exhibit10-1.htm

Attachment 1 - Page 87

Amendment 001

Agreement Number XQ744

Field Name	Description	Unit of Measurement	Field Length	Start Col.	End Col.	Text/Numeric
Lone-term care SERVICES	DESCRIPTION	UNIT OF SERVICE/ COST
ADCOMP	Adult Companion Services	IS Minute Unit	4	51	H	Numeric
ADCOMPS	Adult Companion Services	Amount Paid	6	55	60	Numeric
ADAYHLTH	Adult Day Health Services	15 Minute Unit	4	16	64	Numeric
ADAYHLS	Adult Day Health Services	Amount Paid	6	65	70	Numeric
ALFSVS	Assisted Living Services	Days	2	71	72	Numeric
ALFSVSSS	Assisted Living Services	Amount Paid	6	73	78	Numeric
ATTCARE	Attendant Care Services	15 Minute Unit	4	79	82	Numeric
ATTCARES	Attendant Care Services	Amount Paid	6	83	88	Numeric
CASEAID	Case Aide	15 Minute Unit	4	89	92	Numeric
CASEAIDS	Case Aide	Amount Paid	6	93	98	Numeric
CASEMGMT	Case Management (Internal)	15 Minute Unit	4	99	102	Numeric
CASEMGTS	Case Management (Internal)	Amount Paid	6	103	108	Numeric
CHORE	Chore Services	15 Minute Unit	2	109	110	Numeric
CHORES	Chore Services	Amount Paid	6	111	116	Numeric
COM MH	Community Mental Health	Visit	2	117	118	Numeric
COM MH8	Community Mental Health	Amount Paid	6	119	124	Numeric
CNMS SS	Consumable Medical Supplies	Amount Paid	6	125	130	Numeric
COUNSEL	Counseling	15 Minute Unit	4	131	134	Numeric
COUNSELS		Amount Paid	6	135	140	Numeric
DME SS	Durable Medical Equipment	Amount Paid	6	141	146	Numeric
ENVHUA	Environmental Accessibility Adaptations	Job	2	147	148	Numeric
ENVIRRAAS	Environmental Accessibility Adaptations	Amount Paid	6	149	154	Numeric
ESCORT	Escort Services	15 Minute Unit	4	155	158	Numeric
ESCORTS	Escort Services	Amount Paid	6	159	164	Numeric
FAMT I	Family Training Services (Individual)	15 Minute Unit	2	165	166	Numeric
FAMT IS	Family Training Services (Individual)	Amount Paid	6	167	172	Numeric
FAMT G	Family Training Services (Group)	15 Minute Unit	2	173	174	Numeric
FAMT GS	Family Training Services (Group)	Amount Paid	6	175	180	Numeric
FINARRS	Financial Assessment/Risk Reduction Services	15 Minute Unit	4	181	184	Numeric
FINARRS	Financial Assessment/Risk Reduction Services	Amount Paid	6	185	190	Numeric
FINM RRS	Financial Maintenance/Risk Reduction Services	15 Minute Unit	4	191	194	Numeric
FMM RRS	Financial Maintenance/Risk Reduction Services	Amount Paid	6	195	200	Numeric
HDMEAL	Home Delivered Meals	Meal	2	201	202	Numeric
HDMEALS	Home Delivered Meals	Amount Paid	6	203	208	Numeric
HOMESRVS	Homemaker Services	15 Minute Unit	4	209	212	Numeric
HOMESRVCS	Homemaker Services	Amount Paid	6	213	218	Numeric
MH CM	Mental Health Case Management	15 Minute Unit	4	219	222	Numeric
MH CMS	Mental Health Case Management	Amount Paid	6	223	228	Numeric
SNF	Nursing Facility Services- Long-term	Days	2	229	230	Numeric
SNFSS	Nursing Facility Services-Long-term	Amount Paid	6	231	236	Numeric
NUTR RRS	Nutritional Assessment/Risk Reduction Services	15 Minute Unit	14	237	240	Numeric
NUTR RRS	Nutritional Assessment/Risk Reduction Services	Amount Paid	6	241	246	Numeric
OT	Occupational Therapy	15 Minute Unit	4	247	250	Numeric
OTS	Occupational Therapy		6	251	256
PCS	Personal Care Services	15 Minute Unit	4	257	260	Numeric
PCS	Personal Care Services	Amount Paid	6	261	266
PERS I	Personal Emergency Response System Installation	Job	2	267	268	Numeric
PERS IS	Personal Emergency Response System	Amount	6	269	274	Numeric

Attachment I - Page 88

Amendment 001

Agreement Number XQ744

Field Name	Description	Unit of Measurement	Field Length	Start Col.	End Col.	Text/Numeric
	Installation	Paid
PERS M	Personal Emergency Response System -Maintenance	Day	2	275	276	Numeric
PERS MS	Personal Emergency Response System-Maintenance	Amount Paid	6	277	282	Numeric
PEST I	Pest Control - Initial Visit	Job	2	283	284	Numeric
PEST IS	Pest Control-Initial Visit	Amount Paid	6	285	290	Numeric
PEST M	Pest Control — Maintenance	Month	1	291	291	Numeric
PEST MS	Pest Control- Maintenance	Amount Paid	6	292	297	Numeric
PT	Physical Therapy	15 Minute Unit	4	298	301	Numeric
PTS	Physical Therapy	Amount Paid	6	302	307	Numeric
RISKREDU	Physical Risk Assessment and Reduction	IS Minute Unit	4	308	311	Numeric
RISKREDS	Physical Risk Assessment and Reduction	Amount Paid	6	312	317	Numeric
PRIVNURS	Private Duty Nursing Services	15 Minute Unit	4	318	321	Numeric
PRIVNURS	Private Duty Nursing Services	Amount Paid	6	322	327	Numeric
PT R	Registered Physical Therapist	Visit	2	328	329	Numeric
PT RS	Registered Physical Therapist	Amount Paid	6	330	335	Numeric
RSPTH	Respiratory Therapy	15 Minute Unit	4	336	339	Numeric
RSPTHS	Respiratory Therapy	Amount Paid	6	340	345	Numeric
RESP HM	Respite Care - In Home	15 Minute Unit	4	346	349	Numeric
RESP HMS	Respite Care- In Home	Amount Paid	6	350	355	Numeric
RESP FA€	Respite Care - Facility-Based	Days	2	356	357	Numeric
RESP FAS	Respite Care- Facility-Based	Amount Paid	6	358	363	Numeric
NURSE	Skilled Nursing	Visit	4	364	367	Numeric
NURSES	Skilled Nursing	Amount Paid	6	368	373	Numeric
SPTH	Speech Therapy	15 Minute Unit	4	374	377	Numeric
SPTHS	Speech Therapy	Amount Paid	6	378	383	Numeric
TRANSPOR	Transportation Services (not included in Escort or Adult Day Health services)	Trips	3	384	386	Numeric
TRANSPORS	Transportation Services (not included in Escort or Adult Day Health services)	Amount Paid	6	387	392	Numeric
OTH UNIT	Other LTC Service not listed (unit)	Unit/Visit	6	393	398	Numeric
DESCR 1	Description of other LTC service		35	399	433	Text
OTH SS	Other LTC service not listed (amount)	Amount Paid	6	434	439	Numeric
DESCR 2	Description of other LTC service		35	440	474	Text

