CN-680000-HQA28-A2.pdf

AHCA CONTRACT NO. HQA028

AMENDMENT NO. 2

AHCA Contract No. HQA028, Amendment No. 2, Page 1 of 2 April 2020

THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the "Agency," and CAPITOL BRIDGE, LLC, hereinafter referred to as the "Vendor," is hereby amended as follows:

1. In accordance with Standard Contract, Section W., Requirements of Section 287.058, Florida Statutes, Item 6., which provides for renewal of this Contract for a period that may not exceed three (3) years or the original term of the Contract, whichever is longer, both Parties hereby agree to exercise the renewal option for a period of thirty-six (36) months beginning January 1, 2025. Therefore, Standard Contract, Section W., Requirements of Section 287.058, Florida Statutes, Item 5., is hereby amended to now read as follows:

This Contract shall begin January 1, 2024, and end on December 31, 2027, inclusive.

2. Attachment I, Exhibit II, Price Sheet, is hereby deleted in its entirety and replaced with Exhibit II-A, Price Sheet. All references in the Agreement to Exhibit II, Price Sheet, shall hereinafter refer to Exhibit II-A, Price Sheet.

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.

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Docusign Envelope ID: B4327E9C-C4C1-4822-BCD8-8D178EEB39EA

AHCA CONTRACT NO. HQA028

AMENDMENT NO. 2

AHCA Contract No. HQA028, Amendment No. 2, Page 2 of 2 April 2020

IN WITNESS WHEREOF, the Parties hereto have caused this three (3) page Amendment to be executed by their officials thereunto duly authorized. This Amendment is not valid until signed and dated by both Parties.

CAPITOL BRIDGE, LLC 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 Exhibit II-A Price Sheet

12/27/2024

Kara Volk

Contracts Manager Deputy Secretary HQA

12/27/2024

Kimberly Smoak

ATTACHMENT I-A

EXHIBIT II

PRICE SHEET

Table 1: Rates

No. Service/Position Title Current Rate Renewal Year 2025 (3%

Escalation)

Renewal Year 2026 (3%

Escalation)

Renewal Year 2027 (3%

Escalation)

1. Physician Expert $235.00 / Hour $242.00 / Hour $249.00 / Hour $257.00 / Hour

2. Utilization Nursing Review

$100.00 / Hour $103.00 / Hour $106.00 / Hour $109.00 / Hour

3. Medical Claims Coding Expert

$130.00 / Hour $134.00 / Hour $138.00 / Hour $142.00 / Hour

4. Legal Expert Review $175.00 / Hour $180.00 / Hour $186.00 / Hour $191.00 / Hour

5. Administrative Reviewer

$0.00 $70.00 / Hour $72.00 / Hour $74.00 / Hour

6. Initial Eligibility Determination Filing

$87.85 (Per Dispute) $85.00 plus a Credit Card Transaction Fee $2.85.

$123.88 (Per Dispute) $120.00 plus a Credit Card Transaction Fee $3.88

$127.59 (Per Dispute) $123.60 plus a Credit Card Transaction Fee $3.99

$131.40 (Per Dispute) $127.30 plus a Credit Card Transaction Fee $4.10

7. Late Fee Charge for Review Fee Not Paid within 35 days of the Final Order. Late fees will start on day 36 and will accrue every 30 days. An additional $50 late charge will accrue every 30 days until the invoice is paid.

$50.00 $50.00 $50.00 $50.00

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AHCA Contract No. HQA028, Attachment 1-A, Exhibit II, Page 1 of 1

HQA028 - Attachment 1-A Exhibit II Price Sheet - Vendor Changes