APPENDIX X [Amendment Number 7]
Exhibit
10.1
APPENDIX
X
[Amendment
Number 7]
Agency Code 12000 Contract
No. C020454
Period 4/1/08-9/30/10 Funding
Amount for Period Based
on approved capitation rates
This is
an AGREEMENT between THE STATE OF NEW YORK, acting by and through The
New York State Department of Health, having its principal office at Corning
Tower, Room ▇▇▇▇, ▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇ ▇▇ ▇▇▇▇▇, (hereinafter
referred to as the STATE), and WellCare
of New York.
Inc., (hereinafter referred to as the CONTRACTOR), to modify Contract
Number C020454 as set forth below and to extend the contract period
through September 30, 2010. The effective date of these modifications is April
1, 2008, unless otherwise noted below.
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1.
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Effective October 1,
2008, amend Section 1 "Definitions" to add a definition for "Medicaid
Managed
Care Quality Incentive" to read as
follows:
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"Medicaid
Managed Care Quality Incentive" means a monetary incentive in the form of
a percentage of the managed care capitation payment rates that is awarded to
MCOs with superior performance in relation to a predetermined set of measures
which may include quality of care, consumer satisfaction and compliance
measures.
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2.
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Effective
October 1, 2008, amend Section 2.7 "Termination" to read as
follows:
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2.7
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Termination |
a) SDOH
Initiated Termination
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i)
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SDOH
shall have the right to terminate this Agreement, in whole or in part; for
either the Contractor's MMC or FHPlus product; or for either or both
products in specified counties of Contractor's service area, if the
Contractor:
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A)
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takes
any action that threatens the health, safety, or welfare of its
Enrollees;
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B)
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has
engaged in an unacceptable practice under 18 NYCRR Part 515, that affects
the fiscal integrity of the MMC or FHPlus Program or engaged in an
unacceptable practice pursuant to Section 27.2 of this
Agreement;
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C)
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has
its Certificate of Authority suspended, limited or revoked by
SDOH;
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D)
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materially
breaches the Agreement or fails to comply with any term or condition of
this Agreement that is not cured within twenty (20) days, or to such
longer period as the parties may agree, of SDOH's written request for
compliance;
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E)
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becomes
insolvent;
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F)
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brings
a proceeding voluntarily, or has a proceeding brought against it
involuntarily, under Title 11 of the U.S. Code (the Bankruptcy
Code);
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G)
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knowingly
has a director, officer, partner or person owning or controlling more than
five percent (5%) of the Contractor's equity, or has an employment,
consulting, or other agreement with such a person for the provision of
items and/or services that are significant to the Contractor's contractual
obligation who has been debarred or suspended by the federal, state or
local government, or otherwise excluded from participating in procurement
activities; or
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Appendix
X
MMC/FHPlus
Contract Amendment
April 1,
2008
Page
1
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H)
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failed
to qualify for any incentive based on SDOH's Medicaid Managed Care Quality
Incentive calculation in each of three consecutive years; after two
consecutive years of failing to qualify for any such incentive, the
Contractor will be notified by SDOH that the Contractor has one year
remaining to raise its scores to the requisite level or be subject to
SDOH-initiated termination or non-renewal of this Agreement. By December 1
of each calendar year, SDOH will issue the general parameters of the
Quality Incentive measures to be implemented for the subsequent year which
form the basis for awarding the Quality Incentive in the year following
the measurement. In no instance will quality data scores for years prior
to measurement year 2007 be utilized for contract
termination.
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ii)
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The
SDOH will notify the Contractor of its intent to terminate this Agreement
for the Contractor's failure to meet the requirements of this Agreement
and provide Contractor with a hearing prior to the
termination.
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iii)
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If
SDOH suspends, limits or revokes Contractor's Certificate of Authority
under PHL § 4404, and:
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A)
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if
such action results in the Contractor ceasing to have authority to serve
the entire contracted service area, as defined by Appendix M of this
Agreement, this Agreement shall terminate on the date the Contractor
ceases to have such authority;
or
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B)
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if
such action results in the Contractor retaining authority to serve some
portion of the contracted service area, the Contractor shall continue to
offer its MMC and/or FHPlus products under this Agreement in any
designated geographic areas not affected by such action, and shall
terminate its MMC and/or FHPlus products in the geographic areas where the
Contractor ceases to have authority to
serve.
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iv)
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No
hearing will be required if this Agreement terminates due to SDOH
suspension, limitation or revocation of the Contractor's Certificate of
Authority.
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v)
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Prior
to the effective date of the termination the SDOH shall notify Enrollees
of the termination, or delegate responsibility for such notification to
the Contractor, and such notice shall include a statement that Enrollees
may disenroll immediately without
cause.
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b)
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Contractor
and SDOH Initiated
Termination
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The
Contractor and the SDOH each shall have the right to terminate this Agreement in
its entirety, for either the Contractor's MMC or FHPlus product, or for either
or both products in specified counties of the Contractor's service area, in the
event that SDOH and the Contractor fail to reach agreement on the monthly
Capitation Rates. In such event, the party exercising its right shall give the
other party written notice specifying the reason for and the effective date of
termination, which shall not be less time than will permit an orderly transition
of Enrollees, but no more than ninety (90) days.
c) Contractor
Initiated Termination
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i)
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The
Contractor shall have the right to terminate this Agreement in its
entirety, for either the Contractor's MMC or FHPlus product, or for either
or both products in specified counties of the
Contractor's service area, in the event that SDOH
materially breaches the Agreement or fails to comply with any term or
condition of this Agreement that is not cured within twenty (20) days, or
within such longer period as the parties may agree, of the Contractor's
written request for compliance. The Contractor shall give SDOH written
notice specifying the reason for and the effective date of the
termination, which shall not be less time than will permit an orderly
transition of Enrollees, but no more than ninety (90)
days.
