Amendment No. 10 To Contract No. Fa615 Between Ahca And Staywell Health Plan of Florida

Exhibit 10.4









WellCare of Florida, Inc. d/b/a

Staywell Health Plan of Florida Medicaid HMO Contract


AHCA CONTRACT NO. FA615

AMENDMENT NO. 10




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 STAYWELL HEALTH PLAN OF FLORIDA, hereinafter referred to as the "Vendor" or "Health Plan", is hereby amended as follows:




1. Standard Contract, Section III, Item C, Contract Managers, sub-item 1, is hereby amended to change the Agency's Contract Manager's name to Suzanne S. Gjevukaj. All other contact information remains unchanged.




2. Effective March 1, 2009, Attachment I, Scope of Services, is hereby amended to include Exhibit III-F, March 1, 2009 - 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-E, February 1, 2009 - August 31, 2009 Medicaid Non-Reform HMO Capitation Rates, shall hereinafter also refer to Exhibit III-F, March 1, 2009 - August 31, 2009 Medicaid Non-Reform HMO Capitation Rates, as appropriate.




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 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 six (6) page Amendment (which includes all attachments hereto) 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/ Heath Schiesser SIGNED

BY: /s/ Holly Benson


NAME: Heath Schiesser

NAME: Holly Benson


TITLE: President and CEO

TITLE: Secretary


DATE:

DATE: 4/22/09


List of attachments/exhibits included as part of this Amendment:



Specify

Type Letter/

Number Description
Exhibit III-F March 1, 2009 - August 31, 2009 Medicaid Non-Reform

HMO Capitation Rates (5 Pages)


AHCA Contract No. FA615, Amendment No. 10, Page 1 of 1

AHCA Form 2100-0002 (Rev. NOV03)
















EXHIBIT III-F

March 1, 2009 -August 31, 2009

MEDICAID Non-Reform HMO CAPITATION RATES

By Area, Age and Eligibility Category

Revised on February 16, 2009




TABLE 1

General 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+) BTHM0+2M0 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 1,094.22 184.16 99.63 60.40 127.26 68.32 250.84 150.73 313.03 10,249.54 1,491.48 438.21 195.46 209.48 684.74 688.27 300.62 93.17 84.30
02 1,094.22 184.16 99.63 60.40 127.26 68.32 250.84 150.73 313.03 10,249.54 1,491.48 438.21 195.46 209.48 684.74 688.27 300.62 93.17 84.30
03 1,196.62 202.96 110.34 67.92 140.84 76.51 278.65 168.47 353.53 11,246.01 1,651.16 486.56 222.16 237.31 773.96 781.87 334.70 88.46 80.57
04 1,049.14 178.79 97.34 60.45 124.13 68.04 246.51 149.64 315.69 10,783.85 1,587.50 468.19 215.03 229.34 748.28 757.29 292.70 88.80 80.98
05 1,194.06 202.97 110.37 68.18 140.78 76.87 279.19 169.16 355.65 12,038.26 1,765.98 519.70 236.81 252.51 825.86 834.51 221.32 79.80 74.00
06 1,038.39 178.07 97.17 60.92 124.01 68.48 247.03 150.57 319.86 10,970.19 1,617.13 476.72 220.10 233.82 764.56 774.50 270.21 77.95 71.38
07 1,074.14 183.63 100.12 62.40 127.54 70.12 253.83 154.32 326.38 11,607.26 1,714.80 505.56 234.47 249.87 814.51 826.24 367.55 83.10 76.28
08 1,015.73 174.04 95.01 59.33 121.03 66.85 241.01 146.72 311.46 10,344.94 1,523.63 449.17 206.42 220.49 718.78 727.41 251.83 77.41 70.98
09 1,049.42 178.45 97.12 60.00 123.89 67.48 245.50 148.81 312.90 10,887.75 1,607.33 473.84 219.83 233.26 762.25 772.33 215.52 82.97 75.87
10 1,064.83 182.89 99.98 62.78 127.46 70.63 254.09 155.07 330.14 14,097.57 2,095.67 618.54 292.06 308.77 1,009.40 1,026.88 316.67 92.40 84.73
11 1,348.59 228.59 124.07 76.21 158.52 85.96 313.61 189.56 397.28 14,238.94 2,095.21 617.24 284.21 302.64 987.26 998.51 364.12 137.86 124.45
6B* 1,038.25 178.05 97.16 60.91 123.99 68.47 247.00 150.55 319.81 10,969.70 1,617.05 476.70 220.09 233.81 764.51 774.47 270.21 77.95 71.38


