-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, KFE5TH+cy2zGvO16vMxqDelHsKBGqhQT6UccShpnteQwiH63Qg17abD8Rowlqy6y HQCCuIlPQzq1pzip4f9Upg== 0001299933-07-007002.txt : 20071205 0001299933-07-007002.hdr.sgml : 20071205 20071205160849 ACCESSION NUMBER: 0001299933-07-007002 CONFORMED SUBMISSION TYPE: 8-K PUBLIC DOCUMENT COUNT: 3 CONFORMED PERIOD OF REPORT: 20071130 ITEM INFORMATION: Entry into a Material Definitive Agreement FILED AS OF DATE: 20071205 DATE AS OF CHANGE: 20071205 FILER: COMPANY DATA: COMPANY CONFORMED NAME: AMERIGROUP CORP CENTRAL INDEX KEY: 0001064863 STANDARD INDUSTRIAL CLASSIFICATION: HOSPITAL & MEDICAL SERVICE PLANS [6324] IRS NUMBER: 541739323 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 8-K SEC ACT: 1934 Act SEC FILE NUMBER: 001-31574 FILM NUMBER: 071286815 BUSINESS ADDRESS: STREET 1: 4425 CORPORATION LANE STREET 2: SUITE 100 CITY: VIRGINIA BEACH STATE: VA ZIP: 23462 BUSINESS PHONE: 7574906900 MAIL ADDRESS: STREET 1: 4425 CORPORATION LN CITY: VIRGINIA BEACH STATE: VA ZIP: 23462 8-K 1 htm_24214.htm LIVE FILING AMERIGROUP Corporation (Form: 8-K)  

 

UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549

FORM 8-K

CURRENT REPORT

Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934

     
Date of Report (Date of Earliest Event Reported):   November 30, 2007

AMERIGROUP Corporation
__________________________________________
(Exact name of registrant as specified in its charter)

     
Delaware 001-31574 54-1739323
_____________________
(State or other jurisdiction 		_____________
(Commission 		______________
(I.R.S. Employer
of incorporation) File Number) Identification No.)
      
4425 Corporation Lane, Virginia Beach, Virginia   23462
_________________________________
(Address of principal executive offices) 		  ___________
(Zip Code)
     
Registrant’s telephone number, including area code:   (757) 490-6900

Not Applicable
______________________________________________
Former name or former address, if changed since last report

 

Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions:

[  ]  Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425)
[  ]  Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12)
[  ]  Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b))
[  ]  Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-4(c))

Item 1.01 Entry into a Material Definitive Agreement.

AMERIGROUP Corporation's indirect wholly-owned subsidiary, AMERIGROUP Florida, Inc. entered into an amendment to its Agency for HealthCare Administration Contract No. FA614 on November 30, 2007 (AHCA Contract No. FA614 Amendment No. 5). This amendment expands services into Volusia County. It is effective December 1, 2007.

The foregoing description does not purport to be a complete statement of the parties’ rights and obligations under the contract. The above description is qualified in its entirety by reference to AHCA Contract No. FA614 Amendment No. 5 which is filed as Exhibit 10.1 to this Form 8-K.

AMERIGROUP Corporation's indirect wholly-owned subsidiary, AMERIGROUP Florida, Inc. entered into an amendment to the Agency for HealthCare Administration Contract No. FA614 on November 30, 2007 (AHCA Contract No. FA614 Amendment No. 6). This amendment retroactively revises capitation rates for dual-eligibles to September 1, 2007.

The foregoing description does not purport to be a complete statement of the parties’ rights and obligations under the contract. The above description is qualified in its entirety by reference to AHCA Contract No. FA614 Amendment No. 6 which is filed as Exhibit 10.2 to this Form 8-K.

On November 30, 2007, AMERIGROUP Corporation's indirect wholly-owned subsidiary, AMERIGROUP Florida, Inc. entered into an amendment to its Medicaid Reform contract with the Agency for HealthCare Administration to provide Medicaid managed care services in Broward County, Florida. This amendment retroactively revises capitation rates for dual-eligibles to September 1, 2007.

The foregoing description does not purport to be a complete statement of the parties’ rights and obligations under the contract.





SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned hereunto duly authorized.

         
    AMERIGROUP Corporation
          
December 5, 2007   By:   James W. Truess
       
        Name: James W. Truess
        Title: Executive Vice President and Chief Financial Officer

Exhibit Index


     
Exhibit No.   Description
 
10.1
  AHCA Contract No. FA614 Amendment No. 5
10.2
  AHCA Contract No. FA614 Amendment No. 6
EX-10.1 2 exhibit1.htm EX-10.1 EX-10.1

Amerigroup Florida, Inc. Medicaid HMO Contract d/b/a Amerigroup Community Care

AHCA CONTRACT NO. FA614

AMENDMENT NO. 5

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

1.   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 $1,082,799,481.00 (an increase of $13,248,088.00), subject to availability of funds.

2.   Attachment I, Section B, 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 Exhibit III, the sum of total capitation payments under this Contract shall not exceed the total Contract amount of $1,082,799,481.00 (an increase of $13,248,088.00).

3.   Attachment I, Scope of Services is hereby amended to include Exhibit I-C, Third Revised Maximum Enrollment Levels, attached hereto and made a part of the Contract. All references in the Contract to Exhibit I-B, Second Revised Maximum Enrollment Levels shall hereinafter also refer it Exhibit I-C, Third Revised Maximum Enrollment Levels, as appropriate.

4.   Attachment I, Scope of Services is hereby amended to include Exhibit II-E, Fifth Revised Capitation Rates, attached hereto and made a part of the Contract. All references in the Contract to Exhibit II-D, Fourth Revised Capitation Rates, shall hereinafter also refer it Exhibit II-E, Fifth Revised Capitation Rates, as appropriate.

5.   This Amendment shall become effective upon execution by both parties, or December 1, 2007, 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. FA614, Amendment No. 5, Page 1 of 2

1

Amerigroup Florida, Inc. Medicaid HMO Contract d/b/a Amerigroup Community Care

IN WITNESS WHEREOF, the parties hereto have caused this four (4) 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
      SIGNED
BY: /S/ William McHugh ...............
   BY:
 
    
NAME:William McHugh .......................
   NAME:Andrew C. Agwunobi, M.D
 
    
TITLE: CEO
      TITLE:Secretary
 
       
DATE: 11-29-07
      DATE:
List of attachments included as part of this Amendment:
Specify
Type
  Letter/Number
        ............. 		 
Description
 
       
Exhibit
Exhibit
  I-C
II-E 		  Third Revised maximum Enrollment Levels (1 Page)
Fifth Revised Capitation Rates (1 Page)

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FA614, Amendment No. 5, Page 2 of 2

Amerigroup Florida, Inc. Medicaid HMO Contract d/b/a Amerigroup Community Care

EXHIBIT I-C
THIRD REVISED ENROLLMENT LEVELS

Table 1

                 
County:           Maximum Enrollment Level
Brevard
     8,000          
Broward
             14,000  
Miami-Dade
     25,000          
Hernando
     8,000          
Hillsborough
     40,000          
Lake
     8,000          
Lee
     18,000          
Manatee
     8,000          
Orange
     30,000          
Osceola
     8,500          
Palm Beach
     12,000          
Pasco
     15,000          
Pinellas
     25,000          
Polk
     30,000          
Sarasota
     8,000          
Seminole
     8,000          
Volusia
     8,000          

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

2

AHCA Contract No. FA614, Exhibit I-C, Page 1 of 1
EXHIBIT II-E
FIFTH REVISED CAPITATION RATES

A. Table 2 — General Capitation Rates plus Mental Health Rates:

         
Area 4 Counties:
        
County:
   Provider Number:
Volusia
     015005342  

B. Table 4 — General Capitation Rates plus Mental Health Rates plus Transportation Rates:

         
Area 3 Counties:
        
County:
   Provider Number:
Hernando
     015005350  
Lake
     015005341  
Area 5 Counties:
        
County:
   Provider Number:
Pasco
     015005304  
Pinellas
     015005305  
Area 6 Counties:
        
County:
   Provider Number:
Hillsborough
     015005300  
Polk
     015005307  
Manatee
     015005318  
Area 7 Counties:
        
