ANTITRUST AND FLORIDA MANAGED MEDICAID: REFORMS TO ENSURE QUALITY SERVICES AND COMPETITION

Transcription

1 ATTORNeyS.&. COUNSEI.ORS ANTITRUST AND FLORIDA MANAGED MEDICAID: REFORMS TO ENSURE QUALITY SERVICES AND COMPETITION Prepared For: The Agency for Health Care Administration Elizabeth Dudek, Secretary Prepared and Respectfully Submitted By: Edward Vishnevetsky, Esq. Munsch Hardt Kopf & Harr, P.C 500 North Akard; Ste Dallas, TX (214)

2 I. INTRODUCTION The undersigned and the law firm of Munsch Hardt Kopf & Harr, P.C. ("Munsch Hardt") have been retained by several Florida health care providers (in consideration of their Medicaid beneficiaries) to prepare this paper in order to alert the Florida Agency for Health Care Administration (AHCA) of current and future potentially anticompetitive conduct as it relates to the creation and proliferation of unlicensed exclusive provider organizations in Florida Managed Medicaid. To that effect, please direct all future correspondence regarding this paper to the undersigned firm, care of Edward L. Vishnevetsky. II. BACKGROUND 1. Antitrust Antitrust law promotes or maintains competition among businesses by regulating anticompetitive behavior. In health care, competition benefits consumers because it helps contain costs, improves quality, maintains choice and encourages innovation. The United States Department of Justice (DOJ) recently stressed the importance of antitrust enforcement and competition policy in healthcare. 1 The DOJ Antitrust Division enforces the antitrust laws of the United States? The DOJ shares jurisdiction over civil antitrust cases with the Federal Trade Commission (FTC) and often works jointly with the FTC to provide regulatory guidance to businesses. 3 The Antitrust Division also has the power to file criminal cases against willful violators of the antitrust laws." The three major Federal antitrust laws are: (a) the Sherman Antitrust Act (the "Sherman Act"); (b) the Clayton Act; and (c) the Federal Trade Commission Act (the "FTC Act"). In addition to these federal statutes, most states have antitrust laws that are enforced by state attorneys general or private plaintiffs. Many of these statutes are based on the federal antitrust laws. In Florida, the Attorney General's Office enforces the state antitrust laws." a. Sherman Act The Sherman Act outlaws all contracts, combinations, and conspiracies that unreasonably restrain interstate and foreign trade." This includes agreements among competitors to fix prices, rig bids, and allocate customers, which are punishable as criminal felonies.' The Sherman Act also makes it a crime to monopolize any part of interstate commerce. 8 An unlawful monopoly 1 Sharis A. Pozen, Acting Assistant Attorney General, Antitrust Division, U.S. Dep't of Justice, Competition and Health Care: A Prescription for High Quality, Affordable Care, Remarks as Prepared for the World Annual Leadership Summit on Mergers and Acquisitions in Health Care, at 16 (Mar. 19,2012) U.S.C fd. 4 fd. at 3. 5 Fla. Stat U.S.C fd U.S.C. 2. MHDocs _ Page 12

3 exists when one firm controls the market for a product or service, and it has obtained that market power, not because its product or service is superior to others, but by suppressing competition with anticompetitive conduct. 9 b. Clayton Act The Clayton Act is a civil statute that prohibits mergers or acquisitions that are likely to lessen competition.l'' Under the Clayton Act, the government challenges mergers that are likely to increase prices to consumers.l ' As amended by the Robinson-Patman Act of 1936, the Clayton Act also bans certain discriminatory prices, services, and allowances in dealings between merchants.v' The Clayton Act was amended again in 1976 by the Hart-Scott-Rodino Antitrust Improvements Act to require companies planning large mergers or acquisitions to notify the government of their plans in advance. 13 c. FTC Act The FTC Act bans "unfair methods of competition" and "unfair or deceptive acts or practices.v'" The Supreme Court has said that all violations of the Sherman Act also violate the FTC Act. 1S Thus, although the FTC does not technically enforce the Sherman Act, it can bring cases under the FTC Act against the same kinds of activities that violate the Sherman Act. 16 The FTC Act also reaches other practices that harm competition, but that may not fit neatly into categories of conduct formally prohibited by the Sherman Act State Immunity Exception States have the authority to exempt certain forms of anticompetitive conduct from federal antitrust laws. Under the "state action immunity doctrine" propounded by the U.S. Supreme Court in Parker v. Brown,18 state regulatory programs that authorize anticompetitive conduct to further a legitimate state policy do not violate federal antitrust laws. In this vein, many states have enacted legislation aimed at providing antitrust immunity for certain types of cooperative agreements among healthcare providers by substituting regulation for competition. For instance, Florida's Legislature has specifically stated that rural health network cooperative agreements are intended to be "protected from federal antitrust laws," but the agreements are still subject to approval and regulation by the Florida Department of Health Copperweld Corp. v. Independence Tube Corp., 467 U.S. 752, 768 (1984) U.S.C Id U.S.C. 13. B 15 U.S.C U.S.C FTCv. Brown Shoe Co., 384 U.S. 316, (1966). 16 I d. 17Id U.S. 341, (1943). 19Fla. Stat (1) (2012). MHDocs _ P a g" 13

4 a. Exclusive Provider Organization The creation of Exclusive Provider Organizations (EPOs) in Florida may also fit within the state action immunity doctrine. EPOs allow managed care plans to condition the payment of benefits on the use of exclusive providers.r" An EPO, on its face, violates antitrust law, because it eliminates competition in a specific geographic area. However, Florida law specifically excepts EPOs from violation if certain conditions are met. Specifically, a managed care plan that wants to create an EPO must submit an application identifying the parties to the EPO and receive approval from AHCA. Once an EPO is established, AHCA continually monitors the EPO by requiring it to submit the following items: (a) a list of the EPO's provider networks every six months; (b) annual grievance reporting; and (c) investigations of quality of care complaints received. Although EPOs are not statutorily exempted from federal or state antitrust laws (like rural health network cooperative agreements), Florida law treats EPOs as an exception to antitrust laws. 3. Florida Managed Medicaid Medicaid managed care provides for the delivery of Medicaid health benefits and additional services in the United States through an arrangement between a state Medicaid agency and managed care plans that accept a set payment - "capitation" - for these services. All managed care plans contract with doctors, hospitals, clinics, and other health care providers such as pharmacies, labs, x-ray centers, medical equipment companies, infusion, and home health care companies. This group of contracted health care providers is known as the health plan's "network." Managed care plans typically contract with providers that: (a) are enrolled in Medicaid; (b) are willing to accept a certain reimbursement rate; (c) can provide services to all beneficiaries in a specific geographic area; and (d) agree to abide by specific quality and utilization review guidelines." a. Current Structure In Florida, a "managed care plan" is either a health maintenance organization (HMO) or a prepaid health plan. 22 Florida law requires that most Medicaid beneficiaries choose some type of managed care option.r' The two types of privatized managed care options for Florida Medicaid beneficiaries are (a) HMOs; and (b) Provider Service Networks (PSNs). b. Future Structure In 2011, AHCA created a Statewide Medicaid Managed Care (SMMC) Program. The SMMC program has two key components: (a) the Managed Medical Assistance Program; and (b) the Long-Term Care Managed Care Program. The programs should be implemented beginning in See FI. Stat (3). 21 See generally David M. Cutler, et. al., How does managed care do it?, 31 RAND J. Eco. 526 (Autumn 2000). 22 FI. Stat (13). 23 FI. Stat and MHDocs Page 14

5 According to the SMMC Program overview, AHCA will invite eligible plans to participate in the two programs using invitations to negotiate (ITNs). AHCA will then choose the plans that may participate in the programs through a competitive bid process. Only certain types of managed care plans may participate in the Florida Managed Medical Assistance Program, including: (a) Health Maintenance Organizations; (b) Provider Service Networks; (c) Accountable Care Organizations; (d) Exclusive Provider Organizations; and (e) Children's Medical Services Networks. Based on AHCA timelines, it is anticipated that the Florida Managed Medical Assistance Program will be available in certain areas of the State in the last quarter of 2013 and will be in all areas by October 1,2014; in addition, it is anticipated that the Florida Long-Term Care Managed Care Program will be available in certain areas of the State in the first quarter of 2013 and will be in all areas by October 1, Third Party Administrators Third party Administrators (TPAs) are prominent players in the managed care industry. They are essentially outsourced administrative managers. Insurers, such as HMOs, contract with TPAs to manage their claims processing, provider networks, premium collection, utilization review, and/or perform administrative and membership functions. While some TPAs may operate as units of insurance companies, they are often independent. Fl. Stat governs TPA licensure requirements. HI. ANTICOMPETITIVE EXCLUSIVITYARRANGEMENTS Numerous Medicaid managed care plans in Florida refuse to contract with more than one provider per service category in a specific geographic area. This type of behavior eliminates patient choice. According to the CMS State Medicaid Manual, a managed care plan contract with a state must "allow each enrollee to choose his or her health professional to the extent possible and appropriate.v'" "The purpose of the free choice provision is to allow [Medicaid] recipients the same opportunities to choose among available providers of covered health care and services as normally offered to the general population.vf By only contracting with one provider, Medicaid managed care plans in Florida do not offer Medicaid recipients the same opportunities to choose among providers as normally offered to the general population. Given that contracting with one service provider is anticompetitive, Florida permits this behavior on only one condition -- the creation of a properly registered EPO. Pursuant to Fl. Stat , a managed care plan that wants to create an EPO must submit an application identifying the parties to the EPO and receive approval from AHCA. The application and approval processes are purposefully stringent in order to limit the number of anti competitive EPOs in Florida. 24 ems State Medicaid Manual, Pub. 45, Ch. 2, ld at MHDocs Page 15

