental Health Plan - 015016901(HERNANDO) BTHMO+2MO 3MO-11MO 1-5 6-13 14-20(F) 14-20(M) 21-54(F) 21-54(M) 55-64 65+
TANF/FC/SOBRA 956.51 190.37 94.52 67.12 136.49 72.38 254.10 164.92 342.33 342.33 SSI/No Medicare 8796.56 1536.63 401.17 243.67 248.87 248.87 702.91 702.91 649.30 649.30 SSI/Part B 356.54 356.54 356.54 356.54 356.54 356.54 356.54 356.54 356.54 356.54 SSI/Part A & B 299.65 299.65 299.65 299.65 29 9.65 299.65 299.65 299.65 299.65 211.35 AHCA Contract No. FA522, Amendment No. 9, Page 2 of 4 AHCA Form 2100-0002 (Rev. NOV03) WELL CARE HMO, INC., D/B/A STAYWELL
Medicaid HMO Contract HEALTH PLAN OF FLORIDA
Area 05 General Rates plus Mental Health Plan - 015016903(PASCO) 015016904(PINELLAS) BTHMO+2MO 3MO-11MO 1-5 6-13 14-20 (F) 14-20 (M) 21-54 (F) 21-54 (M) 55-64 65+ TANF/FC/SOBRA 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 1615.41 420.86 252.27 258.55 258.55 735.80 735.80 681.19 681.19 SSI/Part B 332.83 332.63 332.63 332.63 332.63 332.63 332.63 332.63 332.63 332.63 SSI/Part A & B 321.24 321.24 321.24 321.24 321.24 321.24 321.24 321.24 321.24 227.10 Area 06 General Rates plus Mental Health Plan - 015016902(HILLSBOROUGH) 015016905(POLK) 015016912(MANATEE) BTHMO+2MO 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 319.38 319.38 319.38 319.38 319.38 319.38 319.38 319.38 319.38 319.38 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 - 015016906(ORANGE) 015016907(OSCEOLA) 015016908(SEMINOLE) 015016913(BREVARD) BTHMO+2MO 3MO-11MO 1-5 6-13 14-20 (F) 14-20 (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 312.78 312.78 312.78 312.78 312.78 312.78 312.78 312.78 312.78 312.78 SSI/Part A & 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 - 015016911(LEE) 015016914(SARASOTA) BTHMO+2MO 3MO-11MO 1-5 6-13 14-20 (F) 14-20 (M) 21-54 (F) 21-54 (M) 55-64 65+ TANF/FC/SOBRA 785.53 156.86 78.13 56.61 113.39 60.74 210.44 136.92 284.23 284.23 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 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 11 General Rates plus Mental Health plus Transportation Plan — 015016909(DADE)
BTHMO+2MO 3MO-11MO 1-5 6-13 14-20 (F) 14-20 (M) 21-54 (F) 21-54 (M) 55-64 65+ TANF/FC/SOBRA 1112.09 221.48 110.76 82.14 162.18 87.53 296.62 192.80 398.87 398.87 SSI/No Medicare 12145.45 2131.39 560.13 336.09 345.82 345.82 983.20 983.20 907.03 907.03 SSI/Part B 462.31 462.31 462.31 462.31 462.31 462.31 462.31 462.31 462.31 462.31 SSI/Part A & B 439.76 439.76 439.76 439.76 439.76 439.76 439.76 439.76 439.76 305.52
January 1, 2006 through June 30, 2006 — Estimated HMO rates; not for use unless approved by CMS.