County:
   Provider Number:
Orange
     015005308  
Seminole
     015005313  
Osceola
     015005314  
Brevard
     015005336  
Area 8 Counties:
        
County:
   Provider Number:
Lee
     015005302  
Sarasota
     015005306  
Area 9 Counties:
        
County:
   Provider Number:
Palm Beach
     015005310  
Area 10 Counties:
        
County:
   Provider Number:
Broward
     015005311  
Area 11 Counties:
        
County:
   Provider Number:
Miami-Dade
     015005312  

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FA614, Exhibit II-E, Page 1 of 1

3 EX-10.2 3 exhibit2.htm EX-10.2 EX-10.2

Amerigroup Florida, Inc. Medicaid HMO Contract d/b/a Amerigroup Community Care

AHCA CONTRACT NO. FA614

AMENDMENT NO. 6

THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the “Agency” and AMERIGROUP 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

Capitation Rates (5 Pages)

AHCA Contract No. FA614, Amendment No. 4, Page 1 of 1

1

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
ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)

                 
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+)

                                                                 
            Female   Male   Female   Male                                        
011,131.99202.30
021,131.99202.30
31,296.42233.58
041,128.87203.75
051,260.50227.66
061,111.64201.87
071,129.81204.44
081,059.95192.36
091,098.82197.96
101,119.46203.01
111,448.96260.41
  105.58
105.58
122.13
106.78
119.09
106.04
107.10
100.83
103.63
106.51
136.24 		  66.22
66.22
77.48
67.92
75.94
68.10
68.40
64.75
65.91
68.32
86.18 		  135.19
135.19
156.47
136.68
152.59
135.60
137.11
129.15
132.56
136.20
174.38 		  72.29
72.29
84.50
74.01
82.61
74.02
74.43
70.40
71.62
74.23
94.02 		  265.45
265.45
308.68
269.88
301.42
269.07
271.08
255.88
261.85
270.06
343.72 		  167.89
167.89
196.24
171.79
191.81
171.81
172.77
163.25
166.57
172.18
218.26 		  347.47
347.47
408.68
358.59
400.30
360.32
361.05
342.35
346.99
360.84
453.77 		  10,081.87
10,081.87
11,326.29
10,675.98
11,774.49
10,832.05
11,163.75
9,491.26
10,597.24
13,743.01
14,396.52 		  1,458.88
1,458.88
1,656.79
1,563.58
1,721.01
1,590.31
1,640.70
1,388.78
1,556.56
2,028.53
2,111.55 		  435.95
435.95
495.12
467.86
514.94
475.95
490.80
415.62
465.60
606.68
631.62 		  201.26
201.26
233.33
220.87
241.96
225.91
233.68
196.24
221.41
290.75
299.15 		  222.08
222.08
256.55
242.36
266.53
247.84
256.10
215.38
242.54
319.15
329.01 		  716.10
716.10
826.59
781.86
857.42
799.09
824.52
694.16
781.98
1,026.77
1,058.44 		  703.88
703.88
816.63
772.10
846.21
790.01
815.86
685.42
773.10
1,016.73
1,046.51 		  270.05
270.05
272.84
329.54
228.63
283.50
326.33
190.94
204.68
255.52
335.29 		  98.2880.72
98.2880.72
91.4075.41
94.1977.67
88.3873.66
85.4570.71
88.9173.77
84.4169.83
91.8076.03
105.0486.99
159.90130.52
TABLE 2
 General + Mental Health 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+)