6 1. Unauthorized EPOs In many instances, managed care plans do not follow the requirements to properly create or register an EPO in Florida. Instead, the managed care plan creates an informal EPO without submitting an application to, or obtaining approval from, AReA. Although the managed care plan does not denote the arrangement as an EPO, by contracting with only one provider and refusing to even consider other providers that may be able to provide the same services at a lower cost and with higher quality, the managed care plan has effectively established a de facto EPO. As such, this arrangement must follow EPO registration guidelines. Without authorization from AHeA, any Medicaid-related business conducted by an unauthorized EPO violates state and federal antitrust laws. As of July 1, 2012, there are eighteen (18) HMOs and six (6) PSNs covering 1,147,917 Florida Managed Medicaid lives." Ofthese managed care plans, at least seven (7) HMOs27 and one (1) PSN 28 have unofficial EPOs in place for the provision of durable medical equipment (DME), as evinced by their Provider Directories (or affirmative statement(s) by the managed care plan that an EPO exists)?9 These managed care plans cover 922,005 Florida Managed Medicaid lives, or approximately 80.31% of all Florida Managed Medicaid enrollees. Yet, AHeA has no record of any authorized EPOs created or registered by these managed care plans." Consequently, at least 80% of all Florida Managed Medicaid beneficiaries receiving DME are being serviced by unauthorized EPOs. 2. TP A Involvement, Ownership and Control in Unauthorized EPOs In addition to creating an unauthorized EPO directly between a managed care plan and a provider, some managed care plans use a TPA to establish an unauthorized EPO. Specifically, the managed care plan hires a TPA that contracts with an exclusive "network" provider. Meanwhile, the TPA refuses to contract with any other providers that may be able to provide the same services at a lower cost and at a higher quality. The resulting de facto EPO is just as illegitimate as if it were created directly by the managed care plan and provider. Even more problematic, oftentimes both the TPA and the exclusive provider are owned by, and share similar governing boards as, the same parent company. The following figure illustrates such a relationship: 26 See Exhibit 1, "Medicaid Managed Care, Sunnnary Enrollment, As of July 1,2012". 27 These eight HMOs are: ArneriGroup, HealthEase, Molina Healthcare, Simply Healthcare Plan, Staywell, Sunshine, and United Healthcare Plan. 28 The one PSN is Prestige. 29 See Exhibits See Exhibit 10. MHDocs P age 16

7 Common ownership and control of TPA and Exclusive Provider In this scenario, the TPA has a financial incentive to contract with the Exclusive Provider because they are owned by the same company. As a result, Florida Medicaid beneficiaries are deprived of the choice of other providers that may be able to provide services for less cost or higher quality in the relevant geographic area. Ultimately, the parent company profits from the use of the related TPA and Exclusive Provider. For example, in 2012, two Florida Medicaid managed care plans, HealthEase and Staywell (both part of the WellCare Affiliate Network) entered into an Ancillary Services Agreement with All-Med Management Systems, Inc. ("All-Med Management") whereby AU- Med Management would act as the TPA for the WellCare Affiliate Network. All-Med Management is licensed as both a TPA and a provider of DME in Florida. Consequently, All- Med Management (as a TPA), exclusively contracted with All-Med Management (as an Exclusive Provider) to provide DME to HealthEase and Staywell Managed Medicaid beneficiaries. 31 In 2012, Univita Health, Inc. acquired All-Med Services of Florida, Inc. and its subsidiaries, including All-Med Management.Y Therefore, Univita Health, Inc. owns, controls and operates both the TPA (All-Med Management) and the Exclusive Provider (All-Med Management) for all DME provided to HealthEase and Staywell beneficiaries, and is able to profit from the contractual and self-referring relationship between the TPA and Exclusive Provider. Moreover, the de facto EPa created between HealthEase, Staywell and All-Med Management (the Exclusive Provider) through All-Med Management (the TPA) was never authorized by AHCA. Similarly, in 2009, one of the Florida Medicaid managed care plans, Amerigroup Florida, Inc. ("Amerigroup"), entered into a Management Services Agreement with Atenda Healthcare, Inc. whereby Atenda Healthcare, through one of its affiliated companies, would act as the TPA for Amerigroup's participating provider nerwork.v' In 2010, Univita 31 See Exhibit See Exhibit See Exhibit 13. MHDocs l Pagel7

8 Health, Inc. purchased Atenda Healthcare, Inc. and its affiliated companies ("Atenda,,)?4 Atenda then contracted with Univita Healthcare, LLC to be the exclusive DME provider for Amerigroup. Univita Healthcare, LLC is owned, controlled and operated by the same managers as Univita Health, Inc. Therefore, Univita Health, Inc. owns, controls and/or operates both the TPA (Atenda) and the Exclusive Provider (Univita Healthcare, LLC) for all DME provided to Amerigroup beneficiaries, and is able to profit from the contractual and self-referring relationship between the TPA and Exclusive Provider. Moreover, the de facto EPO created between Amerigroup and Univita Healthcare, LLC (through Atenda) was never authorized by AHCA. 3. Case Law Courts have long recognized that our federal antitrust laws (15 U.S.C. 1 et seq.) prohibit exclusivity agreements among insurers and providers that create, or attempt to create, a monopoly. For example, in a closely watched case in 2010, the U.S. Court of Appeals for the Third Circuit reinstated a Pittsburgh hospital's antitrust lawsuit against a competing hospital and the area's largest health insurer. 35 In 2009, West Penn filed an antitrust lawsuit against the region's largest hospital and insurer alleging a "mutual protection" conspiracy-i.e., that the defendants had conspired to eliminate competition in their respective markets in order to create a "super monopoly"-in violation of Sections 1 and 2 of the Sherman Act. The District Court dismissed the case.'" The Third Circuit reinstated West Penn's case, finding that West Penn had sufficiently alleged direct evidence of an agreement between the hospital and the insurer to protect each other from rivals. 3? The Third Circuit's holding demonstrates that insurer-provider exclusivity arrangements must undergo and withstand strict scrutiny under the law in order to proceed. Furthermore, the McCarran-Ferguson Act ("the Act") does not insulate insurer-provider exclusivity agreements from federal antitrust scrutiny. The Act exempts the "business of insurance" from federal antitrust law to the extent that the business of insurance is regulated by state law. However, exclusivity agreements between insurers and providers are not the "business of insurance." In Group Life & Health Ins. Co. v. Royal Drug Co., Inc., the plaintiffs, independent pharmacies, challenged agreements between a health insurer and three "participating pharmacies.v" Under the agreements, the insurer's policyholders could purchase prescription drugs from the participating pharmacies at a price of $2 per prescription, and the insurer would reimburse the pharmacy for the cost of acquiring the drug prescribed. By contrast, policyholders who selected a non-participating pharmacy were required to pay the full retail price charged by the pharmacy and could then seek reimbursement from the insurer for 75% of the difference between that price and $2. The Supreme Court concluded that Congress did not intend to protect insurer-provider exclusivity agreements because those agreements are not the 34 See Exhibit West Penn Allegheny Health System, Inc. v. UPMC, 627 F.3d 85 (3d Cir. 2010) WL (W.D. Pa. 2009). 37 UPMC, 627 F.3d at U.S. 205,211 (1979). MHDocs _ Page 18