File 2: Acute Care Services

Code	Field Name	Description	Unit of Measurement	Field Length	Start Col.	End Col.	Text/Numeric
	ACUTE SERVICES	DESCRIPTION	UNITS OF SERVICE/ COST
	SSN	Social Security Number (left justify)	000000000	9	1	9	Numeric
	MEDICAID	Medicaid ID Number	0000000000	10	10	19	Numeric
	MONTH	Report Month	MMYYYY	6	20	25	Numeric
	CLINIC	Clinic Services	Visit	2	26	27	Numeric
	CLINICSS	Clinic Services Costs	Amount Paid	6	28	33	Numeric
	DENTAL	Dental Services	Visit	6	34	39	Numeric
	DENTALSS	Dental Services Costs	Amount Paid	6	40	45	Numeric
	DIALYSIS	Dialysis Center	Visit	2	46	47	Numeric
	DIALYSSS	Dialysis Center Costs	Amount Paid	6	48	53	Numeric
	ER	Emergency Room Services	Visit	2	54	55	Numeric
	ER SS	Emergency Room Services Costs	Amount Paid	6	56	61	Numeric
	FQHC	FQHC Services	Visit	2	62	63	Numeric
	FQHC SS	FQHC Services Costs	Amount Paid	6	64	69	Numeric

Attachment I - Page 89

Amendment 001 Agreement Number XQ744

Code	Field Name	Description	Unit of . Measurement	Field Length	Start Col.	End Col.	Text/Numeric
	HEAR	Hearing Services including hearing aids	Amount Paid	6	70	75	Numeric
	MPTSVS	Inpatient Hospital Services	Day	3	76	78	Numeric
	INPTSVSS	Inpatient Hospital Services Costs	Amount Paid	6	79	84	Numeric
	LAB	Independent Laboratory or Portable X-ray Services	Amount Paid	6	85	90	Numeric
	ARNP	Nurse Practitioner Services	Visit	2	91	92	Numeric
	ARNP SS	Nurse Practitioner Services Costs	Amount Paid	6	93	98	Numeric
	RX SS	Pharmaceuticals	Amount Paid	6	99	104	Numeric
	PA	Physical Assistant	Visit	2	105	106	Numeric
	PA S$	Physical Assistant Costs	Amount Paid	6	107	112	Numeric
	MD	Physician Services	Visit	2	113	114	Numeric
	MD SS	Physician Services Costs	Amount Paid	6	115	120	Numeric
	OUTPT	Outpatient Hospital Services	Encounter	3	121	123	Numeric
	OUTPT SS	Outpatient Hospital Services Costs	Amount Paid	6	124	129	Numeric
	PODIATRY	Podiatry	Visit	2	130	131	Numeric
	PODIATSS	Podiatry Costs	Amount Paid	6	132	137	Numeric
	RURAL	Rural Health Services	Visit	2	138	139	Numeric
	RURALSS	Rural Health Services Costs	Amount Paid	6	140	145	Numeric
	SNFREHA	Skilled nursing facility services-rehabilitation	Days	2	146	147	Numeric
	SNFREHAS	Skilled nursing facility services-rehabilitation**	Amount Paid	6	148	153	Numeric
	EYE SS	Visual Services including eyeglasses	Amount Paid	6	154	159	Numeric
	OTH UNIT	Other Acute Service not listed (unit)	Unit/ Visit	6	160	165	Numeric
	OTH SS	Other Acute service not listed (amount)	Amount Paid	6	166	171	Numeric
	DESCR 1	Description of other Acute service		35	172	206	Text
	DESCR 2	Description of other Acute service		35	207	241	Text

*'Medicare Crossovers

Encounter Data Pile Naming Format

Replace *** with the contractor's prearranged 3-character file code, MON with the beginning month of the reporting quarter and YY with the reporting year.

	Long-Term Care Services	Acute Care Services
Data File	*** MON YYLTC.txt	*** MON YYACS.txt
Validation Report	*** MON YY LTC DV.pd'f	*** MON YY ACS DV.pdf
Certification File (if applicable)	*** MON YY LTC CERT.doc	*** MON YY ACS CERT.doc
ZIP file	*** MON YY.zip	*** MON YY.zip

Attachment I - Page 90

Amendment 001 Agreement Number XQ744

EXHIBIT D

Report of Grievances/Appeals

(Plan Name)

(Reporting Quarter)

Were any new grievances filed during this reporting quarter? YES NO

	Enrollee's Last Name	Enrollee's First Name	Enrollee's Medicaid D>#	Enrollee's Social Security #	Grievance Type*	Grievance Date	Expedited Request? (VorN)	Disposition Type**	Disposition Date	Resolved? (YorN)
1
2
3
4
5