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Appendix
X
MMC/FHPlus
Contract Amendment
April 1,
2008
Page
2
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ii)
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The
Contractor shall have the right to terminate this Agreement, in its
entirety, for either the Contractor's MMC or FHPlus product, or for either
or both products in specified counties of the Contractor's service area in
the event that its obligations are materially changed by modifications to
this Agreement and its Appendices by SDOH. In such event, Contractor shall
give SDOH written notice within thirty (30) days of notification of
changes to the Agreement or Appendices specifying the reason and the
effective date of termination, which shall not be less time than will
permit an orderly transition of Enrollees, but no more than ninety (90)
days.
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iii)
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The
Contractor shall have the right to terminate this Agreement in its
entirety, for either the Contractor's MMC or FHPlus product, or for either
or both products in specified counties of the Contractor's service area,
if the Contractor is unable to provide services pursuant to this Agreement
because of a natural disaster and/or an act of God to such a degree that
Enrollees cannot obtain reasonable access to services within the
Contractor's organization, and, after diligent efforts, the Contractor
cannot make other provisions for the delivery of such services. The
Contractor shall give SDOH written notice of any such termination that
specifies:
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A)
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the
reason for the termination, with appropriate documentation of the
circumstances arising from a natural disaster and/or an act of God that
preclude reasonable access to
services;
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B)
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the
Contractor's attempts to make other provision for the delivery of
services; and
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C)
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the
effective date of the termination, which shall not be less time than will
permit an orderly transition of Enrollees, but no more than ninety (90)
days.
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d) Termination
Due To Loss of Funding
In
the event that State and/or Federal funding used to pay for services under this
Agreement is reduced so that payments cannot be made in full, this Agreement shall
automatically terminate, unless both parties agree to a modification of the
obligations under this Agreement. The effective date of such
termination
shall be ninety
(90) days after the Contractor receives written notice of the reduction in
payment, unless available funds are insufficient to
continue
payments in full during the
ninety (90) day period, in which case SDOH shall give the Contractor written
notice of the earlier date upon which the
Agreement
shall terminate. A reduction in State
and/or Federal funding cannot reduce monies due and owing to the Contractor on
or before the effective
date
of the termination of the Agreement.
3.
Amend
Section 32.2 "Indemnification by SDOH" to read as
follows:
32.2 Indemnification
by SDOH
Subject to the availability of lawful appropriations as required by State
Finance Law § 41 and consistent with § 8 of the State Court of Claims Act, SDOH
shall hold
the Contractor harmless from and indemnify it for any final judgment of a court
of competent jurisdiction to the extent attributable to the negligence of SDOH
or its
officers or employees when acting within the course and scope of their
employment. Provisions concerning the SDOH's responsibility for any claims for
liability as
may arise during the term of this Agreement are set forth in the New York State
Court of Claims Act, and any damages arising for such liability shall issue from
the
New York State Court of Claims Fund or any applicable, annual appropriation of
the Legislature for the State of New York.
Appendix
X
MMC/FHPlus
Contract Amendment
April 1,
2008
Page 3
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4.
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Amend
Appendix D "New York State Department of Health Marketing Guidelines,"
Section D.3, 3. e) to read as
follows:
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e)
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The
Contractor shall limit the staffing (FTEs) involved in the
marketing/facilitated enrollment process. The limit shall be set at 150
FTEs for New York City and 75 FTEs for the metropolitan New York City area
defined as Nassau, Suffolk, Westchester and Rockland Counties. FTEs
subject to the limit include Marketing Representatives, Facilitated
Enrollers and any other staff that conduct new enrollments, provide
community presentations on coverage options and/or engage in outreach
activities designed to develop enrollment leads. Managers and retention
staff are not included in the limit as long as they do not personally
conduct enrollments.
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5.
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Add
a Section 15 "Accessibility of State Agency Web-based Intranet and
Internet Information and Applications" and a Section 16 "New York State
Tax Law Section 5-a" to Appendix R "Additional Specifications for the MMC
and FHPlus Agreement" to read as
follows:
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15.
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Accessibility
of State Agency Web-based Intranet and Internet Information and
Applications
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Any
web-based intranet and internet information and applications development, or
programming delivered pursuant to the contract will comply with NYS Office for
Technology Policy P04-002, "Accessibility of New York State Web-based Intranet
and Internet Information and Applications", and NYS Mandatory Technology
Standard S04-001, as such policy or standard may be amended, modified or
superseded, which requires that state agency web-based intranet and internet
information and applications are accessible to persons with disabilities. Web
content must conform to NYS Mandatory Technology Standard S04-001, as determined
by quality assurance testing. Such quality assurance testing will be conducted
by Department of Health, contractor or other, and the results of such testing
must be satisfactory to the Department of Health before web content will be
considered a qualified deliverable under the contract.
