Amendment No. 3 to Contract YH04-0001-03 Between Arizona Health Care Cost Containment System and Health Choice Arizona

Contract Categories: Business Finance › Modification Agreements
Summary

This amendment updates the contract between the Arizona Health Care Cost Containment System (AHCCCS) and Health Choice Arizona to correct and revise capitation rates, specifically adjusting the Maternity Delivery Payment. The changes address previous errors in rate calculations and rounding, with new rates provided for various counties and member categories. All other terms of the original contract remain unchanged. The amendment is effective as of October 1, 2003, and requires signatures from both parties to confirm agreement.

Read More Arrow
EX-10.19 9 g86118exv10w19.txt EX-10.19 AMENDMENT NO.3 EXHIBIT 10.19 ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION DIVISION OF BUSINESS AND FINANCE CONTRACT AMENDMENT Page 1 of 1
1. AMENDMENT NO.: 2. CONTRACT NO.: 3. EFFECTIVE DATE OF MODIFICATION: 4. PROGRAM: 03 YH04-0001-03 OCTOBER 1, 2003 DHCM-ACUTE
5. CONTRACTOR/PROVIDER NAME AND ADDRESS: HEALTH CHOICE ARIZONA 1600 WEST BROADWAY, SUITE 260 TEMPE, ARIZONA ###-###-#### 6. PURPOSE: To revise capitation rates contained in Section B. 7. THE CONTRACT REFERENCED ABOVE IS AMENDED AS FOLLOWS: The purpose of this amendment is to adjust the Maternity Delivery Payment. In Amendment 02, the summary rate sheet by GSA had the incorrect rate stated; and, the Final Awarded Rate sheets had a rounding error in the reinsurance offset line. These errors have been corrected and are reflected in the attached revised capitation rates. All other terms and conditions of the contract remains the same. Note: Please sign, date and return one original to: Diane E. Harnisch, CPPB Contract Management Specialist AHCCCS Contracts and Purchasing 701 E. Jefferson, MD5700 Phoenix, Arizona 85034 8. EXCEPT AS PROVIDED FOR HEREIN, ALL TERMS AND CONDITIONS OF THE ORIGINAL CONTRACT NOT HERETOFORE CHANGED AND/OR AMENDED REMAIN UNCHANGED AND IN FULL EFFECT. IN WITNESS WHEREOF THE PARTIES HERETO SIGN THEIR NAMES IN AGREEMENT. 9. NAME OF CONTRACTOR: 10. ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM Health Choice Arizona SIGNATURE OF AUTHORIZED INDIVIDUAL: SIGNATURE: /s/ Carolyn Rose /s/ MICHAEL VEIT ---------------- ----------------- TYPED NAME: TYPED NAME: Carolyn Rose MICHAEL VEIT TITLE: TITLE: Chief Executive officer Contracts and Purchasing Administrator DATE DATE: September 10, 2003 AS OF: 10/1/2003 PLAN: HEALTH CHOICE ARIZONA ACUTE GSA: 4 COUNTY: APACHE/COCONINO/MOHAVE/NAVAJO
ACUTE ACUTE PPC ONGOING ----- ------- TACI TANF AND CHILDREN M & F < 1 year 737.97 383.00 tacs tanf, children and sobra preg female 39.66 93.08 fmal tanf, children, sobra females 14-44 151.00 180.85 male tanf, children males 14-44 122.40 137.53 adlt tanf m & f and sobra females 45+ 281.97 325.23 ssiw ssi aged, disabled, blind medicare 38.50 266.88 ssin ssi aged, disabled, blind non-medicare 86.12 572.83 sfps sobra family planning services 13.96 sb10 tanf supplemental birth payment 5,289.63 sb11 sb payment for tanf expanded 5,289.63 sb20 ssi w/o supplemental birth payment 5,289.63 sb21 ssi w/ supplemental birth payment 5,289.63 sb22 sb payment for ssi expanded with medicare 5,289.63 sb23 sb payment for ssi expanded no medicare 5,289.63 sb33 sb payment for ahcccs care 5,289.63 sb34 sb payment for med eligibles 5,289.63 sb36 sb payment for ahc care/mi 5,289.63 sb50 sobra supplemental birth payment 5,289.63 sb60 kidscare supplemental birth payment acma ahc care 590.95 419.64 mede med eligibility 1,601.66 723.91 hs00 hospitalized kick for ahcccs care 0.00 hs01 hospitalized kick for ahc care/mi 0.00 hs02 hospitalized kick for med eligibles 10,548.19 hfml hifa female 14-44 198.76 hmal hifa male 14-44 151.16 hadt hifa adult 45+, m & f 357.54 kidi kids < 1 m & f kidc kids 1-13 m & f kidf kids 14-19 female kidm kids 14-19 male
AS OF: 10/1/2003 PLAN: HEALTH CHOICE ARIZONA ACUTE GSA: 8 COUNTY: GILA/PINAL
ACUTE ACUTE PPC ONGOING ----- ------- TACI TANF AND CHILDREN M & F < 1 year 737.97 380.35 tacs tanf, children and sobra preg female 39.66 92.41 fmal tanf, children, sobra females 14-44 151.00 160.67 male tanf, children males 14-44 122.40 116.81 adlt tanf m & f and sobra females 45+ 281.97 321.13 ssiw ssi aged, disabled, blind medicare 38.50 239.91 ssin ssi aged, disabled, blind non-medicare 86.12 509.05 sfps sobra family planning services 15.49 sb10 tanf supplemental birth payment 5,606.32 sb11 sb payment for tanf expanded 5,606.32 sb20 ssi w/o supplemental birth payment 5,606.32 sb21 ssi w/ supplemental birth payment 5,606.32 sb22 sb payment for ssi expanded with medicare 5,606.32 sb23 sb payment for ssi expanded no medicare 5,606.32 sb33 sb payment for ahcccs care 5,606.32 sb34 sb payment for med eligibles 5,606.32 sb36 sb payment for ahc care/mi 5,606.32 sb50 sobra supplemental birth payment 5,606.32 sb60 kidscare supplemental birth payment acma ahc care 554.83 386.59 mede med eligibility 1,584.83 730.00 hs00 hospitalized kick for ahcccs care 0.00 hs01 hospitalized kick for ahc care/mi 0.00 hs02 hospitalized kick for med eligibles 9,355.58 hfml hifa female 14-44 176.58 hmal hifa male 14-44 128.38 hadt hifa adult 45+, m & f 353.05 kidi kids < 1 m & f kidc kids 1-13 m & f kidf kids 14-19 female kidm kids 14-19 male
AS OF: 10/1/2003 PLAN: HEALTH CHOICE ARIZONA ACUTE GSA: 10 COUNTY: PIMA
ACUTE ACUTE PPC ONGOING ----- ------- TACI TANF AND CHILDREN M & F < 1 year 1,200.85 372.73 tacs tanf, children and sobra preg female 39.66 88.86 fmal tanf, children, sobra females 14-44 157.05 160.25 male tanf, children males 14-44 127.30 111.45 adlt tanf m & f and sobra females 45+ 293.24 347.05 ssiw ssi aged, disabled, blind medicare 30.10 253.64 ssin ssi aged, disabled, blind non-medicare 81.25 551.47 sfps sobra family planning services 11.78 sb10 tanf supplemental birth payment 5,456.54 sb11 sb payment for tanf expanded 5,456.54 sb20 ssi w/o supplemental birth payment 5,456.54 sb21 ssi w/ supplemental birth payment 5,456.54 sb22 sb payment for ssi expanded with medicare 5,456.54 sb23 sb payment for ssi expanded no medicare 5,456.54 sb33 sb payment for ahcccs care 5,456.54 sb34 sb payment for med eligibles 5,456.54 sb36 sb payment for ahc care/mi 5,456.54 sb50 sobra supplemental birth payment 5,456.54 sb60 kidscare supplemental birth payment acma ahc care 601.35 345.60 mede med eligibility 1,624.59 726.34 hs00 hospitalized kick for ahcccs care 0.00 hs01 hospitalized kick for ahc care/mi 0.00 hs02 hospitalized kick for med eligibles 9,723.91 hfml hifa female 14-44 176.10 hmal hifa male 14-44 122.49 hadt hifa adult 45+, m & f 381.57 kidi kids < 1 m & f kidc kids 1-13 m & f kidf kids 14-19 female kidm kids 14-19 male
AS OF: 10/1/2003 PLAN: HEALTH CHOICE ARIZONA ACUTE GSA: 12 COUNTY: MARICOPA
ACUTE ACUTE PPC ONGOING ----- ------- TACI TANF AND CHILDREN M & F < 1 year 1,196.40 372.71 tacs tanf, children and sobra preg female 39.66 93.54 fmal tanf, children, sobra females 14-44 157.05 161.06 male tanf, children males 14-44 127.30 119.45 adlt tanf m & f and sobra females 45+ 293.24 327.04 ssiw ssi aged, disabled, blind medicare 30.21 233.51 ssin ssi aged, disabled, blind non-medicare 81.25 498.98 sfps sobra family planning services 16.32 sb10 tanf supplemental birth payment 5,668.10 sb11 sb payment for tanf expanded 5,668.10 sb20 ssi w/o supplemental birth payment 5,668.10 sb21 ssi w/ supplemental birth payment 5,668.10 sb22 sb payment for ssi expanded with medicare 5,668.10 sb23 sb payment for ssi expanded no medicare 5,668.10 sb33 sb payment for ahcccs care 5,668.10 sb34 sb payment for med eligibles 5,668.10 sb36 sb payment for ahc care/mi 5,668.10 sb50 sobra supplemental birth payment 5,668.10 sb60 kidscare supplemental birth payment acma ahc care 538.76 404.81 mede med eligibility 1,572.86 734.18 hs00 hospitalized kick for ahcccs care 0.00 hs01 hospitalized kick for ahc care/mi 0.00 hs02 hospitalized kick for med eligibles 9,244.71 hfml hifa female 14-44 177.01 hmal hifa male 14-44 131.28 hadt hifa adult 45+, m & f 359.55 kidi kids < 1 m & f kidc kids 1-13 m & f kidf kids 14-19 female kidm kids 14-19 male
AZ-AHCCCS PROPRIETARY AND CONFIDENTIAL FINAL AWARDED RATE - CYE04 - HEALTH CHOICE: GSA 4 - (EFFECTIVE 10/01/03) PERCENT CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS
[ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $362.08 $ 88.38 $170.68 $127.08 $308.53 - ------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment 1.46% 2.79% 3.22% 3.71% 3.14% Cost Sharing Proposal Adjustment 0.00% 0.00% 0.00% 0.00% 0.00% Reinsurance Incorporating Catastrophic and Transplant Data Adjustment -1.74% 0.09% -0.13% 1.70% -0.02% Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) -0.10% -0.02% -0.05% -0.03% -0.05% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) -0.17% -0.06% -0.16% -0.30% -0.41% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% 2.04% 2.04% - ----------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM (2) 1.45% 4.89% 4.97% 7.27% 4.75% - ----------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $367.33 $ 92.70 $179.15 $136.32 $323.17 - ----------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible (3) 4.27% 0.40% 0.95% 0.88% 0.64% ================================================================================================================= Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $383.00 $ 93.08 $180.85 $137.53 $325.23 - ----------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ----------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $ 255.77 $516.54 $13.68 $5,238.20 $740.35 - --------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment 2.00% 2.94% 0.00% -0.73% 0.00% Cost Sharing Proposal Adjustment 0.00% 0.00% 0.00% 0.00% 0.00% Reinsurance Incorporating Catastrophic and Transplant Data Adjustment 0.18% 3.76% 0.00% 0.00% 0.00% Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) -0.02% -0.04% -0.02% -0.09% 0.00% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) -0.09% -0.38% 0.00% 0.04% 0.00% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% 2.04% 2.04% - --------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM (2) 4.16% 8.53% 2.02% 1.24% 2.04% - --------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 266.41 $560.62 $13.96 $5,303.20 $755.46 - --------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible (3) 0.18% 2.18% 0.00% -0.26% 0.00% =============================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 266.88 $572.83 $13.96 $5,289.63 $755.46 - --------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $566.00 $420.48 $ 1,537.54 $732.17 $ 10,269.35 - ------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment 2.77% 2.77% 2.65% 2.65% 1.39% Cost Sharing Proposal Adjustment 0.00% -4.41% 0.00% -5.09% 0.00% Reinsurance Incorporating Catastrophic and Transplant Data Adjustment 0.00% 0.00% 0.00% 0.00% 0.00% Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) -0.06% -0.06% -0.06% -0.06% -0.23% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) -0.38% -0.38% -0.49% -0.49% -0.49% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% 2.04% 2.04% - ------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM (2) 4.41% -0.20% 4.17% -1.13% 2.72% - ------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $590.95 $419.64 $ 1,601.66 $723.91 $ 10,548.19 - ------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible (3) 0.00% 0.00% 0.00% 0.00% 0.00% ============================================================================================================= Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 590.95 $419.64 $ 1,601.66 $723.91 $ 10,548.19 - -------------------------------------------------------------------------------------------------------------
PERCENT CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS
[ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ----------------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $714.74 $37.84 $143.67 $116.05 $ 269.14 $ 37.03 $ 82.34 - --------------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment 1.46% 2.79% 3.22% 3.71% 3.14% 2.00% 2.94% Cost Sharing Proposal Adjustment 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Reinsurance Incorporating Catastrophic and Transplant Data Adjustment 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) -0.10% -0.02% -0.05% -0.03% -0.05% -0.02% -0.04% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) -0.17% -0.06% -0.16% -0.30% -0.41% -0.09% -0.38% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% 2.04% 2.04% 2.04% 2.04% - --------------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM (2) 3.25% 4.80% 5.11% 5.47% 4.77% 3.97% 4.60% - --------------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $737.97 $39.66 $151.00 $122.40 $ 291.97 $ 38.50 $ 86.12 - --------------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% ================================================================================================================================= Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $737.97 $39.66 $151.00 $122.40 $ 281.97 $ 38.50 $ 86.12 - --------------------------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - --------------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM N/A N/A N/A N/A N/A N/A N/A - --------------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment N/A N/A N/A N/A N/A N/A N/A Cost Sharing Proposal Adjustment N/A N/A N/A N/A N/A N/A N/A Reinsurance Incorporating Catastrophic and Transplant Data Adjustment N/A N/A N/A N/A N/A N/A N/A Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) N/A N/A N/A N/A N/A N/A N/A Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) N/A N/A N/A N/A N/A N/A N/A Premium Tax Implementation Adjustment N/A N/A N/A N/A N/A N/A N/A - --------------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM (2) N/A N/A N/A N/A N/A N/A N/A - --------------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible N/A N/A N/A N/A N/A N/A N/A - --------------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible N/A N/A N/A N/A N/A N/A N/A ================================================================================================================================= Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible N/A N/A N/A N/A N/A N/A N/A - ---------------------------------------------------------------------------------------------------------------------------------
1. The KidsCare age cohort includes individuals 14 to 18 years of age, while the TANF rate cell includes 14 - 44. 2. The adjustment is multiplicative, not additive. 3. The Maternity Delivery Payment does not have a reinsurance component built directly into the rate. However, it is indirectly affected by choosing a different deductible level because the TANF 14-44 female rate is applied as an 8-month offset to the Maternity Delivery Payment, and the female rate is directly affected by a new reinsurance election. Mercer Government Human Services Consulting [ILLEGIBLE] 1 of 8 AZ-AHCCCS PROPRIETARY AND CONFIDENTIAL FINAL AWARDED RATE - CYE04 - HEALTH CHOICE: GSA 4 - (EFFECTIVE 10/01/03) PMPM CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS
[ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - -------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $ 362.08 $ 88.38 $ 170.68 $ 127.08 $ 308.53 - -------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 5.29 $ 2.46 $ 5.50 $ 4.71 $ 9.70 Cost Sharing Proposal Adjustment $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Reinsurance Incorporating Catastrophic and Transplant Data Adjustment ($ 6.40) $ 0.08 ($ 0.23) $ 2.25 ($ 0.06) Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) ($ 0.37) ($ 0.02) ($ 0.08) ($ 0.04) ($ 0.15) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 0.61) ($ 0.06) ($ 0.29) ($ 0.40) ($ 1.32) Premium Tax Implementation Adjustment $ 7.35 $ 1.85 $ 3.58 $ 2.73 $ 6.46 - -------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 5.25 $ 4.32 $ 8.47 $ 9.24 $ 14.64 - -------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 367.33 $ 92.70 $ 179.15 $ 136.32 $ 323.17 - -------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible (2) $ 15.67 $ 0.38 $ 1.70 $ 1.21 $ 2.06 ==================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 383.00 $ 93.08 $ 180.85 $ 137.53 $ 325.23 - -------------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $ 255.77 $ 516.54 $ 13.88 $ 5,238.20 $ 740.35 - ------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 5.13 $ 15.16 $ 0.00 ($ 37.98) $ 0.00 Cost Sharing Proposal Adjustment $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Reinsurance Incorporating Catastrophic and Transplant Data Adjustment $ 0.47 $ 20.01 $ 0.00 $ 0.00 $ 0.00 Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) ($ 0.05) ($ 0.22) ($ 0.00) ($ 4.93) $ 0.00 Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 0.24) ($ 2.09) $ 0.00 $ 1.85 $ 0.00 Premium Tax Implementation Adjustment $ 5.33 $ 11.21 $ 0.28 $ 106.06 $ 15.11 - ------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 10.64 $ 44.08 $ 0.28 $ 65.00 $ 15.11 - ------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 266.41 $ 560.82 $ 13.96 $ 5,303.20 $ 755.46 - ------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible (2) $ 0.47 $ 12.21 $ 0.00 ($ 13.56) $ 0.00 ========================================================================================================================= Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 266.88 $ 572.83 $ 13.96 $ 5,289.63 $ 755.46 - ------------------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ----------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $ 566.00 $ 420.48 $ 1,537.54 $ 732.17 $10,269.35 - ----------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 15.66 $ 11.84 $ 40.74 $ 19.40 $ 142.47 Cost Sharing Proposal Adjustment $ 0.00 ($ 19.06) $ 0.00 ($ 38.23) $ 0.00 Reinsurance Incorporating Catastrophic and Transplant Data Adjustment $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) ($ 0.33) ($ 0.23) ($ 0.92) ($ 0.42) ($ 23.68) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 2.21) ($ 1.57) ($ 7.73) ($ 3.49) ($ 50.90) Premium Tax Implementation Adjustment $ 11.82 $ 8.39 $ 32.03 $ 14.48 $ 210.96 - ----------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 24.95 ($ 0.84) $ 64.12 ($ 8.27) $ 278.85 - ----------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 590.95 $ 419.64 $ 1,601.66 $ 723.91 $10,548.19 - ----------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible (2) $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 ============================================================================================================================= Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 590.95 $ 419.84 $ 1,601.66 $ 723.91 $10,548.19 - -----------------------------------------------------------------------------------------------------------------------------
PMPM CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS
[ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ---------------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $ 714.74 $ 37.84 $ 143.67 $ 116.05 $ 269.14 $ 37.03 $ 82.34 - ---------------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 10.44 $ 1.05 $ 4.63 $ 4.30 $ 8.46 $ 0.74 $ 2.42 Cost Sharing Proposal Adjustment $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Reinsurance Incorporating Catastrophic and Transplant Data Adjustment $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) ($ 0.75) ($ 0.01) ($ 0.07) ($ 0.04) ($ 0.13) ($ 0.01) ($ 0.03) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 1.23) ($ 0.02) ($ 0.24) ($ 0.36) ($ 1.15) ($ 0.03) ($ 0.32) Premium Tax Implementation Adjustment $ 14.76 $ 0.79 $ 3.02 $ 2.45 $ 5.64 $ 0.77 $ 1.72 - ---------------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 23.23 $ 1.82 $ 7.33 $ 6.35 $ 12.83 $ 1.47 $ 3.78 - ---------------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 737.97 $ 39.66 $ 151.00 $ 122.40 $ 281.97 $ 38.50 $ 86.12 - ---------------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 ================================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 737.97 $ 39.66 $ 151.00 $ 122.40 $ 281.97 $ 38.50 $ 86.12 - ---------------------------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM N/A N/A N/A N/A N/A N/A N/A - ------------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment N/A N/A N/A N/A N/A N/A N/A Cost Sharing Proposal Adjustment N/A N/A N/A N/A N/A N/A N/A Reinsurance Incorporating Catastrophic and Transplant Data Adjustment N/A N/A N/A N/A N/A N/A N/A Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) N/A N/A N/A N/A N/A N/A N/A Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) N/A N/A N/A N/A N/A N/A N/A Premium Tax Implementation Adjustment N/A N/A N/A N/A N/A N/A N/A - ------------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM N/A N/A N/A N/A N/A N/A N/A - ------------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible N/A N/A N/A N/A N/A N/A N/A - ------------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible N/A N/A N/A N/A N/A N/A N/A =============================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible N/A N/A N/A N/A N/A N/A N/A - -------------------------------------------------------------------------------------------------------------------------------
1. The kidsCare age cohort covers individuals 14 - 18 years of age, while the TANF rate cell includes 14 - 44. 2. The Maternity Delivery Payment does not have a reinsurance component built directly into the rate. However, it is indirectly affected by choosing a different deductible level because the TANF 14-44 female rate is applied as an 8-month offset to the Maternity Delivery Payment, and the female rate is directly affected by a new reinsurance election. Mercer Government Human Services Consulting [ILLEGIBLE] 2 of 8 AZ-AHCCCS PROPRIETARY AND CONFIDENTIAL FINAL AWARDED RATE - CYE04 - HEALTH CHOICE: GSA 8 - (EFFECTIVE 10/01/03) PERCENT CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS
[ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------------------------ Originally Awarded PMPM $361.00 $87.78 $151.60 $107.87 - ---------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment 1.46% 2.79% 3.22% 3.71% Cost Sharing Proposal Adjustment 0.00% 0.00% 0.00% 0.00% Reinsurance Incorporating Catastrophic and Transplant Data Adjustment -1.74% 0.09% -0.13% 1.70% Hospital Inpatient DRI Trend Update Adjustment- (4.0% estimate changed to 3.8% actual) -0.10% -0.02% -0.05% -0.03% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) -0.17% -0.06% -0.16% -0.30% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% 2.04% - ---------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM (2) 1.45% 4.89% 4.97% 7.27% - ---------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $366.24 $92.07 $159.13 $115.71 - ---------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible (3) 3.85% 0.37% 0.97% 0.95% ==================================================================================================== Adjusted Awarded PMPM for plans Electing the $35k Reinsurance Deductible $380.35 $92.41 $160.67 $116.81 - ---------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------------ Originally Awarded PMPM $304.79 $229.93 $458.90 - ---------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment 3.14% 2.00% 2.94% Cost Sharing Proposal Adjustment 0.00% 0.00% 0.00% Reinsurance Incorporating Catastrophic and Transplant Data Adjustment -0.02% 0.18% 3.76% Hospital Inpatient DRI Trend Update Adjustment- (4.0% estimate changed to 3.8% actual) -0.05% -0.02% -0.04% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) -0.41% -0.09% -0.38% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% - ---------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM (2) 4.75% 4.16% 8.53% - ---------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $319.25 $239.49 $498.06 - ---------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible (3) 0.59% 0.18% 2.21% ======================================================================================== Adjusted Awarded PMPM for plans Electing the $35k Reinsurance Deductible $321.13 $239.91 $509.05 - ---------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $15.18 $5,549.77 $740.35 $531.41 - ----------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment 0.00% -0.73% 0.00% 2.77% Cost Sharing Proposal Adjustment 0.00% 0.00% 0.00% 0.00% Reinsurance Incorporating Catastrophic and Transplant Data Adjustment 0.00% 0.00% 0.00% 0.00% Hospital Inpatient DRI Trend Update Adjustment- (4.0% estimate changed to 3.8% actual) -0.02% -0.09% 0.00% -0.06% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) 0.00% 0.04% 0.00% -0.38% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% 2.04% - ----------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM (2) 2.02% 1.24% 2.04% 4.41% - ----------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $15.49 $5,618.63 $755.46 $554.83 - ----------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible (3) 0.00% -0.22% 0.00% 0.00% ===================================================================================================== Adjusted Awarded PMPM for plans Electing the $35k Reinsurance Deductible $15.49 $5,606.32 $755.46 $554.83 - ----------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ----------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $387.36 $1,521.38 $738.34 $9,108.27 - ----------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment 2.77% 2.65% 2.65% 1.39% Cost Sharing Proposal Adjustment -4.41% 0.00% -5.09% 0.00% Reinsurance Incorporating Catastrophic and Transplant Data Adjustment 0.00% 0.00% 0.00% 0.00% Hospital Inpatient DRI Trend Update Adjustment- (4.0% estimate changed to 3.8% actual) -0.06% -0.06% -0.06% -0.23% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) -0.38% -0.49% -0.49% -0.49% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% 2.04% - ----------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM (2) -0.20% 4.17% -1.13% 2.72% - ----------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $386.59 $1,584.83 $730.00 $9,355.58 - ----------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible (3) 0.00% 0.00% 0.00% 0.00% =========================================================================================================== Adjusted Awarded PMPM for plans Electing the $35k Reinsurance Deductible $386.59 $1,584.83 $730.00 $9,355.58 - -----------------------------------------------------------------------------------------------------------
