EXHIBIT 10.25 AMENDMENT TO MANAGED CARE ALLIANCE AGREEMENT

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Title: EXHIBIT 10.25 AMENDMENT TO MANAGED CARE ALLIANCE AGREEMENT
Date: 3/17/2005
Industry: HTHFAC Sector: HEALTH

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EXHIBIT 10

EXHIBIT 10.25

AMENDMENT TO

MANAGED CARE ALLIANCE AGREEMENT

THIS AMENDMENT (the "Amendment") is entered into this 1st day of January, 2005

by and between CIGNA Health Corporation, for and on behalf of its Affiliates

(individually and collectively, "CIGNA"), and Gentiva CareCentrix, Inc. ("MCA").

W I T N E S S E T H

WHEREAS, CIGNA and MCA entered into a Managed Care Alliance Agreement which

became effective January 1, 2004, ("the Agreement"), whereby MCA agreed to

provide or arrange for the provision of certain home health care services to

Participants, as that term is defined in the Agreement;

WHEREAS, the parties wish to amend certain provisions of the Agreement as set

forth below;

NOW THEREFORE, CIGNA and MCA agree as follows:

1. Effective January 1, 2005, Exhibit A HMO Program Attachment - Capitation

Schedule of Capitation Rates is hereby deleted and replaced with a new

Exhibit A HMO Program Attachment - Capitation Schedule of Capitation Rates

attached hereto.

2. Effective January 1, 2005, Exhibit A HMO Program Attachment - Fee for

Service Reimbursement For Other Services is hereby deleted and replaced

with a new Exhibit A HMO Program Attachment - Fee for Service

Reimbursement For Other Services attached hereto.

3. Effective January 1, 2005, Exhibit A PPO & Indemnity Program Attachment -

Fee for Service Reimbursement For Other Services is hereby deleted and

replaced with a new Exhibit A PPO & Indemnity Program Attachment

Reimbursement For Other Services attached hereto.

4. Effective January 1, 2005, Exhibit A Gatekeeper Program Attachment -

Capitation Schedule of Capitation Rates is hereby deleted and replaced

with a new Exhibit A Gatekeeper Program Attachment - Capitation Schedule

of Capitation Rates attached hereto.

5. Effective January 1, 2005, Exhibit A Gatekeeper Program Attachment - Fee

for Service Reimbursement For Other Services is hereby deleted and

replaced with a new Exhibit A Gatekeeper Program Attachment - Fee for

Service Reimbursement For Other Services attached hereto.

6. The Parties agree to incorporate any new or modified HIPAA codes if and

when such codes become effective.

7. The parties acknowledge that bone growth stimulators are reimbursed on a

fee-for-service basis. At the request of CIGNA, MCA agrees that CIGNA may

8. MCA agrees that all new or established Participants receiving factor

concentrates through MCA as of * and who so agree, shall be * such that

any refill scheduled for those Participants for the period following *

shall be filled by *.

9. CIGNA has requested, and MCA agrees, that any self administered specialty

drug product that CIGNA Tel-Drug has the capability to dispense shall be *

CIGNA Tel-Drug. Further, MCA agrees to work with CIGNA Tel-Drug to

continue to evaluate collaborative opportunities.

* Confidential Treatment Requested

<PAGE>

10. The parties agree that the blended HMO/Gatekeeper capitation rate of *

shall be increased by * effective * should CIGNA elect not to integrate

its * markets into the Agreement. Should CIGNA elect to integrate its *

markets into the Agreement or MCA elects * in this Section 10, the blended

HMO/ Gatekeeper capitation rate shall remain at *. If MCA elects to

proceed relative to these markets, the parties agree to work in good faith

to establish a * amount for all Covered Home Care Services rendered to

Participants by all providers of Covered Home Care Services in the *

markets ("Baseline"). Once the Baseline is agreed upon by the parties, the

parties agree that CIGNA's medical expense for Covered Home Care Services

rendered to Participants by all providers of Covered Home Care Services in

these markets ("Actual Medical Expense") shall not exceed the Baseline.

Prior to the effective date for these markets, the parties agree to

establish terms by which MCA shall reimburse CIGNA the amount, if any, by

which Actual Medical Expense exceeds the Baseline. The election to proceed

by either party shall be made by February 28, 2005. The effective date for

these markets shall be by mutual agreement between the parties, but no

sooner than April 5, 2005.