16. New
York State Tax Law Section 5-a
Section
5-a of the Tax Law, as amended, effective April 26, 2006, requires certain
contractors awarded state contracts for commodities, services and technology
valued at more than $100,000 to certify to the New York State Department of Tax
and Finance (DTF) that they are registered to collect New York State and local
sales and compensating use taxes. The law applies to contracts where the total
amount of such contractors' sales delivered into New York State are in excess of
$300,000 for the four quarterly periods immediately preceding the quarterly
period in which the certification is made, and with respect to any affiliates
and subcontractors whose sales delivered into New York State exceeded $300,000
for the four quarterly periods immediately preceding the quarterly period in
which the certification is made.
This law
imposes upon certain contractors the obligation to certify whether or not the
contractor, its affiliates, and its subcontractors are required to register to
collect sales and compensating use tax and contractors must certify to DTF that
each affiliate and subcontractor exceeding such sales threshold is registered
with DTF to collect New York State and local sales and compensating use taxes.
The law prohibits the State Comptroller, or other approving agencies, from
approving a contract awarded to an offerer meeting the registration requirements
but who is not so registered in accordance with the law.
Appendix
X
MMC/FHPlus
Contract Amendment
April 1,
2008
Page
4
Contractor
must complete and submit directly to the New York State Taxation and Finance,
Contractor Certification Form ST-220-TD. Unless the information upon which the
ST-220-TD is based changes, this form only needs to be filed once with DTF. If
the information changes for the contractor, its affiliate(s), or its
subcontractor(s), a new form (ST-220-TD) must be filed with DTF.
Contractor
must complete and submit to the Department of Health the form ST-220-CA
certifying that the contractor filed the ST-220-TD with DTF. Failure to make
either of these filings may render an offerer non-responsive and
non-responsible. Offerers shall take the necessary steps to provide properly
certified forms within a timely manner to ensure compliance with the
law.
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6.
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The
attached Appendix A, "New York State Standard Clauses," is substituted for
the period beginning April 1,
2008.
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7.
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The
attached Appendix L, "Approved Capitation Payment Rates," is substituted
for the period beginning April 1,
2008.
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All other
provisions of said AGREEMENT shall remain in full force and
effect.
Appendix
X
MMC/FHPlus
Contract Amendment
April 1,
2008
Page
5
IN
WITNESS WHEREOF, the parties hereto have executed or approved this AGREEMENT as
of the dates appearing under their signatures.
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CONTRACTOR
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STATE
AGENCY SIGNATURE
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By:
/s/ ▇▇▇▇▇
▇▇▇▇▇▇▇▇▇
▇▇▇▇▇
▇▇▇▇▇▇▇▇▇
(Printed
Name)
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By:
/s/ ▇▇▇▇▇▇▇▇▇
▇▇▇▇▇
▇▇▇▇▇▇▇▇▇
▇▇▇▇▇
(Printed
Name)
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Title: President
&
CEO
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Title:
Deputy Dir,
DMC
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Date: 7-14-08
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Date:
8/27/08
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State Agency
Certification:
In addition to the acceptance of this contract, I also
certify that original copies of this signature page
will be attached to all other exact copies of
this
contract.
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STATE OF
FLORIDA )
) SS.:
County of
Hillsborough
)
On the
14th
day of July
2008, before me personally appeared ▇▇▇▇▇
▇▇▇▇▇▇▇▇▇, to me known, who being by me duly sworn, did depose and say
that he/she resides at ▇▇▇▇
▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇, ▇▇, that he/she is the President
and CEO of WellCare
of New York, Inc., the corporation described herein which executed the
foregoing instrument; and that he/she signed his/her name thereto by order of
the board of directors of said corporation.
/s/
▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇
(Notary)
SEAL
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Approved:
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Approved:
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ATTORNEY
GENERAL
_______________________________________
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▇▇▇▇▇▇
▇. ▇▇▇▇▇▇▇▇
STATE
COMPTROLLER
___________________________________________
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Title:
APPROVED AS TO FORM NYS ATTORNEY GENERAL
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Title:
APPROVED DEPT. OF AUDIT & CONTROL
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Date:
SEP 04 2008
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Date:
SEP 25 2008
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/s/ ▇▇▇▇▇▇▇▇ ▇.
▇▇▇▇
/s/ Name Illegible
▇▇▇▇▇▇▇▇ ▇.
▇▇▇▇ FOR
THE STATE COMPTROLLER
ASSOCIATE
ATTORNEY
Appendix
X
MMC/FHPlus
Contract Amendment
April 1,
2008
Page
6
| STANDARD CLAUSES FOR NYS CONTRACTS |
APPENDIX
A
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STANDARD CLAUSES FOR NYS
CONTRACTS
The
parties to the attached contract, license, lease, amendment or other agreement
of any kind (hereinafter, "the contract" or "this contract") agree to be bound
by the following clauses which are hereby made a part of the contract (the word
"Contractor" herein refers to any party other than the State, whether a
contractor, licenser, licensee, lessor, lessee or any other party):
1. EXECUTORY
CLAUSE. In accordance with Section 41 of the State Finance Law, the State
shall have no liability under this contract to the Contractor or to anyone else
beyond funds appropriated and available for this contract.
