WELLCARE HEALTH PLANS, INC. - FORM 8-K - EX-10.4 - FA972 AMENDMENT 1 - February 4, 2013

Attached files

file filename
8-K - FORM 8-K - WELLCARE HEALTH PLANS, INC.form8k.htm
EX-10.3 - FA971 AMENDMENT 2 - WELLCARE HEALTH PLANS, INC.fa971.htm
 
Back to 8-k  Exhibit 10.4

 


AHCA CONTRACT NO. FA972
AMENDMENT NO. 1

THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the "Agency" and WELLCARE OF FLORIDA, INC., D/B/A HEALTHEASE, hereinafter referred to as the "Vendor," or “Health Plan,” is hereby amended as follows:
 
1.
Standard Contract, Section III., Item A., Termination, sub-item 3., Termination for Breach, first paragraph, the third sentence is hereby amended to now read as follows:
 
If applicable, the Agency may employ the default provisions in Rule 60A-1.006(3), Florida Administrative Code.
 
2.
Effective September 1, 2012, Attachment I, Scope of Services, Capitated Health Plans, Exhibit 2-NR, Medicaid Non-Reform Capitation Rates, Effective September 1, 2011, is hereby deleted in its entirety and replaced with Exhibit 2-NR, Medicaid Non-Reform HMO Capitation Rates, September 1, 2012 – August 31, 2013 (90112), attached hereto and made a part of this Contract.
 
3.
Effective January 1, 2013, Attachment II, Core Contract Provisions, Section V, Covered Services, Item H., Coverage Provisions is hereby amended to include sub-item 23. as follows:
 
 
23.
Primary Care Services
 
The Health Plan shall process claims for and, if capitated or are approved by the Agency to subcapitate for certain covered services, pay certain physicians who provide Florida Medicaid-covered eligible primary care services in accordance with the Affordable Care Act and 42 CFR sections 438 and 447, for the period January 1, 2013, through December 31, 2014. Health Plans that are approved by the Agency to subcapitate for services shall also pay in accordance with such requirements
 
Unless otherwise stated, this amendment shall be effective upon execution by both Parties.
 
All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in this Contract.
 
This amendment, and all its attachments, are hereby made part of this Contract.
 
This amendment cannot be executed unless all previous amendments to this Contract have been fully executed.
 
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
 

AHCA Contract No. FA972, Amendment No. 1, Page  1 of 2

 
 
 

 
IN WITNESS WHEREOF, the Parties hereto have caused this seven (7) page amendment (including all attachments) to be executed by their officials thereunto duly authorized.
 
 
WELLCARE OF FLORIDA, INC.,  
D/B/A STAYWELL HEALTH PLAN OF    
FLORIDA
 
 STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
 
         
         
SIGNED
BY:
  /s/ Christina Cooper  
SIGNED
BY:
  /s/Elizabeth Dudek
         
NAME:  Christina Cooper   NAME:   Elizabeth Dudek
         
TITLE:  President, FL and HI Division   TITLE:  Secretary
         
DATE:  1/3/13   DATE:  1/10/13
  
 
List of Attachments/Exhibits included as part of this amendment:
                                  
Specify
Type
Number
Description
Attachment I
Exhibit 2-NR
Medicaid Non-Reform HMO Capitation Rates, September 1, 2012 – August 31, 2013 (90112) (5 Pages)

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK


AHCA Contract No. FA972, Amendment No. 1, Page  2 of 2

 
 
 
 
 

 

 


EXHIBIT 2 - NR
ESTIMATED HEALTH PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS
(MEDICAID Non-Reform HMO CAPITATION RATES)
September 1, 2012 - August 31, 2013 (90112)
By Area , Age and Eligibility Category
 

