Exhibit 10.9
WELL CARE HMO, INC., D/B/A STAY WELL HEALTH PLAN MEDICAID HMO CONTRACT
AHCA CONTRACT NO. FA312
AMENDMENT NO. 008
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 STAY WELL HEALTH PLAN, hereinafter referred to as the
"Vendor", is hereby amended as follows:
1. Attachment I. Section 90.0, Payment and Authorized Enrollment Levels, Table
1 is amended as shown below.
<Table>
<Caption>
TABLE 1 PROJECTED ENROLLMENT
COUNTY MAXIMUM ENROLLMENT LEVEL
BREVARD 14,000
BROWARD 25,000
CHARLOTTE 0
CITRUS 0
DADE 25,000
DUVAL 0
ESCAMBIA 0
HERNANDO 8,500
HIGHLANDS 0
HILLSBOROUGH 28,000
LEE 10,000
MANATEE 12,000
MARION 0
ORANGE 38,000
OSCEOLA 12,000
PALM BEACH 15,000
PASCO 7,000
PINELLAS 15,000
POLK 25,000
SANTA ROSA 0
SARASOTA 4,500
SEMINOLE 5,000
VOLUSIA 0
</Table>
2. This amendment shall begin on March 22, 2004, 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.
AHCA CONTRACT NO. FA312, AMENDMENT NO. 008, PAGE 1 OF 2
WELL CARE HMO, INC., D/B/A STAY WELL HEALTH PLAN MEDICAID HMO CONTRACT
IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment
to be executed by their officials thereunto duly authorized.
STAY WELL HEALTH PLAN STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED SIGNED
BY: /s/ Todd S. Farha BY: /s/ Mary Pat Moore
---------------------- --------------------------
NAME: Todd S. Farha NAME: Mary Pat Moore
-------------------- ------------------------
TITLE: PRESIDENT & CHIEF TITLE: INTERIM SECRETARY
EXECUTIVE OFFICER -----------------------
-------------------
DATE: 4/16/04 DATE: 4/26/04
-------------------- ------------------------
THE REMAINDER OF THIS PAGE LEFT BLANK INTENTIONALLY
WELL CARE HMO, INC., D/B/A STAY WELL HEALTH PLAN MEDICAID HMO CONTRACT
AHCA CONTRACT NO. FA312
AMENDMENT NO. 009
THIS AMENDMENT, 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 "Provider," is hereby amended as follows:
1. Attachment I, Section 10.11.5, Functional Assessments (Behavioral
Health), is amended to reduce FARS and CFARS outcome reporting from
quarterly to annually, as follows.
The plan shall ensure its providers administer functional assessments
using the Functional Assessment Rating Scales (FARS) (for persons over
age 18) and Child Functional Rating Scale (CFARS) (for persons age 18
and under). The plan shall ensure the provider administers and
maintains the FARS and CFARS for recipients of behavioral health care
services and upon termination of providing such services.
Additionally, the plan must evaluate these data and report outcome
measures to the agency on a annual basis by August 15.
2. The plan shall comply with the settlement agreement for Hernandez, et
al. v. Medows, case number 02-20964 (see Attachment II). The plan
shall ensure that its enrollees are receiving the functional
equivalent of those received by Medicaid fee-for-service recipients in
accordance with the Hernandez settlement.
3. Attachment I, Section 90.0, Payment and Authorized Enrollment Levels,
is amended effective July 1, 2003 as provided in Tables 2 and 3 shown
below. Any capitation claims calculated based on rates different than
those indicated below are subject to recoupment in accordance with
Section I.J, of the Standard Contract.
Table 2.
Area wide Age-banded Capitation Rates for all agency areas
of the state other than Area 6 and Area 1.