                                                                             
                    Female   Male   Female   Male                                            
01
02
03
04
05
06
07
08
09
10
11
  1,132.01
1,132.02
1,296.43
1,128.88
1,260.51
1,111.66
1,129.83
1,059.96
1,098.84
1,119.48
1,448.98 		  202.32
202.33
233.59
203.76
227.67
201.89
204.46
192.37
197.98
203.03
260.43 		  107.22
108.49
123.45
108.15
120.30
107.89
108.88
102.09
105.18
108.43
137.86 		  77.91
86.47
86.66
77.48
84.61
81.34
81.08
73.55
76.72
81.68
97.47 		  146.11
148.60
162.55
143.01
160.70
147.98
148.96
134.98
139.72
145.05
181.86 		  83.21
85.70
90.58
80.34
90.72
86.40
86.28
76.23
78.78
83.08
101.50 		  269.89
268.86
310.23
271.49
304.71
274.10
275.90
257.36
263.67
272.31
345.62 		  172.33
171.30
197.79
173.40
195.10
176.84
177.59
164.73
168.39
174.43
220.16 		  351.22
350.43
410.02
359.98
403.08
364.57
365.12
343.63
348.57
362.79
455.42 		  10,081.95
10,082.03
11,326.36
10,676.09
11,774.54
10,832.12
11,163.81
9,491.33
10,597.31
13,743.10
14,396.60 		  1,458.96
1,459.04
1,656.86
1,563.69
1,721.06
1,590.38
1,640.76
1,388.85
1,556.63
2,028.62
2,111.63 		  443.39
449.74
501.38
477.61
519.96
482.47
496.92
421.62
471.93
615.03
638.59 		  249.30
280.06
269.08
276.60
274.37
268.01
273.18
230.52
257.55
338.45
338.94 		  266.06
267.29
277.06
274.33
296.20
286.38
292.26
235.05
263.28
346.52
351.84 		  797.48
768.77
850.48
819.11
912.32
870.40
891.44
717.07
806.13
1,058.65
1,085.04 		  734.86
728.75
827.91
789.69
867.11
817.15
841.33
696.24
784.51
1,031.78
1,059.07 		  271.05
291.04
279.47
354.09
231.36
284.81
328.92
197.79
211.53
262.37
342.52 		  109.93
113.28
100.38
110.96
101.19
89.33
99.42
97.63
101.39
113.09
167.95 		  92.37
95.72
84.39
94.44
86.47
74.59
84.28
83.05
85.62
95.04
138.57

2

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+)

                                                             
        Female   Male   Female   Male                                        
011,132.02202.33109.31
021,132.03202.34110.58
031,296.44233.60126.52
041,128.89203.77110.20
051,260.52227.69123.77
061,111.67201.90110.53
071,129.84204.47111.04
081,059.97192.38105.11
091,098.85197.99108.10
101,119.49203.04111.29
111,448.99260.44141.58
  82.23
90.79
93.00
81.71
91.76
86.79
85.54
79.80
82.75
87.56
105.13 		  150.59
153.08
169.14
147.39
168.12
153.63
153.58
141.46
145.98
151.15
189.81 		  86.99
89.48
96.13
84.03
96.98
91.17
90.17
81.69
84.06
88.23
108.20 		  271.74
270.71
313.24
274.30
311.90
277.72
278.43
260.37
264.42
274.13
347.23 		  173.97
172.94
200.46
175.89
201.49
180.05
179.84
167.40
169.94
176.05
221.59 		  354.63
353.84
415.57
365.17
416.36
371.26
369.79
349.19
351.80
366.16
458.40 		  10,081.95
10,082.03
11,326.37
10,676.09
11,774.55
10,832.13
11,163.81
9,491.34
10,597.31
13,743.11
14,396.61 		  1,458.97
1,459.05
1,656.88
1,563.70
1,721.08
1,590.40
1,640.77
1,388.87
1,556.64
2,028.64
2,111.65 		  445.59
451.94
504.76
479.82
524.88
485.64
500.03
424.74
474.66
618.77
642.83 		  253.12269.40
283.88270.63
274.93282.17
280.43277.68
282.89303.65
273.51291.19
278.58296.97
235.93239.77
262.28267.41
344.93352.19
346.28358.26 		  800.35
771.64
854.04
822.42
919.87
874.82
894.55
720.67
807.81
1,060.76
1,088.67 		  738.28
732.17
832.15
793.64
876.10
822.42
845.04
700.54
786.52
1,034.30
1,063.40 		  271.55
291.54
280.01
356.10
235.79
286.65
330.54
199.27
212.26
264.42
346.92 		  112.24
115.59
103.46
114.04
109.53
94.11
102.58
100.78
103.23
115.66
172.01 		  93.85
97.20
86.37
96.42
91.82
77.66
86.31
85.06
86.80
96.69
141.17
TABLE 4
 General + MH + 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+)