11. The parties agree that the blended HMO/Gatekeeper capitation rate of *

shall be increased by * effective * should CIGNA fail to deliver a PPO

claims paid report for the quarter ending June 2004 on or before January

15, 2005.

To the extent that the provisions in the Agreement, including any prior

amendments, conflict with the terms of this Amendment (including the exhibits

and schedules hereto), the terms in this Amendment shall supersede and control.

All other terms and conditions of the Agreement, as previously amended,

including the Program Attachments and the Exhibits attached thereto, shall

remain the same and in full force and effect. Capitalized terms not defined

herein but defined in the Agreement shall have the same meaning as defined in

the Agreement.

This Amendment shall take effect commencing on January 1, 2005.

IN WITNESS WHEREOF, CIGNA and MCA have caused their duly authorized

representatives to execute this Amendment as of the date first written above.

CIGNA HEALTH CORPORATION

By: _________________________________

Its: Senior Vice President

Dated: _________________________________

*Confidential Treatment Requested

<PAGE>

GENTIVA CARECENTRIX, INC.

By: _________________________________

Its: President and COO

Dated: _________________________________

<PAGE>

EXHIBIT A

HMO PROGRAM ATTACHMENT - CAPITATION

SCHEDULE OF CAPITATION RATES

CAPITATION RATES EFFECTIVE 1/1/05 - 12/31/05

These are the capitation rates that apply to services rendered to Patient Panel

Participants enrolled in HMO Programs. An "HMO Program" means a

non-governmental, fully insured HMO or Point of Service product that is

underwritten based on a community rating methodology (i.e. community rating,

community rating by class, adjusted community rating by class).

<TABLE>

Gentiva

Homehealth

Infusion and

DME/HME

Capitation

Rate PMPM

--------------------------------------------------------------------------------

<S> <C>

All Commercial HMO Capitated Affiliates

</TABLE>

<PAGE>

EXHIBIT A

HMO PROGRAM ATTACHMENT - FEE FOR SERVICE

REIMBURSEMENT FOR OTHER SERVICES

RATE AREA DESIGNATIONS:

<TABLE>

STATE RATE AREA RATE DESIGNATION

----------------------------------------------------------------------------------------

Alabama * *

Alaska * *

Arizona * *

Arkansas * *

California * *

Colorado * *

Connecticut * *

Delaware * *

District of Columbia * *

Florida * *

Georgia * *

Hawaii * *

Idaho * *

Illinois * *

Indiana * *

Iowa * *

Kansas * *

Kentucky * *

Louisiana * *

Maine * *

Maryland * *

Massachusetts * *

Michigan * *

Minnesota * *

Mississippi * *

Missouri * *

Montana * *

Nebraska * *

Nevada * *

New Hampshire * *

New Jersey * *

New Mexico * *

New York * *

North Carolina * *

North Dakota * *

Ohio * *

Oklahoma * *

Oregon * *

Pennsylvania * *

Rhode Island * *

South Carolina * *

South Dakota * *

Tennessee * *

Texas * *

Utah * *

Vermont * *

Virginia * *

Washington * *

West Virginia * *

Wisconsin * *

Wyoming * *

</TABLE>

*Confidential Treatment Requested

<PAGE>

TRADITIONAL HOME HEALTH FEE-FOR-SERVICE RATE

RATES EFFECTIVE JANUARY 1, 2005 - DECEMBER 31, 2005

THE FOLLOWING TRADITIONAL HOME HEALTH SERVICES HAVE BOTH VISIT AND HOURLY RATES.

Notes 1, 2, 3, 4, 5 and 6 apply

<TABLE>

AREA 1 AREA 2 AREA 3

------------------------------------------------------------------------

VISIT HOUR VISIT HOUR VISIT HOUR

---------------------------------------------------------------------------------------------------------------------------------

CERTIFIED NURSES AIDE * * * * * *

HOME HEALTH AIDE * * * * * *

LVN/LPN * * * * * *

LVN/LPN - HIGH TECH * * * * * *

PEDIATRIC HIGH TECH LVN/LPN * * * * * *

PEDIATRIC HIGH TECH RN * * * * * *

PEDIATRIC LVN/LPN * * * * * *

PEDIATRIC RN * * * * * *

RN * * * * * *

RN HIGH TECH INFUSION * * * * * *

RN HIGH TECH OTHER * * * * * *

</TABLE>

THE FOLLOWING TRADITIONAL HOME HEALTH SERVICES HAVE VISIT ONLY RATES.

