CN-680000-FP125-A2.pdf
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- Contract number
- FP125
- Issued by
- Florida
About this file
This document is Amendment No. 2 to AHCA Contract No. FP125, an agreement between the State of Florida's Agency for Health Care Administration (the "Agency") and DentaQuest of Florida, Inc. (the "Vendor" or "Dental Plan"). The amendment was executed in April 2020 and specifically updates the Statewide Medicaid Managed Care Dental Health Program's Attachment I, Scope of Services, with an effective date of February 15, 2025.
The amendment focuses on updating dental plan capitation rates for various rate cells across nine different regions in Florida, covering populations such as Medicaid Only/Dual Eligible (0-20 years), Medicaid Only (21+), Dual Eligible (21+), and Medically Needy (0-20 and 21+ years). The capitation rates vary by region and demographic group, ranging from $2.16 to $21.36 per member. The rates are applicable for the rate year spanning February 2025 through October 2025 and are marked as "NOT FOR USE UNLESS APPROVED BY CMS", indicating they require federal approval before implementation. The rates are designed to enhance credibility, with Medically Needy rates set at a statewide level while other rate cells are set at a regional level.
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| File | Type | Posted |
|---|---|---|
| CN-680000-FP125-A1.pdf | ||
| CN-680000-FP125.pdf |
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Text version
AHCA CONTRACT NO. FP125
AMENDMENT NO. 2
AHCA Contract No. FP125, Amendment No. 2, Page 1 of 1
April 2020
THIS CONTRACT, entered into between the State of Florida, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the "Agency" and DENTAQUEST OF FLORIDA, INC., hereinafter referred to as the "Vendor" or “Dental Plan,” is hereby amended as follows:
1. Attachment I, Scope of Services – Update: February 1, 2025, Statewide Medicaid Managed Care Dental Health Program, EXHIBIT I-C – UPDATE: FEBRUARY 1, 2025, DENTAL PLAN RATES – NOT FOR USE UNLESS APPROVED BY CMS, Page 1 of 1, is hereby deleted in its entirety and replaced with Attachment I, Scope of Services – Update: February 15, 2025, Statewide Medicaid Managed Care Dental Health Program, EXHIBIT I-C – UPDATE: FEBRUARY 15, 2025, DENTAL PLAN RATES – NOT FOR
USE UNLESS APPROVED BY CMS, Page 1 of 1, attached hereto and made a part of this Contract. All references in this Contract to Attachment I, Scope of Services – Update: February 1, 2025, Statewide Medicaid Managed Care Dental Health Program, EXHIBIT I-C – UPDATE: FEBRUARY 1, 2025, DENTAL PLAN RATES – NOT FOR
USE UNLESS APPROVED BY CMS, Page 1 of 1, shall hereinafter refer to Attachment I, Scope of Services – Update: February 15, 2025, Statewide Medicaid Managed Care Dental Health Program, EXHIBIT I-C – UPDATE: FEBRUARY 15, 2025, DENTAL PLAN RATES – NOT FOR USE UNLESS APPROVED BY CMS, Page 1 of 1.
All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in this Contract.
This Amendment and all its attachments are hereby made a part of this 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 two (2) page Amendment to be executed by their officials thereunto duly authorized. This Amendment is not valid until signed and dated by both Parties.
DENTAQUEST OF FLORIDA, INC. STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED
BY:
SIGNED
BY:
NAME: NAME:
TITLE: TITLE:
DATE: DATE:
List of Attachments included as part of this Amendment:
Specify Type Number Description Attachment I EXHIBIT I-C – UPDATE: FEBRUARY 15, 2025, DENTAL PLAN
RATES – NOT FOR USE UNLESS APPROVED BY CMS (1 Page)
Docusign Envelope ID: 067E4549-1212-4ACC-8837-B091F482F1CD
SVP
2/24/2025
Brett Bostrack
2/25/2025
Deputy Secretary HQA
Kimberly Smoak
DENTAQUEST OF FLORIDA, INC.
ATTACHMENT I
SCOPE OF SERVICES
STATEWIDE MEDICAID MANAGED CARE DENTAL HEALTH PROGRAM
UPDATE: FEBRUARY 15, 2025
AHCA Contract No. FP125, Attachment I, Exhibit I-C, Update 02/15/25, Page 1 of 1
EXHIBIT I-C – UPDATE: FEBRUARY 15, 2025
DENTAL PLAN RATES - NOT FOR USE UNLESS APPROVED BY CMS
DENTAL PLAN RATES - NOT FOR USE UNLESS APPROVED BY CMS
STATEWIDE MEDICAID MANAGED CARE (SMMC) DENTAL HEALTH PROGRAM
FEBRUARY 2025 THROUGH OCTOBER 2025 RATE YEAR (RY 24/25) CAPITATION RATE DEVELOPMENT BY REGION AND RATE CELL
Region
Rate Cell A B C D E F G H I Medicaid Only/Dual Eligible 0-20 $21.36 $13.16 $16.24 $15.42 $13.61 $13.70 $16.23 $16.17 $15.58 Medicaid Only 21+ $7.24 $4.18 $4.69 $4.30 $3.71 $2.90 $3.08 $2.92 $3.75 Dual Eligible 21+ $4.70 $2.94 $3.46 $2.91 $3.09 $2.16 $3.66 $3.56 $2.83 Medically Needy 0-201 $11.30 $11.30 $11.30 $11.30 $11.30 $11.30 $11.30 $11.30 $11.30 Medically Needy 21+1 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81
1 Capitation rates are set at a regional level for the Medicaid Only and Dual Eligible rate cells but set at a statewide level for the Medically Needy rate cells to enhance credibility.
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
Docusign Envelope ID: 067E4549-1212-4ACC-8837-B091F482F1CD
| FP125 Amendment 2.pdf |
| FP125 A2 Attachment I.pdf |
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