Were any new appeals filed during this reporting quarter? YES NO

	Enrollee's Last Name	Enrollee's First Name	Enrollee's Medicaid	Enrollee's Social Security #	Appeals Type *	Appeals Date	Expedited Request? (YorN)	Disposition Type **	Disposition Date	Resolved? (YorN)
1
2
3
4
5


* Grievance/Appeals Type		** Disposition type
1 = Quality of Care	7 = Enrollment/Disenrollment	1 = Reassigned Case Manager	7 = Disenrolled Self
2 = Access to Care	8= Termination of Contract	2 = Service Added to Plan of Care	8 = Disenrolled by plan
3 = Not Medically Necessary svcs	9= Unauthorized out of plan	3 = Service Increased	9 = In QA Review
4 = Excluded Benefit	10 = Unauthorized in-plan sacs	4 = Changed to Another Provider	10 = In Grievance/Appeal Process
5 = Billing Dispute	11 = Benefits available in plan	5 = Reinstated in Plan	11 = Lost Contact with Enrollee
6 = Contract Interpretation	12 = Other	6 = Billing Issue Resolved	12 = Other

Attachment I - Page 91

Amendment 001 Agreement Number XQ744

EXHIBIT E

Minority Business Enterprise Contract Reporting

Vendor Name

Quarterly Vendor

Expenditure Activity

Reporting Timeframe	Due Date
Quarter 1 (January thru March)	April 15
Quarter 2 (April thru June)	July 05
Quarter 3 (July thru September)	October 15
Quarter 4 (October thru December)	January 15

Subcontractor Name	Subcontractor Address	Subcontractor Telephone #	Subcontractor Federal Identification # or Social Security #	Total Amount Expended With Subcontractor (Current Reporting Quarters Only)	Total Amount Expended With Subcontractor (Prior Reporting Quarters)







Completed By: Telephone #: Completion Date:

Attachment I - Page 92

Amendment 001

Agreement Number XQ744

Long-Term Care Community Diversion Pilot Project

Reconciliation Report

For (Contractor name) (Month/Year)

EXHIBIT F

	Last Name	First Name	Medicaid ID Number	Provider Number	Error Code	Comments
1
2
3
4
5
6
7
8
9
10

Error Codes	Error Summary Description	Error Codes	Error Summary Description
01	Action Code Invalid	14	Recipient Ineligible
02	HMO Number Invalid	15	Recipient Already enrolled
03	HMO Number Not Found	16	Invalid Recipient AID Cat
04	Recipient ID Not Found	17	Capitation Group Not Covered
05	Recipient ID Not on File	18	Transaction Date Invalid
06	Recipient Date of Birth Invalid	19	Transaction Date Incorrect
07	Recipient Date of Birth Unmatched	20	Outpatient Dollars Invalid
08	Recipient Has Major Medical	21	Inpatient Units Invalid
09	HMO Not A Medicaid Provider	22	Invalid Fiscal Year
10	Recipient Amount Not Met	23	Bad Capitation Update
11	Recipient Not Enrolled	24	Cancelled by Choice Counselor .
12	Recipient Enrolled In Other HMO	25	Recipient In a Nursing Home
13	Enrollment Error

Attachment I - Page 93

Amendment 001 Agreement Number XQ744

EXHIBIT G

DEPARTMENT OF ELDER AFFAIRS

LONG-TERM CARE DIVERSION PILOT PROJECT

REQUEST FOR DISENROLLMENT

CURRENT PROVIDER NAME: COUNTY:

PROVIDER ADDRESS:

TELEPHONE NUMBER:( ) FAX:( )

PARTICIPANT NAME:

MEDICAID #: DOB:TELEPHONE NUMBER: ( )

PARTICIPANT ADDRESS:

COUNTY:

□Does enrollee wish to file a grievance?[ ] Yes[ ] No

VOLUNTARY (Check All That Apply):
□Dissatisfied with services (SVR) □Moving to out-of-network nursing home (NET) □Moving to out-of-network ALF	□No longer wish to participate in diversion program (OUT) □Transfer to new provider (TFR)

COMMENTS:


Signature of Participant or Authorized Representative		Date

If representative, please print name		Please state relationship to participant

FOR DIVERSION PROVIDER USE ONLY

INVOLUNTARY (Check All That Apply):
□Death (Date: ____________________) (EXP) □Not eligible for Medicaid (ELG) □Not eligible for project (PRJ) □Moving out of the service area (CTY)	□Fraudulent use of Medicaid ID card (FRD) □Incarceration □Subject to Department of Elder Affairs approval (SDA)

EFFECTIVE DATE OF DISENROLLMENT:
Case Manager Signature		Date CARES Office Notified

Program Administrator Signature		CARES Fax Number
REQUEST FOR TRANSFER TO NEW PROVIDER NAME OF NEW PROVIDER: COUNTY:

Attachment I - Page 94

Amendment 001 Agreement Number XQ744

DEPARTMENT OF ELDER AFFAIRS

LONG-TERM CARE DIVERSION PILOT PROJECT

SOLICITUD PARA DARSE DE BAJA

Nombre actual del proveedor:

Condado:

Dirección del proveedor:

Numero de Teléfono: ( ) FAX:( )

Nombre del Participante:

Numero de Medicaid: Fecha de Nacimiento: Numero de teléfono: __________

Dirección del Participante:Condado:

DESEA INFORMAR ACERCA DE ALGUNA QUEJA?[ ] Si[ ] No

VOLUNTARIO (MARQUE LAS QUE SE APLICAN):
□No esta satisfecho con el servicio (SVR) □Se muda a una clínica de reposo fuera del área (NET) □Se muda a una residencia de vivienda asistida fuera del área (ALF)	□No desea participar en el programa de diversión (OUT) □Solicita un nuevo proveedor (TFR)

COMMENTS:


Firma del participante o representante autorizado		Fecha

Si es represéntate, por favor escribir letras		Por favor indicar el relación con el participante

PARA USO DEL PROVEEDOR DE DIVERSION

INVOLUNTARIO (Marque las que apliquen)
□Fallecimiento (Fecha: _________) (EXP) □No es elegible para Medicaid (ELG) □No es elegible para el programa (PRJ) □Se mudo fuera del área de servicio	□Uso fraudulento de la tarjeta Medicaid (FRD) □ Encarcelamiento (INC) □Sujeto a aprobación del departamento de Elder Affairs (SDA)