TABLE 1 
 General Rates:                                
           TANF              SSI-N        SSI-B
SSI-AB 
           AGE (14-20)  AGE (21-54)                      
    Area
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
Female                  Male
Female                  Male
AGE (55+)
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
  AGE (14-20)
AGE (21-54)
AGE (55+)
    AGE (65-)
AGE(65+)
01   1,044.10   176.87   97.38   60.25   120.03   62.88   275.12   123.66   286.22   23,175.16   2,589.79   260.75   143.76   178.78   725.48   788.53   353.96   99.74   79.65
02   962.26   163.01   90.13   57.49   112.56   59.89   255.25   115.67   264.90   21,691.74   2,423.90   237.61   117.79   152.73   651.93   728.05   353.96   93.24   74.33
03   1,132.49   191.85   106.18   68.14   132.95   70.97   300.83   136.55   312.05   23,983.47   2,680.18   273.22   157.59   192.69   765.02   821.29   353.96   92.76   73.94
04   1,224.06   207.35   113.91   69.29   139.40   72.40   321.40   143.83   334.79   26,645.33   2,977.63   302.25   171.70   211.14   844.47   910.43   353.96   88.79   70.69
05   1,314.12   222.62   123.01   78.07   153.29   81.36   348.21   157.58   361.52   26,552.12   2,967.14   297.54   161.57   202.09   826.11   901.56   353.96   78.87   62.58
06   1,233.32   208.96   116.42   78.18   148.71   81.20   331.03   152.13   342.09   25,907.64   2,895.25   297.29   175.80   213.01   835.41   890.51   353.96   78.53   62.31
07   1,189.59   201.49   110.21   64.80   132.98   67.86   310.16   137.59   323.92   27,626.61   3,087.18   308.28   164.73   207.33   854.09   936.03   353.96   77.12   61.15
09   1,228.70   208.14   114.67   71.23   141.58   74.33   324.06   145.83   337.02   28,336.53   3,166.45   312.52   159.40   204.33   860.57   954.38   353.96   87.68   69.78
10   1,087.72   184.27   101.80   64.51   126.76   67.23   288.12   130.34   299.17   29,961.41   3,348.10   334.98   180.35   226.33   929.01   1,016.15   353.96   91.91   73.25
11   1,365.87   231.40   128.48   84.35   162.48   87.72   364.68   166.55   377.59   26,428.69   2,953.34   295.73   159.73   200.21   820.51   896.71   353.96   104.17   83.26
6B   1,232.80   208.88   116.40   78.35   148.84   81.36   331.06   152.23   342.07   25,906.00   2,895.07   297.32   175.93   213.11   835.58   890.53   353.96   78.53   62.31
8A   1,220.23   206.73   114.76   75.21   145.02   78.23   325.67   148.67   337.25   27,586.10   3,082.83   316.74   187.71   227.26   890.38   948.50   353.96   88.70   70.62
8B   1,111.87   188.36   104.24   66.89   130.51   69.65   295.33   134.05   306.36   25,996.71   2,905.10   292.67   161.74   200.96   814.57   884.82   353.96   85.56   68.05

TABLE 2
General + Mental Health Rates:                                
                                   
          TANF             SSI-N    SSI-B SSI-AB
           AGE (14-20)  AGE (21-54)                      
  Area
BTHMO+2MO
3MO-11MO
AGE (1-5)
 AGE (6-13)
Female                 Male
  Female                  Male
AGE (55+)
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
  AGE (14-20)
AGE (21-54)
AGE (55+)
    AGE (65-)
AGE(65+)
01   1,044.18   176.95   99.62   71.64   131.27   74.12   284.95   133.49   292.73   23,175.56   2,590.19   279.12   191.60   220.46   802.81   817.07   371.28   109.99   89.90
02   962.32   163.07   91.81   66.02   120.98   68.31   262.61   123.03   269.78   21,692.25   2,424.41   261.25   179.34   206.35   751.43   764.78   371.28   103.49   84.58
03   1,132.56   191.92   108.06   77.70   142.38   80.40   309.07   144.79   317.51   23,983.81   2,680.52   288.85   198.29   228.15   830.81   845.57   371.28   103.01   84.19
04   1,224.16   207.45   116.80   83.98   153.90   86.90   334.07   156.50   343.19   26,645.73   2,978.03   320.91   220.29   253.47   923.02   939.42   371.28   99.04   80.94
05   1,314.20   222.70   125.39   90.16   165.22   93.29   358.64   168.01   368.43   26,552.60   2,967.62   319.79   219.52   252.58   919.79   936.13   371.28   89.12   72.83
06   1,233.37   209.01   117.68   84.62   155.06   87.55   336.58   157.68   345.77   25,907.96   2,895.57   312.03   214.19   246.45   897.46   913.41   371.28   88.78   72.56
07   1,189.71   201.61   113.51   81.62   149.57   84.45   324.67   152.10   333.53   27,627.14   3,087.71   332.73   228.41   262.80   957.02   974.02   371.28   87.37   71.40
09   1,228.79   208.23   117.24   84.30   154.48   87.23   335.33   157.10   344.49   28,337.15   3,167.07   341.28   234.28   269.56   981.61   999.05   371.28   97.93   80.03
10   1,087.79   184.34   103.79   74.63   136.75   77.22   296.85   139.07   304.96   29,961.97   3,348.66   360.85   247.71   285.01   1,037.89   1,056.34   371.28   102.16   83.50
11   1,365.94   231.47   130.32   93.71   171.72   96.96   372.76   174.63   382.94   26,429.18   2,953.83   318.30   218.50   251.41   915.52   931.78   371.28   114.42   93.51
6B   1,232.84   208.92   117.63   84.58   154.99   87.51   336.44   157.61   345.63   25,906.32   2,895.39   312.01   214.18   246.43   897.41   913.35   371.28   88.78   72.56
8A   1,220.29   206.79   116.43   83.72   153.41   86.62   333.01   156.01   342.11   27,586.43   3,083.16   332.24   228.07   262.42   955.61   972.58   371.28   98.95   80.87
8B   1,111.94   188.43   106.09   76.29   139.79   78.93   303.44   142.16   311.73   25,997.15   2,905.54   313.10   214.93   247.30   900.55   916.55   371.28   95.81   78.30
 