9 "business of insurance." The Court's ruling is yet another example of the need for strict regulatory oversight of insurer-provider exclusivity arrangements. Neither the "state action immunity doctrine" nor the McCarran-Ferguson Act permits a laissez-faire approach to insurer-provider exclusivity agreements. Rather, such arrangements must be intensely regulated due to the threat posed to output, quality of services, and innovation. By creating arrangements that establish a monopoly on market share in the manner described above, Florida Medicaid managed care plans (as well as the TPAs and providers they contract with) may be guilty of anticompetitive conduct, and may also be guilty of violations of federal and state kickback statutes. IV. RECOMMENDATIONS In light of the foregoing, Florida's regulation of anti competitive managed care arena can be improved by: conduct in the Medicaid 1. Eliminating unauthorized, de facto EPOs that do not comply with the law; 2. Enforcing disclosure of any and all EPOs between and among managed care plans, TPAs, and/or providers (as currently required by Fl. Stat ); 3. Requiring disclosure of any direct or indirect financial relationships between and among managed care plans, TPAs, and/or providers; and 4. Denying approval of authorized EPOs where there is common control or ownership between or among the managed care plans, TPAs, and/or providers. Given that current monopolization of market power may lead to the elimination of providers in certain geographic areas in Florida, one can only imagine how many providers will be eliminated when the SMCC program is fully instituted throughout all geographic areas in Florida. As a result, it is especially important to employ the aforementioned recommendations during the lin process of the SMCC program. There must be transparency and full disclosure of exclusivity arrangements in order for ARCA to preserve and promote competition between and among providers. MHDocs _ Page 19

10 Exhibit 1

11 Medicaid Managed Care [1915(b)] Summary Enrollment Report As of July f st, 2012 (Including Medikids Population) IITANF I/SSI '#To!al Enrolled I "10 Chg From Plan Name Type '".. No Medic ;re--... M~'ricar... Market Share Enrolled Medicare Part B Parts A 8. B Enrolled nrev.month. L prev.rnonth AMERIGROUP HMOMC 153,408 21, , % 187,2.n 0.93 BUENA VISTA HMOMC 20,585 2, ~, % 23, CAREFLORIDA HMOMC 1, SS1 0.2% 2,008 M:') CLEAR HEALTH ALLIANCE HMOMC % \> FREEDOM HMOMC 21,906 2, ,6/3 2.1% ,88 HEALTHEASE HMOMC 156, , , % 176,079 0,15 HE:ALTHYPALM BEACHES HMOMC 12,255 5 Q 3 12; % 12, ' HUMANA HMOMC 31,989 6.$ ,St9 3.5% 40, % ME:DICA HMOMC 2, ; % 3, % MOLINA HE:AL THCARE HMOMC 35,766 5, , % 41,374 U3% PREFERRED MEDICAL PLAN HMOMC 13, S, ' % 15,e ' Y" SIMPLY HEALTHCARE: PLAN HMDMC Z , % 25, % STAYWE:LL HMOMC 170, ,212 HI ~!~:~~~ 17.2% 196, % SUNSHINE HMOMC 101, ,696 ;16, % 114,6$7 1.71% UNITED EVERCARE FREtO ' 2, % % iunited HEAL THCARE PLAN HMOMC 85,973 11, ,426 99, % 98, % UNIVERSAL HMDMC , S,!!~O 3.8% '43, % VISTA HEAL THPLAN of S, Fl HMOMC '. ~~ % 22,487 ;Z.94~, HMO_.ENRJOTAL HMOMC 899, ,6$ ,118, l,042.54!l 90.8% 1,032, % PClES :.GE CPS 1 62 FJ5,.01& 9 1,002 71', % ", Ir.;ECRP,L cr:,;, 19,:, I ;6:i3 1,9% 21,416 l.01' CPSN_EI-lR,.TOTAL CP(;' '1 10 1,197,~',,1SS., 1~i.l $4,1.\ % SETTER HEAlTH, LLC, PSNNR 1, U3:n 0.1% 1, ~' First Coast Advantage Central PSNNR 1,04f; \ "; :; SFCCN PSNNR 5,322 2, B 1S<! 0,7% ,15% WeC.re Health Plans. Inc PSNNR 1, ,;05 0.1% '" PSN_ENR_TOTAL PSNNR 8,751 2, lB 12, % 11.30a 7)1% " MMCP ENR TOTAL 990,B j '206 23,743 1,147, % B4% Medicaid Pilot (1115) HMO and PSN Summary Enrollment Report As of July 1st, 2012 (Including Mediklds Population) IITANF #SSI Enrolled % Chg Plan Name Type No 1- iiledlciir"c- i -Medicare Market Share Enrolled Medicare I PartS I Parts A & B Enrolled, nrev.month prev.morrth POSITIVE RAHF o! % % freedom REHfo'O 3, ! o i wr 1.4% % HUMANA REHMO 4,400 1,3941 7i % 5, % ME;DICA REHMO 2, % % MOLINA HEALTHCARE REHMO 23,717 3,7flS j 9) % 27, % CAREFLORIOA REHMO 2, M 1.0% 3,274 ~1.01% :~ % 86, % SUNSHINE< REHMO 77.7$ 1,832! UNITEOHEALiHCAREPLAN REHMO , ' $;672 2.e% 1l % UNIVERSAL REHMO 17,070 2,5681 1H ,{)1S 6,4% 19, % i! PILOT HMO TOTAL 139,479 18,740 I 39 t eO, % 159, %! I 8ETTER HEALTH, LtC, P$l(1{ 31,003 3, f ,?3~ 11,8% % ems CIISR ! o j 13 :Mn 2.7% % SFCCN PSNR 32,252 4,294 \ 5i 5% 3r;-j,ffl 12.0% ,59% ISI'artdsIJa~ db. FCA F' \!~ n,ss i 51 1,298 67; % 66,684, 1.73% i PILOT PSN TOTAL 12,9b j 2, t..(lMS "t1.3% 148, ~(' j ILOT ENR TOTAL f A,~04 310, % 307, %! CARE ENR TOTAL 172,~ I 28, > ,63~ 0.90% Medicaid Enrollment By Program Type Report (Including Medikids Population) Medicaid Enrollment Ratio JUNE 2012 JULY I! % ChgFrom PROGRAM MMCP PILOT f TOTAL Markel Share MMCP! PILOT i TOTAL Market Share nrev. month I I! HIIIO 1,032,107 ~ 159,115\ 1, ,0% I 160, B,3% 1.01% PSN 11.~OS 1 148,20], 159,515 5:1% , ,196 5:2% 1.68% CPSN 94,"(l9S; i 94,898, '3.0% 93,26BI i 93, % 1.72% i f I ~ANAGED CARE,ENR~OTAL 1,138,313i 307, ,917j 310,7 9, 1.458, % 0,90%,,!,.M'DIPASS 596.~57i 595, ' 596, % 0.05% Nurse Horne Division 1B.4S ,5 18,831j I :60% 2.04% PACE 621 i flJ! 626 '0,02% 0.81% FfS 1.075,3511 1, ;34 1,068,8B5i I 1.DeB 885, '34.U%..a.flO%! i MEDICAID ENR. TOTAL 2,829,1'.; % 2832,366' 310,7;;$ % 0.21%,

12 Exhi it

13 1 tt.i' At U"'I :II: East Region

14 PageJPiig<na S2 Ameriqroup Ancillary ProvidersiProveedores Brevard County/Condado de Brevard - 24hr Psych Res Trtmt Ctr-Aduft Servicio AuxHiar Brevard County! ;ondado de Brevard Wuesfuoff Memorial Hospital 110 Longwood Ave Rockledge (321) Devereux Florida 1264 Us Highway 1 Rockledge (321) Sarno Rd Ste 109 Melbourne (321} The Devereux Florida 1600 Sarno Rd Ste 214 Melbourne (321) Devereux Florida BODO Devereux Dr Viera {407} Apollo Surgery Ctr 375 S Wickham Rd W Melbourne (321) The Brevard Specialty Surgery Ctr 95 Bulldog Blvd Ste 104 Melboume (321) Digestive & Liver cir Of Melboume 25 Stiver Palm Ave Ste B Melbourne (321) Merritt Island Surgery Center 220 NSykes Creek Pkwy Ste 101 Merritt Island {321} Surgery Center Of Melbourne 14G1 S Apollo Blvd Ste 3 Melboume (321) Circles of Care 2020 Commerce Dr Melboume (321) N. Hwy Us 1 TItusville (321) The Devereux Florida 1600 Sarno Rd Ste 214 Melbourne (321) Devereux. florida 8000 Devereux Dr Viera (407) Devereux Florida 1264 Us Highway 1 Rockledge (321) DaVIia - Melbourne Dialysis 2235 S Babcock St Melbourne (321) Frasenius Medical Care Viera 8Q41 Spyglass Hill Dr Unit 101 Viera (321) Renal Care Group Brevard 4940 Stack Blvd Ste C 3-7 Melbourne (321) B1 Hanger Prosthetics.& Orthotics 1121 Geiger St Rockledge (321) S Apollo Blvd Melbourne (321) Univita Haalthcare Titusville (38B) Diagnostic Health, Merritt Island 270 N Sykes Creek Pkwy Merritt Island (321) Neuro Imaging Institute 27 E Hibiscus Blvd Melbourne (321) Neuroskeletai Imaging Inst Orlando 255 N Sykes Creek Pkwy Merritt Island (321) Omni Healthcare 1344 S Apollo Blvd Ste 102 Melbourne (321) Anchor Care And Rehabilitation Center 1515 Part Malabar Blvd Ne Palm Bay (321) Rockledge Health.& Rehabilitation Ctr 587 Barton Blvd Rockledge (321) Neuroskeletal Imaging Illst Melbourne 1344 S Apollo Blvd Ste 406 MelboUme t" (321) I Circles of Care 1770 Cedar St 255 N Sykes Creek Rockledge Pkwy (32i) Merritt Island (321) Neuroskeletal Imaging lnst Orlando 1344 S Apollo Blvd Merritt Island (321) The Health Center Of Merritt Island 500 Crockett Blvd Merritt Island (321) Unilfiia Heaithcare Titusville (88B) , ~ ~l~ 2000 Commerce Dr W Melboume (321) ibrevard Prosthetics 1405 S Valentine se Melbourne (321) S Washington AveSte 241 Titusville (321) N Washington Ave Ste 104 TJtusviUe32796 (321) Univita Healtheare Titusville 3278(} (BBS) The Health Center Of Merritt Island 500 Crockett Blvd Merritt Island (321) Univita Healthcare Titusville (888) Circles of Care 4450 W Eau Gallie Blvd Ste 200 Melboume (321) Diagnostic Health, Merritt Island 270 N Sykes Creek Pkwy Merritt Island (321) Florida Diagnostic Imaging 5201 Babcock St Ne Ste 5 Palm Bay (321) M R I Of Nort!l Brevard 1905 Jess Parrish Ct TItusville (321) Neuro Imaging Institute 27 E Hibiscus Blvd Melbourne (321) Neuroskeleial Imaging Institute - Merritt Island 1344 S Apollo Blvd Merritt Island (321) N Sykes Creek Pkwy Merritt Island (321) Open M R I Of Rockledge 1327 Oak St Melbourne (321) Rockledge Blvd Sfe 101 Rockledge (321) Anchor Care And Rehabilitation Center 1515 Part Malabar Blvd Ne Palm Bay (321) The Health Center Of Merritt Island 500 Crockett Blvd Merritt Island (321)

