EX-10.4 5 exhibit10-4.htm AMENDMENT 8 TO AHCA CONTRACT NO. FAR001 exhibit10-4.htm
Exhibit 10.4
 
HealthEase of Florida, Inc. 
Medicaid Reform HMO Contract
AHCA CONTRACT NO. FAR001
AMENDMENT NO. 8
 
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., hereinafter referred to as the "Vendor", is hereby amended as follows:

1.
Effective January 1, 2008, 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 $382,047,581.00 (a decrease of $28,281,601.00), subject to availability of funds.

2.
Effective January 1, 2008, Attachment I, Section C, 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 Tables 2 thru 8, the sum of total capitation payments under this Contract shall not exceed the total Contract amount of $382,047,581.00 (a decrease of $28,281,601.00).

3.
Effective January 1, 2008, Attachment I, Scope of Services, is hereby amended to include Exhibits 3-B, 5-C, 6-C, and 9-B, attached hereto and made a part of the Contract. All references in the Contract to Exhibits 3-A, 5-B, 6-B, and 9-A, shall hereinafter instead refer to Exhibits 3-B, 5-C, 6-C, and 9-B.

4.
This Amendment shall have an effective date of January 1, 2008, or the date on which other parties execute the Amendment which ever 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.



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AHCA Contract No. FAR001, Amendment No. 8, Page 1 of 2
HealthEase of Florida, Inc. 
Medicaid Reform HMO Contract


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


HEALTHEASE OF FLORIDA, INC
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION
SIGNED BY:    /s/  Todd S. Farha                                                                
SIGNED BY:   /s/   Illegible 
NAME:  Todd S. Farha
(for)
NAME: Andrew C. Agwunobi, M.D.
TITLE: President and CEO
TITLE: Secretary
DATE:1/2/08
DATE: 1/3/08

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

Specify Type 
Letter/ Number
Description                      
Exhibit
3-B
Comprehensive and Catostrophic Component Captation Rates (2 Pages)
Exhibit
5-C
Capitation Rates SSI Medicare Part B Only and SSI Medicare Parts A & B Enrollees for All Medicaid Reform Counties (1 Page)
Exhibit
6-C
Capitation Rates for HIV/AIDS Populations for Each Medicaid Reform County (1 Page)
Exhibit
9-B
Kick Payment Amounts for Covered Obstetrical Delivery Services (1 Page)
     


 
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AHCA Contract No. FAR001, Amendment No. 8, Page 2 of 2
 
EXHIBIT 3-B
COMPREHENSIVE COMPONENT AND CATASTROPHIC COMPONENT CAPITATION RATES
 
TABLE 2
Jan 1, 2008
Area: 10                                           County: Broward
 
Age   Range
    
FY0708
 Discounted
Reform rates
Under Current Methodology
    
Percentage of Current Methodology
    
50% of Current Methodology
    
Preliminary FY0708 Base rates for Risk Adjusted Methodology
    
Budget Neutrality Factor
    
FY0708 Base rates for Risk Adjusted Methodology after Budget Neutrality
    
Percentage of Risk Adjusted Methodology
    
50% of Risk Adjusted Methodology
    
 
Final Rates (with Enhanced Benefit Adjustment)
  
  a       b       c       d       e       f       g       h       i         j
Eligibility Category:
    
Children and Family
                                                                  
                                                                             
Month 0-2 All
                                                                     $ 892.28  
Month 3-11 All
                                                                     $ 205.04  
1-5 All
     $ 106.14       50 %   $ 53.07     $ 117.69       1.07460     $ 126.47       50 %   $ 63.23     $ 112.09  
6-13 All
     $ 82.94       50 %   $ 41.47     $ 117.69       1.07460     $ 126.47       50 %   $ 63.23     $ 100.91  
14-20 Female
     $ 115.00       50 %   $ 57.50     $ 117.69       1.07460     $ 126.47       50 %   $ 63.23     $ 116.36  
14-20 Male
     $ 79.98       50 %   $ 39.99     $ 117.69       1.07460     $ 126.47       50 %   $ 63.23     $ 99.49  
21-54 Female
     $ 202.08       50 %   $ 101.04     $ 117.69       1.07460     $ 126.47       50 %   $ 63.23     $ 158.33  
21-54 Male
     $ 146.71       50 %   $ 73.35     $ 117.69       1.07460     $ 126.47       50 %   $ 63.23     $ 131.64  
55+ All
     $ 325.58       50 %   $ 162.79     $ 117.69       1.07460     $ 126.47       50 %   $ 63.23     $ 217.84  
                                                                             
Composite Based on Total Casemonths
     $ 108.91                                     $ 126.47             $ 0.00     $ 113.43  
                                                                             
Eligibility Category:
    
Aged and Disabled
                                                                  
                                                                             
Month 0-2 All
                                                                     $ 17,528.17  
Month 3-11 All
                                                                     $ 3,534.94  
1-5 All
     $ 631.27       50 %   $ 315.63     $ 813.28       1.06682     $ 867.63       50 %   $ 433.81     $ 722.31  
6-13 All
     $ 355.68       50 %   $ 177.84     $ 813.28       1.06682     $ 867.63       50 %   $ 433.81     $ 589.51  
14-20 All
     $ 343.79       50 %   $ 171.90     $ 813.28       1.06682     $ 867.63       50 %   $ 433.81     $ 583.78  
21-54 All
     $ 930.27       50 %   $ 465.13     $ 813.28       1.06682     $ 867.63       50 %   $ 433.81     $ 866.40  
55+ All
     $ 965.71       50 %   $ 482.85     $ 813.28       1.06682     $ 867.63       50 %   $ 433.81     $ 883.48  
                                                                             
Composite Based on Total Casemonths
     $ 758.94                                     $ 867.63             $ 0.00     $ 783.84  