 
 

 
 
AHCA Contract No. FA972, Attachment I, Exhibit 2-NR, Page 1 of 5
 
 

EXHIBIT 2 - NR
ESTIMATED HEALTH PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS
(MEDICAID Non-Reform HMO CAPITATION RATES)
September 1, 2012 - August 31, 2013 (90112)
By Area , Age and Eligibility Category
 
TABLE 3 
General + MH + Dental Rates:
                                  
                                       
 
TANF
                  
SSI-N
          
SSI-B
SSI-AB
  
Area
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
AGE (14-20)
 AGE (21-54)  
AGE (55+)
BTHMO+2MO
3MO-11MO
AGE (1-5)
 AGE (6-13) AGE (14-20)
AGE (21-54)
AGE (55+)
  
AGE (65-)
AGE (65+)
         
Female
Male
Female
Male
                      
01   1,044.18   176.96   101.49   74.61   134.03   77.30   286.70   135.13   295.93   23,175.56   2,590.20   281.06   194.04   222.64   804.38   819.27   373.69   110.98   90.72
02   962.33   163.09   95.76   72.29   126.81   75.04   266.15   126.34   276.24   21,692.26   2,424.43   265.21   184.33   210.80   753.49   767.67   373.69   104.93   85.77
03   1,132.58   191.95   114.35   87.70   151.68   91.12   312.29   147.80   323.38   23,983.82   2,680.55   295.56   206.73   235.69   833.00   848.62   373.69   104.94   85.78
04   1,224.17   207.47   120.41   89.72   159.24   93.05   337.91   160.09   350.20   26,645.74   2,978.05   324.64   224.98   257.66   925.96   943.53   373.69   101.15   82.68
05   1,314.22   222.73   132.37   101.25   175.54   105.18   362.92   172.02   376.25   26,552.61   2,967.65   326.50   227.96   260.12   922.47   939.88   373.69   91.44   74.74
06   1,233.38   209.04   123.44   93.77   163.57   97.37   338.87   159.82   349.94   25,907.97   2,895.59   317.31   220.83   252.38   899.06   915.65   373.69   90.36   73.86
07   1,189.73   201.64   120.12   92.13   159.35   95.73   327.55   154.80   338.79   27,627.15   3,087.74   339.32   236.70   270.20   959.00   976.79   373.69   89.18   72.89
09   1,228.81   208.27   125.84   97.98   167.20   101.90   338.50   160.06   350.27   28,337.16   3,167.10   349.01   244.00   278.24   983.98   1,002.36   373.69   99.99   81.73
10   1,087.80   184.36   108.23   81.68   143.31   84.78   298.21   140.34   307.44   29,961.98   3,348.68   366.05   254.26   290.86   1,039.64   1,058.79   373.69   103.56   84.65
11   1,366.02   231.55   139.28   108.79   184.83   110.07   374.98   176.70   386.98   26,429.18   2,953.83   329.16   230.76   260.96   918.53   935.98   373.69   117.45   96.01
6B   1,232.85   208.95   123.39   93.73   163.50   97.33   338.73   159.75   349.80   25,906.33   2,895.41   317.29   220.82   252.36   899.01   915.59   373.69   90.36   73.86
8A   1,220.32   206.84   127.98   102.09   170.49   106.32   336.78   159.53   348.99   27,586.45   3,083.20   342.39   240.83   273.82   958.31   976.35   373.69   101.47   82.95
8B   1,111.97   188.48   116.21   92.38   154.76   96.19   306.24   144.78   316.84   25,997.16   2,905.57   321.27   225.21   256.48   902.57   919.37   373.69   97.46   79.66