Fecha de desenlistamiento:
Firma del manejador de caso		Fecha de notificación a las oficinas de CARES
Firma del administrador del programa		Numero de fax de la oficina de CARES
□SOLICITUD PARA TRANSFERIR A UN NUEVO PROVEEDOR NOMBRE DEL NUEVO PROVEEDOR: CONDADO:

Attachment I - Page 95

Amendment 001 Agreement Number XQ744

EXHIBIT H

Provider Name

Street Address

City, FL ZIP

Phone: Plan Contact:

FAX: Email:

List Date x/xx/xx

Covered Services	Provider Name	Name of Provider Contact	Phone Number	Street Address	City	State	Zip Code	County Served	Comments
Adult Companion Services
Adult Companion Services
Adult Day Health Services
Adult Day Health Services
Assisted Living Services
Assisted Living Services
Case Management Services
Chore Services
Chore Services
Consumable Medical Supply Services
Consumable Medical Supply Services
Dental
Dental
Environmental Accessibility Adaptation Services
Environmental Accessibility Adaptation Services
Escort Services
Escort Services
Family Training Services
Family Training Services
Financial Assessment/Risk Reduction Services
Financial Assessment/Risk Reduction Services
Hearing
Hearing
Home Delivered Meals
Home Delivered Meals
Homemaker Services
Homemaker Services
Nursing Facility Services
Nursing Facility Services

Attachment I - Page 96

Amendment 001 Agreement Number XQ744


Nutritional Assessment/Risk Reduction Services
Nutritional Assessment/Risk Reduction Services
Occupational Therapy
Occupational Therapy
Personal Care Services
Personal Care Services
Personal Emergency Response Systems (PERS):
Personal Emergency Response Systems (PERS):
Physical Therapy
Physical Therapy
Respite Care Services
Respite Care Services
Speech Therapy
Speech Therapy
Vision
Vision
Optional Services
Transportation Services
Expanded Services

Staff Positions	Staff Name	Phone Number	Email	Fax Number
Contract Manager / Plan Administrator
Case Management Supervisor
Case Manager
Data Processing
Grievance Coordinator
Medical Director
Medical Records Coordinator
Member Services
Quality Assurance Coordinator
Training Coordinator
Utilization Review

Attachment I - Page 97

Amendment 001 Agreement Number XQ744

EXHIBIT I

Capitation Rates

Provider ID	Provider Name	County Name	1/1/2008 - 8/31/2008 Diversion Capitation Rate
0150771 00	WellCare	Orange	1,351.22
0150771 01	WellCare	Osceola	1,351.22
0150771 02	WellCare	Seminole	1,351.22
0150771 03	WellCare	Duval	1,410.43

The following table lists the initial rates for prospective expansions.

PSA	Counties	1/1/08-8/31/2008 Diversion Capitation Rate
1	Escambia, Okaloosa Santa Rosa, and Walton	1,514.64
2	Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Taylor, Wakulla, and Washington	1,514.64
3	Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lake, Levy, Marion, Putman, Sumter, Suwannee, and Union	1,544.36
4	Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia	1,410.43
5	Pasco and Pinellas	1,568.98
6	Hardee, Highlands, Hillsborough, Manatee, and Polk	1,542.84
7	Brevard, Orange, Osceoia, and Seminole	1,351.22
8	Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota	1,529.72
9	Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie	1,512.27
10	Broward	1,558.68
11	Miami-Dade and Monroe	1,570.30

Attachment I - Page 98

Amendment 001 Agreement Number XQ744

Contract #2007-2008-01

EXHIBIT J

SWORN STATEMENT PURSUANT TO CHAPTER 287.133(3)(a),

FLORIDA STATUTES. ON PUBLIC ENTITY CRIMES

THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.

1. This sworn statement is submitted to_____________________(print name of the public entity)

by _________________________(print individual's name and title)

for _________________________(print name of entity submitting sworn statement)

whose business address is _________________________________________

and, if applicable, its Federal Employer Identification Number (FEIN) is

If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement:

__________________________________________________________________________________

I understand that a "public entity crime" as defined in Paragraph 287.133(l)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material representation.'

I understand that "convicted" or "conviction" as defined in Paragraph 287.133(1 )(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non-jury trial, or entry of a plea of guilty or nolo contendere.

I understand that an "affiliate" as defined in Paragraph 287.133(l)(a), Florida Statutes, means:

A predecessor or successor of a person convicted of a public entity crime; or

An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of the affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A. person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate.

I understand that a "person" as defined in Paragraph 287.133(l)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity.

6.	Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (Indicate which statement applies.)

Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,1989.

Attachment I - Page 99

Amendment 001 Agreement Number XQ744

Contract #2007-2008-01 EXHIBIT J

SWORN STATEMENT PURSUANT TO CHAPTER 287.133(3)(a), FLORIDA STATUTES. ON PUBLIC ENTITY CRIMES

THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.

1. This sworn statement is submitted to the Florida Department of Elder Affairs

by Todd Farha, President and CEO (print individual's name and title)

for WellCare of Florida, Inc. (print name of entity submitting sworn statement)

whose business address is: 8735 Henderson Road Tampa, FL 33634

and, if applicable, its Federal Employer Identification Number (FEIN) is

If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement: ______________________________________________

I understand that a "public entity crime" as defined in Paragraph 287,133(l)(g). Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material representation.

I understand that "convicted" or "conviction" as defined in Paragraph 287.133(l)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an-adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non-jury trial, or entry of a plea of guilty or nolo contendere.

I understand that an "affiliate" as defined in Paragraph 287.133(l)(a), Florida Statutes, means:

A predecessor or successor of a person convicted of a public entity crime; or

An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of the affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate.

6.	Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (Indicate which statement applies.)

X Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989.

Attachment I - Page 99

Amendment 001 Agreement Number XQ744

The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity subsequent to July 1,1989.

_______ The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees,

members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entry submitting this sworn statement on the convicted vendor list. (Attach a copy of the final order.)