Area 03 General Rates plus Mental Health Plan - 015016901(HERNANDO) BTHMO+2MO 3MO-11MO 1-5 6-13 14-20 (F) 14-20 (M) 21-54 (F) 21-54 (M) 55-64 65+ TANF/FC/SOBRA 956.51 190.37 94.52 67.12 136.49 72.38 254.10 164.92 342.39 342.33 SSI/No Medicare 8796.56 1536.63 401.17 243.67 248.87 248.87 702.91 702.91 649.30 649.30 SSI/Part B 237.65 237.65 237.65 237.65 237.65 237.65 237.65 237.65 237.65 237.65 SSI/Part A & B 83.24 83.24 83.24 83.24 83.24 83.24 83.24 83.24 83.24 73.70 Area 05 General Rates plus Mental Health Plan - 015016903(PASCO) 015016904(PINELLAS) BTHMO+2MO 3MO-11MO 1-5 6-13 14-20 (F) 14-20 (M) 21-54 (F) 21-54 (M) 55-64 65+ TANF/FC/SOBRA 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 1615.41 420.86 252.27 258.55 258.55 735.80 735.80 681.19 681.19 SSI/Part B 214.59 214.59 214.59 214.59 214.59 214.59 214.59 214.59 214.59 214.59 SSI/Part A & 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 - 015016902(HILLSBOROUGH) 015016905(POLK) 015016912(MANATEE) BTHMO+2MO 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 67.94 131.99 75.16 230.12 151.25 309.66 109.66 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 201.26 201.26 201.26 201.26 201.26 201.26 201.26 201.26 201.26 201.26 SSI/Part A & 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 - 015016906(OR/LNGE) 015016907(OSCEOLA) 015016908(SEMINOLE) 015016913(BREVARD) BTHMO+2MO 3MO-11MO 1-5 6-13 14-20 (F) 14-20 (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 A & B 84.13 84.13 84.13 84.13 84.13 84.13 84.13 84.13 84.13 74.97 Area 08 General Rates plus Mental Health
Plan - 015016911(LEE) 015016914(SARASOTA) BTHMO+2MO 3MO-11MO 1-5 6-13 14-20 (F) 14-20 (M) 21-54 (F) 21-54 (M) 59-64 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 191.91 191.91 191.91 191.91 191.91 191.91 191.91 191,91 191.91 191.91 SSI/Part A & B 77.95 77.95 77.95 77.95 77.95 77.95 77.95 77.95 77.95 69.13
AHCA Contract No. FA522, Amendment No. 9, Page 3 of 4
AHCA Form 2100-0002 (Rev. NOV03)
WELL CARE HMO, INC., D/B/A STAYWELL Medicaid HMO contract HEALTH PLAN OF FLORIDA Area11 General Rates plus Mental Health plus Transportation Plan - 015016909(DADE) BTHMO+2MO 3MO-11MO 1-5 6-13 14-20 (F) 14-20 (M) 21-54 (F) 21-54 (M) 55-64 65+ TANF/FC/SOBRA 1112.09 221.48 110.76 82.14 162.18 87.53 296.62 192.80 398.87 398.87 SSI/No Medicare 12145.45 2131.39 560.13 336.09 345.82 345.82 983.20 983.20 907.03 907.03 SSI/Part B 280.88 280.88 280.88 280.88 280.88 280.88 280.88 280.88 280.88 280.88 SSI/Part A & B 131.46 131.46 131.46 131.46 131.46 131.46 131.46 131.46 131.46 109.55
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 $663,757,222.00 (an increase of $6,488,350.00) expressed on page seven of this contract.
5. This amendment shall begin on September 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 4 page amendment (including all attachments) to be executed by their officials thereunto duly authorized.
WELLCARE HMO, INC., D/B/A STAYWELL STATE OF FLORIDA, AGENCY FOR SIGNED SIGNED
BY:/s/ Todd S. Farha BY: [Illegible]
NAME: Todd S. Farha NAME: Alan Levine TITLE: President & CEO TITLE: Secretary
DATE:8/31/05 DATE: 9/1/05
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
AHCAContract No. FA522, Amendment No. 9, Page 4 of 4
AHCA Form 2100-0002 (Rev. NOV03)
We use cookies on this site to provide a more responsive and personalized service. Continuing to browse, clicking I Agree, or closing this banner indicates agreement. See our Cookie Policy for more information.
I Agree