TABLE 4
General + MH + Transportation Rates:
                            
                                 
         
TANF
            
SSI-N
    
SSI-B
SSI-AB
          AGE (14-20)  AGE (21-54)                       
Area
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
 Female
Male
  Female
 Male
AGE (55+)
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
 AGE (14-20) 
 AGE (21-54)
AGE (55+)
   AGE (65-)  
AGE (65+)
01   1,050.20   178.92   100.80   72.42   132.86   76.58   287.64   137.29   296.27   23,220.19   2,624.21   287.27   197.37   229.60   827.01   838.17   374.89   114.19   93.11
02   967.80   164.86   92.88   66.73   122.43   70.55   265.06   126.49   273.00   21,732.42   2,455.03   268.58   184.53   214.57   773.21   783.77   374.89   107.00   87.26
03   1,138.56   193.89   109.23   78.48   143.97   82.85   311.76   148.58   321.04   24,023.02   2,710.41   296.01   203.36   236.18   852.07   864.10   374.89   107.41   87.55
04   1,229.96   209.35   117.94   84.73   155.43   89.27   336.66   160.16   346.61   26,691.49   3,012.91   329.26   226.20   262.84   947.83   961.05   374.89   104.55   85.15
05   1,318.77   224.20   126.29   90.75   166.43   95.16   360.69   170.90   371.12   26,589.93   2,996.07   326.60   224.34   260.22   940.03   953.77   374.89   93.73   76.35
06   1,238.15   210.58   118.62   85.24   156.32   89.50   338.72   160.70   348.59   25,947.17   2,925.46   319.19   219.26   254.48   918.72   931.95   374.89   92.87   75.68
07   1,194.72   203.25   114.49   82.27   150.89   86.49   326.91   155.26   336.48   27,668.14   3,118.96   340.22   233.71   271.19   979.25   993.40   374.89   90.67   73.92
09   1,234.50   210.10   118.36   85.04   155.99   89.56   337.89   160.71   347.85   28,377.81   3,198.06   348.70   239.54   277.88   1,003.65   1,018.27   374.89   102.51   83.53
10   1,093.71   186.28   104.95   75.40   138.31   79.64   299.50   142.81   308.45   30,012.86   3,387.45   370.14   254.29   295.43   1,065.48   1,080.39   374.89   106.75   87.00
11   1,370.41   232.93   131.19   94.29   172.90   98.78   374.76   177.45   385.57   26,466.18   2,982.03   325.06   223.28   258.98   935.58   949.27   374.89   117.89   96.16
6B   1,237.62   210.49   118.57   85.20   156.25   89.46   338.58   160.63   348.45   25,945.53   2,925.28   319.17   219.25   254.46   918.67   931.89   374.89   92.87   75.68
8A   1,226.17   208.72   117.58   84.48   154.96   89.02   335.64   159.72   345.57   27,626.55   3,113.74   339.56   233.26   270.63   977.36   991.54   374.89   101.08   82.50
8B   1,117.96   190.40   107.27   77.07   141.38   81.39   306.13   145.96   315.27   26,035.24   2,934.58   320.06   219.85   255.10   921.20   934.56   374.89   99.43   81.07
 
 

  AHCA Contract No. FA972, Attachment I, Exhibit 2-NR, Page 2 of 5   
 
 

EXHIBIT 2 - NR
ESTIMATED HEALTH PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS
(MEDICAID Non-Reform HMO CAPITATION RATES)
September 1, 2012 - August 31, 2013 (90112)
By Area , Age and Eligibility Category
 
TABLE 5 
General + Transportation Rates:                                  
                                       