I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT 1 AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD PROVIDED IN CHAPTER 287.017, FLORIDA STATUTES FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.

	/s/ Todd S. Farha (Signature)
	12/27/07

STATE OF FLORIDA

COUNTY OF HILLSBOROUGH

PERSONALLY APPEARD BEFORE ME, the undersigned authority, Todd S. Farha, who, after first being sworn by me, affixed his/her signature in the space provided above on this 27th Day of December, 2007.

/s/ Sara Gallo

Notary Public

My commission expires: 1/29/2010

Jan 2001

Form 102 Sworn State Public Entity Crimes (Jan 2001)

Attachment I-Page 100

Amendment 001 Agreement Number XQ744

CONTRACT#2007-2008-0

EXHIBIT K

INSTRUCTIONS

CERTIFICATION REGARDING

DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION CONTRACTS/SUBCONTRACTS

Each recipient or vendor whose contract equals or exceeds $100,000 in federal monies must sign this debarment certification prior to contract execution. Independent auditors who audit federal programs regardless of the dollar amount are required to sign a debarment certification form. Neither the Department of Elder Affairs nor its contract recipients or vendors can contract with subrecipients if they are debarred or suspended by the federal government.

This certification is a material representation of fact upon which reliance is placed when this contract is entered into. If it is later determined that the signed knowingly rendered an erroneous certification, the Federal Government may pursue available remedies, including suspension and/or debarment.

3.	The recipient or vendor shall provide immediate written notice to the contract manager at any time the recipient or vendor learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

The terms "debarred," "suspended," "ineligible," "person," "principal," and "voluntarily excluded," as used in this certification, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549 and 45 CFR (Code of Federal Regulations), Part 76. You may contact the contract manager for assistance in obtaining a copy of those regulations.

5.	The recipient or vendor further agrees by submitting this certification that, it shall not knowingly enter into any subcontract with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this contract unless authorized by the Federal Government.

6.	The recipient or vendor further agrees by submitting this certification that it will require each subrecipient of this contract whose payment will equal or exceed $100,000 in federal monies, to submit a signed copy of this certification with each contract.

7.	The Department of Elder Affairs and its contract recipients or vendor may rely upon a certification of a recipient/subrecipients that is not debarred, suspended, ineligible, or voluntarily exclude from contracting/subcontracting unless it knows that the certification is erroneous.

8.	If the recipient or vendor is an Area Agency on Aging (AAA), the AAA may rely upon a certification of a recipient/subrecipient or vendor entity that is not debarred, suspended, ineligible, or voluntarily excluded from contracting/subcontracting unless the AAA knows that the certification is erroneous.
9.	The signed certifications of all subrecipients or vendors shall be kept on file with recipient.

DOEAFORM112A (Revised May 2002)

Attachment I - Page 101

Amendment 001 Agreement Number XQ744

Contract 2007-2008-01

INSTRUCTIONS

CERTIFICATION REGARDING

DEBARMENT, SUSPENSION, INELIGIBILITY

AND VOLUNTARY EXCLUSION CONTRACTS/SUBCONTRACTS

This certification is required by the regulation implementing Executive Order 12549, Debarment and Suspension, signed February; 18,1986. The guidelines were published in the May 29, 1987 Federal Register (52 Fed. Reg., pages 20360-20369).

(1)

The prospective recipient or vendor certifies, by signing this certification, that neither he nor his principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in contacting with the Department of Elder Affairs by any federal department or agency.

(2)	Where the prospective recipient or vendor is unable to certify to any of the statements in this certification, such prospective recipient or vendor shall attach an explanation to this certification.

Signature: /s/ Todd S. Farha

Date: 12/27/07

Todd S. Farha, President & CEO

Name and Title of Authorized Individual(Print or Type)

WellCare of Florida , Inc.

Name of Organization

DOEA Form 112B

(revised May 2002)

Amendment 001 Agreement Number XQ744

EXHIBIT L

Long-Term Care Diversion Pilot Project Hospice Enrollment Report

Number of Enrollees Electing Hospice Monthly

Month of: __________________________

Contractor: ________________________

	County	Number of enrollees	For Profit	Not for Profit
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Submitted by:

Submit to your contract manager by the 15lh day after the reporting month.

Attachment I-Page 103

Amendment 001 Agreement Number XQ744

ATTACHMENT II

CERTIFICATION REGARDING LOBBYING

CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND

COOPERATIVE AGREEMENT

The undersigned certifies, to the best of his or her knowledge and belief, that:

(1)

No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any state or federal agency, a member of congress, an officer or employee of congress, an employee of a member of congress, or an officer or employee of the state legislator, in connection with the awarding of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement.

(2)

If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.

(3)

The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

/s/ Todd S. Farha Signature	12/27/07
Todd S. Farha Name of Authorized Individual	XQ744 Application or contract number
WellCare of Florida, Inc. P.O Box 26011, Tampa, FL 33623 Name and Address of Organization

DOEA Form 103 (Revised Nov 2002)

ATTACHMENT II - Page 1

Amendment 001 Agreement Number XQ744

ATTACHMENT III

CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS

The undersigned, an authorized representative of the recipient named in the contract or agreement to which this form is an attachment, hereby certifies that:

(1)

The recipient and any sub-recipients of services under this contract have financial management systems capable of providing certain information, including: (1) accurate, current, and complete disclosure of the financial results of each grant-funded project or program in accordance with the. prescribed reporting requirements; (2) the source and application of funds for all contract supported activities; and (3) the comparison of outlays with budgeted amounts for each award. The inability to process information in accordance with these requirements could result in a return of grant funds that have not been accounted for properly.

(2)

Management Information Systems used by the recipient, sub-recipient(s), or any outside entity on which the recipient is dependent for data that is to be reported, transmitted or calculated, have been assessed and verified to be capable of processing data accurately, including year-date dependent data. For those systems identified to be non-compliant, recipient(s) will take immediate action to assure data integrity.

(3)

If this contract includes the provision of hardware, software, firmware, microcode or imbedded chip technology, the undersigned warrants that these products are capable of processing year-to-date dependent data accurately. All versions of these products offered by the recipient (represented by the undersigned) and purchased by the State will be verified for accuracy and integrity of data prior to transfer.

