EX-10.10 10 z00001exv10w10.txt EXHIBIT 10.10 Exhibit 10.10 HEALTHEASE OF FLORIDA, INC., d/b/a HEALTHEASE MEDICAID HMO CONTRACT AHCA CONTRACT NO. FA305 AMENDMENT NO. 010 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., d/b/a HealthEase, 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 1 PROJECTED ENROLLMENT
COUNTY Maximum Enrollment Level ALACHUA 0 BAKER 0 BAY 0 BRADFORD 0 BREVARD 14,000 BROWARD 13,500 CALHOUN 500 CHARLOTTE 0 CITRUS 4,500 CLAY 3,200 COLLIER 0 COLUMBIA 0 DADE 20,000 DESOTO 0 DIXIE 0 DUVAL 40,000 ESCAMBIA 18,000 FRANKLIN 250 GADSDEN 3,500 GILCHRIST 0 GULF 0 HARDEE 0 HERNANDO 0 HIGHLANDS 3,000 HILLSBOROUGH 18,000 HOLMES 0 JEFFERSON 1,000 LAKE 6,000 LEE 0 LEON 6,000 LEVY 0 LIBERTY 400 MADISON 1,000 MANATEE 5,000 MARION 12,000 MARTIN 4,000 NASSAU 0 OKALOOSA 0 OKEECHOBEE 0 ORANGE 20,000
AHCA CONTRACT NO. FA305, AMENDMENT NO. 010, PAGE 1 OF 2 HEALTHEASE OF FLORIDA, INC., d/b/a HEALTHEASE MEDICAID HMO CONTRACT OSCEOLA 8,000 PALM BEACH 9,000 PASCO 6,000 PINELLAS 9,000 POLK 8,000 PUTNAM 4,000 ST. JOHNS 0 SANTA ROSA 4,000 SARASOTA 3,000 SEMINOLE 4,000 SUMTER 0 SUWANNEE 0 TAYLOR 0 UNION 0 VOLUSIA 12,000 WALTON 0 WAKULLA 1,000 WASHINGTON 0
2. This amendment shall begin on February 24, 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. IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment (including all attachments) to be executed by their officials thereunto duly authorized. HEALTHEASE of FLORIDA, INC 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 Executive TITLE: INTERIM SECRETARY Officer DATE: 4/27/04 DATE: 5/03/04 AHCA CONTRACT NO. FA305, AMENDMENT NO. 010, PAGE 2 OF 2 HEALTHEASE OF FLORIDA,INC., d/b/a HEALTH EASE MEDICAID HMO CONTRACT AHCA CONTRACT NO. FA305 AMENDMENT NO. 011 THIS AMENDMENT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the "Agency" and HEALTHEASE OF FLORIDA, INC., d/b/a HealthEase, 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 shown below. 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 for Hernandez, et al. v. Medows, case number 02-20964(se 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 1.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 1. Area 0 2
01 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+ TANF/PC/SOBRA 261.91 63.76 40.04 45.16 98.44 113.35 173.96 263.42 263.42 SSI/NO/MEDICARE 1627.17 299.83 159.90 167.91 167.91 507.18 507.18 520.68 520.68 SSI/Part B 283.03 283.03 283.03 283.03 283.03 283.03 283.03 283.03 283.03 SSI/Part A & B 282.14 282.14 282.14 282.14 282.14 282.14 282.14 282.14 199.17
Area 03
01 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+ TANF/PC/SOBRA 304.04 74.58 47.33 53.30 115.21 132.40 204.22 310.61 310.61 SSI/NO/MEDICARE 1722.67 318.21 170.47 178.77 178.77 529.93 539.93 354.25 554.25 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 261.55 261.55 261.55 261.55 261.55 261.55 261.55 261.55 184.90
Area 04
01 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+ TANF/PC/SOBRA 272.14 66.78 42.37 47.98 103.10 118.94 183.29 279.31 279.31 SSI/NO/MEDICARE 1595.82 294.29 157.35 165.25 165.25 498.99 498.99 512.40 512.40 SSI/Part B 249.15 249.15 249.15 249.15 249.15 249.15 249.15 249.15 249.15 SSI/Part A & B 265.42 265.42 265.42 265.42 265.42 265.42 265.42 265.42 187.52
Area 05