 
TANF
                  
SSI-N
          
SSI-B
SSI-AB
Area
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
AGE (14-20)
AGE (21-54)
AGE (55+)
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
AGE (14-20) AGE (21-54)
AGE (55+)
   AGE (65-)
AGE(65+)
         
Female
Male
Female
Male
                      
01   1,050.12   178.84   98.56   61.03   121.62   65.34   277.81   127.46   289.76   23,219.79   2,623.81   268.90   149.53   187.92   749.68   809.63   357.57   103.94   82.86
02   967.74   164.80   91.20   58.20   114.01   62.13   257.70   119.13   268.12   21,731.91   2,454.52   244.94   122.98   160.95   673.71   747.04   357.57   96.75   77.01
03   1,138.49   193.82   107.35   68.92   134.54   73.42   303.52   140.34   315.58   24,022.68   2,710.07   280.38   162.66   200.72   786.28   839.82   357.57   97.16   77.30
04   1,229.86   209.25   115.05   70.04   140.93   74.77   323.99   147.49   338.21   26,691.09   3,012.51   310.60   177.61   220.51   869.28   932.06   357.57   94.30   74.90
05   1,318.69   224.12   123.91   78.66   154.50   83.23   350.26   160.47   364.21   26,589.45   2,995.59   304.35   166.39   209.73   846.35   919.20   357.57   83.48   66.10
06   1,238.10   210.53   117.36   78.80   149.97   83.15   333.17   155.15   344.91   25,946.85   2,925.14   304.45   180.87   221.04   856.67   909.05   357.57   82.62   65.43
07   1,194.60   203.13   111.19   65.45   134.30   69.90   312.40   140.75   326.87   27,667.61   3,118.43   315.77   170.03   215.72   876.32   955.41   357.57   80.42   63.67
09   1,234.41   210.01   115.79   71.97   143.09   76.66   326.62   149.44   340.38   28,377.19   3,197.44   319.94   164.66   212.65   882.61   973.60   357.57   92.26   73.28
10   1,093.64   186.21   102.96   65.28   128.32   69.65   290.77   134.08   302.66   30,012.30   3,386.89   344.27   186.93   236.75   956.60   1,040.20   357.57   96.50   76.75
11   1,370.34   232.86   129.35   84.93   163.66   89.54   366.68   169.37   380.22   26,465.69   2,981.54   302.49   164.51   207.78   840.57   914.20   357.57   107.64   85.91
6B   1,237.58   210.45   117.34   78.97   150.10   83.31   333.20   155.25   344.89   25,945.21   2,924.96   304.48   181.00   221.14   856.84   909.07   357.57   82.62   65.43
8A   1,226.11   208.66   115.91   75.97   146.57   80.63   328.30   152.38   340.71   27,626.22   3,113.41   324.06   192.90   235.47   912.13   967.46   357.57   90.83   72.25
8B   1,117.89   190.33   105.42   67.67   132.10   72.11   298.02   137.85   309.90   26,034.80   2,934.14   299.63   166.66   208.76   835.22   902.83   357.57   89.18   70.82

TABLE 6
General + Dental Rates:
                                    
                                       
 
TANF
                  
SSI-N
          
SSI-B
SSI-AB
Area
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
AGE (14-20)
AGE (21-54)
AGE (55+)
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
AGE (14-20) AGE (21-54)
AGE (55+)
   AGE (65-) 
AGE (65+)
         