2. NON-ASSIGNMENT
CLAUSE. In accordance with Section 138 of the State Finance Law, this
contract may not be assigned by the Contractor or its right, title or interest
therein assigned, transferred, conveyed, sublet or otherwise disposed of without
the previous consent, in writing, of the State and any attempts to assign the
contract without the State's written consent are null and void. The Contractor
may, however, assign its right to receive payment without the State's prior
written consent unless this contract concerns Certificates of Participation
pursuant to Article 5-A of the State Finance Law.
3. COMPTROLLER'S
APPROVAL. In accordance with Section 112 of the State Finance Law
(or, if this contract is with the State University or City University of New
York, Section 355 or Section 6218 of the Education Law), if this contract
exceeds $50,000 (or the minimum thresholds agreed to by the Office of the State
Comptroller for certain S.U.N.Y. and C.U.N.Y. contracts), or if this is an
amendment for any amount to a contract which, as so amended, exceeds said
statutory amount, or if, by this contract, the State agrees to give something
other than money when the value or reasonably estimated value of such
consideration exceeds $10,000, it shall not be valid, effective or binding upon
the State until it has been approved by the State Comptroller and filed in his
office. Comptroller's approval of contracts let by the Office of General
Services is required when such contracts exceed $85,000 (State Finance Law
Section 163.6.a).
4. WORKERS'
COMPENSATION BENEFITS. In accordance with Section 142 of the State
Finance Law, this contract shall be void and of no force and effect unless the
Contractor shall provide and maintain coverage during the life of this contract
for the benefit of such employees as are required to be covered by the
provisions of the Workers' Compensation Law.
5. NON-DISCRIMINATION
REQUIREMENTS. To the extent required by Article 15 of the Executive Law
(also known as the Human Rights Law) and all other State and Federal statutory
and constitutional non-discrimination provisions, the Contractor will not
discriminate against any employee or applicant for employment because of race,
creed, color, sex, national origin, sexual orientation, age, disability, genetic
predisposition or carrier status, or marital status. Furthermore, in accordance
with Section 220-e of the Labor Law, if this is a contract for the construction,
alteration or repair of any public building or public work or for the
manufacture, sale or distribution of materials, equipment or supplies, and to
the extent that this contract shall be performed within the State of New York,
Contractor agrees that neither it nor its subcontractors shall, by reason of
race, creed, color, disability, sex, or national origin: (a) discriminate in
hiring against any New York State citizen who is qualified and available to
perform the work; or (b) discriminate against or intimidate any employee hired
for the performance of work under this contract. If this is a building service
contract as defined in Section 230 of the Labor Law, then, in accordance with
Section 239 thereof, Contractor agrees that neither it nor its subcontractors
shall by reason of race, creed, color, national origin, age, sex or disability:
(a) discriminate in hiring against any New York State citizen who is qualified
and available to perform the work; or (b) discriminate against or intimidate any
employee hired for the performance of work under this contract. Contractor is
subject to fines of $50.00 per person per day for any violation of Section 220-e
or Section 239 as well as possible termination of this contract and forfeiture
of all moneys due hereunder for a second or subsequent
violation.
6. WAGE
AND HOURS PROVISIONS. If this is a public work contract covered by
Article 8 of the Labor Law or a building service contract covered by Article 9
thereof, neither Contractor's employees nor the employees of its subcontractors
may be required or permitted to work more than the number of hours or days
stated in said statutes, except as otherwise provided in the Labor Law and as
set forth in prevailing wage and supplement schedules issued by the State Labor
Department. Furthermore, Contractor and its subcontractors must pay at least the
prevailing wage rate and pay or provide the prevailing supplements, including
the premium rates for overtime pay, as determined by the State Labor Department
in accordance with the Labor Law.
7. NON-COLLUSIVE
BIDDING CERTIFICATION. In accordance with Section 139-d of the State
Finance Law, if this contract was awarded based upon the submission of bids,
Contractor affirms, under penalty of perjury, that its bid was arrived at
independently and without collusion aimed at restricting competition. Contractor
further affirms that, at the time Contractor submitted its bid, an authorized
and responsible person executed and delivered to the State a non-collusive
bidding certification on Contractor's behalf.
8. INTERNATIONAL
BOYCOTT PROHIBITION. In accordance with Section 220-f of the Labor Law
and Section 139-h of the State Finance Law, if this contract exceeds $5,000, the
Contractor agrees, as a material condition of the contract, that neither the
Contractor nor any substantially owned or affiliated person, firm, partnership
or corporation has participated, is participating, or shall participate in an
international boycott in violation of the federal Export Administration Act of
1979 (50 USC App. Sections 2401 et seq.) or regulations thereunder. If such
Contractor, or any of the aforesaid affiliates of Contractor, is convicted or is
otherwise found to have violated said laws or regulations upon the final
determination of the United States Commerce Department or any other appropriate
agency of the United States subsequent to the contract's execution, such
contract, amendment or modification thereto shall be rendered forfeit and void.
The Contractor shall so notify the State Comptroller within five (5) business
days of such conviction, determination or disposition of appeal (2NYCRR
105.4).
9. SET-OFF
RIGHTS. The State shall have all of its common law, equitable and
statutory rights of set-off. These rights shall include, but not be limited to,
the State's option to withhold for the purposes of setoff any moneys due to
the Contractor under this contract up to any amounts due and owing to the State
with regard to this contract, any other contract with any State department or
agency, including any contract for a term commencing prior to the term of this
contract, plus any amounts due and owing to the State for any other reason
including, without limitation, tax delinquencies, fee delinquencies or monetary
penalties relative thereto. The State shall exercise its set-off rights in
accordance with normal State practices including, in cases of set-off pursuant
to an audit, the finalization of such audit by the State agency, its
representatives, or the State Comptroller.