                                                                             
                    Female   Male   Female   Male                                            
01
02
03
04
05
06
07
08
09
10
11
  1,137.56
1,137.57
1,303.13
1,133.91
1,264.71
1,115.71
1.133.77
1,065.54
1,104.22
1,123.27
1,452.24 		  203.71
203.72
235.26
205.01
228.72
202.90
205.44
193.77
199.32
203.97
261.24 		  108.08
109.35
124.49
108.93
120.95
108.52
109.49
102.95
106.02
109.01
138.36 		  78.43
86.99
87.29
77.95
85.01
81.72
81.45
74.07
77.23
82.04
97.78 		  148.03
150.52
164.87
144.75
162.15
149.38
150.32
136.91
141.58
146.35
182.98 		  84.47
86.96
92.09
81.48
91.67
87.31
87.17
77.49
79.99
83.94
102.24 		  272.98
271.95
313.95
274.28
307.04
276.35
278.09
260.46
266.66
274.42
347.43 		  174.71
173.68
200.67
175.56
196.90
178.58
179.28
167.12
170.70
176.05
221.56 		  354.40
353.61
413.86
362.87
405.49
366.89
367.38
346.83
351.65
364.96
457.29 		  10,125.36
10,125.44
11,381.17
10,720.46
11,809.84
10,866.95
11,201.13
9,532.67
10,640.50
13,782.23
14,425.98 		  1,486.99
1,487.07
1,692.25
1,592.34
1,743.85
1,612.87
1,664.85
1,415.54
1,584.51
2,053.89
2,130.60 		  449.03
455.38
508.50
483.38
524.54
487.00
501.77
427.00
477.55
620.11
642.40 		  251.78
282.54
272.20
279.13
276.38
270.00
275.30
232.88
260.02
340.69
340.62 		  272.18
273.41
284.79
280.59
301.18
291.30
297.53
240.88
269.38
352.05
355.99 		  817.47
788.76
875.73
839.55
928.58
886.44
908.63
736.11
826.01
1,076.67
1,098.57 		  751.37
745.26
848.76
806.56
880.53
830.40
855.51
711.96
800.93
1,046.66
1,070.25 		  277.82
297.81
288.09
361.06
237.24
290.13
334.56
203.87
218.45
269.67
347.44 		  123.66
127.01
120.22
126.74
115.22
100.93
111.55
112.43
117.20
130.75
180.46 		  101.13
104.48
97.05
104.50
95.42
81.99
92.03
92.50
95.70
106.30
146.55

3

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 UNLESS APPROVED BY 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+)

                                                                     
            Female   Male   Female   Male                                            
011,137.54203.69
021,137.54203.69
031,303.12235.25
041,133.90205.00
051,264.70228.71
061,115.69202.88
071,133.75205.42
081,065.53193.76
091,104.20199.30
101,123.25203.95
111,452.22261.22
  106.44
106.44
123.17
107.56
119.74
106.67
107.71
101.69
104.47
107.09
136.74 		  66.74
66.74
78.11
68.39
76.34
68.48
68.77
65.27
66.42
68.68
86.49 		  137.11
137.11
158.79
138.42
154.04
137.00
138.47
131.08
134.42
137.50
175.50 		  73.55
73.55
86.01
75.15
83.56
74.93
75.32
71.66
72.83
75.09
94.76 		  268.54
268.54
312.40
272.67
303.75
271.32
273.27
258.98
264.84
272.17
345.53 		  170.27
170.27
199.12
173.95
193.61
173.55
174.46
165.64
168.88
173.80
219.66 		  350.65
350.65
412.52
361.48
402.71
362.64
363.31
345.55
350.07
363.01
455.64 		  10,125.28
10,125.28
11,381.10
10,720.35
11,809.79
10,866.88
11,201.07
9,532.60
10,640.43
13,782.14
14,425.90 		  1,486.91
1,486.91
1,692.18
1,592.23
1,743.80
1,612.80
1,664.79
1,415.47
1,584.44
2,053.80
2,130.52 		  441.59
441.59
502.24
473.63
519.52
480.48
495.65
421.00
471.22
611.76
635.43 		  203.74
203.74
236.45
223.40
243.97
227.90
235.80
198.60
223.88
292.99
300.83 		  228.20
228.20
264.28
248.62
271.51
252.76
261.37
221.21
248.64
324.68
333.16 		  736.09
736.09
851.84
802.30
873.68
815.13
841.71
713.20
801.86
1,044.79
1,071.97 		  720.39
720.39
837.48
788.97
859.63
803.26
830.04
701.14
789.52
1,031.61
1,057.69 		  277.61
277.61
281.24
336.51
234.51
288.82
331.97
197.02
211.60
262.82
340.21 		  112.01
112.01
111.24
109.97
102.41
97.05
101.04
99.21
107.61
122.70
172.41 		  89.48
89.48
88.07
87.73
82.61
78.11
81.52
79.28
86.11
98.25
138.50
TABLE 6
 General + 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+)