In the event of any decrease in functionality related to time and date related codes and internal subroutines that impede the hardware or software programs from operating properly, the recipient agrees to immediately make required corrections to restore hardware and software programs to the same level of functionality as warranted herein, at no charge to the State, and without interruption to the ongoing business of the state, time being of the essence.

(4)	The recipient and any sub-recipient(s) of services under this contact warrant their policies and procedures include a disaster plan to provide for service delivery to continue in case of an emergency including emergencies arising from data integrity compliance issues.

The recipient shall require that the language of this certification be included in all subcontracts, subgrants, and other agreements and that all sub-contractors shall certify compliance accordingly.

WellCare of Florida, Inc. 8735 Henderson Road, Tampa, FL 33634 Name and Address of Organization
/s/ Todd S. Farha Signature	President & CEO Title	12/27/07 Date
Todd S. Farha Name of Authorized Individual

ATTACHMENT III - Page 1

Amendment 001 Agreement Number XQ744

ATTACHMENT IV

AGREEMENT TO PROVIDE SERVICES TO INDIVIDUALS IDENTIFIED AS MEDICAID PENDING

……………….. No, contractor does not elect to provide services to individuals designated as Medicaid Pending.

………………..Yes, contractor elects to provide services to individuals designated as Medicaid Pending.

By checking YES above, contractor agrees to provide services to individuals referred to them by CARES who have been designated as Medicaid Pending in accordance with Section 430.705(5), Florida Statutes. The contractor will meet all conditions of this contract and the following:

The contractor is responsible for compliance with all pertinent insurance laws and regulations prior to providing services to Medicaid Pending individuals.

CARES staff will refer individuals, identified as Medicaid pending and who choose to receive Medicaid Pending services, to the chosen contractor. Included with the referral will be the Freedom of Choice form, 701 B Assessment, 3008, Informed Consent, and the Level of Care.

The contractor may assist Medicaid pending individuals through the Medicaid financial eligibility process by submitting the ACCESS Florida Application (online or hardcopy) to the Department of Children and Families and when contacted by DCF, forward at a minimum the following documentation: Financial Release (CF ES 2613), CARES' level of care decision (Form 603) and the Certification of Enrollment Status (HCBS) (CF-AA 2515). Applications may be completed and submitted online at the following website: www.myflorida.com/accesssflorida

Once the individual is determined financially eligible, the contractor must notify CARES and provide a copy of the Notice of Case Action within two business days of receipt.

The contractors will be responsible for submitting 834 enrollment transactions to the Medicaid fiscal agent one week prior to the regular submission date for only the Medicaid pending individuals. The enrollment date will be retroactive to the first of the month following the CARES eligibility determination, not to exceed four (4) months.

Services must be in place on the first of the month following the CARES eligibility determination.

The contractor will be paid the capitation rate for services rendered retroactive to the first of the month following the CARES eligibility determination. The contractor shall make available, on request from the department, proof of services, which meet the timeframes listed above.

Payment will be made once full financial eligibility has been determined

In the event the individual is determined not to be financially eligible by the Department of Children & Families, the contractor must notify CARES and can seek reimbursement from the individual in accordance with the Medicaid Coverage and Limitations Handbooks and the associated fee schedules.

Signature. /s/ Todd S. Farha

Date: 12/27/07

Todd S. Farha

Name and Title of Authorized Individual (Print or type)

ATTACHMENT IV - Page 1

CONTRACTOR: Wellcare	STATE OF FLORIDA, DEPARTMENT OF ELDER AFFAIRS
SIGNED BY: /s/ Todd Farha	SIGNED BY: /s/ Illegible for
NAME: Todd Farha	NAME: E. Douglas Beach, PH.D.
TITLE: President & CEO	TITLE: Secretary
DATE: 12/27/07	DATE: 12/31/07
FEDERAL ID NUMBER: 592583622 FISCAL YEAR END DATE:

SECTION 1	GENERAL CONTRACT REQUIREMENTS	5
1.1	Entire Agreement; Conflict	5
1.2	Misuse of Symbols, Emblems, or Names in Reference to Medicaid	5
1.3	Contractor Qualifications	5
1.4	Contract Management	5
1.5	Insolvency Protection	9
1.6	Surplus Requirements	9
1.7	Bonds	9
1.8	Insurance	10
1.9	Interest and Savings	10
1.10	Third Party Resources	10
1.11	State Ownership	11
1.12	Ownership and Management Disclosure	11
1.13	Independent Provider	13
1.14	Damages from Federal Disallowances	13
1.15	Offer of Gratuities	13
1.16	Attorneys' Fees	13
1.17	Venue	13
1.18	Legal Action Notification	13
1.19	Force Majeure	13
1.20	Sanctions	14
1.21	Additional Applicable Laws and Regulations	15
1.22	Inspection and Audit of Financial Records	15
1.23	Reporting	15
1.24	Fiscal Intermediary	15
1.25	Subcontracts	16
1.26	Subcontractor Terminations	20
1.27	Termination	20
1.28	Assignment	21
SECTION 2	RECIPIENT ELIGIBILITY TO PARTICIPATE IN THE PROJECT	21
2.1	Eligibility Requirements	21
2.2	Eligibility	22
2.3	Persons Not Eligible for Enrollment	22
2.4	Optional State Supplementation (OSS)	22
SECTION 3	EDUCATIONAL MATERIALS AND CHOICE COUNSELING	23
3.1	Educational Materials	23
3.2	Choice Counseling	23
3.3	Prohibited Activities	23
SECTION 4	ENROLLMENT AND DISENROLLMENT	24
4.1	Enrollment Procedures	24
4.2	Effective Date of Enrollment	24
4.3	Transition Care Planning	24
4.4	Orientation	25
4.5	Plan of Care	26
4.6	Integration of Care	28
4.7	Disenrollment	29
4.8	Disputes of Appropriate Enrollments	31
4.9	Medicaid Pending	31
SECTION 5	ENROLLEE RECORDS	32