10. RECORDS.
The Contractor shall establish and maintain complete and accurate books,
records, documents, accounts and other evidence directly pertinent to
performance under this contract (hereinafter, collectively, "the Records"). The
Records must be kept for the balance of the calendar year in which they were
made and for six (6) additional years thereafter. The State Comptroller, the
Attorney General and any other person or entity authorized to conduct an
examination, as well as the agency or agencies involved in this contract, shall
have access to the Records during normal business hours at an office of the
Contractor within the State of New York or, if no such' office is available, at
a mutually agreeable and reasonable venue within the State, for the term
specified above for the purposes of inspection, auditing and copying. The State
shall take reasonable steps to protect from public disclosure any of the Records
which are exempt from disclosure under Section 87 of the Public Officers Law
(the "Statute") provided that: (i) the Contractor shall timely inform an
appropriate State official, in writing, that said records should not be
disclosed; and (ii) said records shall be sufficiently identified; and (iii)
designation of said records as exempt under the Statute is reasonable. Nothing
contained herein shall diminish, or in any way adversely affect, the State's
right to discovery in any pending or future litigation.
June,
2006
Page
1
| STANDARD CLAUSES FOR NYS CONTRACTS |
APPENDIX
A
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11.
IDENTIFYING
INFORMATION AND PRIVACY NOTIFICATION,
(a) FEDERAL EMPLOYER IDENTIFICATION NUMBER and/or FEDERAL SOCIAL SECURITY
NUMBER. All invoices or New York State standard vouchers submitted for payment
for the sale of goods or services or the lease of real or personal property to a
New York State agency must include the payee's identification number, i.e., the
seller's or lessor's identification number. The number is either the payee's
Federal employer identification number or Federal social security number, or
both such numbers when the payee has both such numbers. Failure to include this
number or numbers may delay payment. Where the payee does not have such number
or numbers, the payee, on its invoice or New York State standard voucher, must
give the reason or reasons why the payee does not have such number or
numbers.
(b)
PRIVACY NOTIFICATION. (1) The authority to request the above personal
information from a seller of goods or services or a lessor of real or personal
property, and the authority to maintain such information, is found in Section 5
of the State Tax Law. Disclosure of this information by the seller or lessor to
the State is mandatory. The principal purpose for which the information is
collected is to enable the State to identify individuals, businesses and others
who have been delinquent in filing tax returns or may have understated their tax
liabilities and to generally identify persons affected by the taxes administered
by the Commissioner of Taxation and Finance. The information will be used for
tax administration purposes and for any other purpose authorized by
law.
(2) The
personal information is requested by the purchasing unit of the agency
contracting to purchase the goods or services or lease the real or personal
property covered by this contract or lease. The information is maintained in New
York State's Central Accounting System by the Director of Accounting Operations,
Office of the State Comptroller, ▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇▇, ▇▇▇ ▇▇▇▇
▇▇▇▇▇.
12.
EQUAL
EMPLOYMENT OPPORTUNITIES FOR MINORITIES
AND WOMEN.
In accordance with Section 312 of the Executive Law, if this contract is:
(i) a written agreement or purchase order instrument, providing for a total
expenditure in excess of $25,000.00, whereby a contracting agency is committed
to expend or does expend funds in return for labor, services, supplies,
equipment, materials or any combination of the foregoing, to be performed for,
or rendered or furnished to the contracting agency; or (ii) a written agreement
in excess of $100,000.00 whereby a contracting agency is committed to expend or
does expend funds for the acquisition, construction, demolition, replacement,
major repair or renovation of real property and improvements thereon; or (iii) a
written agreement in excess of $100,000.00 whereby the owner of a State assisted
housing project is committed to expend or does expend funds for the acquisition,
construction, demolition, replacement, major repair or renovation of real
property and improvements thereon for such project,
then:
(a) The
Contractor will not discriminate against employees or applicants for employment
because of race, creed, color, national origin, sex, age, disability or marital
status, and will undertake or continue existing programs of affirmative action
to ensure that minority group members and women are afforded equal employment
opportunities without discrimination. Affirmative action
shall mean recruitment, employment, job assignment, promotion, upgradings,
demotion, transfer, layoff, or termination and rates of pay or other forms of
compensation;
(b) at
the request of the contracting agency, the Contractor shall request each
employment agency, labor union, or authorized representative of workers with
which it has a collective bargaining or other agreement or understanding, to
furnish a written statement that such employment agency, labor union or
representative will not discriminate on the basis of race, creed, color,
national origin, sex, age, disability or marital status and that such union or
representative will affirmatively cooperate in the implementation of the
contractor's obligations herein; and
(c) the
Contractor shall state, in all solicitations or advertisements for employees,
that, in the performance of the State contract, all qualified applicants will be
afforded equal employment opportunities without discrimination because of race,
creed, color, national origin, sex, age, disability or marital
status.
Contractor
will include the provisions of "a", "b", and "c" above, in every subcontract
over $25,000.00 for the construction, demolition, replacement, major repair,
renovation, planning or design of real property and improvements thereon (the
"Work") except where the Work is for the beneficial use of the Contractor.