Female
Male
Female
Male
                      
01   1,044.10   176.88   99.25   63.22   122.79   66.06   276.87   125.30   289.42   23,175.16   2,589.80   262.69   146.20   180.96   727.05   790.73   356.37   100.73   80.47
02   962.27   163.03   94.08   63.76   118.39   66.62   258.79   118.98   271.36   21,691.75   2,423.92   241.57   122.78   157.18   653.99   730.94   356.37   94.68   75.52
03   1,132.51   191.88   112.47   78.14   142.25   81.69   304.05   139.56   317.92   23,983.48   2,680.21   279.93   166.03   200.23   767.21   824.34   356.37   94.69   75.53
04   1,224.07   207.37   117.52   75.03   144.74   78.55   325.24   147.42   341.80   26,645.34   2,977.65   305.98   176.39   215.33   847.41   914.54   356.37   90.90   72.43
05   1,314.14   222.65   129.99   89.16   163.61   93.25   352.49   161.59   369.34   26,552.13   2,967.17   304.25   170.01   209.63   828.79   905.31   356.37   81.19   64.49
06   1,233.33   208.99   122.18   87.33   157.22   91.02   333.32   154.27   346.26   25,907.65   2,895.27   302.57   182.44   218.94   837.01   892.75   356.37   80.11   63.61
07   1,189.61   201.52   116.82   75.31   142.76   79.14   313.04   140.29   329.18   27,626.62   3,087.21   314.87   173.02   214.73   856.07   938.80   356.37   78.93   62.64
09   1,228.72   208.18   123.27   84.91   154.30   89.00   327.23   148.79   342.80   28,336.54   3,166.48   320.25   169.12   213.01   862.94   957.69   356.37   89.74   71.48
10   1,087.73   184.29   106.24   71.56   133.32   74.79   289.48   131.61   301.65   29,961.42   3,348.12   340.18   186.90   232.18   930.76   1,018.60   356.37   93.31   74.40
11   1,365.95   231.48   137.44   99.43   175.59   100.83   366.90   168.62   381.63   26,428.69   2,953.34   306.59   171.99   209.76   823.52   900.91   356.37   107.20   85.76
6B   1,232.81   208.91   122.16   87.50   157.35   91.18   333.35   154.37   346.24   25,906.01   2,895.09   302.60   182.57   219.04   837.18   892.77   356.37   80.11   63.61
8A   1,220.26   206.78   126.31   93.58   162.10   97.93   329.44   152.19   344.13   27,586.12   3,082.87   326.89   200.47   238.66   893.08   952.27   356.37   91.22   72.70
8B   1,111.90   188.41   114.36   82.98   145.48   86.91   298.13   136.67   311.47   25,996.72   2,905.13   300.84   172.02   210.14   816.59   887.64   356.37   87.21   69.41







AHCA Contract No. FA972, Attachment I, Exhibit 2-NR, Page 3 of 5   
 
 
 
EXHIBIT 2 - NR
ESTIMATED HEALTH PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS
(MEDICAID Non-Reform HMO CAPITATION RATES)
September 1, 2012 - August 31, 2013 (90112)
By Area , Age and Eligibility Category
 
 
TABLE 7 
 General + Dental + Transportation Rates:                                  
                                       
 
TANF
                  
SSI-N
          
SSI-B
SSI-AB
Area
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
AGE (14-20)
AGE (21-54)
AGE (55+)
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
  AGE (14-20)
AGE (21-54)
AGE (55+)
    AGE (65-)
 AGE (65+)
         
Female
Male
Female
Male
                      
01   1,050.12   178.85   100.43   64.00   124.38   68.52   279.56   129.10   292.96   23,219.79   2,623.82   270.84   151.97   190.10   751.25   811.83   359.98   104.93   83.68
02   967.75   164.82   95.15   64.47   119.84   68.86   261.24   122.44   274.58   21,731.92   2,454.54   248.90   127.97   165.40   675.77   749.93   359.98   98.19   78.20
03   1,138.51   193.85   113.64   78.92   143.84   84.14   306.74   143.35   321.45   24,022.69   2,710.10   287.09   171.10   208.26   788.47   842.87   359.98   99.09   78.89
04   1,229.87   209.27   118.66   75.78   146.27   80.92   327.83   151.08   345.22   26,691.10   3,012.53   314.33   182.30   224.70   872.22   936.17   359.98   96.41   76.64
05   1,318.71   224.15   130.89   89.75   164.82   95.12   354.54   164.48   372.03   26,589.46   2,995.62   311.06   174.83   217.27   849.03   922.95   359.98   85.80   68.01
06   1,238.11   210.56   123.12   87.95   158.48   92.97   335.46   157.29   349.08   25,946.86   2,925.16   309.73   187.51   226.97   858.27   911.29   359.98   84.20   66.73
07   1,194.62   203.16   117.80   75.96   144.08   81.18   315.28   143.45   332.13   27,667.62   3,118.46   322.36   178.32   223.12   878.30   958.18   359.98   82.23   65.16
09   1,234.43   210.05   124.39   85.65   155.81   91.33   329.79   152.40   346.16   28,377.20   3,197.47   327.67   174.38   221.33   884.98   976.91   359.98   94.32   74.98
10   1,093.65   186.23   107.40   72.33   134.88   77.21   292.13   135.35   305.14   30,012.31   3,386.91   349.47   193.48   242.60   958.35   1,042.65   359.98   97.90   77.90
11   1,370.42   232.94   138.31   100.01   176.77   102.65   368.90   171.44   384.26   26,465.69   2,981.54   313.35   176.77   217.33   843.58   918.40   359.98   110.67   88.41
6B   1,237.59   210.48   123.10   88.12   158.61   93.13   335.49   157.39   349.06   25,945.22   2,924.98   309.76   187.64   227.07   858.44   911.31   359.98   84.20   66.73
8A   1,226.14   208.71   127.46   94.34   163.65   100.33   332.07   155.90   347.59   27,626.24   3,113.45   334.21   205.66   246.87   914.83   971.23   359.98   93.35   74.33
8B   1,117.92   190.38   115.54   83.76   147.07   89.37   300.82   140.47   315.01   26,034.81   2,934.17   307.80   176.94   217.94   837.24   905.65   359.98   90.83   72.18
 