Notes 1, 3, 4, 5, 7 and 8 apply

<TABLE>

AREA 1 AREA 2 AREA 3

------------------------------------------------------------------------

VISIT HOUR VISIT HOUR VISIT HOUR

---------------------------------------------------------------------------------------------------------------------------------

DIABETIC NURSE * N/A * N/A * N/A

DIETITIAN * N/A * N/A * N/A

ENTEROSTOMAL THERAPIST * N/A * N/A * N/A

MATERNAL CHILD HEALTH * N/A * N/A * N/A

MEDICAL SOCIAL WORKER * N/A * N/A * N/A

OCCUPATIONAL THERAPIST * N/A * N/A * N/A

OCCUPATIONAL THERAPIST ASSISTANT * N/A * N/A * N/A

PHLEBOTOMIST * N/A * N/A * N/A

PHOTOTHERAPY PACKAGE SERVICE * N/A * N/A * N/A

PHYSICAL THERAPIST * N/A * N/A * N/A

PHYSICAL THERAPIST ASSISTANT * N/A * N/A * N/A

PSYCHIATRIC NURSE * N/A * N/A * N/A

REHABILITATION NURSE * N/A * N/A * N/A

RESPIRATORY THERAPIST * N/A * N/A * N/A

RESPIRATORY THERAPIST - CPAP clinic * N/A * N/A * N/A

RN ASSESSMENT, INITIAL * N/A * N/A * N/A

RN SKILLED NURSING VISIT-EXTENSIVE * N/A * N/A * N/A

SPEECH THERAPIST * N/A * N/A * N/A

</TABLE>

THE FOLLOWING TRADITIONAL HOME HEALTH SERVICE HAS HOURLY ONLY RATES.

Notes 3, 4 and 5 apply

<TABLE>

AREA 1 AREA 2 AREA 3

------------------------------------------------------------------------

VISIT HOUR VISIT HOUR VISIT HOUR

---------------------------------------------------------------------------------------------------------------------------------

HOMEMAKER N/A * N/A * N/A *

</TABLE>

THE FOLLOWING TRADITIONAL HOME HEALTH SERVICE IS PRICED ON A PER DIEM BASIS.

Notes 3, 4 and 5 apply

<TABLE>

AREA 1 AREA 2 AREA 3

------------------------------

PER DIEM PER DIEM PER DIEM

---------------------------------------------------------------------------------------

COMPANION/LIVE IN * * *

</TABLE>

NOTES:

1. Visits are defined as two (2) hours or less in duration (EXCEPT MATERNAL

CHILD HEALTH VISITS, which have no maximum duration).

2. Hourly rate for visits exceeding two (2) hours in duration, starting with

hour 3.

3. CIGNA does not reimburse for travel time, weekend, holiday or evening

differentials.

4. Above prices have no exclusions.

5. All services not listed above will be billed at * until rates are mutually

established and become part of the fee schedule.

6. RN High Tech Infusion visit and hourly utilization/costs to be reported

with HIT.

7. Respiratory Therapist visit utilization/costs to be reported with HME/RT.

8. Diabetic Nurse, Psychiatric Nurse and Rehabilitation Nurse assume

specialty certification which is not readily available in the home care

environment. Use requires special coordination.

*Confidential Treatment Requested

<PAGE>

HOME INFUSION RATES

RATES EFFECTIVE JANUARY 1, 2005 - DECEMBER 31, 2005

THE FOLLOWING HOME INFUSION THERAPY SERVICE RATES EXCLUDE DRUGS. DRUGS ARE

PRICED AS A PERCENTAGE DISCOUNT OFF AWP (IF APPLICABLE), AND THERE IS NO PRICE

DIFFERENCE BETWEEN PRIMARY AND MULTIPLE THERAPIES

<TABLE>

PRIMARY OR PRIMARY OR PRIMARY OR

MULTIPLE THERAPY MULTIPLE THERAPY MULTIPLE THERAPY

PER DIEM DISPENSING FEE DRUG DISCOUNT OFF AWP

----------------------------------------------------------------------------------------------------------------