Section 312 does not apply to: (i) work, goods or services unrelated to this
contract; or (ii) employment outside New York State; or (iii) banking services,
insurance policies or the sale of securities. The State shall consider
compliance by a contractor or subcontractor with the requirements of any federal
law concerning equal employment opportunity which effectuates the purpose of
this section. The contracting agency shall determine whether the imposition of
the requirements of the provisions hereof duplicate or conflict with any such
federal law and if such duplication or conflict exists, the contracting agency
shall waive the applicability of Section 312 to the extent of such duplication
or conflict. Contractor will comply with all duly promulgated and lawful rules
and regulations of the Governor's Office of Minority and Women's Business
Development pertaining hereto.
13.
CONFLICTING
TERMS.
In the event of a conflict between the terms of the contract (including
any and all attachments thereto and amendments thereof) and the terms of this
Appendix A, the terms of this Appendix A shall
control.
14.
GOVERNING
LAW.
This contract shall be governed by the laws of the State of New York
except where the Federal supremacy clause requires
otherwise.
15. LATE
PAYMENT.
Timeliness of payment and any interest to be paid to Contractor for late
payment shall be governed by Article 11-A of the State Finance Law to the extent
required by law.
16. NO
ARBITRATION.
Disputes involving this contract, including the breach or alleged breach
thereof, may not be submitted to binding arbitration (except where statutorily
authorized), but must, instead, be heard in a court of competent jurisdiction of
the State of New York.
17. SERVICE
OF PROCESS.
In addition to the methods of service allowed by the State Civil Practice
Law & Rules ("CPLR"), Contractor hereby consents to service of process upon
it by registered or certified mail, return receipt requested. Service hereunder
shall be complete upon Contractor's actual receipt of process or upon the
State's receipt of the return thereof by the United States Postal Service as
refused or undeliverable. Contractor must promptly notify the State, in writing,
of each and every change of address to which service of process can be made.
Service by the State to the last known address shall be sufficient. Contractor
will have thirty (30) calendar days after service hereunder is complete in which
to respond.
June,
2006
Page
2
| STANDARD CLAUSES FOR NYS CONTRACTS |
APPENDIX
A
|
18. PROHIBITION
ON PURCHASE OF TROPICAL HARDWOODS.
The Contractor certifies
and warrants that all wood products to be used under this contract award will be
in accordance with, but not
limited to, the specifications and provisions of State Finance Law §165. (Use of
Tropical Hardwoods) which prohibits purchase and use of
tropical hardwoods, unless specifically exempted, by the State or any
governmental agency or political subdivision or public benefit corporation.
Qualification for an exemption under this law will be the responsibility of the
contractor to establish to meet with the approval of the
State.
In
addition, when any portion of this contract involving the use of ▇▇▇▇▇, whether
supply or installation, is to be performed by any subcontractor, the prime
Contractor will indicate and certify in the submitted bid proposal that the
subcontractor has been informed and is in compliance with specifications and
provisions regarding use of tropical hardwoods as detailed in §165 State Finance
Law. Any such use must meet with the approval of the State; otherwise, the bid
may not be considered responsive. Under bidder certifications, proof of
qualification for exemption will be the responsibility of the Contractor to meet
with the approval of the State.
19. ▇▇▇▇▇▇▇▇ FAIR EMPLOYMENT PRINCIPLES. In
accordance with the ▇▇▇▇▇▇▇▇ Fair Employment Principles (Chapter 807 of the Laws
of 1992), the Contractor hereby stipulates that the Contractor either (a) has no
business operations in Northern Ireland, or (b) shall take lawful steps in good
faith to conduct any business operations in Northern Ireland in accordance with
the ▇▇▇▇▇▇▇▇ Fair Employment Principles (as described in Section 165 of the New
York State Finance Law), and shall permit independent monitoring of compliance
with such principles.
20. OMNIBUS
PROCUREMENT ACT OF 1992. It is the policy of New York State to
maximize opportunities for the participation of New York State business
enterprises, including minority and women-owned business enterprises as bidders,
subcontractors and suppliers on its procurement contracts.
Information
on the availability of New York State subcontractors and suppliers is available
from:
NYS
Department of Economic Development
Division
for Small Business
▇▇ ▇▇▇▇▇
▇▇▇▇▇ ▇▇ -- ▇▇▇
Floor
Albany,
New York 12245
Telephone:
▇▇▇-▇▇▇-▇▇▇▇
Fax:
▇▇▇-▇▇▇-▇▇▇▇
▇▇▇▇://▇▇▇.▇▇▇▇▇▇.▇▇▇▇▇.▇▇.▇▇
A
directory of certified minority and women-owned business enterprises is
available from:
NYS
Department of Economic Development
Division
of Minority and Women's Business Development
▇▇ ▇▇▇▇▇
▇▇▇▇▇ ▇▇ - ▇▇▇ Floor
Albany,
New York 12245
Telephone:
▇▇▇-▇▇▇-▇▇▇▇
Fax:
▇▇▇-▇▇▇-▇▇▇▇
▇▇▇▇://▇▇▇.▇▇▇▇▇▇.▇▇▇▇▇.▇▇.▇▇
The
Omnibus Procurement Act of 1992 requires that by signing this bid proposal or
contract, as applicable, Contractors certify that whenever the total bid amount
is greater than $1 million:
(a) The
Contractor has made reasonable efforts to encourage the participation of New
York State Business Enterprises as suppliers and subcontractors, including
certified minority and women-owned business enterprises, on this project, and
has retained the documentation of these efforts to be provided upon request to
the State;
(b) The
Contractor has complied with the Federal Equal Opportunity Act of 1972 (P.L.