                                                                             
                    Female   Male   Female   Male                                            
01
02
03
04
05
06
07
08
09
10
11
  1,132.00
1,132.00
1,296.43
1,128.88
1,260.51
1,111.65
1,129.82
1,059.96
1,098.83
1,119.47
1,448.97 		  202.31
202.31
233.59
203.76
227.68
201.88
204.45
192.37
197.97
203.02
260.42 		  107.67
107.67
125.20
108.83
122.56
108.68
109.26
103.85
106.55
109.37
139.96 		  70.54
70.54
83.82
72.15
83.09
73.55
72.86
71.00
71.94
74.20
93.84 		  139.67
139.67
163.06
141.06
160.01
141.25
141.73
135.63
138.82
142.30
182.33 		  76.07
76.07
90.05
77.70
88.87
78.79
78.32
75.86
76.90
79.38
100.72 		  267.30
267.30
311.69
272.69
308.61
272.69
273.61
258.89
263.60
271.88
345.33 		  169.53
169.53
198.91
174.28
198.20
175.02
175.02
165.92
168.12
173.80
219.69 		  350.88
350.88
414.23
363.78
413.58
367.01
365.72
347.91
350.22
364.21
456.75 		  10,081.87
10,081.87
11,326.30
10,675.98
11,774.50
10,832.06
11,163.75
9,491.27
10,597.24
13,743.02
14,396.53 		  1,458.89
1,458.89
1,656.81
1,563.59
1,721.03
1,590.33
1,640.71
1,388.80
1,556.57
2,028.55
2,111.57 		  438.15
438.15
498.50
470.07
519.86
479.12
493.91
418.74
468.33
610.42
635.86 		  205.08
205.08
239.18
224.70
250.48
231.41
239.08
201.65
226.14
297.23
306.49 		  225.42
225.42
261.66
245.71
273.98
252.65
260.81
220.10
246.67
324.82
335.43 		  718.97
718.97
830.15
785.17
864.97
803.51
827.63
697.76
783.66
1,028.88
1,062.07 		  707.30
707.30
820.87
776.05
855.20
795.28
819.57
689.72
775.11
1,019.25
1,050.84 		  271.34
271.34
273.16
331.51
233.06
285.34
327.95
192.42
205.41
257.57
339.69 		  100.59
100.59
94.48
97.27
96.72
90.23
92.07
87.56
93.64
107.61
163.96 		  82.20
82.20
77.39
79.65
79.01
73.78
75.80
71.84
77.21
88.64
133.12

4

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 UNLESS APPROVED BY 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+)