SECTION 6	SERVICE PROVISIONS	32
6.1	Genera] Provisions	32
6.2	Long-Term Care Services	34
6.3	Minimum Long-Term Care Service Provider Qualifications	37
6.4	Acute-Care Services	39
6.5	Acute Care Provider Qualifications	40
6.6	Optional Services	40
6.7	Expanded Services	40
6.8	Availability/Accessibility of Services	41
6.9	Staffing Requirements	41
6.10	Emergency Care Requirements	42
6.11	Out of Network Use of Non-Emergency Services	42
6.12	Adult Protective Services	43
SECTION 7	UTILIZATION MANAGEMENT	44
SECTION 8	QUALITY ASSURANCE AND IMPROVEMENT REQUIREMENTS	45
8.1	General	45
8.2	Quality Assurance Program	45
8.3	Quality Assurance Committee	46
8.4	Quality Improvement Activities and Performance Measures	46
8.5	Independent Medical Review	47
8.6	Incident Reporting	47
SECTION 9	GRIEVANCE/APPEALS PROCEDURES	48
9.1	Grievance System Requirements	48
9.2	Appeal Process	49
9.3	Grievance Process	52
9.4	Medicaid Fair Hearing System	52
SECTION 10	PAYMENT	53
10.1	Payment to Contractor	53
10.2	Capitation Rates	53
10.3	Payment in Full	54
10.4	Capitation Payments	54
10.5	Payment Discrepancies	54
SECTION 11	PROGRAM REPORTING REQUIREMENTS	54
11.1	General Requirements	54
11.2	834 Transactions	57
11.3	Disenrollment Summary Report	58
11.4	Encounter Data Report	58
11.5	Grievance/Appeals Report	58
11.6	Updated Provider Network Listing	58
11.7	Minority Business Enterprise Contract Reporting	59
11.8	Emergency Management Plan	59
11.9	Enrollee Satisfaction Reporting	59
11.10	Hospice Services	59
SECTION 12	FINANCIAL REPORTING	59
12.1	General Financial Reporting	59
12.2	Member Payment Liability Protection	59
12.3	Financial Reporting Template	60
12.4	Audited Financial Statements	60
12.5	Unaudited Quarterly Financial Statements	60
12.6	Balance Sheet	61
12.7	Income Statement by Category of Service	65
12.8	Income Statement by Line of Business	74
12.9	Net Worth and Working Capital	75
12.10	Claim Lag Reports & Outstanding Claims Liability (OCL)	76
12.11	Analysis of Total Medical Liability to Actual Claims Paid	76
12.12	Member Months	76
12.13	Notes and Other Information	76

SECTION 12	FINANCIAL REPORTING (cont)
12.14	Ratio Analysis	76
12.15	Footnote Disclosure Requirements	77
SECTION 13	DEFINITIONS	77
EXHIBIT A	MULTIPLE SIGNATURE VERIFICATION AGREEMENT	84
EXHIBITB	DISENROLLMENT SUMMARY REPORT	86
EXHIBIT C	ENCOUNTER DATA REPORTING FORMAT	87
EXHIBIT D	REPORT OF GRIEVANCES/APPEALS	91
EXHIBIT E	MINORITY BUSINESS ENTERPRISE CONTRACT REPORTING	92
EXHIBITF	RECONCILIATION REPORT	93
EXHIBIT G	DISENROLLMENT FORM	94
EXHIBIT H	PROVIDER NETWORK AND STAFF LISTING	96
EXHIBIT I	CAPITATION RATES	98
EXHIBITJ	PUBLIC ENTITY CRIMES	99
EXHIBIT K	DEBARMENT AND SUSPENSION	101
EXHIBIT L	HOSPICE ENROLLMENT REPORT	103

a)	Are based on valid and reliable clinical evidence or a consensus of healthcare professionals in the particular field.
b)	Consider the needs of the enrollees.
c)	Are adopted in consultation with contracting health care professionals.
d)	Are reviewed and updated periodically as appropriate.

C.	Have the capacity to integrate the delivery of acute and long-term care services to enrollees and;
D.	Meet all the requirements to enroll as a Medicaid provider and;

4.	Provide through the CARES program, information regarding long-term care options to persons applying for Medicaid long-term care assistance.
5.	Provide policy and contract clarification, in consultation with the Agency.

(b)	Completion of a criminal history background check to determine whether subcontactor has any history of felony convictions, including adjudication withheld on a felony, plea of nolo contendere to a felony, or entry into a pretrial for a felony.
(c)	Any sanctions imposed by Medicare or Medicaid in any state.

6.	Verification that all subcontractors and their employees with direct contact with enrollees have completed Abuse, Neglect, and Exploitation Training.
E.	The process for periodic re-credentialing shall include the following:

E.	When both the Agency and the contractor have liens against the proceeds of a third party resource, the Agency shall prorate the amount due to Medicaid to satisfy such liens under Section 409.910, F.S., between the Agency and the contractor. This prorated amount shall satisfy both liens in full.
F.	All funds recovered from third parties shall be treated as income for the contractor.

1.	In accordance with Section 409.907(8)(a), F.S., contractors must submit, prior to execution of a contract, complete sets of fingerprints of principals of the contractor to the department for the purpose of conducting a criminal history record check.
2.	Principals of the contractor are defined in Section 409.907(8)(a), F.S.

A.	In accordance with Section 4707 of the Balanced Budget Act of 1997, and Section 409.912(22), F.S, the following sanctions may be imposed against the contractor if it is determined that the contractor has violated any provision of this contract, or the applicable statutes or rules governing Medicaid HMOs:
1.	Suspension of the contractor's enrollment.

C.	The Agency and/or department may impose intermediate sanctions in accordance with 42 CFR 438.702, including:
1.	Civil monetary penalties in the amounts specified in Chapter 409.912(22), F.S.