92-261), as amended;
(c) The
Contractor agrees to make reasonable efforts to provide notification to New York
State residents of employment opportunities on this project through listing any
such positions with the Job Service Division of the New York State Department of
Labor, or providing such notification in such manner as is consistent with
existing collective bargaining contracts or agreements. The Contractor agrees to
document these efforts and to provide said documentation to the State upon
request;
and
(d) The
Contractor acknowledges notice that the State may seek to obtain offset credits
from foreign countries as a result of this contract and agrees to cooperate with
the State in these efforts.
21. RECIPROCITY
AND SANCTIONS PROVISIONS. Bidders are hereby notified that if
their principal place of business is located in a country, nation, province,
state or political subdivision that penalizes New York State vendors, and if the
goods or services they offer will be substantially produced or performed outside
New York State, the Omnibus Procurement Act 1994 and 2000 amendments (Chapter
684 and Chapter 383, respectively) require that they be denied contracts which
they would otherwise obtain. NOTE: As of May 15, 2002, the list of
discriminatory jurisdictions subject to this provision includes the states of
South Carolina, Alaska, West Virginia, Wyoming, Louisiana and Hawaii. Contact
NYS Department of Economic Development for a current list of jurisdictions
subject to this provision.
22. PURCHASES
OF APPAREL. In accordance with State Finance Law 162 (4-a), the
State shall not purchase any apparel from any vendor unable or unwilling to
certify that: (i) such apparel was manufactured in compliance with all
applicable labor and occupational safety laws, including, but not limited to,
child labor laws, wage and hours laws and workplace safety laws, and (ii) vendor
will supply, with its bid (or, if not a bid situation, prior to or at the time
of signing a contract with the State), if known, the names and addresses of each
subcontractor and a list of all manufacturing plants to be utilized by the
bidder.
June,
2006
Page
3
| STANDARD CLAUSES FOR NYS CONTRACTS |
APPENDIX
A
|
THIS PAGE
IS INTENTIONALLY LEFT BLANK
June,
2006
Page
4
APPENDIX
L
Approved
Capitation Payment Rates
APPENDIX
L
April
1,2008
L-l
WELLCARE OF NEW YORK, INC.
Medicaid
Managed Care Rates
|
MMIS ID#: 01182503
|
Effective Date:
04/01/08
|
|
Approved by DOB: Yes
|
Region: Northeast
|
|
Reinsurance: No
|
County: ALBANY
|
|
Premium Group
|
Rate
Amount
|
|
TANF/SN Children
|
$104.98
|
|
TANF
Adult
|
$251.84
|
|
SSI Children
|
$201.23
|
|
SSI Adult
|
$553.84
|
|
Maternity
Kick Payment
|
$5,224.48
|
|
Newborn
Kick Payment
|
$2,045.37
|
Optional Benefits Offered:
|
þ Emergency
Transportation
|
o Dental
|
|
þ Non-Emergent
Transportation
|
þ Family
Planning
|
Box
will be checked if the optional benefit is covered by the
plan
WELLCARE OF NEW YORK, INC.
Medicaid Managed Care Rates
|
MMIS ID#: 01182503
|
Effective Date: 04/01/08
|
|
Approved by DOB: Yes
|
Region: Central
|
|
Reinsurance: No
|
County: COLUMBIA
|
|
Premium Group
|
Rate
Amount
|
|
TANF/SN Children
|
$108.04
|
|
TANF
Adult
|
$274.83
|
|
SSI Children
|
$193.29
|
|
SSI Adult
|
$509.93
|
|
Maternity
Kick Payment
|
$5,668.30
|
|
Newborn
Kick Payment
|
$2,221.60
|
Optional Benefits Offered:
|
þ Emergency Transportation
|
o Dental
|
|
þ Non-Emergent Transportation
|
þ Family
Planning
|
Box
will be checked if the optional benefit is covered by the
plan
WELLCARE OF NEW YORK, INC.
Medicaid
Managed Care Rates
|
MMIS ID#: 01182503
|
Effective Date: 04/01/08
|
|
Approved by DOB: Yes
|
Region: Mid-▇▇▇▇▇▇
|
|
Reinsurance: No
|
County: DUTCHESS
|
|
Premium Group
|
Rate
Amount
|
|
TANF/SN Children
|
$120.43
|
|
TANF
Adult
|
$289.19
|
|
SSI Children
|
$201.90
|
|
SSI Adult
|
$561.26
|
|
Maternity
Kick Payment
|
$6,187.83
|
|
Newborn
Kick Payment
|
$2,623.69
|
Optional Benefits Offered:
|
þ Emergency Transportation
|
o Dental
|
|
o Non-Emergent Transportation
|
þ Family
Planning
|
Box
will be checked if the optional benefit is covered by the
plan
WELLCARE OF NEW YORK, INC.