PERCENT CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS
[ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - --------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $714.74 $37.84 $143.67 $116.05 - -------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment 1.46% 2.79% 3.22% 3.71% Cost Sharing Proposal Adjustment 0.00% 0.00% 0.00% 0.00% Reinsurance Incorporating Catastrophic and Transplant Data Adjustment 0.00% 0.00% 0.00% 0.00% Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) -0.10% -0.02% -0.05% -0.03% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) -0.17% -0.06% -0.16% -0.30% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% 2.04% - -------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM (2) 3.25% 4.80% 5.11% 5.47% - -------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $737.97 $39.66 $151.00 $122.40 - -------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible 0.00% 0.00% 0.00% 0.00% ============================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $737.97 $39.66 $151.00 $122.40 - -------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------------- Originally Awarded PMPM $269.14 $37.03 $82.34 - ------------------------------------------------------------------------------------------ Outpatient & Emergency Room Adjustment 3.14% 2.00% 2.94% Cost Sharing Proposal Adjustment 0.00% 0.00% 0.00% Reinsurance Incorporating Catastrophic and Transplant Data Adjustment 0.00% 0.00% 0.00% Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) -0.05% -0.02% -0.04% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) -0.41% -0.09% -0.38% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% - ------------------------------------------------------------------------------------------ Total Adjustment Impacting Base PMPM (2) 4.77% 3.97% 4.60% - ------------------------------------------------------------------------------------------ Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $281.97 $38.50 $86.12 - ------------------------------------------------------------------------------------------ Impact of Electing the $35k Reinsurance Deductible 0.00% 0.00% 0.00% ========================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $281.97 $38.50 $86.12 - ------------------------------------------------------------------------------------------ [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - -------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM N/A N/A N/A N/A - ---------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment N/A N/A N/A N/A Cost Sharing Proposal Adjustment N/A N/A N/A N/A Reinsurance Incorporating Catastrophic and Transplant Data Adjustment N/A N/A N/A N/A Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) N/A N/A N/A N/A Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) N/A N/A N/A N/A Premium Tax Implementation Adjustment N/A N/A N/A N/A - ---------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM (2) N/A N/A N/A N/A - ---------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible N/A N/A N/A N/A - ---------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible N/A N/A N/A N/A ========================================================================================================== Adjusted Awarded PMPM For Plans Electing the $35k Reinsurance Deductible N/A N/A N/A N/A - ---------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - --------------------------------------------------------------------------------------------------- Originally Awarded PMPM N/A N/A N/A - ----------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment N/A N/A N/A Cost Sharing Proposal Adjustment N/A N/A N/A Reinsurance Incorporating Catastrophic and Transplant Data Adjustment N/A N/A N/A Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) N/A N/A N/A Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) N/A N/A N/A Premium Tax Implementation Adjustment N/A N/A N/A - ----------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM (2) N/A N/A N/A - ----------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible N/A N/A N/A - ----------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible N/A N/A N/A =============================================================================================== Adjusted Awarded PMPM For Plans Electing the $35k Reinsurance Deductible N/A N/A N/A - -----------------------------------------------------------------------------------------------
1. The KidsCare age cohort includes Individuals 14 to 18 years of age, while the TANF rate cell includes 14 - 44. 2. The adjustment is multiplicative, not additive. 3. The Maternity Delivery Payment does not have a reinsurance component built directly into the rate. However, it is indirectly affected by choosing a different deductible level because the TANF 14-44 female rate is applied as an 8-month offset to the Maternity Delivery Payment, and the female rate is directly affected by a new reinsurance election. Mercer Government Human Services Consulting [ILLEGIBLE] 3 of 8 AZ-AHCCCS PROPRIETARY AND CONFIDENTIAL FINAL AWARDED RATE - CYE04 - HEALTH CHOICE: GSA 8 - (EFFECTIVE 10/01/03) PMPM CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS
[ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - -------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $361.00 $ 87.78 $151.60 $107.87 - ------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 5.27 $ 2.45 $ 4.88 $ 4.00 Cost Sharing Proposal Adjustment $ 0.00 $ 0.00 $ 0.00 $ 0.00 Reinsurance Incorporating Catastrophic and Transplant Data Adjustment ($ 6.38) $ 0.08 ($ 0.21) $ 1.91 Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) ($ 0.37) ($ 0.02) ($ 0.07) ($ 0.04) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 0.61) ($ 0.05) ($ 0.26) ($ 0.34) Premium Tax Implementation Adjustment $ 7.32 $ 1.84 $ 3.18 $ 2.31 - ------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 5.24 $ 4.29 $ 7.53 $ 7.84 - ------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $366.24 $ 92.07 $159.13 $115.71 ============================================================================================================= Impact of Electing the $35k Reinsurance Deductible (2) $ 14.11 $ 0.34 $ 1.54 $ 1.10 - ------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM For Plans Electing the $35k Reinsurance Deductible $380.35 $ 92.41 $160.67 $116.81 - ------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ---------------------------------------------------------------------------------------------- Originally Awarded PMPM $304.79 $ 229.93 $458.90 - --------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 9.58 $ 4.61 $ 13.47 Cost Sharing Proposal Adjustment $ 0.00 $ 0.00 $ 0.00 Reinsurance Incorporating Catastrophic and Transplant Data Adjustment ($ 0.06) $ 0.42 $ 17.78 Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) ($ 0.15) ($ 0.04) ($ 0.10) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 1.30) ($ 0.21) ($ 1.80) Premium Tax Implementation Adjustment $ 6.39 $ 4.79 $ 9.96 - --------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 14.46 $ 9.56 $ 39.16 - --------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $319.25 $ 239.49 $498.06 ============================================================================================= Impact of Electing the $35k Reinsurance Deductible (2) $ 1.87 $ 0.42 $ 10.99 - --------------------------------------------------------------------------------------------- Adjusted Awarded PMPM For Plans Electing the $35k Reinsurance Deductible $321.13 $ 239.91 $509.05 - --------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - -------------------------------------------------------------------------------------------- Originally Awarded PMPM $15.18 $5,549,77 $740.35 $531.41 - ------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 0.00 ($ 40.24) $ 0.00 $ 14.71 Cost Sharing Proposal Adjustment $ 0.00 $ 0.00 $ 0.00 $ 0.00 Reinsurance Incorporating Catastrophic and Transplant Data Adjustment $ 0.00 $ 0.00 $ 0.00 $ 0.00 Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) ($ 0.00) ($ 5.23) $ 0.00 ($ 0.31) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) $ 0.00 $ 1.96 $ 0.00 ($ 2.07) Premium Tax Implementation Adjustment $ 0.31 $ 112.37 $ 15.11 $ 11.10 - ------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 0.31 $ 68.86 $ 15.11 $ 23.42 - ------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $15.49 $5,618.83 $755.46 $554.83 - ------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible (2) $ 0.00 ($ 12.31) $ 0.00 $ 0.00 =========================================================================================== Adjusted Awarded PMPM For Plans Electing the $35k Reinsurance Deductible $15.49 $5,606.32 $755.46 $554.83 - ------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------------------- Originally Awarded PMPM $387.36 $1,521.38 $738.34 $9,108.27 - ------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 10.72 $ 40.31 $ 19.56 $ 126.36 Cost Sharing Proposal Adjustment ($ 17.56) $ 0.00 ($ 38.56) $ 0.00 Reinsurance Incorporating Catastrophic and Transplant Data Adjustment $ 0.00 $ 0.00 $ 0.00 $ 0.00 Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) ($ 0.21) ($ 0.91) ($ 0.42) ($ 21.01) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 1.45) ($ 7.65) ($ 3.52) ($ 45.15) Premium Tax Implementation Adjustment $ 7.73 $ 31.70 $ 14.60 $ 187.11 - ------------------------------------------------------------------------------------------------ Total Adjustment Impacting Base PMPM ($ 0.77) $ 63.45 ($ 8.34) $ 247.32 - ------------------------------------------------------------------------------------------------ Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $386.59 $1,584.83 $730.00 $9,355.58 - ------------------------------------------------------------------------------------------------ Impact of Electing the $35k Reinsurance Deductible (2) $ 0.00 $ 0.00 $ 0.00 $ 0.00 ================================================================================================ Adjusted Awarded PMPM For Plans Electing the $35k Reinsurance Deductible $386.59 $1,584.83 $730.00 $9,355.58 - ------------------------------------------------------------------------------------------------
PMPM CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS
[ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------------------------ Originally Awarded PMPM $714.74 $37.84 $143.67 $116.05 - ----------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 10.44 $ 1.05 $ 4.93 $ 4.30 Cost Sharing Proposal Adjustment $ 0.00 $ 0.00 $ 0.00 $ 0.00 Reinsurance Incorporating Catastrophic and Transplant Data Adjustment $ 0.00 $ 0.00 $ 0.00 $ 0.00 Hospital Inpatient DRI Trend Update Adjustment - -(4.0% estimate changed to 3.8% actual) ($ 0.75) ($ 0.01) ($ 0.07) ($ 0.04) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 1.23) ($ 0.02) ($ 0.24) ($ 0.36) Premium Tax Implementation Adjustment $ 14.76 $ 0.79 $ 3.02 $ 2.45 - ----------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 23.23 $ 1.82 $ 7.33 $ 6.35 - ----------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $737.97 $38.66 $151.00 $122.40 - ----------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible $ 0.00 $ 0.00 $ 0.00 $ 0.00 ===================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $737.97 $39.66 $151.00 $122.40 - ----------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - -------------------------------------------------------------------------------------------- Originally Awarded PMPM $269.14 $37.03 $82.34 - ------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 8.46 $ 0.74 $ 2.42 Cost Sharing Proposal Adjustment $ 0.00 $ 0.00 $ 0.00 Reinsurance Incorporating Catastrophic and Transplant Data Adjustment $ 0.00 $ 0.00 $ 0.00 Hospital Inpatient DRI Trend Update Adjustment - -(4.0% estimate changed to 3.8% actual) ($ 0.13) ($ 0.01) ($ 0.03) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 1.15) ($ 0.03) ($ 0.32) Premium Tax Implementation Adjustment $ 5.64 $ 0.77 $ 1.72 - ------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 12.83 $ 1.47 $ 3.78 - ------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $281.97 $38.50 $86.12 - ------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible $ 0.00 $ 0.00 $ 0.00 =========================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $281.97 $38.50 $88.12 - ------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ----------------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM N/A N/A N/A N/A N/A N/A N/A - ---------------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment N/A N/A N/A N/A N/A N/A N/A Cost Sharing Proposal Adjustment N/A N/A N/A N/A N/A N/A N/A Reinsurance Incorporating Catastrophic and Transplant Data Adjustment N/A N/A N/A N/A N/A N/A N/A Hospital Inpatient DRI Trend Update Adjustment - -(4.0% estimate changed to 3.8% actual) N/A N/A N/A N/A N/A N/A N/A Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) N/A N/A N/A N/A N/A N/A N/A Premium Tax Implementation Adjustment N/A N/A N/A N/A N/A N/A N/A - ---------------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM N/A N/A N/A N/A N/A N/A N/A - ---------------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible N/A N/A N/A N/A N/A N/A N/A - ---------------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible N/A N/A N/A N/A N/A N/A N/A ================================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible N/A N/A N/A N/A N/A N/A N/A - ----------------------------------------------------------------------------------------------------------------------------------
1. The KidsCare age cohort covers Individuals 14-18 years of age while the TANF rate cell includes 14 - 44. 2. The Maternity Delivery Payment does not have a reinsurance component built directly into the rate. However, it is indirectly affected by choosing a different deductible level because the TANF 14-44 female rate is applied as an 8-month offset to the Maternity Delivery Payment, and the female rate is directly affected by a new reinsurance election. Mercer Government Human Services Consulting [ILLEGIBLE] 4 of 8 AZ-AHCCCS PROPRIETARY AND CONFIDENTIAL FINAL AWARDED RATE-CYE04 -HEALTH CHOICE: GSA 10 PIMA ONLY- (EFFECTIVE 10/01/03) PERCENT CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS
[ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------------------------------------------------------ Originally Awarded PMPM $ 352.67 $ 84.37 $ 151.12 $ 102.82 $ 329.46 $ 243.09 $ 497.41 - ----------------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment 1.46% 2.79% 3.22% 3.71% 3.14% 2.00% 2.94% Cost Sharing Proposal Adjustment 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Reinsurance Incorporating Catastrophic and Transplant Data Adjustment -1.74% 0.09% -0.13% 1.70% -0.02% 0.18% 3.76% Hospital Impatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) -0.10% -0.02% -0.05% -0.03% -0.05% -0.02% -0.04% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) -0.17% -0.06% -0.16% -0.30% -0.41% -0.09% -0.38% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% 2.04% 2.04% 2.04% 2.04% - ----------------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM(2) 1.45% 4.89% 4.97% 7.27% 4.75% 4.16% 8.53% - ----------------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 357.79 $ 88.50 $ 158.62 $ 110.30 $ 345.10 $ 253.20 $ 539.85 - ----------------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible(3) 4.18% 0.41% 1.02% 1.05% 0.57% 0.17% 2.15% =================================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 372.73 $ 88.86 $ 160.25 $ 111.45 $ 347.05 $ 253.64 $ 551.47 - ----------------------------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------------------------------------ Originally Awarded PMPM $ 11.55 $ 5,402.48 $ 740.35 $ 575.97 $ 346.29 - ------------------------------------------------------------------------------------------------------------------ Outpatient & Emergency Room Adjustment 0.00% -0.73% 0.00% 2.77% 2.77% Cost Sharing Proposal Adjustment 0.00% 0.00% 0.00% 0.00% -4.41% Reinsurance Incorporating Catastrophic and Transplant Data Adjustment 0.00% 0.00% 0.00% 0.00% 0.00% Hospital Impatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) -0.02% -0.09% 0.00% -0.06% -0.06% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) 0.00% 0.04% 0.00% -0.38% -0.38% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% 2.04% 2.04% - ------------------------------------------------------------------------------------------------------------------ Total Adjustment Impacting Base PMPM(2) 2.02% 1.24% 2.04% 4.41% -0.20% - ------------------------------------------------------------------------------------------------------------------ Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 11.78 $ 5,469.52 $ 755.46 $ 601.35 $ 345.60 - ------------------------------------------------------------------------------------------------------------------ Impact of Electing the $35k Reinsurance Deductible(3) 0.00% -0.24% 0.00% 0.00% 0.00% ================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 11.78 $ 5,456.54 $ 755.46 $ 601.35 $ 345.60 - ------------------------------------------------------------------------------------------------------------------ [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - -------------------------------------------------------------------------------------- Originally Awarded PMPM $ 1,559.55 $ 734.64 $ 9,488.88 - -------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment 2.65% 2.65% 1.39% Cost Sharing Proposal Adjustment 0.00% -5.09% 0.00% Reinsurance Incorporating Catastrophic and Transplant Data Adjustment 0.00% 0.00% 0.00% Hospital Impatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) -0.06% -0.08% -0.23% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) -0.49% -0.49% -0 49% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% - -------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM(2) 4.17% -1.13% 2.72% - -------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 1,624.59 $ 726.34 $ 9,723.91 - -------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible(3) 0.00% 0.00% 0.00% ====================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 1,624.59 $ 726.34 $ 9,723.91 - --------------------------------------------------------------------------------------