(1)	There is continued egregious behavior by the contractor, including but not limited to behavior that is described in 42 CFR 438.700, or that is contrary to any requirements of Sections 1903(m) and 1932 of the Social Security Act; or
(2)	There is substantial risk to enrollees' health; or

(3)	The sanction is necessary to ensure the health of the contractor's enrollees: (i) While improvements are made to remedy violations under 42 CFR 438.700; or (ii) Until there is an orderly termination or reorganization of the contractor.
b)	The State must impose temporary management (regardless of any other sanction that may be imposed) if it finds that, a contractor has repeatedly failed to meet substantive requirements in section 1903(m) or section 1932 of the Social Security Act or 42 CFR 438.706. The State must also grant

1.	The contractor agrees to make payment to all providers pursuant to 42 CFR 447.46,42 CFR 447.45(d)(2), 42 CFR 447.45(d)(3), 42 CFR 447.45(d)(5) and 42 CFR 447.45(d)(6). If third party liability exists, payment of claims must be determined in accordance with Section 1.11, Third Party Resources.
2.	Provide for prompt submission of information needed to make payment.

4.	Provide for monitoring and oversight by the contractor of the subcontractor to provide assurance that all licensed subcontractors are credentialed in accordance with Section 1.5.D.3, Credentialing and Re-credentialing Policies and Procedures.
5.	Provide for monitoring of services rendered to enrollees- by the subcontractor.

1.	Identify the population covered by the subcontract and the counties served.
2.	Specify the amount, duration and scope of services to be provided by the subcontractor, including a requirement that the subcontractor continue to provide services through the term of the capitation period for which the Agency has paid the contractor.
3.	Provide for timely access to appointments and services.

1.	Require safeguarding of information about enrollees in accordance with 42 CFR 438.224.
2.	Require compliance with HIPAA privacy and security provisions.

5.	Require that the subcontractor secure and maintain during the life of the subcontract worker's compensation insurance for all of its employees connected with the work under this contract unless such employees are covered by the protection afforded by the contractor. Such insurance must comply with the Florida's Worker's Compensation Law.
6.	Pursuant to Section 641.315(9), F.S., contain no provision that prohibits a physician from providing inpatient services in a contracted hospital to an enrollee if such services are determined by the organization to be medically necessary and covered services under the organization's contract with the contract holder.

C	In the event of a notice of termination and unless a written waiver is executed by the department or Agency, the contractor must:
1.	Continue performance under the terms of the contract until the termination date.
2.	Immediately cease enrollment of new enrollees under the contract.
3.	Immediately perform the duties as specified in the approved Termination Plan.

A.	65 years of age or older.
B.	Has Medicare Parts A & B as reflected in the Florida Medicaid Management Information System (FMMIS) through the Medicaid Eligibility Verification System (MEVS).
C.	Medicaid eligible with incomes up to the Institutional Care Program level (ICP).
D.	Reside in the project service area.

E.	Determined by CARES to be at risk of nursing home placement and meet one or more of the following clinical criteria:
1.	Require some help with five or more activities of daily living (ADLs); or
2.	Require some help with four ADLs plus requiring supervision or administration of medication; or
3.	Require total help with two or more ADLs; or

5.	Have a diagnosis of a degenerative or chronic condition requiring daily nursing services.
F.	Determined by CARES to be a person who, on the effective date of enrollment, can be safely served with home and community-based services.

A.	Persons residing outside the project service area.
B.	Persons residing in a state hospital, intermediate care facility for persons with developmental disabilities, or a correctional institution.
C.	Persons participating in or enrolled in another Medicaid waiver project.

2.	The advantages to the enrollees of the integration and coordination of acute and long-term care.
3.	The qualifications for enrollment in the project.

4.	That the enrollee has the right to choose any available contractor in the service area and may change contractors if the enrollee is not satisfied with his/her initial choice.
5.	The benefits provided under the project.
6.	Pursuant to 42 CFR 438.10(g)(3), the contractor shall provide information on the contractor's physician incentive plans or on the contractor's structure and operation to any Medicaid recipient, upon request.

A.	When a person is determined to be both financially and clinically eligible and chooses to enroll in the Long-Term Care Community Diversion Program, CARES staff will complete a CARES referral package. CARES staff will forward the CARES referral package, with the date of enrollment, to the contractor.
B.	Upon receipt, the contractor will log in and date stamp the CARES referral package.

1.	Recipient address is located in the same county as the contractor's provider service area
2.	Recipient program codes (should be MS, MMS, or MWA)
3.	Residing in a nursing home
4.	Current enrollment in a Medicaid HMO
5.	Current enrollment in the MediPass Program
6.	Has presence of Medicare Parts A &B If a recipient does not have Medicare Parts A & B on MEVS, then the recipient is not eligible for the program. Once the presence of Medicare Parts A & B is on MEVS, then the recipient can be submitted for electronic enrollment.

C.	The enrollee handbook must be written so it can be read and understood by the enrollees or their representatives at or below an eighth grade reading level. The following items must be included:
1.	Terms and conditions of enrollment including the reinstatement process.
2.	An explanation of the role of the case manager.

6.	Instructions on how enrollees obtain access to the services included in their care plans.
7.	The consequences of obtaining care from out-of-network providers.

8.	Information regarding the enrollee's right to disenroll at any time and instructions to initiate the disenrollment process. Information must explain that if voluntary disenrollment is requested prior to the fiscal agent's monthly processing deadline, disenrollment will be effective the first of the following month.
9.	Information regarding the enrollee's rights and responsibilities.
10.	Grievance and appeals process.
11.	Information regarding the confidentiality of enrollee records.

b)	A detailed description of the contractor's process used to determine whether services are medically necessary.
c)	A detailed description of the contractor's quality assurance program.
d)	A detailed description of the contractor's credentialing process.

e)	The policies and procedures relating to the contractor's prescription drug benefits program.
f)	The policies and procedures relating to the confidentiality and disclosure of the enrollee's medical records. g) Information that enrollees may obtain from the contractor regarding quality performance indicators, including aggregate enrollee satisfaction data

15.	Information that services will continue upon appeal of a suspended authorization and that the enrollee may have to pay in case of an adverse ruling.
16.	Information regarding the health care advanced directives pursuant to Chapter 765, F.S.. Written information regarding advance directives provided by the contractor must reflect changes in state law as soon as possible, but no later than 90 days after the effective date of the change.