TABLE 8
 General + Mental Health + Dental + Transportation Rates:                                
                                       
 
TANF
                  
SSI-N
          
SSI-B
SSI-AB
Area
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
AGE (14-20)
AGE (21-54)
AGE (55+)
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
AGE (14-20) AGE (21-54)
AGE (55+)
    AGE (65-)
AGE (65+)
         
Female
Male
Female
Male
                      
01   1,050.20   178.93   102.67   75.39   135.62   79.76   289.39   138.93   299.47   23,220.19   2,624.22   289.21   199.81   231.78   828.58   840.37   377.30   115.18   93.93
02   967.81   164.88   96.83   73.00   128.26   77.28   268.60   129.80   279.46   21,732.43   2,455.05   272.54   189.52   219.02   775.27   786.66   377.30   108.44   88.45
03   1,138.58   193.92   115.52   88.48   153.27   93.57   314.98   151.59   326.91   24,023.03   2,710.44   302.72   211.80   243.72   854.26   867.15   377.30   109.34   89.14
04   1,229.97   209.37   121.55   90.47   160.77   95.42   340.50   163.75   353.62   26,691.50   3,012.93   332.99   230.89   267.03   950.77   965.16   377.30   106.66   86.89
05   1,318.79   224.23   133.27   101.84   176.75   107.05   364.97   174.91   378.94   26,589.94   2,996.10   333.31   232.78   267.76   942.71   957.52   377.30   96.05   78.26
06   1,238.16   210.61   124.38   94.39   164.83   99.32   341.01   162.84   352.76   25,947.18   2,925.48   324.47   225.90   260.41   920.32   934.19   377.30   94.45   76.98
07   1,194.74   203.28   121.10   92.78   160.67   97.77   329.79   157.96   341.74   27,668.15   3,118.99   346.81   242.00   278.59   981.23   996.17   377.30   92.48   75.41
09   1,234.52   210.14   126.96   98.72   168.71   104.23   341.06   163.67   353.63   28,377.82   3,198.09   356.43   249.26   286.56   1,006.02   1,021.58   377.30   104.57   85.23
10   1,093.72   186.30   109.39   82.45   144.87   87.20   300.86   144.08   310.93   30,012.87   3,387.47   375.34   260.84   301.28   1,067.23   1,082.84   377.30   108.15   88.15
11   1,370.49   233.01   140.15   109.37   186.01   111.89   376.98   179.52   389.61   26,466.18   2,982.03   335.92   235.54   268.53   938.59   953.47   377.30   120.92   98.66
6B   1,237.63   210.52   124.33   94.35   164.76   99.28   340.87   162.77   352.62   25,945.54   2,925.30   324.45   225.89   260.39   920.27   934.13   377.30   94.45   76.98
8A   1,226.20   208.77   129.13   102.85   172.04   108.72   339.41   163.24   352.45   27,626.57   3,113.78   349.71   246.02   282.03   980.06   995.31   377.30   103.60   84.58
8B   1,117.99   190.45   117.39   93.16   156.35   98.65   308.93   148.58   320.38   26,035.25   2,934.61   328.23   230.13   264.28   923.22   937.38   377.30   101.08   82.43



 
AHCA Contract No. FA972, Attachment I, Exhibit 2-NR, Page 4 of 5   
 
 
 
