AHCA CONTRACT NO. FA523

AHCA CONTRACT NO. FA523

AMENDMENT NO. 6

THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the “Agency” and AMERIGROUP FLORIDA, INC., hereinafter referred to as the “Vendor”, is hereby amended as follows:

1. Standard Contract, Section II.A, Contract Amount, the first sentence is hereby amended to now read:

To pay for contracted services according to the conditions of Attachment I in an amount not to exceed $668,923,610.00, (an increase of $2,139,090.00), subject to the availability of funds.

2.

Attachment I, section 90.0, Payment and Authorized Enrollment Levels, Table 2 is hereby amended to read as follows:

3.

Attachment I, section 90.0, Payment and Authorized Enrollment Levels, Table 3 is hereby amended to read as follows:

Table 3

Area

Age-banded Capitation Rates, Including Community Mental Health and Mental Health Targeted Case Management

Table 3.
Areas 5, 6, 7, and 8 Age-banded Capitation Rates, Including Community Mental Health and Mental Health Targeted Case Management

Area 05 General Rates plus Mental Health Plan — 015005304(PASCO) 015005305(PINELLAS)

<1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+

▇▇▇▇ ▇▇ General Rates plus Mental Health Plan — 015005300(HILLSBOROUGH) 015005307(POLK) 015005318(MANATEE)

<1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+

AHCA Contract No. FA523, Amendment No. 6, Page 1 of 2

AHCA Form 2100-0002 (Rev. NOV03)

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AMERIGROUP FLORIDA, INC. Medicaid HMO Contract

Area 07 General Rates plus Mental Health Plan — 015005308(ORANGE) 015005313(SEMINOLE) 015005314(OSCEOLA)

SSI/No Medicare 3217.90 406.84 260.45 239.73 239.73 628.24 628.24 594.96 594.96
SSI/Part B 266.03 266.03 266.03 266.03 266.03 266.03 266.03 266.03 266.03
SSI/Part A & B 293.59 293.59 293.59 293.59 293.59 293.59 293.59 293.59 208.25

▇▇▇▇ ▇▇ General Rates plus Mental Health Plan — 015005302(▇▇▇) 015005306(SARASOTA)

<1 year 1-5 6-13 14-20 Male 14-20 Female 21-54 Male 21-54 Female 55-64 65+

TANF/FC/SOBRA 296.69 67.77 46.25 49.88 98.88 119.48 180.88 251.72 251.72
SSI/No Medicare 3079.31 393.43 223.95 221.50 221.50 594.93 594.93 563.76 563.76
SSI/Part B 243.57 243.57 243.57 243.57 243.57 243.57 243.57 243.57 243.57
SSI/Part A & B 292.10 292.10 292.10 292.10 292.10 292.10 292.10 292.10 206.49

4.

Attachment I, Section 90.0, Payment and Authorized Enrollment Levels, Table 3, the second paragraph is hereby amended to now read:

Notwithstanding the payment amounts which may be computed with the above rate table, the sum of total capitation payments under this contract shall not exceed the total contract amount of $668,923,610.00, (an increase of $2,139,090.00), expressed on page seven of this contract.

5.

This amendment shall begin on May 1, 2005, or the date on which the amendment has been signed by both parties, whichever is later.

All provisions in the Contract and any attachments thereto in conflict with this amendment shall be and are hereby changed to conform with this amendment.

All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the Contract.

This amendment and all its attachments are hereby made a part of the Contract.

This amendment cannot be executed unless all previous amendments to this Contract have been fully executed.

IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment (including all attachments) to be executed by their officials thereunto duly authorized.

THE REMAINDER OF THIS PAGE LEFT BLANK INTENTIONALLY AHCA Contract No. FA523, Amendment No. 6, Page 2 of 2

AHCA Form 2100-0002 (Rev. NOV03)

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