AHCA Contract No. FAR001, Exhibit 3-B, Page 1 of  2


EXHIBIT 3-B
COMPREHENSIVE COMPONENT AND CATASTROPHIC COMPONENT CAPITATION RATES

TABLE   2
Jan 1, 2008 
Area: 4                                                       County: Duval, Baker, Clay, Nassau
 

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

Age Range
FY0708 Discounted Reform rates Under Current Methodology
Percentage of Current Methodology
50% of Current Methodology
Preliminary FY0708 Base rates for Risk Adjusted Methodology
Budget Neutrality Factor
FY0708 Base rates for Risk Adjusted Methodology after Budget Neutrality
Percentage of Risk Adjusted Methodology
50% of Risk Adjusted Methodology
  Final Rates (with Enhanced Benefit Adjustment)
a
b
c
d
e
f
g
h
I
          j
Eligibility Category:
Children and Family
     
                   
Month 0-2 All
                
$ 926.73
Month 3-11 All
                
$ 215.12
1-5 All
$113.17
50%
$56.58
$124.53
1.04120
$129.66
50%
$64.83
$ 117.02
6-13 All
$82.75
50%
$41.37
$124.53
1.04120
$129.66
50%
$64.83
$ 102.36
14-20 Female
$119.81
50%
$59.91
$124.53
1.04120
$129.66
50%
$64.83
$ 120.22
14-20 Male
$81.70
50%
$40.85
$124.53
1.04120
$129.66
50%
$64.83
$ 101.85
21-54 Female
$218.13
50%
$109.06
$124.53
1.04120
$129.66
50%
$64.83
$ 167.60
21-54 Male
$158.54
50%
$79.27
$124.53
1.04120
$129.66
50%
$64.83
$ 138.88
55+ All
$350.55
50%
$175.28
$124.53
1.04120
$129.66
50%
$64.83
$ 231.41
                   
Composite Based on Total Casemonths
$119.40
        
$129.66
  
$0.00
$ 120.02
                   
Eligibility Category:
Aged and Disabled
             
                   
Month 0-2 All
                
$ 14,558.96
Month 3-11 All
                
$ 2,969.69
1-5 All
$537.41
50%
$268.70
$657.05
1.05080
$690.42
50%
$345.21
$ 591.69
6-13 All
$312.13
50%
$156.06
$657.05
1.05080
$690.42
50%
$345.21
$ 483.13
14-20 All
$296.53
50%
$148.27
$657.05
1.05080
$690.42
50%
$345.21
$ 475.61
21-54 All
$790.16
50%
$395.08
$657.05
1.05080
$690.42
50%
$345.21
$ 713.49
55+ All
$809.32
50%
$404.66
$657.05
1.05080
$690.42
50%
$345.21
$ 722.72
                   
Composite Based on Total Casemonths
$623.67
        
$690.42
  
$0.00
$ 633.26
 
AHCA Contract No. FAR001, Exhibit 3-B, Page 2 of  2


 
EXHIBIT 5-C
CAPITATION RATES
SSI MEDICARE PART B ONLY
AND
SSI MEDICARE PARTS A AND B ENROLLEES
FOR ALL MEDICAID REFORM COUNTIES
 
TABLE 4

Area: 10                                            County: Broward

ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
 
 
 
Under Age 65
Age 65 & Over
SSI/Parts A & B
$149.01
$100.91
SSI/Part B Only
$244.40
$244.40


Area: 4                County: Duval, Baker, Clay, and Nassau

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

 
Under Age 65
Age 65 & Over
SSI/Parts A & B
$156.46
$105.72
SSI/Part B Only
$362.68
$362.68




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AHCA Contract No. FAR001, Exhibit 5-C, Page 1 of 1
EXHIBIT 6-C
CAPITATION RATES FOR HIV/AIDS POPULATIONS FOR EACH MEDICAID REFORM COUNTY



 
TABLE 5

Area: 10
County: Broward

ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
 
Capitation Rate
HIV (no medicare)
$1,933.92
AIDS (no medicare)
$3,629.23
HIV-SSI/Parts A & B, SSI Part B Only
$   271.50
AIDS-SSI/Parts A & B, SSI Part B Only
$   579.63


Area: 4
County: Duval, Baker, Clay, and Nassau


ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS)
 
Capitation Rate
HIV (no medicare)
$1,196.17
AIDS (no medicare)
$2,354.82
HIV-SSI/Parts A & B, SSI Part B Only
$   162.15
AIDS-SSI/Parts A & B, SSI Part B Only
$   346.18


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AHCA Contract No. FAR001, Exhibit 6-C, Page 1 of 1
EXHIBIT 9-B
KICK PAYMENT AMOUNTS FOR COVERED OBSTETRICAL DELIVERY SERVICES
 
TABLE 8

Area: 10
County: Broward
 
CPT Code
Obstetrical Delivery CPT Code Description
Payment Amount
59409
Vaginal delivery only
$3,950.67
59410
Vaginal delivery including postpartum care
59515
Cesarean delivery including postpartum care
59612
Vaginal delivery only, after previous cesarean delivery
59614
Vaginal delivery only, after previous cesarean delivery including postpartum care
59622
Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery including postpartum care
 
Area: 04
County: Duval, Baker, Clay, Nassau
 
CPT Code
Obstetrical Delivery CPT Code Description
Payment Amount
59409
Vaginal delivery only
$3,936.56
59410
Vaginal delivery including postpartum care
59515
Cesarean delivery including postpartum care
59612
Vaginal delivery only, after previous cesarean delivery
59614
Vaginal delivery only, after previous cesarean delivery including postpartum care
59622
Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery including postpartum care


AHCA Contract No. FAR001, Exhibit 9-B, Page 1 of 1