Ancillary Drugs * *

Biological Response Modifiers * *

Cardiac (Inotropic) Therapy * *

Chelation Therapy * *

Chemotherapy * *

Enteral Therapy * N/A

Enzyme Therapy * *

Growth Hormone * *

IV Immune Globulin * *

Other Injectable Therapies * *

Other Infusion Therapies * *

Pain Management Therapy * *

Steroid Therapy * *

Thrombolytic (Anticoagulation) Therapy * *

Synagis * *

Remodulin Therapy * *

</TABLE>

THE FOLLOWING HOME INFUSION THERAPY SERVICE RATES EXCLUDE DRUGS. DRUGS ARE

PRICED AS A PERCENTAGE DISCOUNT OFF AWP, AND THERE IS A PRICE DIFFERENCE BETWEEN

PRIMARY AND MULTIPLE ANTI-INFECTIVE THERAPIES

<TABLE>

PER DIEM DRUG DISCOUNT OFF AWP

----------------------------------------------------------------------------------------------------------------

Anti-Infectives - Primary Anti-Infective * *

Anti-Infectives - Multiple Anti-Infective * *

</TABLE>

THE FOLLOWING HOME INFUSION THERAPY SERVICE RATE EXCLUDES DRUGS. DRUGS ARE

PRICED PER VIAL, AND THERE IS NO PRICE DIFFERENCE BETWEEN PRIMARY AND MULTIPLE

ANTI-INFECTIVE THERAPIES

<TABLE>

PRIMARY OR

MULTIPLE THERAPY

PER DIEM COST OF DRUG

-------------------------------------------------------------------------------------------------------------

Flolan Therapy *

Flolan 0.5 mg vial *

Flolan 1.5 mg vial *

Flolan diluent vial *

</TABLE>

THE FOLLOWING HOME INFUSION THERAPY SERVICE RATES INCLUDE DRUGS, AND THERE IS NO

PRICE DIFFERENCE BETWEEN PRIMARY AND MULTIPLE THERAPIES

<TABLE>

PRIMARY OR

MULTIPLE THERAPY

PER DIEM

-------------------------------------------------------------------------------------------------------------

<S> <C>

Enteral Therapy *

Hydration Therapy *

Total Parenteral Nutrition *

</TABLE>

*Confidential Treatment Requested

<PAGE>

SCHEDULE 2A, PAGE 2: HOME INFUSION HMO/FLEX FEE-FOR-SERVICE THERAPY RATES

NOTES:

1. Per Diems EXCLUDING drugs include all costs related to the therapy except

the cost of drugs, including but not limited to facility overhead,

supplies, delivery, professional labor including compounding and

monitoring, all nursing required, maintenance of specialized catheters,

equipment/patient supplies, disposables, pumps, general and administrative

expenses, etc.

2. Per Diems INCLUDING drugs include ALL costs - including but not limited to

cost of drugs, facility overhead, supplies, delivery, professional labor

including compounding and monitoring, all nursing required, maintenance of

specialized catheters, equipment/patient supplies, disposables, pumps,

general and administrative expenses, etc.

3. "DISPENSING FEE" is defined as per each time the drug is dispensed by the

home infusion provider.

4. "PER DIEM" costs are the same for primary or multiple treatments for all

drug categories, except ANTI-INFECTIVES.

5. The per diem rate shall only be charged for those days the Participant

receives medication.

6. For home infusion pharmaceuticals not listed on fee schedule, * will

apply.

7. Case Managers should utilize Enteral Therapy WITHOUT drugs as an infusion

benefit infrequently. Generally, patient's requiring Enteral Therapy

WITHOUT drugs should have services coordinated through the DME benefit.

THE FOLLOWING ARE FOR THE STATED ITEM ONLY. UNLESS OTHERWISE NOTED, NURSING,

SUPPLIES, ETC. ARE NOT INCLUDED.

