Attached files
| file | filename |
|---|---|
| 8-K - FORM 8-K REGARDING AMENDMENT #7 TO CONTRACT NO. 0654 BETWEEN THE GEORGIA DEPARTMENT OF COMMUNITY HEALTH AND WELLCARE OF GEORGIA, INC. - WELLCARE HEALTH PLANS, INC. | form8k.htm |
Exhibit 10.1
AMENDMENT
#7 TO CONTRACT NO. 0654 BETWEEN
GEORGIA
DEPARTMENT OF COMMUNITY HEALTH AND
WELLCARE
OF GEORGIA, INC.
This
Amendment is between the Georgia Department of Community Health (hereinafter
referred to as "DCH" or the "Department") and WellCare of Georgia, Inc.
(hereinafter referred to as
"Contractor") and is made effective this 23 day of September, 2009 (hereinafter
referred
to as the "Effective Date"). Other than the changes, modifications and additions
specifically articulated in this Amendment #7 to Contract # 0654,
RFP#41900-001-0000000027, the original Contract shall remain in effect and
binding on and against DCH and Contractor. Unless expressly modified or added in
this Amendment #7, the terms and conditions of the original Contract are
expressly incorporated into this Amendment #7 as if completely restated
herein.
WHEREAS, DCH and Contractor
executed a contract for the provision of services to members of the Georgia
Families Program;
WHEREAS,
DCH pays Contractor a per member per month capitation rate for each
Georgia Families member enrolled in the Contractor's plan;
WHEREAS, DCH has
sought permission from the Centers for Medicare and Medicaid Services
(hereinafter referred to as "CMS") to revise the capitation rates payable to
Contractor for State Fiscal Year 2010; and
WHEREAS, pursuant to Section 32.0, Amendments in
Writing, DCH and Contractor desire to amend the above-referenced Contract
by adding additional funding as set forth below.
NOW THEREFORE, for and in
consideration of the mutual promises of the Parties, the terms, provisions and
conditions of this Amendment and other good and valuable consideration, the
sufficiency of which is hereby acknowledged, DCH and Contractor hereby agree as
follows:
|
I.
|
Upon
receiving written notice from CMS indicating that agency's approval of the
revised capitation
rates, the parties shall delete the current Attachment H, Capitation
Payment,
in its entirety and
replace it with the new Attachment H, Capitation
Payment, contained
at Exhibit 1 to this
Amendment.
|
|
II.
|
DCH
and Contractor agree that they have assumed an obligation to perform the
covenants, agreements, duties and obligations of the Contract, as modified
and amended herein, and agree to abide by all the provisions, terms and
conditions contained in the Contract as modified and
amended.
|
|
III.
|
This
Amendment shall be binding and inure to the benefit of the parties hereto,
their heirs, representatives, successors and assigns. Whenever the
provisions of this Amendment and the Contract are in conflict, the
provisions of this Amendment shall take precedence and
control.
|
Amendment
#7
Contract
#0654
Page
1 of 4
|
VI.
|
It
is understood by the Parties hereto that, if any part, term, or provision
of this Amendment or this entire Amendment is held to be illegal or in
conflict with any law of this State, then DCH, at its sole option, may
enforce the remaining unaffected portions or provisions of this Amendment
or of the Contract and the rights and obligations of the parties shall be
construed and enforced as if the Contract or Amendment did not contain the
particular part, term or provision held to be
invalid.
|
|
VII.
|
This
Amendment shall become effective as stated herein and shall remain
effective for so long as the Contract is in
effect.
|
|
VIII.
|
This
Amendment shall be construed in accordance with the laws of the State of
Georgia.
|
|
IX.
|
All
other terms and conditions contained in the Contract and any amendment
thereto, not amended by this Amendment, shall remain in full force and
effect.
|
- SIGNATURES ON THE FOLLOWING PAGE
-
Amendment
#7
Contract
#0654
Page 2 of
4
SIGNATURE
PAGE
IN WITNESS WHEREOF, DCH and
Contractor, through their authorized officers and agents, have caused this
Amendment to be executed on their behalf as of the date indicated.
GEORGIA
DEPARTMENT OF COMMUNITY HEALTH
| /s/ Dr. Rhonda M. Medows, M.D. | 9/23/09 | |
|
Dr.