Medicaid
Managed Care Rates
|
MMIS ID#: 01182503
|
Effective Date: 04/01/08
|
|
Approved by DOB: Yes
|
Region: Central
|
|
Reinsurance: No
|
County: ▇▇▇▇▇▇
|
|
Premium Group
|
Rate
Amount
|
|
TANF/SN Children
|
$105.97
|
|
TANF
Adult
|
$271.58
|
|
SSI Children
|
$189.79
|
|
SSI Adult
|
$504.22
|
|
Maternity
Kick Payment
|
$5,668.30
|
|
Newborn Kick
Payment
|
$2,221.60
|
Optional Benefits Offered:
|
þ Emergency
Transportation
|
o Dental
|
|
o Non-Emergent
Transportation
|
þ Family
Planning
|
Box
will be checked if the optional benefit is covered by the
plan
WELLCARE
OF NEW YORK, INC.
Medicaid
Managed Care Rates
|
MMIS
ID#: 01182503
|
Effective
Date: 04/01/08
|
|
Approved
by DOB: Yes
|
Region:
Mid-▇▇▇▇▇▇
|
|
Reinsurance:
No
|
County:
ORANGE
|
|
Premium Group
|
Rate
Amount
|
|
TANF/SN
Children
|
$119.20
|
|
TANF
Adult
|
$285.18
|
|
SSI
Children
|
$197.93
|
|
SSI
Adult
|
$551.99
|
|
Maternity
Kick Payment
|
$6,187.83
|
|
Newborn
Kick Payment
|
$2,623.69
|
Optional Benefits Offered:
|
o Emergency
Transportation
|
oDental
|
|
o Non-Emergent
Transportation
|
þ Family
Planning
|
Box
will be checked if the optional benefit is covered by the
plan
WELLCARE OF NEW YORK, INC.
Medicaid
Managed Care Rates
|
MMIS ID#: 01182503
|
Effective Date: 04/01/08
|
|
Approved by DOB: Yes
|
Region: Northeast
|
|
Reinsurance: No
|
County: RENSSELAER
|
|
Premium Group
|
Rate
Amount
|
|
TANF/SN
Children
|
$102.92
|
|
TANF
Adult
|
$248.59
|
|
SSI Children
|
$197.73
|
|
SSI Adult
|
$548.20
|
|
Maternity
Kick Payment
|
$5,224.48
|
|
Newborn
Kick Payment
|
$2,045.37
|
Optional Benefits Offered:
|
þ Emergency Transportation
|
oDental
|
|
o Non-Emergent Transportation
|
þ Family
Planning
|
Box
will be checked if the optional benefit is covered by the
plan
WELLCARE OF NEW YORK, INC.
Medicaid
Managed Care Rates
|
MMIS
ID#: 01182503
|
Effective
Date: 04/01/08
|
|
Approved
by DOB: Yes
|
Region:
Northern Metro
|
|
Reinsurance:
No
|
County:
ROCKLAND
|
|
Premium Group
|
Rate
Amount
|
|
TANF/SN Children
|
$104.95
|
|
TANF Adult
|
$257.96
|
|
SSI Children
|
$202.70
|
|
SSI Adult
|
$510.07
|
|
Maternity
Kick Payment
|
$5,365.27
|
|
Newborn Kick
Payment
|
$1,910.46
|
Optional Benefits Offered:
|
þ Emergency Transportation
|
o Dental
|
|
o Non-Emergent Transportation
|
þ Family Planning
|
Box
will be checked if the optional benefit is covered by the
plan
WELLCARE
OF NEW YORK, INC.
Medicaid
Managed Care Rates
|
MMIS
ID#: 01182503
|
Effective
Date: 04/01/08
|
|
Approved
by DOB: Yes
|
Region:
Mid-▇▇▇▇▇▇
|
|
Reinsurance:
No
|
County:
ULSTER
|
|
Premium Group
|
Rate
Amount
|
|
TANF/SN
Children
|
$119.20
|
|
TANF
Adult
|
$285.18
|
|
SSI
Children
|
$197.93
|
|
SSI
Adult
|
$551.99
|
|
Maternity
Kick Payment
|
$6,187.83
|
|
Newborn
Kick Payment
|
$2,623.69
|
Optional Benefits Offered:
|
o Emergency
Transportation
|
o Dental
|
|
o Non-Emergent
Transportation
|
þ Family
Planning
|
Box
will be checked if the optional benefit is covered by the
plan
WELLCARE
OF NEW YORK, INC
Family
Health Plus Rates
Effective
April 1, 2008
|
Optional
benefits
covered
|
||||
| County |
FHPlus
|
Maternity
Kicks
|
Family
Planning
|
Dental
|
| ALBANY |
$309.54
|
$5,224.48
|
Yes
|
Yes
|
|
COLUMBIA
|
$319.50
|
$5,668.30
|
Yes
|
Yes
|
|
DUTCHESS
|
$324.83
|
$6,187.83
|
Yes
|
Yes
|
|
▇▇▇▇▇▇
|
$319.50
|
$5,668.30
|
Yes
|
Yes
|
|
NEW
YORK CITY
|
$220.17
|
$5,908.52
|
Yes
|
Yes
|
|
ORANGE
|
$324.83
|
$6,187.83
|
Yes
|
Yes
|
|
RENSSELAER
|
$309.54
|
$5,224.48
|
Yes
|
Yes
|
|
ROCKLAND
|
$311.01
|
$5,365.27
|
Yes
|
Yes
|
|
ULSTER
|
$324.83
|
$6,187.83
|
Yes
|
Yes
|