15 Amerigroup Ancillary Providers/Proveedores de Servicro AUXKUar PagefP<igJna ~ Marion County/Condado de Marion - Imaging Fadlity/Fadlid<:td de imagen Hadloqrafica _,', T~"'_ ~ " island Health And Indian River DaVita - leesburg Villages Endo Surg Rehabilitation Ctr Dialysis Ctr Ctr County/ "5 ~'rna Blvd 801 E Dixie Ave ste Se 174th Place,land Condado de 108-A Rd 6' 3-Q202 Indian River Leesburg Clermont Radiology Summerfield 34491, c (863) Oakley Seaver Dr (352) Ihe Palms Rehab Sta B I\.nd Healthcare Ctr DaVila - Mt Dora Clermont Babcock St Ne Dialysis (352) Palm Bay W Old Us Hwy ;321) Mount Dora Univita Healthcere Rockledge Health & Univita Heafthcare (352) Rehabilitation Ctr 587 Barton Blvd serving This Area DaVita - Ocala Reg Rockledge Winter Beach Kidney Ctr South Ocala :321) ~9i N Us Hwy "2201 lfista Manor ;~~~:!{E~(~~Jdi ; Ste40D lady Lake Clermont Radiology r~iwtt~~;:;;~ 1804 Oakley Seaver Dr ""'" "... ;i':_,,~..a,,_.,...""'" 1550 Jess Parrish Ct (352} 75H240 Sts B : DaVita - Ocala Reg Iltusville DaVits - Sebastian :321) Dialysis Lake Griffin East Clermont : Krdney Ctr North West Melbourne 1424 Us Highway 1 I Dialysis (352) 241-/3100 ' 2620 W Highway 316 Sebastian E North Ave Citra Health & (772) Leesburg (352) Rehabilitation (352) 315-0D62 DaVita - Ocala Reg ~enter indian River Dialysis 2125 W New Haven Center Renal Care Group Kidney Ctr West 9401 Sw Highway 200 o'vs th St Ste 1D2 Clermont Melboume Vera Beach Mohawk Rd Bldg 600 :321) (772) Minneola Ocara (352) (352) RCe Vem Beach DaVila - Regional 1515 Indian River Blvd Kidney Ctr Home Di Ste A-i Sa 1st Ave Vera Beach Ocala (772) (352) Bay Area Sleep Ocala Regional I\ssociates Kidney Ctr East 1101 W HibIscUS Blvd 2870 Se 1st Ave 3te 100 Ocala Vlelbourne (352) :800) !8 U:, Highway 1 Univita Healthcare ge 32955,dOc., Winter Beach Space Coast Sleep (888) Disorders Ctr 340 Classic Ct Ste 106 'AeJboume :321) Advanced Prosthetics & Orthotics Lake Harris Health 2763 W Old Us Hwy Ctr Lake Port Blvd Mount Dora (352) LeesbU~ 3474B (352) The Health Center Hanger Prosthetics Of l\!ierritt Island & Orthotics 500 Crockett Blvd 601 Mount Homer Rd Marion County! M.erritt Island Eustis Condado de Hanger Prosthetics :321) (352) Marion & Orthotics l1nivita Healthcare Hanger Prosthetics 1750 Sw 1st St Ocala & Orthotics East (352) E Dixie Ave Ste rrtusvifle Univiia Healthcare :888) Leesburg (352) Univita Healthcare Ocala {8SS) Lady Lake (888) I.nchol' Care And Rehabilitation lake Harris Health A 1 Imaging of Ocala Center ~;? Ctr 301 Se 17th St Ste 1515 Part Malabar HearX 701 Lake Port Blvd vd Ne 1501 N, Us Hwy 441, Leesburg Ocala ~~1'" "lay Bldg, 1600 (352) Surgery Ctr Of (352) Lady Lake Un1vita Heafthcare Ocala In, -,alth Cenier (352) Sw 34th St ~ Merritt Island Ocala ioo Crockett BlVd Lady lake (352) Davita - lake vlerritt Island (88B) Dialysis 321) N 1st St Leesburg (407)

16 Page/Pagir1854 Ameriqroup AndHa!y Providers/Proveedcres de Servicio Auxiliar _ ""_=""~'"",.,_~_"r~,..,,,,,,,,,,,,,,,,' Marion county/conoado de Marion - Nursing Home/Hogar de Comralescencia <.", Family Preservation Health Central DaVita - Orlando, Sves of Florida Surgery Center North Dialysis 1690 Nw 9th Ave 1435 Division St 5135 Adanson St Ste Okeechobee Ocoee (772) (407) Orlando (407) Millenia Surgery ctr 4901 S Vineland Rd DaVita - Orlando Ste 150 Behavioral Support Southwest Dialysis Orlando Svcs 6925 Lake Elienor Dr (407) Family Preservatioll 315 N Lakemont Ave Ste 650 Sves of Ronda MNH Surgical Ctr Ste B Orlando Nw 5th St 1101 N Maitland Ave Winter Park (407) a Okeechobee Maitland (407) FMC Dialysis (772)!;i (407) Devereux: Florida Services - Winter Orlando 6147 Christian Way Park Opthalmology Orlando Aloma Ave (407) 296"5300 Winter Park Surgery Crr (407) Unilliia Healthcare 105 Bonnie Loch Ct Eckerd Youth Orlando AlternatIves Fresenlus Medical Marion House (407) 428--D Lee Rd Care East Orlando Healthcare Ctr Ocala E Silver Springs Orlando Surgery Ctr Winter Park Alafaya TrI Ste (888) lvd 2000 N Orange Ave (407) Orlando Ocala Orlando (407) (352) 23(>-2626 (407) Park Place Surgery Home Dialysis Of Dscf Univita Heaithcare Ctr Okeechobee 2501 N Orange Ave 2450 Maitland Ctr County! Ste 537n Saunders Pkwy$te 100 Devereux Florida Orlando Prosthetics & Cotuiedo de Okeechobee Maitland Executive Dr (407) Orthotics Okeechobee (BBB) (407) Orlando Physicians Surgical (321) N Orange Ocala Orange County! Care Blossom TTl (407) Aloma Ave Ste 1140 S Semoran Blvd Orlando Condado de 200 Ste A (407) Orange Winter Park Orlando (407) (407) Metric Dr Ste 300 Sand Lake SUl"gery Winter Park N Wymore Rd Center (407) Winter Park Devereux Ror"ida 7477 Sand LAke (407) Orlando Arficial i 1010 Executive Dr Commons Blvd Kldney Ctr : Orlando Orlando 3~ Clay Ave Ste 151 (321) (407) Orlando Apopka Dialysis Surgical Lie Ward (407) Executive Pari<ct 1140 S Semoran Blvd 110 W Underwood St Apopka Orlando Dialysis SteA SteB (407) Town Loop Blvd Orlando Orlando Ste 104 A (407) (407) lama Apoka! Orlando W Orange 501 N Wymore Rd University Surqical (407) Blossom Trail Family Pre servation Winter Park Ctr Apopka Orlando Park Svcs of Florida (407) University Blvd (407) Dialysis 103 Nw 5th St Ste W Colonial Dr Okeechobee Winter Park BMA Of West Sie 120 MariOi'll House (772) (407) 677--D066 Orlando Orlando W Colonial Dr Healthcare Ctr (407) Suite E Silver Springs 1690 Nw 9th Ave Orlando Winter Garden Blvd Okeechobee (407) Dialysis Ocala I (772) (352) Central Orlando 1222 Winter Garden Vineland Rd Bldg 3 'r~wl i$~ Dialysis.A-;'~.~5:J", ' ~~~. Ste N Orange RCe Okeechobee Winter Garden Blossom Trl Sie Sw 16th St (407) Orlando Okeechobee (407) Winter Park Dialysis (863) Un!vita Heatthcare 3727 N Goldenrod Rd DaVifa - Ocoee Ste 101 Dialysis Winter Park W Colonial Dr Ocala (407) ! Ste 5 (888) The Birth Place Ocoee Winter Park Herno 1150 E Plant St Ste F (239) Dialysis Winter Garden Mebic Dr Ste 300 DaYUta - Orlando (407) Winter Park Dialysis (407) Sturtevant St Central Florida Orlando Winter Park Home Surgical Ctr Marion House (407) PO Dialysis W Cotonial Dr Healthcare Ctr 4100 Metric Dr Sts 200 sts 3 DaVita - Orlando 3930 E Silver Springs Winter Park Ocoee Univita Healthcare East Dialysis Blvd (407) (407) S Semoran Blvd Ocala (352) Citrus Ambulatory SteC Orlando Orlando Surgery Ctc Ocala Health & (888) (407) S Delaney Ave Rehabilitation Ctr Family Preservation Sts 8 DaYita - Orlando 1201 Se 24th Rd Svcs of Florida Orlando Home Training Dialy Ocala Nw 5th St (407) Oakwater eir (352} Okeechobee Orlando (772) (407) ",''''''---'