<TABLE>

<S> <C>

Blood Transfusion per Unit (Tubing, Filters) *

Catheter Care Per Diem *

Midline Insertion (Catheter & Supplies) *

PICC Line Insertion (Catheter & Supplies) *

Blood Product *

</TABLE>

*Confidential Treatment Requested

<PAGE>

SCHEDULE 2A, PAGE 3: HOME INFUSION THERAPY HMO/FLEX FEE-FOR-SERVICE RATES

FACTOR CONCENTRATES

<TABLE>

VIAL PRICE UNIT PRICE

-----------------------------------------------------------------------------------------------------------

FACTOR VII

Novoseven 1200MCG Vial *

Novoseven 4800MCG Vial *

Novoseven in 1200MCG or 4800MCG QTY *

FACTOR VIII (RECOMBINANT)

Recombinate *

Kogenate or Helixate *

Bioclate N/A

Helixate FS *

Kogenate FS *

Refacto *

Advate *

FACTOR VIII (MONOCLONAL)

Hemofil-M or A. R. C. Method M *

Monoclate P *

Monarc-M *

FACTOR VIII (OTHER)

Koate *

Humate *

Alphanate SDHT *

FACTOR IX (RECOMBINANT)

BeneFix *

FACTOR IX (MONOCLONAL/HIGH PURITY)

Mononine *

Alphanine *

FACTOR IX (OTHER)

Konyne - 80 N/A

Proplex T *

Bebulin *

Profilnine SD *

ANTI-INHIBITOR COMPLEX

Autoplex-T *

Feiba-VH *

Hyate-C *

HEMOSTATIC AGENTS

DDAVP - 10ml vial *

Stimate - 2.5ml vial *

</TABLE>

Above rates include all necessary ancillary supplies and waste disposal unit;

24-hour on-call clinical support; home infusion monitoring system; product

delivery nationwide; patient training, education, and evaluation

*Confidential Treatment Requested

<PAGE>

DME / HME RESPIRATORY RATES:

RATES EFFECTIVE JANUARY 1, 2005 - DECEMBER 31, 2005

<TABLE>

HCPCS CHC GENTIVA PURCHASE RENTAL DAILY

CODE CODE CODE DESCRIPTION PRICE PRICE PRICE

---------------------------------------------------------------------------------------------------------------------