Rhonda M. Medows, M.D.
Commissioner
|
Date
|
|
WELLCARE
OF GEORGIA, INC.
|
|
||
|
BY:
|
/s/ Heath
Schiesser
*
SIGNATURE
|
Sep.
11,
2009
Date
|
|
|
Heath
Schiesser
Please
Print/Type Name Here
|
|||
|
AFFIX
CORPORATE SEAL HERE
(Corporations
without a seal, attach
a
Certificate
of Corporate Resolution)
|
|||
|
ATTEST:
|
/s/ Karen Mulroe | |
|
**
SIGNATURE
|
||
| Secretary | ||
|
TITLE
|
* Must be
President, Vice President, CEO or Other Authorized Officer
**Must be
Corporate Secretary
Amendment
#7
Contract
#0654
Page 3 of
4
EXHIBIT
1
CONFIDENTIAL
- NOT FOR CIRCULATION
ATTACHMENT
H
Attachment
H is a table displaying the contracted rates by rate cell for each contracted
region. These rates will be the basis for calculating capitation payments in
each contracted Region.
(The
table is displayed on the following page.)
Amendment
#7
Contract
#0654
Page 4 of
4
WellCare
|
Region
Aid
Category Age/Gender
Group
|
WellCare
July-September
2009
|
WellCare
October
2009 to June 2010
|
||
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
0 -
2 Months, Male and Female
|
$ 1,646.47
|
$ 1,578.16
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
3-11
Months, Male and Female
|
$ 181.81
|
$ 174.98
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
$ 122.15
|
$ 117.66
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
6-13
Years, Male and Female
|
$ 111.06
|
$ 106.90
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Female
|
$ 185.49
|
$ 178.56
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Male
|
$ 132.03
|
$ 127.14
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Female
|
$ 317.02
|
$ 305.67
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
21
-44 Years, Male
|
$ 290.78
|
$ 280.43
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
$ 519.77
|
$ 501.36
|
|
Atlanta
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
$ 542.16
|
$ 522.57
|
|
Atlanta
|
PeachCare
|
0 -
2 Months, Male and Female
|
$ 154.40
|
$ 148.62
|
|
Atlanta
|
PeachCare
|
3-11
Months, Male and Female
|
$ 154.40
|
$ 148.62
|
|
Atlanta
|
PeachCare
|
1 -
5 Years, Male and Female
|
$ 113.81
|
$ 109.58
|
|
Atlanta
|
PeachCare
|
6-13
Years, Male and Female
|
$ 114.52
|
$ 110.22
|
|
Atlanta
|
PeachCare
|
14
- 20 Years, Female
|
$ 139.02
|
$ 133.78
|
|
Atlanta
|
PeachCare
|
14-20
Years, Male
|
$ 125.82
|
$ 121.16
|
|
Atlanta
|
Breast
and Cervical Cancer
|
Breast
and Cervical Cancer
|
$ 996.24
|
$ 960.69
|
|
Atlanta
|
Maternity
Delivery/Kick Payment
|
Maternity
Delivery/Kick Payment
|
$ 5,828.22
|
$ 5,576.09
|
|
Atlanta
|
NICU
Kick
|
NICU
Kick
|
$ 89,180.47
|
$ 85,376.23
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
0 -
2 Months, Male and Female
|
$ 1,675.18
|
$ 1,605.98
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
3-11
Months, Male and Female
|
$ 185.21
|
$ 178.14
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
$ 122.76
|
$ 118.27
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
6-13
Years, Male and Female
|
$ 114.59
|
$ 110.40
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Female
|
$ 180.50
|
$ 173.81
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Male
|
$ 127.44
|
$ 122.78
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Female
|
$ 311.28
|
$ 300.28
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Male
|
$ 299.54
|
$ 288.94
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
$ 598.73
|
$ 577.68
|
|
Central
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
$ 708.27
|
$ 682.55
|
|
Central
|
PeachCare
|
0 -
2 Months, Male and Female
|
$ 160.54
|
$ 154.45
|
|
Central
|
PeachCare
|
3-11
Months, Male and Female
|
$ 160.54
|