<Table>
<Caption>
Area 03
<1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+
TANF/FC/SOBRA 304.04 74.58 47.23 82.20 115.21 132.40 204.22 310.61 110.61
SSI/No Medicare 1722.67 318.21 170.47 178.77 178.77 539.93 539.93 554.25 554.25
SSI/Part B 288.07 288.07 288.07 288.07 288.07 288.07 288.07 288.07 288.07
SSI/Part A & B 261.55 261.55 261.55 261.55 261.55 261.55 261.55 261.55 184.50
Area 04
<1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+
TANF/FC/SOBRA 271.14 66.78 42.37 47.98 103.10 118.94 183.25 279.31 279.31
SSI/No Medicare 1595.82 294.29 157.35 165.25 165.25 498.99 498.99 512.40 512.40
SSI/Part B 249.15 249.18 249.15 249.15 249.15 249.15 249.15 249.15 249.15
SSI/Part A & B 265.42 265.42 265.42 265.42 265.42 265.42 265.42 265.42 187.52
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 285.33 69.91 44.12 49.85 107.87 123.86 191.30 290.61 290.61
SSI/No Medicare 1640.03 302.32 161.06 169.11 169.11 511.37 511.37 524.95 524.95
SSI/Part B 217.17 217.17 217.17 217.17 217.17 217.17 217.17 217.17 217.17
SSI/Part A & B 276.42 276.42 276.42 276.42 276.42 276.42 276.42 276.42 195.30
Area 07
<1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+
TANF/FC/SOBRA 278.86 68.56 43.44 49.09 105.94 121.93 188.01 286.09 286.09
SSI/No Medicare 1590.95 298.73 157.71 165.37 165.37 499.72 499.72 512.25 512.25
SSI/Part B 265.79 265.79 265.75 265.79 265.79 265.79 265.79 265.79 265.79
SSI/Part A & B 259.85 259.85 259.85 259.85 259.85 258.85 259.85 259.85 183.50
Area 08
<1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+
TANF/FC/SOBRA 257.19 63.11 40.00 45.22 97.50 312.18 173.06 263.38 263.38
SSI/No Medicare 1611.33 297.66 159.61 167.51 167.51 505.95 505.95 519.07 519.07
SSI/Part B 250.97 250.97 250.97 250.97 250.97 250.97 250.87 250.97 250.97
SSI/Part A & B 253.44 253.44 253.44 253.44 253.44 253.44 253.44 258.44 179.15
</Table>
AHCA CONTRACT NO. FA312, AMENDMENT NO. 009, PAGE 1 OF 3
WELL CARE HMO, INC., D/B/A STAY WELL HEALTH PLAN MEDICAID HMO CONTRACT
<Table>
<Caption>
Area 09
<1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+
TANF/FC/SOBRA 278.08 68.26 43.21 48.86 105.44 121.17 186.89 284.35 284.35
SSI/No Medicare 1801.74 333.04 179.03 187.98 187.98 567.15 567.15 581.73 581.73
SSI/Part B 251.63 251.63 251.63 251.63 251.63 251.63 251.63 251.63 251.63
SSI/Part A & B 290.09 290.09 290.09 290.09 290.09 290.09 290.09 290.09 204.83
</Table>
<Table>
<Caption>
Area 10
<1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+
TANF/FC/SOBRA 292.87 71.89 45.66 51.65 111.29 128.28 197.65 301.04 301.04
SSI/No Medicare 3177.44 402.11 215.86 226.70 226.70 684.10 684.10 701.42 701.42
SSI/Part B 267.12 267.12 267.12 267.12 267.12 267.12 267.12 267.12 267.12
SSI/Part A & B 319.69 319.69 319.69 319.69 319.69 319.69 319.69 319.69 228.90
</Table>
<Table>
<Caption>
Area 11
<1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+
TANF/FC/SOBRA 346.97 84.89 53.58 60.41 130.98 150.12 231.97 352.05 352.05
SSI/No Medicare 2143.27 432.47 231.39 242.81 242.81 734.42 734.42 753.18 753.18
SSI/Part B 420.82 420.82 420.82 420.82 420.82 420.82 420.82 420.82 420.82
SSI/Part A & B 357.12 357.12 357.12 357.12 357.12 357.12 357.12 357.12 252.28
</Table>
STAYWELL Medicaid HMO Contract
July 1, 2003 contract Number : ________
Table 3.
Area 6 or Area 1 Age-banded Capitation Rates, including Community Mental
Health and Mental Health Targeted Case Management.
<Table>
<Caption>
Area 01
<1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+
TANF/FC/SOBRA 261.93 64.58 46.91 51.02 104.29 114.62 176.23 267.49 267.49
SSI/No Medicare 1637.19 305.09 213.99 207.65 207.65 549.97 549.97 544.97 544.97
SSI/Part B 289.84 289.84 289.84 289.84 289.84 289.84 289.84 289.84 289.84
SSI/Part A & B 301.66 301.66 301.66 301.66 301.66 301.66 301.66 301.66 318.69
</Table>
<Table>
<Caption>
Area 06
<1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+
TANF/FC/SOBRA 279.39 71.17 59.81 65.78 122.52 124.65 190.77 289.28 289.28
SSI/No Medicare 1498.70 293.07 243.27 196.57 196.57 526.87 526.87 511.41 511.41
SSI/Part B 242.93 242.93 242.93 242.93 242.93 242.93 242.93 242.93 242.93
SSI/Part A & B 263.55 263.55 263.55 263.55 263.55 263.55 263.55 263.55 187.50
</Table>
4. This amendment shall begin on June 1, 2004 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.
REMAINDER OF PAGE LEFT BLANK INTENTIONALLY
AHCA CONTRACT NO. FA312, AMENDMENT NO. 009, PAGE 2 OF 3
WELL CARE HMO, INC., D/B/A STAY WELL HEALTH PLAN MEDICAID HMO CONTRACT
IN WITNESS WHEREOF, the parties hereto have caused this 3 page amendment
(including all attachments) to be executed by their officials thereunto duly
authorized.
WELL CARE HMO, INC.,
d/b/a Stay Well Health Plan of Florida STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED SIGNED
BY: /s/ Thaddeus Bereday BY: /s/ Steven Grigas
_____________________________ _____________________________
NAME: Thaddeus Bereday FOR: Alan Levine
___________________________ ___________________________
TITLE: Senior Vice President & TITLE: Secretary
General Counsel __________________________
__________________________
DATE: 6/30/04 DATE: 6-30-04
__________________________ __________________________
AHCA CONTRACT NO. FA312, AMENDMENT NO. 009, PAGE 3 OF 3