A4660 DM590 2520 MONITOR, BLOOD PRESSURE (A4660) W/STETH & CUFF *

A4670 DM590 2518 MONITOR, BLOOD PRESSURE (A4670), AUTOMATIC *

A9900 A9900 7552 BREEZE (A9900) CPAP/BIPAP MASK *

A9900 A9900 7553 FULL FACE (A9900) MIRAGE CPAP/BIPAP MASK *

A9900 A9900 7554 GEL/SILICON (A9900) CPAP/BIPAP MASK INCL GLD SEAL, PHANTM, MONARCH *

A9900 A9900 7556 SPECIALTY (A9900) CPAP/BIPAP MASK (PROFILE OR SIMPICITY) *

DM590 HI531 2570 PUMP, ENTERAL (B9002) * *

B9998 DM590 6828 ENTERAL SUPPLIES (B9998) *

DM590 DM570 7551 BACK-PACK (E1399), FOR PORTABLE ENTERAL PUMP *

DM590 DM590 2522 CANNULA, NASAL *

DM590 DM590 7509 ENTERAL PUMP, PORTABLE (B9002) * *

DM590 DM590 7508 MASK, CPAP GEL OR SILICONE (K0183) *

E0100 E0100 2020 CANE (E0100), ADJ OR FIX, W/ TIP *

E0105 E0105 2021 CANE, QUAD (E0105) OR THREE PRONG, ADJ OR FIX, W/ TIPS *

E0110 E0110 2028 CRUTCHES, FOREARM (E0110), ADJ OR FIX, PAIR, W/ TIPS, GRIPS *

E0111 E0111 2023 CRUTCH FOREARM (E0111), ADJ OR FIX, EACH, W/ TIP AND GRIPS *

E0112 E0112 2027 CRUTCHES UNDERARM, WOOD (E0112), ADJ OR FIX, PAIR, COMPLETE *

E0113 E0113 2025 CRUTCH UNDERARM, WOOD (E0113), ADJ OR FIX, EACH, COMPLETE *

E0114 E0114 2026 CRUTCHES UNDERARM, ALUM (E0114), ADJ OR FIX, PAIR, COMPLETE *

E0116 E0116 2024 CRUTCH UNDERARM, ALUM (E0116), ADJ OR FIX, EACH, COMPLETE *

E0130 E0130 2037 WALKER, RIGID (E0130) (PICKUP), ADJ OR FIX HEIGHT *

E0135 E0135 2036 WALKER, FOLDING (E0135) (PICKUP), ADJ OR FIX HEIGHT *

E0141 E0141 2040 WALKER, WHEELED (E0141), W/OUT SEAT *

E0142 DM570 2034 RIGID WALKER (E0142), WHEELED, W/ SEAT, *

E0143 E0143 2029 WALKER FOLDING, WHEELED (E0143), W/OUT SEAT *

E0145 DM570 2039 WALKER (E0145), WHEELED, W/ SEAT AND CRUTCH ATTACHMENTS *

E0146 DM570 2038 WALKER, WHEELED, W/ SEAT (E0146) *

E0147 E0147 2030 WALKER HVY DUT (E0147), MULT BRAKING SYS, VAR WHEEL RESISTANCE *

E0153 E0153 2032 CRUTCH PLATFORM ATTACHMENT (E0153), FOREARM EA *

E0154 E0154 2033 WALKER PLATFORM ATTACHMENT (E0154), EA *

E0155 E0155 2041 WALKER WHEEL ATTACHMENT (E0155), RIGID (PICKUP) WALKER *

E0156 DM570 2035 WALKER SEAT ATTACHMENT (E0156) *

E0157 E0157 2022 WALKER, CRUTCH ATTACHMENT (E0157), EACH *

E0158 E0158 2031 WALKER LEG EXTENSIONS (E0158) *

E0163 E0163 2047 COMMODE CHAIR, STATIONARY (E0163), W/ FIX ARMS *

E0164 E0164 2045 COMMODE CHAIR, MOBILE (E0164), W/ FIX ARMS *

E0165 E0165 2046 COMMODE CHAIR (E0165), STATIONARY, W/ DETACH ARMS *

E0165 E0165 2591 COMMODE, XXWIDE(E0165) *

E0166 E0166 2044 COMMODE CHAIR (E0166), MOBILE, W/ DETACH ARMS *

E0167 E0167 2051 COMMODE CHAIR, PAIL OR PAN (E0167) *

E0176 E0176 2142 CUSHION (E0176) OR AIR PRESSURE PAD, NON-POSITIONING *

E0176 E0176 2394 REPLACEMENT PAD (E0176) ALTERNATING PRESS *

E0177 E0177 2224 CUSHION OR WATER PRESS PAD (E0177), NONPOSITIONING *

E0178 E0178 2160 CUSHION OR GEL PRESS PAD (E0178), NONPOSITIONING *

E0179 E0179 2154 CUSHION (E0179) OR DRY PRESSURE PAD, NONPOSTIONING *

E0180 E0180 2196 PUMP (E0180), ALTERNATING PRESSURES W/PAD * *

E0181 E0181 2197 PUMP (E0181), ALTERNATING PRESS W/PAD, HVY DUTY * *

E0184 E0184 2074 MATTRESS, DRY PRESSURE (E0184) *

E0185 E0185 2076 MATTRESS (E0185), GEL OR GEL-LIKE PRESSURE PAD *

E0186 E0186 2064 MATTRESS, AIR PRESSURE (E0186) *

E0187 E0187 2099 MATTRESS, WATER PRESSURE (E0187) *

E0188 DM570 2217 PAD, SYNTHETIC SHEEPSKIN (A9900) *

E0189 DM570 2177 PAD, LAMBSWOOL SHEEPSKIN (E0189), ANY SIZE *

E0192 E0192 2573 CUSHION, JAY FOR W/C (E0192) * *

E0192 E0192 2572 CUSHION, ROHO FOR W/C (E0192) * *

E0192 E0192 2178 W/C PAD (E0192), LOW PRESS AND POSITIONING EQUALIZATION * *

E0193 E0193 2098 MATTRESS, LOW AIR LOSS (E0193), INCL. BED * * *

E0194 DM570 2063 AIR FLUIDIZED BED (E0194) * *

E0270 E1399 6887 HOSPITAL BED INSTITUTIONAL * *

E0196 E0196 2077 MATTRESS, GEL PRESSURE (E0196) *

E0197 E0197 2065 MATTRESS, AIR PRESSURE PAD (E0197) *

E0198 E0198 2100 MATTRESS (E01