$ 154.45
|
|
Central
|
PeachCare
|
1 -
5 Years, Male and Female
|
$ 126.61
|
$ 122.02
|
|
Central
|
PeachCare
|
6-13
Years, Male and Female
|
$ 128.54
|
$ 123.91
|
|
Central
|
PeachCare
|
14-20
Years, Female
|
$ 155.64
|
$ 150.03
|
|
Central
|
PeachCare
|
14-20
Years, Male
|
$ 137.34
|
$ 132.43
|
|
Central
|
Breast
and Cervical Cancer
|
Breast
and Cervical Cancer
|
$ 996.09
|
$ 960.52
|
|
Central
|
Maternity
Delivery/Kick Payment
|
Maternity
Delivery/Kick Payment
|
$ 5,742.45
|
$ 5,494.02
|
|
Central
|
NICU
Kick
|
NICU
Kick
|
$ 82,199.07
|
$ 78,693.93
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
0-2
Months, Male and Female
|
$ 1,690.27
|
$ 1,620.66
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
3-11
Months, Male and Female
|
$ 201.57
|
$ 194.06
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
$ 129.78
|
$ 125.12
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
6-13
Years, Male and Female
|
$ 110.86
|
$ 106.84
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Female
|
$ 202.07
|
$ 194.73
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Male
|
$ 118.96
|
$ 114.68
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
21
-44 Years, Female
|
$ 347.60
|
$ 335.32
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
21
-44 Years, Male
|
$ 306.59
|
$ 295.68
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
$ 591.28
|
$ 570.54
|
|
East
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
$ 713.80
|
$ 688.53
|
|
East
|
PeachCare
|
0 -
2 Months, Male and Female
|
$ 174.78
|
$ 168.29
|
|
East
|
PeachCare
|
3-11
Months, Male and Female
|
$ 174.78
|
$ 168.29
|
|
East
|
PeachCare
|
1 -
5 Years, Male and Female
|
$ 134.56
|
$ 129.75
|
|
East
|
PeachCare
|
6-13
Years, Male and Female
|
$ 123.76
|
$ 119.32
|
|
East
|
PeachCare
|
14-20
Years, Female
|
$ 164.53
|
$ 158.57
|
|
East
|
PeachCare
|
14-20
Years, Male
|
$ 129.92
|
$ 125.18
|
|
East
|
Breast
and Cervical Cancer
|
Breast
and Cervical Cancer
|
$ 1,003.31
|
$ 967.49
|
|
East
|
Maternity
Delivery/Kick Payment
|
Maternity
Delivery/Kick Payment
|
$ 5,921.35
|
$ 5,665.19
|
|
East
|
NICU
Kick
|
NICU
Kick
|
$ 80,632.48
|
$ 77,196.62
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
0 -
2 Months, Male and Female
|
$ 1,790.19
|
$ 1,716.84
|
Page 1 of
2
|
Region
|
Aid
Category
|
Age/Gender
Group
|
WellCare
July-September
2009
|
WellCare
October
2009 to June 2010
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
3-11
Months, Male and Female
|
$ 192.84
|
$ 185.49
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
$ 142.26
|
$ 137.04
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
6-13
Years, Male and Female
|
$ 142.91
|
$ 137.68
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Female
|
$ 222.25
|
$ 214.02
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Male
|
$ 158.97
|
$ 153.20
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Female
|
$ 403.72
|
$ 389.44
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
21
-44 Years, Male
|
$ 400.10
|
$ 385.65
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
$ 658.72
|
$ 635.51
|
|
North
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
$ 812.41
|
$ 782.42
|
|
North
|
PeachCare
|
0 -
2 Months, Male and Female
|
$ 167.09
|
$ 160.75
|
|
North
|
PeachCare
|
3-11
Months, Male and Female
|
$ 167.09
|
$ 160.75
|
|
North
|
PeachCare
|
1 -
5 Years, Male and Female
|
$ 123.94
|
$ 119.38
|
|
North
|
PeachCare
|
6-13
Years, Male and Female
|
$ 128.72
|
$ 124.00
|
|
North
|
PeachCare
|
14-20
Years, Female
|
$ 172.01
|
$ 165.66
|
|
North
|
PeachCare
|
14-20
Years, Male
|
$ 138.46
|
$ 133.42
|
|
North
|
Breast