17 PagelPagina 55 Ameriurouo Ancillary Providers/Proveedores de Servicio Auxiliar...-~.- Osceola County/Condado de Osceola - 24hr Psych Res Trtmt Ctr-Child ""-~. Professional Ocoee Health Care Imaging Center Center 7806 Lake Underhill 1556 Maguire Rd Rd Ste 101 OCoee Orlando (407) Ai Imaging of (407) ABC Prosthetics & R G Therapy Svcs Adventist Care Ocoee Professional Orthotics 630 N Maitland Ave Centers Courtland 9450 W Colonial Dr Univita Healthcare, imaging 115 W Columbia St Maitland Courtland sr ocoee :. Consultants stea& B (407) B8 Orlando (407) Lake Underhill Orlando (407) Univita Healthcare Orlando A 1 Imagin.g of Ste 101 (407) 999-B977 Lake Bennett Health (888) Orlando Orlando & Rehabilitation 500 N Semoran Blvd (407) N Orange Ave Orlando Center Ste 104 Ste 103 University :tt:; Kelton Ave Orlando 32604! Orlando Oooee ~ Diagnostic Institute (407) ! (407) (850) , 111 N Lakemont Ave Drew Medical : Ste t a Ocoee Health Care 1561 W Fairbanks Ave. Winter Park Orlando Center Winter Park (407) (407) I Center For 1556 Maguire Rd (407) Ocoee ABC Prosthetics & Diagnostic Imaging Advanced (407) Orthotics Of Winter 1295 Orange Ave Prosthetics & 51 W KaleySt Park Winter Park Sunbelt Health & Orthotics Orlando W Columbia St (407) Rehab Center- 73 W Underwood St (407) SteA&B Apopka Orlando Orlando Park Center Dr 305 E Oak St (407) Sand Lake Rd (407) Ste 110 Apopka Hanger Prosthetics Ste 300 Orlando (407) Orlando & Orthotics 2909 N Orange Ave (407) (407) Winter Park Care & 1Q000 W Colonial Dr Ste 104 Rehabilitation Ctr Ste 184 Orlando Oakwater Clr 775 N Alafaya Tri 2970 Scarlett Rd Ocooe3476i (407) Orlando Orlando Winter Park (407) (407) (321) Combined Medical (407) Svcs Group Mid FloTida Imaging 1100 S Orlando Ave Winter Park W Colonial Dr East Orlando Health 1150 S Semoran Blvd ocoee Orlando SteD (407) & Rehab Center {407) (407) Orlando Chickasaw Trf Hanger Prosthetics (407) Emery Medical Orlando Saunders &. Orthotics East (407) Prosthetics & 124 Underwood sr 200 N Orlando Ave Orlando E Semoran Blvd Ocoee Health Care Orthotics Winter Park Children First ILl' ~ Apopka Center Serving Thls Area (407) Therapy (407) Maguire Rd Orlando B Edgewater Dr cooter Store - (407) Bi A FO Imaging Ocoee W Colonial Dr Orlando _,.<,.ldo 6388 Sliver Star Rd ' (407) ste C (407) Silver Star Rd Ste 1a Orlando Orlando Westminster Towers Orlando (407) Herman & Assoc (800) W Luoerne Cir Pediatric Specialists (407) Orlando Neuroskeletal 4401 E Colonial Dr Ste Uoivita Healtheare Heart Study ctr (407) Imaging Institute E Colonial Dr Merritt Island Orlando Ste 107 Orlando R G Therapy Svcs 1315 S Orange Ave (407) Orlando :;U!ft N Maitland Ave Orlando (407) Maitland (407) Ocoee Health Care Center (407) West Coast 1556 Maguire Rd 63B6 Silver Star Rd Ste2h West Rehab Svcs Radiology Ocoee Orlando S Semoran Blvd 1193 Blackwood Ave (407) FH Oerrtra Care -! (407) Ste F Ste H Children First R G Therapy Svcs Orlando Ocoee Colonial Town I Mobile Sonix Therapy (407) (407) N Maitland Ave 630 N Bumby Ave 2071 Eagles Rest Dr 4448 Edgewater Dr Maitland Orlando Apopka Orlando (407) (407) (407) (407) Univiia Healthcare, Neuroskeleta! Herman & Assoc, Imaging Jnst Pediatric Specialists Melbourne 4401 E Colonial Dr Ste Orlando S Orange Ave 107 ' (88B) Orlando Orlando (407) (407) Osceola Neuroskeletal Ocoee Health Care County! Imaging Inst Center Condado de Orlando 1556 Maguire Rd 1315 S Orange Ave Ocoee Osceola Orlando (407) (407) R G Therapy Svcs Neuroskeletal 630 N Maitland Ave Alere Women's & Imaging Institute - Maitland Univita Healthcare Devereux Florida Children's Health Winter Park (407) Children First 3497 W Vine St 2111 Glenwood Dr Ste Uniltita Healthcare Therapy Kissimmee Ori"ndo Edgewater Dr Orlando (407) ' Winter Park Orlando (888) (407) a Healthcare Orlando (407) Orlando Ultrasound (888) Hennan & Assoc Assoc Pediatric Specialists Orlando 32B Lake Underhill 4401 E Colonial Dr ste (888) Rd Ste id1 107 Orlando Orlando (407) (407) Q