                                                         
Female   Male   Female   Male                                            
011,137.55203.70108.5371.06141.59
021,137.55203.70108.5371.06141.59
031,303.13235.26126.2484.45165.38
041,133.91205.01109.6172.62142.80
051,264.71228.73123.2183.49161.46
061,115.70202.89109.3173.93142.65
071,133.76205.43109.8773.23143.09
081,065.54193.77104.7171.52137.56
091,104.21199.31107.3972.45140.68
101,123.26203.96109.9574.56143.60
111,452.23261.23140.4694.15183.45
  77.33
77.33
91.56
78.84
89.82
79.70
79.21
77.12
78.11
80.24
101.46 		  270.39
270.39
315.41
275.48
310.94
274.94
275.80
261.99
266.59
273.99
347.14 		  171.91
171.91
201.79
176.44
200.00
176.76
176.71
168.31
170.43
175.42
221.09 		  354.06
354.06
418.07
366.67
415.99
369.33
367.98
351.11
353.30
366.38
458.62 		  10,125..28
10,125.28
11,381.10
10,720.35
11,809.79
10,866.88
11,201.07
9,532.60
10,640.43
13,782.14
14,425.90 		  1,486.92
1,486.92
1,692.20
1,592.24
1,743.82
1,612.82
1,664.80
1,415.49
1,584.45
2,053.82
2,130.54 		  443.79
443.79
505.6
475.84
524.44
483.65
498.76
424.12
473.95
615.50
639.67 		  203.74
203.74
242.30
227.23
252.49
233.40
241.20
204.01
228.61
299.47
308.17 		  228.20
228.20
269.39
251.97
278.96
257.57
266.08
225.93
252.77
330.35
339.58 		  736.09
736.09
855.40
805.61
881.23
819.55
844.82
716.80
803.54
1,046.90
1,075.60 		  723.81
723.81
841.72
792.92
868.62
808.53
833.75
705.44
791.53
1,034.13
1,062.02 		  278.11
278.11
281.78
338.52
238.94
290.66
333.59
198.50
212.33
264.87
344.61 		  114.32
114.32
114.32
113.05
110.75
101.83
104.20
102.36
109.45
125.27
176.47 		  90.96
90.96
90.05
89.71
87.96
81.18
83.55
81.29
87.29
99.90
141.10
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+)

                                                                             
                    Female   Male   Female   Male                                            
01
02
03
04
05
06
07
08
09
10
11
  1,137.57
1,137.58
1,303.14
1,133.92
1,264.72
1,115.72
1,133.78
1,065.55
1,104.23
1,123.28
1,452.25 		  203.72
203.73
235.27
205.02
228.74
202.91
205.45
193.78
199.33
203.98
261.25 		  110.17
111.44
127.56
110.98
124.42
111.16
111.65
105.97
108.94
111.87
142.08 		  82.75
91.31
93.63
82.18
92.16
87.17
85.91
80.32
83.26
87.92
105.44 		  152.51
155.00
171.46
149.13
169.57
155.03
154.94
143.39
147.84
152.45
190.93 		  88.25
90.74
97.64
85.17
97.93
92.08
91.06
82.95
85.27
89.09
108.94 		  274.83
273.80
316.96
277.09
314.23
279.97
280.62
263.47
268.41
276.24
349.04 		  176.35
175.32
203.34
178.05
203.29
181.79
181.53
169.79
172.25
177.67
222.99 		  357.81
357.02
419.41
368.06
418.77
373.58
372.05
352.39
354.88
368.33
460.27 		  10,125.36
10,125.44
11,381.18
10,720.46
11,809.85
10,866.96
11,201.13
9,532.68
10,640.50
13,782.24
14,425.99 		  1,487.00
1,487.08
1,692.27
1,592.35
1,743.87
1,612.89
1,664.86
1,415.56
1,584.52
2,053.91
2,130.62 		  451.23
457.58
511.88
485.59
529.46
490.17
504.88
430.12
480.28
623.85
646.64 		  255.60
286.36
278.05
282.96
284.90
275.50
280.70
238.29
264.75
347.17
347.96 		  275.52
276.75
289.90
283.94
308.63
296.11
302.24
245.60
273.51
357.72
362.41 		  820.34
791.63
879.29
842.86
936.13
890.86
911.74
739.71
827.69
1,078.78
1,102.20 		  754.79
748.68
853.00
810.51
889.52
835.67
859.22
716.26
802.94
1,049.18
1,074.58 		  278.32
298.31
288.63
363.07
241.67
291.97
336.18
205.35
219.18
271.72
351.84 		  125.97
129.32
123.30
129.82
123.56
105.71
114.71
115.58
119.04
133.32
184.52 		  102.61
105.96
99.03
106.48
100.77
85.06
94.06
94.51
96.88
107.95
149.15

5

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

6 -----END PRIVACY-ENHANCED MESSAGE-----