Attached files
| file | filename |
|---|---|
| 8-K - 8-K - WELLCARE HEALTH PLANS, INC. | form8k1614.htm |
| EX-99.1 - EXHIBIT - WELLCARE HEALTH PLANS, INC. | exhibit991windsornewsrelea.htm |
AMENDMENT #17 TO CONTRACT NO. 0654
BETWEEN
GEORGIA DEPARTMENT OF COMMUNITY HEALTH
AND
WELLCARE OF GEORGIA, INC.
This Amendment is between the Georgia Department of Community Health (hereinafter referred to as “DCH” or the “Department”) and WellCare of Georgia, Inc. (hereinafter referred to as “Contractor”) and is made effective on the date DCH receives written approval from the Centers for Medicare and Medicaid Services (hereinafter referred to as “CMS”). Unless expressly modified or added in this Amendment #17, the terms and conditions of the above-referenced contract, as previously amended, are expressly incorporated into this Amendment #17 as if completely restated herein.
WHEREAS, DCH and Contractor executed Contract #0654 with an effective date of July 18, 2005 for the provision of services to members of the Georgia Families Program;
WHEREAS, DCH pays Contractor a per member per month capitation rate for each Georgia Families member enrolled in the Contractor’s plan;
WHEREAS, the Parties desire to implement the provisions of Section 1202 of the Affordable Care Act which require that the Department reimburse physicians practicing in family medicine, general internal medicine, pediatric medicine, and related subspecialists at Medicare levels for the procedure codes specified in the Affordable Care Act beginning January 1, 2013;
WHEREAS, DCH has sought permission from the Centers for Medicare and Medicaid Services (hereinafter referred to as “CMS”) to revise the capitation rates payable to Contractor beginning January 1, 2013; and
WHEREAS, pursuant to Section 32.0, Amendments in Writing, DCH and Contractor desire to amend the above-referenced Contract by modifying the funding as set forth below.
NOW THEREFORE, for and in consideration of the mutual promises of the Parties, the terms, provisions and conditions of this Amendment and other good and valuable consideration, the sufficiency of which is hereby acknowledged, DCH and Contractor hereby agree as follows:
I. | Upon receiving written notice from CMS indicating that agency’s approval of the revised capitation rates to be effective as of January 1, 2013, the parties shall delete the current Attachment H, Capitation Payment, in its entirety and replace it with the new Attachment H, Capitation Payment, contained at Exhibit 1 to this Amendment. In the event CMS disapproves revision of the capitation rates as described herein, this amendment shall have no effect. DCH shall notify Contractor in writing upon receipt of the CMS decision regarding the revision of the capitation rates. |
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Amendment #17
Contract #0654
WellCare of Georgia, Inc.
II. | To add the following subsection to Section 4.10, Provider Contracts and Payments: |
4.10.7 | Payments Pursuant to Section 1202 of the Affordable Care Act |
The following provisions apply only for the time period of January 1, 2013 through June 30, 2013:
4.10.7.1 | Contractor shall provide payment at or above the Medicare primary care payment levels for all eligible providers. The Medicare primary care payments levels apply to the procedure codes specified in the Affordable Care Act. |
4.10.7.2 | Contractor shall ensure that eligible providers receive the full and direct benefit of the increase. |
4.10.7.3 | Contractor shall submit sufficient documentation, as specified by the state, to the state, to adequately document and validate expenditures eligible for 100 percent federal match to the state. |
4.10.7.4 | Contractor shall adhere to the definitions and requirements for eligible providers and services as specified in the applicable federal and state statutes and regulations. |
III. | DCH and Contractor agree that they have assumed an obligation to perform the covenants, agreements, duties and obligations of the Contract, as modified and amended herein, and agree to abide by all the provisions, terms and conditions contained in the Contract as modified and amended. |
IV. | This Amendment shall be binding and inure to the benefit of the parties hereto, their heirs, representatives, successors and assigns. Whenever the provisions of this Amendment and the Contract are in conflict, the provisions of this Amendment shall take precedence and control. |
VIII. | It is understood by the Parties hereto that, if any part, term, or provision of this Amendment or this entire Amendment is held to be illegal or in conflict with any law of this State, then DCH, at its sole option, may enforce the remaining unaffected portions or provisions of this Amendment or of the Contract and the rights and obligations of the parties shall be construed and enforced as if the Contract or Amendment did not contain the particular part, term or provision held to be invalid. |
X. | This Amendment shall be construed in accordance with the laws of the State of Georgia. |
XI. | All other terms and conditions contained in the Contract and any amendment thereto, not amended by this Amendment, shall remain in full force and effect. |
SIGNATURES ON THE FOLLOWING PAGE
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Amendment #17
Contract #0654
WellCare of Georgia, Inc.
SIGNATURE PAGE
IN WITNESS WHEREOF, DCH and Contractor, through their authorized officers and agents, have caused this Amendment to be executed on their behalf as of the date indicated.
GEORGIA DEPARTMENT OF COMMUNITY HEALTH
/s/ Clyde L. Reese III | ||
Clyde L. Reese III, Esq., Commissioner | Date | |
/s/ Jerry Dubberly | 12/16/2013 | |
Jerry Dubberly, Chief | Date | |
Division of Medical Assistance Plans | ||
WELLCARE OF GEORGIA, INC.
BY: | /s/ Roman T. Kulich | 12/12/2013 | |
*SIGNATURE | Date | ||
Roman Kulich | |||
Please Print/Type Name Here | |||
Region President | |||
*TITLE | |||
* Must be President, Vice President, CEO or Other Officer Authorized to Execute on Behalf of and Bind the Entity to a Contract |
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Amendment #17
Contract #0654
WellCare of Georgia, Inc.
EXHIBIT 1 TO AMENDMENT #17
CONFIDENTIAL - NOT FOR CIRCULATION
ATTACHMENT H
Attachment H is a table displaying the contracted rates by rate cell for each contracted region. These rates will be the basis for calculating capitation payments in each contracted Region.
(The table is displayed on the following page.)
*(THE FOLLOWING THREE PAGES CONTAIN A TABLE OF THE CAPITATION RATES PAYABLE TO WELLCARE OF GEORGIA, INC. WITH RESPECT TO MEMBERS ENROLLED IN ITS MEDICAID PLAN. IT HAS BEEN OMITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION)*
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Amendment #17
Contract #0654
WellCare of Georgia, Inc.