18 Page/Pagina 56 Amerigroup Ancillary ProvfdersfProveedores de Servicio Auxiliar Osceola County/Condado de Osceola - Adult Companion Services/El Compatierc adulto Atiende a Kissimmee Endoscopy Center 715 Oak Commons Blvd Kissimmee (407) Kissimmee Surgery Center 2275 N Central AVe Kissimmee (407) Osceola Mental Health 206 Park PI Blvd Kissimmee (407) St Cloud Dialysis 4750 Old Canoe Creek Ad Saint Cloud (407) Hanger Prosthetics a Orthotics East 308 E Oak St Kissimmee (407) Unillita Healthcare Kissimmee (888) D1 Alere Women's & Children's Health Kissimmee (800) Univita Healthcare Kissimmee {S88) Combined Medical Svcs Group Kissimmee (407) Saunders Prosthetics & Orthotics Kissimmee (407) Florida Eye Clinic A SC 160 Boston Ave Altamonte Springs (407) lake Mary Surgery Gil" 460 sr Charles Ct Lake Mary (407) Lake Mary Surgical Ctr 1070 Greenwood Blvd Lake Mary (407) Rinehart Lake Mary Surgical Center 917 Rinehart Rd Ste 1001 lake MaJY32746 (407) BMA North Orlando 750 S North Lake Blvd Ste 1024 Altamonte Springs (407) Casselberry Dialysis 4970 S Us Hwy 17/92 Casselberry (321) Fresenius Med Care-Sanford 419 E 1st St Sanford (407) Home Dialysis Of Dscf 1701 Wist st Sanford (407) Executive Park Altamonte Springs (407) Alere Women's 8.. Children's Health Ntamonte Springs (800) I Uoivita Hsalthcare 1 l I Altamonte Springs! ; (888) Drew Medical 277 Douglas Ave Ste 1014 Altamonte Springs (407) Red Bug Lake Rd Oviedo (407) Heart study Ctr 755 W State Rd 434 SteA Longwood (407) Professionals Imaging Consultants 1049 Willa Springs Dr Ste 1051 Winter Springs (407) S International Pkwy Ste 1351 Lake Mary (407) De1lel'eWC Florida 3497 W Vine St Kissimmee (407) l~2~~~lf&l11tei~! Celebration Dialysis 1154 Celebration Blvd Kissimmee (407) DaVita" Kissimmee Dialysis 802 N John Young Pkwy Kissimmee (407) 847>4423 Nephrology Consultants Dialysis 4750 Old Canoe Creek Rd Saint Cloud (407) A 1 Imaging of Kissimmee 810 N John Young Pkwy Kissimmee (407) Drew Medical 208 W OakSt Kissimmee (407) A F 0 Imaging 56 W Oak St Kissimmee (407) Medi~ound Inc 301 N John Young P\<wy Kissimmee (407) Professional Imaging Consultants 911 E Oak St Kissimmee (407) MediSOl.ll1d Inc 301 III John Young Pkwy Kissimmee (407) Mid Florida Imaging 819 E Oak si Ste C Kissimmee (407) Univita Healthcare Kissimmee (888) Seminole County! Condado de Seminole Univita Healthcare Serviog This Area Altamonte Springs (888) Family Presentation Svcs of Rorida 2500 W Lake Mary Blvd LaKe Mary (407) Hanger Prosthetics & Orthotics East 819 E 1st SI Sanford (407) Uohrita Heelthcare Altamonte Springs (888) Audiology Assoc 108 Forest Ave Altamonte Springs (407) < HearX ;, 600 E Altamonte Dr Ste 1100 Altamonte Springs (407) Combined Medical SliCS Group Attamonte Springs (407)

19 Amerigroup AnciUary Providers!Proveedores de Servicio Auxiliar Page!Piiglna OJ Voiusia County/Condado de Vojusia - Speech Therapy Services/Servicios de Terapia del Habla Saunders Prf'~thetics & ics j This Area Alta, nonte Springs (407) Center For Diagnostic Imaging 1000 W Broadway St Ste 104 Oviedo (407) "" )rida Imaging vestmonte Dr.e,118 Altamonte Springs (407) Open M R I Of Stanford 303 Wist St Sanford (407) Vincon Diagnostic Ctr 5732 Canton Cv Winter Springs (407) Falcon Sleep Center 120 Alexandria Blvd Ste 19 Oviedo (407) Unillita Healthcare serving This Area Altamonte Springs ;,.~ Valusia County! Candado de Valusia O$land SUrgery Ctr 651 W Plymouth Ave Deland (386) Orange City Surgery Center 975 Town Center Dr Ste 100 Orange City (386) Children'S Advocacy Center 1011 W International Speedway Blvd Daytona Beach (386) Devereux Florida 120 E New York Ave Deland (407) Family Preservation Svcs of Florida 1540 Cornerstone Blvd Ste 200 Daytona Beach (386) Halifax Health 1041 DunJawton Ave Port Orange (386) Jimmy Ann Dr Daytona Beach (386} The House Next Door 121 W Pennsylvania Ave Deland (386) k Deltona Blvd Deltona {386} ~1an4i~B~ 13MA Deltona 1200 Deltona Blvd Ste 53 Deltona (386) i)avita Daytona South Dialysis 1026 S Ridgewood Ave Daytona Beach (386) DaVila - Deland Dialysis 350 E New York Ave Deland (386) DaVita - Greater Daytona Home Traini 575 N Clyde Morris Blvd SteA Daytona Beach (386) DaVfta - New Smyra Beach Dialysis 11Q S Orange St New Smyma Beach (386) DaVita - Orange City Dialysis 242 Treemont Dr Bldg 2 Orange City (386) DaVila - Ormond Beach DialYSIS 495 S Nova Rd Ste 109 Ormond Beach (386) Daytona South Dialysis 1801 S Nova Rd Ste 306 South Deytona (386) New Smyrna Artificial Kidney Ctr 821 State Road 44 New Smyrna Beach (904) SMA Deltona 1200 Deltona Blvd Ste 53 Deltona (386) Advanced! Prosthetics &, Orthotics! 123 S Industrial Dr Ste I 104 ~ Orange City ; (386) : Hanger Prosthetics! & Orthotics j 1400 Mason Ave Ste C :1' Daytona Beach (386) ~ ; 2754 Enterprise Rd Ste 'A, Orange City j (386) / Onlvita Healthcare, i j Daytona Beach I (888) 'I Stand Up MRI & I Diagnostic Ctr i 555 W Granada Blvd ; Ste H-1 I Ormond Beach (386) ! I 1 Halifax Health 1041 Ounlawton Ave Port Orange (386) N Clyde Morris Blvd Daytona Beach (386) Jimmy Ann Dr Daytona Beach (386) Family Preservation SIlCS of Florida 1540 Cornerstone Blvd Sta 200 Daytona Beach (386) TOOT~Of Daytona Beach 1704 Huntrngton ViHage Cir Daytona Beach (386) Woodlands Terrace 1 Extended Care Ctr 120 W Chipola Ave Deland (386) Univita Healthcare Daytona Beach (888) Halifax Health 1041 Dunlawton Ave Port Orange (386) Jimmy Ann Dr Daytona Beach (386) Halifax Health 303 N Clyde Morris Blvd Daytona Beach (386} Halifax Health 1041 Dunlawton Ave Port Orange (386) Halifax Health 1041 Dunlawton Ave Port Orange (386) N Clyde Morris Blvd Daytona Beach (386) Halifax Health 841 Jimmy Ann Dr Daytona Beach (386) Halifax Health 1041 Dunlawton Ave Port Orange (386) N Clyde Morris Blvd Daytona Beach (386) East Central Florida Outpatiem Imaging 1195 Dunlawton Ave Port Orange (386) i 1673 Mason Ave Ste i 305 I Daytona Beach I. (386) '! 1890 Lpga Blvd Ste 110 Daytona Beach (386) LAD Imaging 1555 Saxon Blvd. Ste. 401 Deltona (386} I I Univita Healthcara Daytona Beach (888) Signature Health Care Of Ormond 103 N Clyde Mom'S Blvd Ormond Beach (386) The Terrace Of Daytona Beach 1704 Huntington ViHage Cir Daytona Beach (386) Univita Healthcare Daytona Beach 3212::' (88B)

20 Exhibit 3

21 PROVIDER EXPER!ENCE 'iveucare Health Plans, Inc, has placed a renewed emphasis In the experiences of both our members and providers. As 3. result, the organization has created a team of dedicated susmess Process Improvement (BPI) and cross-functional JUStness leaders charged with streamlining and enhancing overall provider-facing activities, such as contracting, claims oayrnent, provider cau center, authorizations, provider ::lemographic data, and more. Ihe Provider Experience team is responsible for partnering with tmcttonal owners from across the enterprise to: 1} document :he current state of activities, 2) define future provider-centric f 'ions and 3) oversee the improvement initiatives designed :0.rte end-to-end excellence for our providers, )ur provider experience Vision simply states: "To be the health )lan of choice for providers participating in government health irograms by erhancing member care through operational ixcellence in the execution of our business model" t should be noted that one of our very first undertakings 'las to conduct an initial Provider Satisfaction Survey so we.ould learn from, and understand more thoroughly, our valued )rovider network. The survey touched on a variety of subjects,eluding cal! center/member services, provider relations,.orrtlnuity/coordinatton of care, provider network, utilization nd quality management, finance issues, pharmacy and drug seneflts, and overall satisfaction and loyalty. Currently, we are 1the process of evaluating this information to identify specific ction plans toward improving the overall business relationship vith our providers. We Sincerely thank those who elected to artkipate in this year's effort, and look forward to next fa!! {hen we will again survey providers to measure improvement gainst this year's baseline. he emphasis the organization has placed on the provider xperience Is essential to ensuring that our providers have the ur ': they need in order to deliver the high quality of care la, ~Jr members deserve. By leveraging technology, working lose!y with our providers, and investing in growth, WellCare now uniquely positioned in making a difference toward btaining service excellence. You ~nfind the.followi~g'docurrents on " Clinical Practice Guidelines - ASthma - Diabetes and more 4 Provider Resources.and Tools - Diabetes Tool Kit - Depression Tool Kit - Prellatar and Postpartum Tool kit - ADHb T901 K.it ~more.. HEDlS.lnfc)\l1Ia;i:ion " Provider Manuals " Quality l~p~~;~ment Prpgrarn and Updates " Member RightS and R~P9.nsibjlities e EI~ctiohic'tla:;mssGbmissiohs ',. " '.,",.:"...,'..," AbDmONAL..cRlTERlA.AVAILABLE Ou~ 'review crii~;3.and,gujde!ine~ are available to provtders upon request, piovi9~rsm;iyrequest a copy of the criteria used for specific d~et!nfnati.on ('jf medical necessity by calling thecustomer Service Dumber listed on the Ronda Quick Refer~oceGu[de~ Also, please.rernernberthat all Cljnical Coverage GuicleUnes, detallihg medical iiece;s$.itycriteria for several medical procedures; devices an9tests; are.availablevi~ the provider resources link at W83 RtSOUR\:ES Visit to access our Preventive Health Guidelines, Ciini~r Practice GUidelines, EPSDT documents, Pharmacy Gqiclelines, CulturalC~mpetency Plan and-other helpful resources, If you would like to receive a hard copy of any of these documents, please contact your Provider Relations representative.

