AmeriHealth Caritas Florida, Inc.- DSNP

This master agreement establishes a Highly Integrated Dual Eligible Special Needs Plan (HIDE) that provides coordinated Medicare and Medicaid benefits to dual-eligible beneficiaries in Florida. The contract authorizes AmeriHealth Caritas Florida to deliver comprehensive services across three service regions: Broward, Miami-Dade, and Palm Beach counties. The scope of covered services includes behavioral health services, long-term support and services, home health services, and medical supplies and equipment. The plan operates with exclusively aligned enrollment (EAE) and covers Medicare cost-sharing obligations for four categories of eligibility: Qualified Medicare Beneficiary (QMB), Qualified Medicare Beneficiary Plus (QMB Plus), Specified Low-Income Medicare Beneficiary Plus (SLMB Plus), and Full Benefit Dual Eligible (FBDE). This structure enables integrated delivery of healthcare services to this vulnerable population through a single coordinated plan.

AmeriHealth Caritas Florida, Inc. serves as the prime contractor under this master agreement with the Agency for Health Care Administration (AHCA), the contracting organization for the State of Florida. The contract period runs from January 1, 2026, through December 31, 2028, with an option to renew for up to three additional years subject to satisfactory performance and legislative appropriation. The contract value does not exceed $135,460.60, with Medicaid rates subject to approval by the Centers for Medicare & Medicaid Services (CMS). AmeriHealth Caritas Florida is required to maintain a performance bond of $13,546.06 and must comply with extensive federal and state regulatory requirements, including HIPAA and HITECH compliance, background screening protocols, and ten-year records retention obligations.