AHCA CONTRACT NO. FA614

AHCA CONTRACT NO. FA614

AMENDMENT NO. 9

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, 2008, Standard Contract, Section III, Item C., Contract Managers, sub-item 1,

is hereby amended to now read as follows:

1.

The Agency’s Contract Manager’s name, address and telephone number for this Contract is as follows:

▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇
Agency for Health Care Administration ▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇, ▇▇ #▇▇

▇▇▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇

(▇▇▇) ▇▇▇-▇▇▇▇

2. Effective September 1, 2008, Attachment I, Scope of Services, is hereby amended to include Exhibit

III-D, September 1, 2008 — August 31, 2009 Medicaid Non-Reform HMO Capitation Rates, attached hereto and made a part of the Contract. All references in the Contract to Exhibit III-C, January 1, 2008 — August 31, 2008 Medicaid Non-Reform HMO Capitation Rates, shall hereinafter also refer to Exhibit III-D, September 1, 2008 — August 31, 2009 Medicaid Non-Reform HMO Capitation Rates, as appropriate.

3. Effective, December 1, 2008, Attachment II, Medicaid Prepaid Health Plan Model Contract, Section V,

Covered Services, Item C, Expanded Services, sub-item 2 is hereby deleted in its entirety and replaced with the following:

2. The following is a list of the Health Plan’s Expanded Services:

a.

OTC Medications — Up to ten ($10.00) credit per household each month for selected over- the-counter drugs and/or health supplies.

b.

Respite Care Services — Annual maximum of not more than an initial homehealth visit by RN @ $65.00 and eight (8) follow-up visits by an aide at $23.00 per visit. Follow-up visits are four (4) hours in length. Maximum of sixteen (16) hours in a given month and thirty- two (32) hours per year.

c.

Enhanced Hearing Aid Benefit — Upgrade from standard medically necessary, behind-theear hearing aid benefit to digital canal hearing aid up to $500.

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.

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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 seven (7) page Amendment (which includes all attachments hereto) to be executed by their officials thereunto duly authorized.

AMERIGROUP FLORIDA, INC. STATE OF FLORIDA, AGENCY
D/B/A AMERIGROUP COMMUNITY CARE FOR HEALTH CARE ADMISTRATIONSIGNED SIGNED

Capitation Rates (5 Pages)

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REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

TABLE 2
General + Mental Health Rates:

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

TABLE 4
General + Mental Health + Transportation Rates:

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

TABLE 5
General + Transportation Rates:

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

TABLE 6

General + Dental Rates:

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

TABLE 7
General + Dental + Transportation Rates:

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

TABLE 8
General + Mental Health + Dental + Transportation Rates:

EXHIBIT III-D
September 1, 2008 – August 31, 2009
Medicaid Non-Reform HMO Capitation Rates
By Area, Age and Eligibility Category

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