PERCENT CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS
[ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ---------------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM N/A N/A N/A N/A N/A N/A N/A - ---------------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment N/A N/A N/A N/A N/A N/A N/A Cost Sharing Proposal Adjustment N/A N/A N/A N/A N/A N/A N/A Reinsurance Incorporating Catastrophic and Transplant Data Adjustment N/A N/A N/A N/A N/A N/A N/A Hospital Inpatient DRI Trend Update Adjustment -(4.0% estimate changed to 3.8% actual) N/A N/A N/A N/A N/A N/A N/A Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) N/A N/A N/A N/A N/A N/A N/A Premium Tax Implementation Adjustment N/A N/A N/A N/A N/A N/A N/A - ---------------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM(2) N/A N/A N/A N/A N/A N/A N/A - ---------------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible N/A N/A N/A N/A N/A N/A N/A - ---------------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible N/A N/A N/A N/A N/A N/A N/A ================================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible N/A N/A N/A N/A N/A N/A N/A - ---------------------------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ---------------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $ 1,163.05 $ 37.84 $ 149.42 $ 120.69 $ 279.90 $ 28.95 $ 77.68 - ---------------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment 1.46% 2.79% 3.22% 3.71% 3.14% 2.00% 2.94% Cost Sharing Proposal Adjustment 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Reinsurance Incorporating Catastrophic and Transplant Data Adjustment 0.00% 0.00% 0.00% 0,00% 0.00% 0.00% 0.00% Hospital Inpatient DRI Trend Update Adjustment -(4.0% estimate changed to 3.8% actual) -0.10% -0.02% -0.05% -0.03% -0.05% -0.02% -0.04% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) -0.17% -0.06% -0.16% -0.30% -0.41% -0.09% -0.38% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% 2.04% 2.04% 2.04% 2.04% - ---------------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM(2) 3.25% 4.80% 5.11% 5. 47% 4.77% 3.97% 4.80% - ---------------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 1,200.85 $ 39.66 $ 157.05 $ 127.30 $ 293.24 $ 30.10 $ 81.25 - ---------------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0 00% ================================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 1,200.85 $ 39.66 $ 157.05 $ 127.30 $ 293.24 $ 30.10 $ 81.25 - ----------------------------------------------------------------------------------------------------------------------------------
1. The KidsCare age cohort includes individuals 14 to 18 years of age, while the TANF rate cell includes 14 - 44. 2. The adjustment is multiplicative, not additive. 3. The Maternity Delivery Payment does not have a reinsurance component built directly into the rate. However, it is indirectly affected by choosing a different deductible level because the TANF 14-44 female rate is applied as an 8-month offset to the Maternity Delivery Payment, and the female rate is directly affected by a new reinsurance election. Mercer Government Human Services Consulting [ILLEGIBLE] 5 of 8 AZ-AHCCCS PROPRIETARY AND CONFIDENTIAL FINAL AWARDED RATE - CYE04 - HEALTH CHOICE: GSA 10 PIMA ONLY - (EFFECTIVE 10/01/03) PMPM CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS
[ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - -------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $ 352.67 $ 84.37 $ 151.12 $ 102.82 $ 329.46 $ 243.09 - -------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 5.15 $ 2.35 $ 4.87 $ 3.81 $ 10.36 $ 4.87 Cost Sharing Proposal Adjustment $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Reinsurance Incorporating Catastrophic and Transplant Data Adjustment ($ 6.23) $ 0.08 ($ 0.21) $ 1.82 ($ 0.06) $ 0.44 Hospital Inpatient DRI Trend Update Adjustment -(4.0% estimate changed to 3.8% actual) ($ 0.36) ($ 0.02) ($ 0.07) ($ 0.04) ($ 0.16) ($ 0.04) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 0.60) ($ 0.05) ($ 0.26) ($ 0.32) ($ 1.40) ($ 0.23) Premium Tax implementation Adjustment $ 7.16 $ 1.77 $ 3.17 $ 2.21 $ 6.90 $ 5.06 - -------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 5.12 $ 4.13 $ 7.50 $ 7.48 $ 15.84 $ 10.11 - -------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 357.79 $ 88.50 $ 158.62 $ 110.30 $ 345.10 $ 253.20 - -------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible(2) $ 14.94 $ 0.36 $ 1.62 $ 1.16 $ 1.96 $ 0.44 ========================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 372.73 $ 88.86 $ 160.25 $ 111.45 $ 347.05 $ 253.64 - -------------------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ----------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $ 497.41 $ 11.55 $ 5,402.48 $ 740.35 $ 575.97 $ 346.29 - ----------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 14.60 $ 0.00 ($ 39.18) $ 0.00 $ 15.94 $ 9.58 Cost Sharing Proposal Adjustment $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 ($ 15.70) Reinsurance Incorporating Catastrophic and Transplant Data Adjustment $ 19.27 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Hospital Inpatient DRI Trend Update Adjustment -(4.0% estimate changed to 3.8% actual) ($ 0.21) ($ 0.00) ($ 5.09) $ 0.00 ($ 0.33) ($ 0.19) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 2.02) $ 0.00 $ 1.91 $ 0.00 ($ 2.25) ($ 1.20) Premium Tax implementation Adjustment $ 10.80 $ 0.24 $ 109.39 $ 15.11 $ 12.03 $ 6.91 - ----------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 42.44 $ 0.23 $ 67.04 $ 15.11 $ 25.39 ($ 0.89) - ----------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 539.85 $ 11.78 $ 5,469.52 $ 755.46 $ 601.35 $ 345.60 - ----------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible(2) $ 11.61 $ 0.00 ($ 12.98) $ 0.00 $ 0.00 $ 0.00 ============================================================================================================================= Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 551.47 $ 11.78 $ 5,456.54 $ 755.46 $ 601.35 $ 345.60 - ----------------------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - -------------------------------------------------------------------------------------- Originally Awarded PMPM $ 1,559.55 $ 734.64 $ 9,466.86 - -------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 41.32 $ 19.46 $ 131.33 Cost Sharing Proposal Adjustment $ 0.00 ($ 38.36) $ 0.00 Reinsurance Incorporating Catastrophic and Transplant Data Adjustment $ 0.00 $ 0.00 $ 0.00 Hospital Inpatient DRI Trend Update Adjustment -(4.0% estimate changed to 3.8% actual) ($ 0.93) ($ 0.42) ($ 21.83) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 7.84) ($ 3.51) ($ 46.92) Premium Tax implementation Adjustment $ 32.49 $ 14.53 $ 194.48 - -------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 65.04 ($ 8.29) $ 257.06 - -------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 1,624.59 $ 726.34 $ 9,723.91 - -------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible(2) $ 0.00 $ 0.00 $ 0.00 ====================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 1,624.59 $ 726.34 $ 9,723.91 - --------------------------------------------------------------------------------------
PMPM CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS
[ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - -------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM N/A N/A N/A N/A N/A N/A - -------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment N/A N/A N/A N/A N/A N/A Cost Sharing Proposal Adjustment N/A N/A N/A N/A N/A N/A Reinsurance Incorporating Catastrophic and Transplant Data Adjustment N/A N/A N/A N/A N/A N/A Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) N/A N/A N/A N/A N/A N/A Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) N/A N/A N/A N/A N/A N/A Premium Tax Implementation Adjustment N/A N/A N/A N/A N/A N/A - -------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM N/A N/A N/A N/A N/A N/A - -------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible N/A N/A N/A N/A N/A N/A - -------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible N/A N/A N/A N/A N/A N/A ========================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible N/A N/A N/A N/A N/A N/A - -------------------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ---------------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM N/A $ 1,163.05 $ 37.84 $ 149.42 $ 120.69 $ 279.90 - ---------------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment N/A $ 16.99 $ 1.05 $ 4.81 $ 4.48 $ 8.80 Cost Sharing Proposal Adjustment N/A $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Reinsurance Incorporating Catastrophic and Transplant Data Adjustment N/A $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) N/A ($ 1.21) ($ 0.01) ($ 0.07) ($ 0.04) ($ 0.13) Fee-for-Service Schedule Change Referral Physician and Lab & X-Ray COS) N/A ($ 2.00) ($ 0.02) ($ 0.25) ($ 0.37) ($ 1.19) Premium Tax Implementation Adjustment N/A $ 24.02 $ 0.79 $ 3.14 $ 2.55 $ 5.86 - ---------------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM N/A $ 37.80 $ 1.82 $ 7.63 $ 6.61 $ 13.34 - ---------------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible N/A $ 1,200.85 $ 39.66 $ 157.05 $ 127.30 $ 293.24 - ---------------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible N/A $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 ================================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible N/A $ 1,200.85 $ 39.66 $ 157.05 $ 127.30 $ 293.24 - ---------------------------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - -------------------------------------------------------------------------- Originally Awarded PMPM $ 28.95 $ 77.68 - -------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 0.58 $ 2.28 Cost Sharing Proposal Adjustment $ 0.00 $ 0.00 Reinsurance Incorporating Catastrophic and Transplant Data Adjustment $ 0.00 $ 0.00 Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) ($ 0.01) ($ 0.03) Fee-for-Service Schedule Change Referral Physician and Lab & X-Ray COS) ($ 0.03) ($ 0.30) Premium Tax Implementation Adjustment $ 0.60 $ 1.63 - -------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 1.15 $ 3.57 - -------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 30.10 $ 81.25 - -------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible $ 0.00 $ 0.00 ========================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 30.10 $ 81.25 - --------------------------------------------------------------------------
1. The KidsCare age cohort covers Individuals 14 - 18 years of age while the TANF rate cell includes 14 - 44. 2. The Maternity Delivery Payment does not have a reinsurance component built directly into the rate. However, it is indirectly affected by choosing a different deductible level because the TANF 14-44 female rate is applied as an 8-month offset to the Maternity Delivery Payment, and the female rate is directly affected by a new reinsurance election. Mercer Government Human Services Consulting [ILLEGIBLE] 6 of 8 AZ-AHCCCS PROPRIETARY AND CONFIDENTIAL FINAL AWARDED RATE - CYE04 - HEALTH CHOICE: GSA 12- (EFFECTIVE 10/01/03) PERCENT CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS
[ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------------------------------------------ Originally Awarded PMPM $353.70 $88.86 $152.00 $110.35 $310.47 $223.79 $449.81 - ------------------------------------------------------------------------------------------------------------------------ Outpatient & Emergency Room Adjustment 1.46% 2.79% 3.22% 3.71% 3.14% 2.00% 2.94% Cost Sharing Proposal Adjustment 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Reinsurance Incorporating Catastrophic and Transplant Data Adjustment -1.74% 0.09% -0.13% 1.70% -0.02% 0.18% 3.76% Hospital Impatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) -0.10% -0.02% -0.05% -0.03% -0.05% -0.02% -0.04% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) -0.17% -0.06% -0.16% -0.30% -0.41% -0.09% -0.38% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% 2.04% 2.04% 2.04% 2.04% - ------------------------------------------------------------------------------------------------------------------------ Total Adjustment Impacting Base PMPM(2) 1.45% 4.89% 4.97% 7.27% 4.75% 4.16% 8.53% - ------------------------------------------------------------------------------------------------------------------------ Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $358.83 $93.21 $159.55 $118.37 $325.20 $233.10 $488.19 - ------------------------------------------------------------------------------------------------------------------------ Impact of Electing the $35k Reinsurance Deductible(3) 3.87% 0.36% 0.95% 0.91% 0.56% 0.18% 2.21% ======================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $372.71 $93.54% $161.08 $119.45 $327.04 $233.51 $496.98 - ------------------------------------------------------------------------------------------------------------------------ [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------------------------------------------------------ Originally Awarded PMPM $16.00 $5,610.56 $740.35 $516.02 $405.62 $1,509.89 $742.57 $9,000.32 - ------------------------------------------------------------------------------------------------------------------------------------ Outpatient & Emergency Room Adjustment 0.00% -0.73% 0.00% 2.77% 2.77% 2.65% 2.65% 1.39% Cost Sharing Proposal Adjustment 0.00% 0.00% 0.00% 0.00% -4.41% 0.00% -5.09% 0.00% Reinsurance Incorporating Catastrophic and Transplant Data Adjustment 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) -0.02% -0.09% 0.00% -0.06% -0.06% -0.06% -0.06% -0.23% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) 0.00% 0.04% 0.00% -0.38% -0.38% -0.49% -0.49% -0.49% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% 2.04% 2.04% 2.04% 2.04% 2.04% - ------------------------------------------------------------------------------------------------------------------------------------ Total Adjustment Impacting Base PMPM(2) 2.02% 1.24% 2.04% 4.41% -0.20% 4.17% -1.13% 2.72% - ------------------------------------------------------------------------------------------------------------------------------------ Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $16.32 $5,680.18 $755.48 $538.76 $404.81 $1,572.86 $734.18 $9,244.71 - ------------------------------------------------------------------------------------------------------------------------------------ Impact of Electing the $35k Reinsurance Deductible(3) 0.00% -0.21% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% ==================================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $16.32 $5,668.10 $755.46 $538.76 $404.81 $1,572.86 $734.18 $9,244.71 - ------------------------------------------------------------------------------------------------------------------------------------
PERCENT CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS
[ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------------------------------------------------------ Originally Awarded PMPM N/A N/A N/A N/A N/A N/A N/A - ------------------------------------------------------------------------------------------------------------------------------------ Outpatient & Emergency Room Adjustment N/A N/A N/A N/A N/A N/A N/A Cost Sharing Proposal Adjustment N/A N/A N/A N/A N/A N/A N/A Reinsurance Incorporating Catastrophic and Transplant Data Adjustment N/A N/A N/A N/A N/A N/A N/A Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) N/A N/A N/A N/A N/A N/A N/A Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) N/A N/A N/A N/A N/A N/A N/A Premium Tax Implementation Adjustment N/A N/A N/A N/A N/A N/A N/A - ------------------------------------------------------------------------------------------------------------------------------------ Total Adjustment Impacting Base PMPM(2) N/A N/A N/A N/A N/A N/A N/A - ------------------------------------------------------------------------------------------------------------------------------------ Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible N/A N/A N/A N/A N/A N/A N/A - ------------------------------------------------------------------------------------------------------------------------------------ Impact of Electing the $35k Reinsurance Deductible N/A N/A N/A N/A N/A N/A N/A ==================================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible N/A N/A N/A N/A N/A N/A N/A - ------------------------------------------------------------------------------------------------------------------------------------ [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------------------------------------------------------ Originally Awarded PMPM $1,158.74 $ 37.84 $ 149.42 $ 120.69 $ 279.90 $ 29.05 $ 77.68 - ------------------------------------------------------------------------------------------------------------------------------------ Outpatient & Emergency Room Adjustment 1.46% 2.79% 3.22% 3.71% 3.14% 2.00% 2.94% Cost Sharing Proposal Adjustment 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Reinsurance Incorporating Catastrophic and Transplant Data Adjustment 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) -0.10% -0.02% -0.05% -0.03% -0.05% -0.02% -0.04% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) -0.17% -0.06% -0.16% -0.30% -0.41% -0.09% -0.38% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% 2.04% 2.04% 2.04% 2.04% - ------------------------------------------------------------------------------------------------------------------------------------ Total Adjustment Impacting Base PMPM (2) 3.25% 4.80% 5.11% 5.47% 4.77% 3.97% 4.60% - ------------------------------------------------------------------------------------------------------------------------------------ Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $1,196.40 $ 39.66 $ 157.05 $ 127.30 $ 293.24 $ 30.21 $ 81.25 - ------------------------------------------------------------------------------------------------------------------------------------ Impact of Electing the $35k Reinsurance Deductible 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% ==================================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $1,196.40 $ 39.66 $ 157.05 $ 127.30 $ 293.24 $ 30.21 $ 81.25 - ------------------------------------------------------------------------------------------------------------------------------------
1. The KidsCare age cohort includes Individuals 14 to 18 years of age, while the TANF rate cell includes 14 - 44. 2. The adjustment is multiplicative, not additive. 3. The Maternity Delivery Payment does not have a reinsurance component built directly into the rate. However, it is indirectly affected by choosing a different deductible level because the TANF 14-44 female rate is applied as an 8-month offset to the Maternity Delivery Payment, and the female rate is directly affected by a new reinsurance election. Mercer Government Human Services Consulting [ILLEGIBLE] 7 of 8 AZ-AHCCCS PROPRIETARY AND CONFIDENTIAL FINAL AWARDED RATE - CYE04 - HEALTH CHOICE: GSA 12 - (EFFECTIVE 10/01/03) PMPM CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS
[ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - --------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $353.70 $ 88.86 $152.00 $110.35 $310.47 $223.79 $449.81 $ 16.00 - ------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 5.17 $ 2.48 $ 4.90 $ 4.09 $ 9.76 $ 4.49 $ 13.20 $ 0.00 Cost Sharing Proposal Adjustment $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Reinsurance Incorporating Catastrophic and Transplant Data Adjustment ($ 6.25) $ 0.08 ($ 0.21) $ 1.95 ($ 0.06) $ 0.41 $ 17.43 $ 0.00 Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) ($ 0.36) ($ 0.02) ($ 0.07) ($ 0.04) ($ 0.15) ($ 0.04) ($ 0.10) ($ 0.00) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 0.60) ($ 0.06) ($ 0.26) ($ 0.35) ($ 1.32) ($ 0.21) ($ 1.82) $ 0.00 Premium Tax Implementation Adjustment $ 7.18 $ 1.86 $ 3.19 $ 2.37 $ 6.50 $ 4.66 $ 9.76 $ 0.33 - ------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 5.13 $ 4.35 $ 7.55 $ 8.02 $ 14.73 $ 9.31 $ 38.38 $ 0.32 - ------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $358.83 $ 93.21 $159.55 $118.37 $325.20 $233.10 $488.19 $ 16.32 - ------------------------------------------------------------------------------------------------------------------------- Impact of Electing, the $35k Reinsurance Deductible (2) $ 13.88 $ 0.33 $ 1.51 $ 1.08 $ 1.83 $ 0.41 $ 10.79 $ 0.00 ========================================================================================================================= Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $372.71 $ 93.54 $161.06 $119.45 $327.04 $233.51 $496.98 $ 16.32 - ------------------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - --------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $5,610.56 $740.35 $516.02 $ 405.62 $1,509.89 $742.57 $9,000.32 - -------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment ($ 40.68) $ 0.00 $ 14.28 $ 11.23 $ 40.00 $ 19.67 $ 124.86 Cost Sharing Proposal Adjustment $ 0.00 $ 0.00 $ 0.00 ($ 18.39) $ 0.00 ($ 38.76) $ 0.00 Reinsurance Incorporating Catastrophic and Transplant Data Adjustment $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) ($ 5.28) $ 0.00 ($ 0.30) ($ 0.22) ($ 0.90) ($ 0.42) ($ 20.76) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) $ 1.98 $ 0.00 ($ 2.01) ($ 1.51) ($ 7.59) ($ 3.54) ($ 44.61) Premium Tax Implementation Adjustment $ 113.60 $ 15.11 $ 10.78 $ 8.10 $ 31.46 $ 14.68 $ 184.89 - -------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 69.82 $ 15.11 $ 22.74 ($ 0.81) $ 62.97 ($ 8.38) $ 244.39 - -------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $5,680.18 $755.46 $538.76 $ 404.81 $1,572.86 $734.18 $9,244.71 - -------------------------------------------------------------------------------------------------------------- Impact of Electing, the $35k Reinsurance Deductible (2) ($ 12.07) $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 ============================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $5,668.10 $755.46 $538.76 $ 404.81 $1,572.86 $734.18 $ 9,244.71 - --------------------------------------------------------------------------------------------------------------
PMPM CHANGE DUE TO PROGRAMMATIC ADJUSTMENTS
[ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - --------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM N/A N/A N/A N/A N/A N/A N/A - --------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment N/A N/A N/A N/A N/A N/A N/A Cost Sharing Proposal Adjustment N/A N/A N/A N/A N/A N/A N/A Reinsurance Incorporating Catastrophic and Transplant Data Adjustment N/A N/A N/A N/A N/A N/A N/A Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) N/A N/A N/A N/A N/A N/A N/A Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) N/A N/A N/A N/A N/A N/A N/A Premium Tax Implementation Adjustment N/A N/A N/A N/A N/A N/A N/A - ----------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM N/A N/A N/A N/A N/A N/A N/A - ----------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible N/A N/A N/A N/A N/A N/A N/A - ----------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible N/A N/A N/A N/A N/A N/A N/A ======================================================================================================================= Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible N/A N/A N/A N/A N/A N/A N/A - ----------------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - --------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $1,158.74 $ 37.84 $ 149.42 $ 120.69 $ 279.90 $ 29.06 $ 77.68 - ---------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 16.93 $ 1.05 $ 4.81 $ 4.48 $ 8.80 $ 0.58 $ 2.28 Cost Sharing Proposal Adjustment $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Reinsurance Incorporating Catastrophic and Transplant Data Adjustment $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) ($ 1.21) ($ 0.01) ($ 0.07) ($ 0.04) ($ 0.13) ($ 0.01) ($ 0.03) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 1.99) ($ 0.02) ($ 0.25) ($ 0.37) ($ 1.19) ($ 0.03) ($ 0.30) Premium Tax Implementation Adjustment $ 23.93 $ 0.79 $ 3.14 $ 2.55 $ 5.86 $ 0.60 $ 1.63 - --------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 37.86 $ 1.82 $ 7.63 $ 6.61 $ 13.34 $ 1.15 $ 3.57 - --------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $1,196.40 $ 39.66 $ 157.05 $ 127.30 $ 293.24 $ 30.21 $ 81.25 - --------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 =============================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $1,196.40 $ 39.66 $ 157.05 $ 127.30 $ 293.24 $ 30.21 $ 81.25 - ---------------------------------------------------------------------------------------------------------------
1. The KidsCare age cohort covers individuals 14 - 18 years of age while the TANF rate cell includes 14 - 44. 2. The Maternity Delivery Payment does not have a reinsurance component built directly into the rate. However, it is indirectly affected by choosing a different deductible level because the TANF 14-44 female rate is applied as an 8-month offset to the Maternity Delivery Payment, and the female rate is directly affected by a new reinsurance election. Mercer Government Human Services Consulting [ILLEGIBLE] 8 of 8