22 NEW HOME HEALTH AND DMEPROYJDER T~e Staywell arid HealthEase Plans hav~en~ered:i~t9 af1exdu$ive<:qn~~~t with An-:Med,M.~na~etnen't~ystem.s, lnc., for home health, durable niedkatequlpment,(dme) and respjrato,ry services. Effective Aprltl, 2012, AH~M~d will serve patients in Florida who are rnernberscf these.plans, ', ' Please coordinate horne health and DME requests through AH~Med.For new referrals and preauthertzation requests of home health and DME services, cat! All-Med at : Submit all prescriptioris/orders via fax to ~4264_ We,'re confident All-Med will be a great partner for these services, The company has 23 years of experience working with patients throughout our state. Headquartered in Miami Lakes, Florida, they provide quality DME, respiratory and home health services from multiple distribution centers and a network of sub-contracted providers throughout the state. For more information about AII-Med and their services, please call If you have any questions regarding this matter, please contact Customer Service at (Staywell) or (HealthEase). 18

23 Exhibit 4

24 Who knew you had so many doctors +n your family? l.quien iba a decir que habia tantos doctores en su familia?. ~,\",.;, < /,.:' '..... Medicaid Area 7 Brevard) Orange, Osceola & Seminole Counties 2012 Florida Provider Directory Version One MO IN~' HEAlTHCARE

25 Ancillarv Providers IN ALPHABETICAL OROEff BY COUNTY, THEN SPECIALTY Audiology Hearusa Inc For Listing Of Locations: languages Spoken: English Durable Medical Equipment & Medical Supplies All Med Management Systems (305) Fax; (305) End Stage Renal Disease Treatment Facility Renal Care Group Brevard 4940 Stack Blvd St 0-7 Melbourne, FL (317) Fax: (317) languages Spoken: English Home Health AIl Med Management Systems (305) ~ax: (305) anguages Spoken: English Home Infusion All Med Management Systems {305) Fax: (305) laboratory Quest Diagnostics For Listing Of Locations: Myquest ( ) Prosthetic/Orthotic Supplier Hanger Prosthetics & Orthotics Inc- Melbourne 737 South Apollo Boulevard Melbourne, FL32901 (321) Hanger Prosthetics & Orthotics Inc-. Rockledge 1121 Geiger Street Rockledge, FL (321) Hours; 8:30am-5:00pm Skilled Nursing Facility Anchor Care & Rehabilitation 1515 Port Malabar Blvd Ne Palm Bay,FL (321) Center Titusville Rehab & Nursing Center 1705 Jess Parish Crt Titusville, FL 32796, (321) West Melbourne Health & Rehabilitation Center 2125 W New Haven Ave Melbourne, FL ; (321} Wound Care Wound Technology Network Inc, For Listing Of Locations: j Languages Spoken; English Ambulatory Surgical Center Citrus Ambulatory Surgery Center, 2861 South Delaney AVe,Ste B Orlando, PL (407) Oakwater Surgical Center, 3885 Oakwater Cir. Orlando, FL Fax: Hours: 8:30 Am - 5:00 Pm Same Day Surgicenter Of Orlando 88WKaleySt Orlando, FL (407) , Languages Spoken; English Audiology Hearusa Inc For Listing Of Locations:, Diagnostic Radiology Boston Diagnostic Imaging - Orlando 1751 S Orange Ave, Orlando, FL 32806, (4])7) Mid Florida Imaging - Wmterpark 200 N Orlando Ave Winter Park, FL Fax: i Westroast Radiology 1193 Blockwood Ave, Ste H Ocoee, FL Fax: ; WestcoastRadiology! 572 Ocoee Commerce Pkway! Ocoee, FL i Fax: Durable Medical Equipment & Medical Supplies ; All Med Management Systems, (305)826..Q244 Fax: (305) Providers are accepting new patients unless noted. "Not Accepting New Patients - No aceptan pacientes nuevo. -e information in this provider directory is subject to change. If you have any questions regarding the status of.. particular provider, please contact Molina Member Services at or TTY at

26 Ancillarv Providers IN ALPHABETICAL ORDER' BY COUNTY, THEN SPECJALTY End Stage Renal Disease Treatment Facility Bma - Apopka 1056 W Orange Blossom 11 Apopka, FL Fax: ]6 Bma Of West Orlando 5600 W Colonial Dr, Ste 101 Orlando, FL Fax: Fmc - Dialysis Services Wmter Park 5216 Dr. Phillips Boulevard Orlando. FL Fax: Fmc - East Orlando 2400 State Rd 415 Sanford, FL Fax: Hours: 8:00am - 7:00pm Open Mri Of Sanford 100 Clay Ave, Ste 151 Orlando, FL Fax: Home Health All Med Management Systems (305) FaJc(305) languages Spoken: English Home Infusion All Med Management Systems (305) Fax: (305) laboratory Quest Diagnostics For Listing Of Locations: Myquest ( ) Occepatienal Iherapy Collaborative Functlon 726 West Colonial Drive Orlando, FL32804 (407) i Herman And Associates Pediatric Specialists i 4401 East Colonial Drive, Ste 107 Orlando, FL (407) K & L Therapy Services, Inc Curry Ford Road, Suite E < Orlando, FL (407) Lifespan Therapy Services, Inc. D/B/A The Therapy Place 9318 E Colonial Drive,Ste B-3 Orlando, FL (407) Otter Therapy, Inc S. Morningside Ct. Orlando, FL (407) Hours; 8:30am-5:00pm Languages Spoken; English Pediatric Therapy Services Of Greater Orlando 886 South Dillard Street Wmter Garden, FL (407) l~ LanguagesSpoken:English Ucp Of Central Florida 3305 South Orange Avenue Orlando, FL (407) , : Physical Therapy Herman And Associates Pediatric Specialists 4401 East Colonial Drive, Ste!O7 Orlando, FL (407) , K & L Therapy Services, Inc Curry Ford Road, Suite E Orlando, FL (407}42}-7284 lifespan Therapy Services, Inc. D/B/A The Therapy place 9318 E, Colonial Drive, Ste B-3 Orlando, Fi (407) 28]-3803 Hours: 8;30am-5:00pm Otter Therapy, Inc S. Mornmgside Ct Orlando, FL32765 (407) Pediatric Therapy Services Of Greater Orlando 886 South Dillard Street Winter Garden, FL (407) Ucp Of Central Florida : 3305 South Orange Avenue, Orlando, FL (407) Prosthetic/Orthotic Supplier Advanced Prosthetics & Orthotics Of! America-Orlando, 73 W Underwood Orlando, FL (954) Hours: 8:30am-5;OOpm Hanger Prosthetics & Orthotics Inc W Colonial Dr I Ocoee, FL f Fax: Providers are accepting new patients unless noted. "Not Accepting New Patients - No aceptan pacientes nuevo, ne information in this provider directory is subject to change. If you have any questions regarding the status of a particular provider, please contact Molina Member Services at or TTY at