01 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+ TANF/PC/SOBRA 285.33 69.91 44.12 49.25 107.97 123.86 191.30 290.61 290.61 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 276.42 276.42 276.42 276.42 276.42 276.42 276.42 276.42 195.20
Area 07
01 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Male 55-64 65+ TANF/PC/SOBRA 279.36 68.56 43.44 49.09 105.94 121.92 188.01 286.09 286.09 SSI/NO/MEDICARE 1590.95 293.73 167.71 165.37 165.37 499.72 499.72 512.25 512.25 SSI/Part B 265.79 265.79 265.79 265.79 265.79 265.79 265.79 265.79 265.79 SSI/Part A & B 259.85 259.85 259.85 259.85 259.85 259.85 259.85 259.85 183.50
AHCA CONTRACT NO. FA305, AMENDMENT NO. 011, PAGE 1 OF 3
HEALTHEASE OF FLORIDA, INC., d/b/a HEALTHEASE MEDICAID HMO CONTRACT Area 08 1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+ TANP/FC/SOBRA 257.19 52.11 40.00 45.22 57.50 112.18 173.06 263.38 263.38 SSI/NO Medicare 1611.33 297.66 239.63 167.52 167.51 505.95 505.95 519.07 519.07 SSI/ Part B 250.97 250.97 250.97 250.97 250.97 250.97 250.97 250.97 250.97 SSI/ Part A & B 253.44 253.44 253.44 253.44 253.44 253.44 253.44 253.44 179.15 Area 09 1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+ TANP/FC/SOBRA 278.08 68.26 43.21 68.86 105.44 121.17 286.89 284.35 284.35 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 Area 10 1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+ TANP/FC/SOBRA 292.87 71.88 45.66 51.65 111.29 128.28 197.65 301.04 301.04 SSI/NO Medicare 2177.44 403.11 315.86 226.70 226.70 684.10 684.10 701.42 701.42 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 319.69 319.69 319.69 319.69 319.69 319.69 319.69 319.69 225.90 Area 11 1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+ TANP/FC/SOBRA 347.50 85.26 53.83 60.83 131.65 150.81 232.98 353.25 353.25 SSI/NO Medicare 2349.00 427.18 233.39 245.61 245.61 744.91 744.91 760.78 760.78 SSI/ Part B 424.57 424.57 424.57 424.57 424.57 424.57 424.57 424.57 424.57 SSI/ Part A & B 367.79 367.79 367.79 367.79 367.79 367.79 367.79 367.79 256.40 Table 3. Area 5 or Area 1 Age - banded Capitation Rates, Including Community Mental Health and Mental Health Targeted Case Management. Area 01 1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+ TANP/FC/SOBRA 261.93 64.58 65.91 51.01 104.29 114.62 176.23 267.49 267.49 SSI/NO Medicare 1627.19 305.09 213.99 207.65 207.65 549.97 549.97 544.97 544.97 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 301.66 301.66 301.66 301.66 301.66 301.66 301.66 301.66 218.69 Area 05 1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+ TANP/FC/SOBRA 279.29 71.17 59.81 65.79 122.52 124.65 190.77 289.28 289.28 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
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. AHCA CONTRACT NO. FA305, AMENDMENT NO. 011, PAGE 2 OF 3 HEALTHEASE OF FLORIDA, INC., d/b/a HEALTH EASE 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. HealthEase of Florida, Inc., STATE OF FLORIDA, AGENCY FOR d/b/a HealthEase HEALTH CARE ADMINISTRATION SIGNED SIGNED BY: /s/ [ILLEGIBLE] BY: /s/ [ILLEGIBLE] --------------------------------- ------------------------- FOR NAME: [ILLEGIBLE] NAME: ALAN LEVINE TITLE: SENIOR VICE PRESIDENT & TITLE: SECRETARY GENERAL COUNSEL DATE: 6/30/04 DATE: 6-30-04 THE REMAINDER OF THIS PAGE LEFT BLANK INTENTIONALLY AHCA CONTRACT NO. FA305, AMENDMENT NO. 011, PAGE 3 OF 3