TABLE 2

General + Mental Health Rates:
TANF SSl-N SSI-B SSI-AB
Area BTHMO+2MO 3MO-11MO AGE (1-5) AGE (6-13) AGE (14-20) AGE (21-54) AGE (55+) BTHM0+2M0 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 1,094.24 184.18 101.24 71.89 138.00 79.06 255.20 155.09 316.71 10,249.62 1,491.56 445.52 242.68 252.71 764.74 718.72 300.83 104.62 95.75
02 1,094.25 184.19 102.49 80.31 140.45 81.51 254.19 154.08 315.93 10,249.69 1,491.63 451.77 272.92 253.92 736.51 712.72 320.48 107.92 99.05
03 1,196.63 202.97 111.64 76.94 146.82 82.49 280.17 169.99 354.85 11,246.08 1,651.23 492.71 257.30 257.47 797.45 792.96 341.43 97.29 89.40
04 1,049.15 178.80 98.69 69.84 130.36 74.27 248.09 151.22 317.06 10,783.96 1,587.61 477.78 269.81 260.77 784.90 774.58 316.83 105.28 97.46
05 1,194.07 202.98 111.56 76.71 148.75 84.84 282.43 172.40 358.38 12,038.31 1,766.03 524.64 268.67 281.68 879.83 855.05 224.00 92.40 86.60
06 1,038.41 178.09 98.99 73.94 136.17 80.64 251.97 155.51 324.03 10,970.26 1,617.20 483.13 261.48 271.70 834.66 801.18 271.50 81.77 75.20
07 1,074.16 183.65 101.87 74.87 139.19 81.77 258.57 159.06 330.38 11,607.32 1,714.86 511.58 273.30 285.42 880.29 851.28 370.10 93.44 86.62
08 1,015.74 174.05 96.25 67.97 126.75 72.57 242.47 148.18 312.72 10,345.01 1,523.70 455.07 240.11 239.83 741.30 738.04 258.56 90.40 83.97
09 1,049.44 178.47 98.64 70.62 130.92 74.51 247.29 150.60 314.45 10,887.82 1,607.40 480.06 255.35 253.65 785.99 783.54 222.25 92.39 85.29
10 1,064.85 182.91 101.87 75.91 136.16 79.33 256.30 157.28 332.06 14,097.66 2,095.76 626.75 338.95 335.68 1,040.74 1,041.68 323.40 100.32 92.65
11 1,348.61 228.61 125.66 87.31 165.88 93.32 315.48 191.43 398.90 14,239.02 2,095.29 624.09 323.33 325.08 1,013.40 1,010.85 371.22 145.78 132.37
6B* 1,038.27 178.07 98.88 73.21 135.48 79.96 251.67 155.22 323.75 10,969.77 1,617.12 483.09 261.35 271.58 834.41 801.07 271.50 81.77 75.20



AHCA Contract No. FA615, Exhibit III-F, Page 1 of 5
















EXHIBIT III-F

March 1, 2009 - August 31, 2009

MEDICAID Non-Reform HMO CAPITATION RATES

By Area, Age and Eligibility Category

Revised on February 16, 2009




TABLE 3

General + WIH + Dental Rates
TANF ...