and Cervical Cancer
|
Breast
and Cervical Cancer
|
$ 1,008.97
|
$ 972.94
|
|
North
|
Maternity
Delivery/Kick Payment
|
Maternity
Delivery/Kick Payment
|
$ 5,704.89
|
$ 5,458.10
|
|
North
|
NICU
Kick
|
NICU
Kick
|
$ 82,842.77
|
$ 79,311.86
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
0 -
2 Months, Male and Female
|
$ 1,628.72
|
$ 1,562.20
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
3-11
Months, Male and Female
|
$ 186.14
|
$ 179.04
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
$ 133.80
|
$ 128.95
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
6-13
Years, Male and Female
|
$ 121.50
|
$ 117.12
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Female
|
$ 195.90
|
$ 188.67
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Male
|
$ 132.97
|
$ 128.12
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Female
|
$ 369.67
|
$ 356.39
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
21
-44 Years, Male
|
$ 396.79
|
$ 382.48
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
$ 742.13
|
$ 715.77
|
|
Southeast
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
$ 923.92
|
$ 890.72
|
|
Southeast
|
PeachCare
|
0 -
2 Months, Male and Female
|
$ 161.35
|
$ 155.23
|
|
Southeast
|
PeachCare
|
3-11
Months, Male and Female
|
$ 161.35
|
$ 155.23
|
|
Southeast
|
PeachCare
|
1 -
5 Years, Male and Female
|
$ 134.89
|
$ 130.00
|
|
Southeast
|
PeachCare
|
6-13
Years, Male and Female
|
$ 142.79
|
$ 137.75
|
|
Southeast
|
PeachCare
|
14-20
Years, Female
|
$ 162.72
|
$ 156.84
|
|
Southeast
|
PeachCare
|
14-20
Years, Male
|
$ 154.72
|
$ 149.19
|
|
Southeast
|
Breast
and Cervical Cancer
|
Breast
and Cervical Cancer
|
$ 1,015.86
|
$ 979.58
|
|
Southeast
|
Maternity
Delivery/Kick Payment
|
Maternity
Delivery/Kick Payment
|
$ 6,031.48
|
$ 5,770.55
|
|
Southeast
|
NICU
Kick
|
NICU
Kick
|
$ 76,845.57
|
$ 73,576.46
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
0 -
2 Months, Male and Female
|
$ 1,833.77
|
$ 1,757.58
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
3-11
Months, Male and Female
|
$ 205.02
|
$ 197.45
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
1 -
5 Years, Male and Female
|
$ 142.69
|
$ 137.55
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
6-13
Years, Male and Female
|
$ 122.44
|
$ 117.99
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
14
- 20 Years, Female
|
$ 196.04
|
$ 188.92
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
14-20
Years, Male
|
$ 121.47
|
$ 117.05
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
21
- 44 Years, Female
|
$ 331.39
|
$ 319.87
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
21
-44 Years, Male
|
$ 282.47
|
$ 272.58
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Female
|
$ 577.38
|
$ 557.45
|
|
Southwest
|
Medicaid
(LIM/Refugee/RSM)
|
45+
Years, Male
|
$ 699.06
|
$ 674.63
|
|
Southwest
|
PeachCare
|
0 -
2 Months, Male and Female
|
$ 178.04
|
$ 171.49
|
|
Southwest
|
PeachCare
|
3-11
Months, Male and Female
|
$ 178.04
|
$ 171.49
|
|
Southwest
|
PeachCare
|
1 -
5 Years, Male and Female
|
$ 150.00
|
$ 144.69
|
|
Southwest
|
PeachCare
|
6 -
13 Years, Male and Female
|
$ 143.89
|
$ 138.78
|
|
Southwest
|
PeachCare
|
14-20
Years, Female
|
$ 171.84
|
$ 165.60
|
|
Southwest
|
PeachCare
|
14-20
Years, Male
|
$ 143.49
|
$ 138.32
|
|
Southwest
|
Breast
and Cervical Cancer
|
Breast
and Cervical Cancer
|
$ 1,007.61
|
$ 971.63
|
|
Southwest
|
Maternity
Delivery/Kick Payment
|
Maternity
Delivery/Kick Payment
|
$ 5,536.79
|
$ 5,297.26
|
|
Southwest
|
NICU
Kick
|
NICU
Kick
|
$ 82,732.78
|
$ 79,204.54
|
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