EXHIBIT 2 - NR
ESTIMATED HEALTH PLAN RATES; NOT FOR USE UNLESS APPROVED BY CMS
(MEDICAID Non-Reform HMO CAPITATION RATES)
September 1, 2012 - August 31, 2013 (90112)
By Area , Age and Eligibility Category
TABLE 9                                                                                                                                                         
 Mental Health Rates:                                    
                                       
 
TANF
                  
SSI-N
          
SSI-B
SSI-AB
  
Area
BTHMO+2MO
3MO-11MO
AGE (1-5)
AGE (6-13)
AGE (14-20)
AGE (21-54)
  
AGE (55+)
BTHMO+2MO
3MO-11MO
AGE (1-5)
  AGE (6-13)             AGE (14-20)
 AGE (21-54)
AGE (55+)
    AGE (65-)
AGE (65+)
         
Female
Male
Female
Male
                      
01   0.08   0.08   2.24   11.39   11.24   11.24   9.83   9.83   6.51   0.40   0.40   18.37   47.84   41.68   77.33   28.54   17.32   10.25   10.25
02   0.06   0.06   1.68   8.53   8.42   8.42   7.36   7.36   4.88   0.51   0.51   23.64   61.55   53.62   99.50   36.73   17.32   10.25   10.25
03   0.07   0.07   1.88   9.56   9.43   9.43   8.24   8.24   5.46   0.34   0.34   15.63   40.70   35.46   65.79   24.28   17.32   10.25   10.25
04   0.10   0.10   2.89   14.69   14.50   14.50   12.67   12.67   8.40   0.40   0.40   18.66   48.59   42.33   78.55   28.99   17.32   10.25   10.25
05   0.08   0.08   2.38   12.09   11.93   11.93   10.43   10.43   6.91   0.48   0.48   22.25   57.95   50.49   93.68   34.57   17.32   10.25   10.25
06   0.05   0.05   1.26   6.44   6.35   6.35   5.55   5.55   3.68   0.32   0.32   14.74   38.39   33.44   62.05   22.90   17.32   10.25   10.25
07   0.12   0.12   3.30   16.82   16.59   16.59   14.51   14.51   9.61   0.53   0.53   24.45   63.68   55.47   102.93   37.99   17.32   10.25   10.25
09   0.09   0.09   2.57   13.07   12.90   12.90   11.27   11.27   7.47   0.62   0.62   28.76   74.88   65.23   121.04   44.67   17.32   10.25   10.25
10   0.07   0.07   1.99   10.12   9.99   9.99   8.73   8.73   5.79   0.56   0.56   25.87   67.36   58.68   108.88   40.19   17.32   10.25   10.25
11   0.07   0.07   1.84   9.36   9.24   9.24   8.08   8.08   5.35   0.49   0.49   22.57   58.77   51.20   95.01   35.07   17.32   10.25   10.25
6B   0.04   0.04   1.23   6.23   6.15   6.15   5.38   5.38   3.56   0.32   0.32   14.69   38.25   33.32   61.83   22.82   17.32   10.25   10.25
8A   0.06   0.06   1.67   8.51   8.39   8.39   7.34   7.34   4.86   0.33   0.33   15.50   40.36   35.16   65.23   24.08   17.32   10.25   10.25
8B   0.07   0.07   1.85   9.40   9.28   9.28   8.11   8.11   5.37   0.44   0.44   20.43   53.19   46.34   85.98   31.73   17.32   10.25   10.25

 Area    Corresponding Counties
     
 Area 1    Escambia, Okaloosa, Santa Rosa, Walton
 Area 2    Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Washington, Wakulla
 Area 3    Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamiliton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, Union
 Area 4    Baker, Clay, Duval, Flagler, Nassau, St. Johns, Volusia
 Area 5    Pasco, Pinellas
 Area 6    Hardee, Highlands, Manatee, Polk
 Area 6B    Hillsborough
 Area 7    Brevard, Orange, Osceola, Seminole
 Area 8A    Lee
 Area 8B    Charlotte, Collier, De Soto, Glades, Hendry, Sarasota
 Area 9    Indian River, Okeechobee, St. Lucie, Martin, Palm Beach
 Area 10    Broward
 Area 11    Dade, Monroe
 
 
 
AHCA Contract No. FA972, Attachment I, Exhibit 2-NR, Page 5 of 5   

WELLCARE HEALTH PLANS, INC. Reports