27 cillarv Providers IN ALPHABETICAL ORDEit BY COUNTY, THEN SPECIALTY Hanger Prosthetics &: Orthotics- Orlando 124 Underwood St Orlando, FL (407) Hanger Prosthetics Orthotics Inc- Wmter Park 1100 South Orlando Avenue Winter Park, FL (407) Radiology Al-.Imaging Centers Llc 500 N Semoran Blvd, Ste lq3 Orlando, FL Fax; Hours: 8:30am-5;00pm AI-Imaging Centers lie 9450 W Colonial Dr, Ste 12 Ocoee,FL Fax: Mid Florida Imaging - S Semoran 1150 S Semoran Blvd, Ste D Orlando, FL Fax; Skilled Nursing Facility Adventist Care Centers Courtland Inc 730 Courtland St, Ste 20(] Orlando, FL (407) Delaney Park Health & Rehab Center 215AnnieSt Orlando, FL (407) East Orlando Health & Rehab Center Inc 250 S ChickasawTrI Orlando, FL Fax; Ocoee Healthcare Center 1556 Maguire Rd Ocoee, FL 3476I (407) Orlando Health And Reahbilitation th St Orlando, FL (407) Poinciana Dialysis 558 N Semoran Blvd Winter Park, FL Fax: Center Sunbelt Health &Rehab Center Apopka Inc 305 EOa1cSt Apopka, PL Q-2266 Fax: Speech Therapy Collaborative Function 726 West Colonial Drive Orlando, FL (407) Florida Speech-Language Pathology Inc- Orlando 1525 South Alafaya Trail, Ste 101 Orlando, FL (407) Fax: Florida Speech-Language Pathology Inc- Orlando 5216 Dr. Phillips Boulevard Orlando, FL (407) Herman And Associates Pediatric Specialists 4401 East Colonial Drive, Ste 107 Orlando, FL (407) K & L Therapy Services, Inc Curry Ford Road, Suite E Orlando, FL (407) lifespan Therapy Services, Inc.DIBIA The Therapy Place 9318 E. Colonial Drive, Ste B-3 Orlando, FL (407) Otter Therapy, Inc S. Morningside Ct. Orlando, FL (407) Pediatric Therapy Services Of Greater Orlando 886 South Dillard Street Winter Garden, FL (407) Simply Speaking, lie 3564 Avalon Park Blvd, East, Suite 1,#249 Orlando, PL (407) Ucp Of Central Florida 3305 South Orange Avenue Orlando, FL (407) West Orange Speech Pathologists, 6388 SilverStar Road, # 2e Orlando, FL32818 (407) Hours: 8:30am-5;OOpm Urgent Care After Hours Pediatrics Practices Inc 4101 Towne Center Blvd Orlando, FL Inc. Providers are accepting new patients unless noted. "Not Accepting New Patients - No aceptan pacientes nuevo. The injormation. in this provider directory is subject to change. If you have any questions regarding the status of 11particular provider; please contact Molina Member Services at or TTY at

28 After Hours Pediatrics Practices Inc 5018 Dr Phillips Blvd Orlando, FL After Hours Pediatrics Practices Inc 651 N Alafaya Trl Orlando, FL Celebration Dialysis 1154 Celebration Blvd Night LitePediatrics lie Celebration,FL Lake Underhill Rd Ste 103 (407) Durable Medical Equipment & Medical Supplies All Med Management (305) Fax: (305) End Stage Renal Disease Treatment Facility Orlando, FL i Fax; i Hours: M -F 4pm -l lpm.sat -Sun 12pm-12am ' Kissimmee Dialysis 802 N John Young Pkwy Kissimmee, PL Night Lite Pediatrics Llc (407) ?50 W Colonial Dr Ste 205 Wmter Garden, FL Fax: , Poinciana l)jalysis Hours:M -F 4pm -lipid.sat-sun 12pm-12am 1002 Cypress Pkwy Poinciana, FL Night Lite Pediatrics lie Fax: W. Sandlake Rd Orlando, FL Fax: I St Cloud Dialysis Hours: M -F 4pm -llpm,sat -Sun 12pm-12am I 4750 Old Canoe CreekRd "anguages Spoken: English Saint Cloud, FL Night lite Pediatrics lie 844 N Thornton Ave Orlando, FL (407) Fax: (407) Hours: M -F 4pm -Llpm,Sat -Sun 12pm-12am Wound Care Wound 'Iechnology Network Inc For listing Of Locations: Audiology Hearusa Inc For Listing Of Locations: (407) Systems Home Health All Med Management Systems i (305} FaX: (305) Home Infusion 1 All Med Management Systems f (305) Fax: (305) laboratory 1 Quest Diagnostics : For Listing Of Locations: ; Myquest ( ) Occupational, Cja Therapy & Beyond, Llc 809 East Oak Street, 106 Kissimmee, FL (407) Therapy Physical Therapy Cja Therapy &: Beyond, lie 809 East Oak Street, 106 Kissimmee, Fl, (407) Prosthetic/Orthotic Supplier Hanger Prosthetics & Orthotics - Kissimmee 308EOakSt Kissimmee, FL Fax; Hours: 8:00am - 5:00pm Radiology, AI-Imaging Centers tic! 810 N John Young Pkwy Kissimmee, FL Fax: Mid Florida Imaging - Kissimmee 819 E Oak St, Ste C i Kissimmee, FL 34744! I Fax: , Speech Therapy Cja Therapy & Beyond, lie 809 East Oak Street, 106 Kissimmee, FL I (407) Small Steps Pediatric Therapy 5216 Dr. Phillips Boulevard Orlando, FL (407) I I Providers Clreaccepting new patients unless noted. "Not Accepting New Patients ~ No aceptan pacientes nuevo. 'he information in this provider directory is subject to change. If you have any questions regarding the status of..iparticular provider; please contact Molina Member Services at or TTY at

29 Exhibit 5

30 From: Sent: MondaYI July 09[ :00 PM To: ~~ Subject:' Good Afternoon/ I hope your weekend went well.! regretto inform you that we are not able to do a contract with your DME company. I spoke with Jean and my Manager and we are in a statewide exclusive agreement with AHmed, Thank you for your time! Brandis Account Executive Burney} MHSA T: ext 304 F: Vifinderley Place, Suite 204 J Maitland I FL I [email protected] I wvl/w,simp!yhealthcareplans.com

31 , I '., i İ. ~, ~~ Me icaid Provider Directory Osceola and Seminole Counties

32 Ancillary Providers 'iagnostic Radiology Home Health Agency Specialty Imaging Services Inc Specialty Imaging Services Inc 2501 Howell Branch Road Casselberry, FL Office Hours: M~F 8:30am ~5pm Office Phone: (407) Vlncon Pa Vlncon PA 5732Canton Cv Winter Springs, FL Office Hours: M-F 8am - 5:30pm Office Phone: (407) SMA of Apopka SMA of Apopka 1065 W Orange Blossom Trail Apopka, FL 'flee Phone: (407) BMAOrlando SMA Orlando 3100 Clay Ave Suite 151. Orlando, FL Office Phone: (407) BMA West Orlando SMA West Orlando 5600 W Colonial Dr SUIte 101 Orlando t FL Office Phone; (407) SMA Winter Park SMA Winter Park 6848 Aloma Ave Winter Park, FL Office Phone: (407) Klsstmee Dialysis Klsshnee Dialysis 4750 Old Canoe Creek Road Salnt Cloud, FL Office Phone: (954) SMA North Orlando SMA North Orlando 750 S North Lake Blvd Suite 1024 Altamonte Springs, FL Office Phone: (407) SMA Sanford BMASanford 419 E 1st Street Sanford FL Office Phone: (407) Atl~Med Services of Florida All-Med Senrkesof Florida Commerce Way Miami Lakes, FL Office Phone; (305) Respltec Medical-Care 8. Equipment Inc Rsspltec Medical-Care & Equipment Inc 401 Commerce Way Unit 101 Longwood, FL Office Phone: (407) Graham, James HearUSA 1503 S Orange Ave Orlando, FL Office Phone: (407) Mendez, Sheryl HearUSA 1503 S Orange Ave Orlando, FL Offtce Phone: (407) Shipman, Teresa HearUSA 1503 S Orange Ave Orlando, FL Office Phone: (407) 849-{)520 Bess, Ronald Best Hearing Aids 103AWOakSt Kissimmee, FL Office Phone: (407) th St Saint Cloud, FL Office Phone: (407) 892~8663 Graham, James HearUSA 600 E Altamonte Dr Ste 1100 Altamonte Springs, FL Office Phone: (407) Mendez, Sheryl HearUSA 600 E Altamonte Dr Ste 1100 Altamonte Springs, FL Office Phone: (407) Woodin, Gerard HearUSA 600 E Altamonte Dr Ste 1100 Altamonte Springs, FL Office Phone: (407) American Nurses American Nurses 1510 E Colonial Dr Ste 300 Orlando, FL Office Phone: (407) Interim Healthcars of Greater Orlando Interim Healthcara of Greater Orlando 1890 State Rd 436 Ste 355 Winter Park, FL Office Hours: M-F 8am - 5pm Office Phone: (407) Maxim Healthcara Services Inc Maxim Healthcare Services Inc 1707 Orlando Central Pkwy Ste 250 Orlando,FL Office Phone: (407) S Directory is subject to change. Please cat! to make sure the provider still participates in the network. X = Providers with this symbol are not accepting new patients. SHP_Orlando Area_06.1S.12