Amendment No. 5 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 revise the capitation rates for certain healthcare programs, effective October 1, 2003. The adjustment corrects previous rate calculations by removing a reinsurance adjustment, as explained in a prior memo. All other terms of the original contract remain unchanged. Both parties have agreed to and signed this amendment.

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EX-10.21 11 g86118exv10w21.txt EX-10.21 AMENDMENT NO.5 EXHIBIT 10.21 ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION DIVISION OF BUSINESS AND FINANCE CONTRACT AMENDMENT PAGE 1 OF 1 WITH ATTACHMENT
1. AMENDMENT NO.: 2. CONTRACT NO.: 3. EFFECTIVE DATE OF MODIFICATION: 4. PROGRAM: 05 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: A. The rates contained in the existing Section B are deleted and replaced with the attached revised capitation rates. The purpose of this amendment is to adjust the TANF/KC and SSI prospective rates. It is the opinion of MERCER and AHCCCS that the net capitation rates should not have included the reinsurance adjustment stated in the Final Awarded Rate sheet. This adjustment was explained in a memo to the CFO's on September 22, 2003. These rates have been adjusted and are reflected in the attached document. Note: Please sign, date and Michael Veit, Contracts & return one original to: Purchasing Administrator 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 22, 2003 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] [ILLEGIBLE] [ILLEGIBLE] - ----------------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $ 362.08 $ 88.38 $ 170.68 $ 127.08 $ 308.53 $ 255.77 $ 516.54 - ----------------------------------------------------------------------------------------------------------------------------------- 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 $ 373.85 $ 92.62 $ 179.39 $ 134.04 $ 323.23 $ 265.93 $ 540.28 - ----------------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible (3) 4.19% 0.41% 0.95% 0.90% 0.64% 0.18% 2.26% =================================================================================================================================== Adjusted Awarded PMPM for Plans Electing The $35k Reinsurance Deductible $ 389.52 $ 93.00 $ 181.09 $ 135.24 $ 325.29 $ 266.40 $ 552.49 - ----------------------------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ----------------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $ 13.68 $ 5,238.20 $ 740.35 $ 566.00 $ 420.48 $ 1,537.54 $ 732.17 $ 10,269.35 - ----------------------------------------------------------------------------------------------------------------------------------- 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 $ 13.96 $ 5,303.20 $ 755.46 $ 590.95 $ 419.64 $1.601.66 $ 723.91 $ 10,548.19 - ----------------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible (3) 0.00% -0.26% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% =================================================================================================================================== Adjusted Awarded PMPM for Plans Electing The $35k Reinsurance Deductible $ 13.96 $ 5,289.63 $ 755.46 $ 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 $ 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 (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] [ILLEGIBLE] [ILLEGIBLE] - ----------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $ 362.08 $ 88.38 $ 170.68 $ 127.08 $ 308.53 $ 255.77 $ 516.54 - ----------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 5.29 $ 2.46 $ 5.50 $ 4.71 $ 9.70 $ 5.13 $ 15.16 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 charged to 3.8% actual) ($ 0.38) ($ 0.02) ($ 0.08) ($ 0.04) ($ 0.15) ($ 0.05) ($ 0.21) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 0.62) ($ 0.06) ($ 0.29) ($ 0.39) ($ 1.32) ($ 0.24) ($ 2.02) Premium Tax Implementation Adjustment $ 7.48 $ 1.85 $ 3.59 $ 2.68 $ 6.46 $ 5.32 $ 10.81 - ----------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 11.77 $ 4.24 $ 8.71 $ 6.96 $ 14.70 $ 10.16 $ 23.74 - ----------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 373.85 $ 92.62 $ 179.39 $ 134.04 $ 323.23 $ 265.93 $ 540.28 - ----------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible (2) $ 15.67 $ 0.38 $ 1.70 $ 1.21 $ 2.06 $ 0.47 $ 12.21 ============================================================================================================================= Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 389.52 $ 93.00 $ 181.09 $ 135.24 $ 135.29 $ 266.40 $ 552.49 - ----------------------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ----------------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $ 13.68 $ 5,238.20 $ 740.35 $ 566.00 $ 420.48 $ 1,537.54 $ 732.17 $ 10,269.35 - ----------------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 0.00 ($ 37.98) $ 0.00 $ 15.66 $ 11.64 $ 40.74 $19.40 $ 142.47 Cost Sharing Proposal Adjustment $ 0.00 $ 0.00 $ 0.00 $ 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 $ 0.00 $ 0.00 $ 0.00 Hospital Inpatient DRI Trend Update Adjustment - -(4.0% estimate charged to 3.8% actual) ($ 0.00)($ 4.93) $ 0.00 ($ 0.33)($ 0.23)($ 0.92)($ 0.42)($ 23.68) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) $ 0.00 $ 1.85 $ 0.00 ($ 2.21)($ 1.57)($ 7.73)($ 3.49)($ 50.90) Premium Tax Implementation Adjustment $ 0.28 $ 106.06 $ 15.11 $ 11.82 $ 8.39 $ 32.03 $ 14.48 $ 210.96 - ----------------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 0.28 $ 65.00 $ 15.11 $ 24.95 ($ 0.84) $ 64.12 ($ 8.27) $ 278.85 - ----------------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 13.96 $ 5,303.20 $ 755.46 $ 590.95 $ 419.64 $ 1,601.66 $ 723.91 $ 10,548.19 - ----------------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible (2) $ 0.00 ($ 13.56) $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 =================================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 13.96 $ 5,289.63 $ 755.46 $ 590.95 $ 419.64 $ 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) ($ 0.76) ($ 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 at 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 at 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] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ---------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $ 361.00 $ 87.78 $ 151.60 $ 107.87 $ 304.79 $ 229.93 $ 458.90 - --------------------------------------------------------------------------------------------------------------------------- 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 $ 372.73 $ 91.99 $ 159.34 $ 113.77 $ 319.31 $ 239.07 $ 479.99 - --------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible(3) 3.79% 0.37% 0.97% 0.97% 0.59% 0.18% 2.29% =========================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 386.84 $ 92.33 $ 160.88 $ 114.88 $ 321.19 $ 239.49 $ 490.98 - --------------------------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------ [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------ Originally Awarded PMPM $ 15.18 $5,549.77 $ 740.35 - ------------------------------------------------------------------------ Outpatient & Emergency Room Adjustment 0.00% -0.73% 0.00% - ------------------------------------------------------------------------ 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) -0.02% -0.09% 0.00% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) 0.00% 0.04% 0.00% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% - ------------------------------------------------------------------------ Total Adjustment Impacting Base PMPM(2) 2.02% 1.24% 2.04% - ------------------------------------------------------------------------ Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 15.49 $5,618.63 $ 755.46 - ------------------------------------------------------------------------ Impact of Electing the $35k Reinsurance Deductible(3) 0.00% -0.22% 0.00% ======================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 15.49 $5,606.32 $ 755.46 - ------------------------------------------------------------------------ - -------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - -------------------------------------------------------------------------------------------------- Originally Awarded PMPM $ 531.41 $ 387.36 $1,521.38 $ 738.34 $9,108.27 - ------------------------------------------------------------------------------------------------- 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 $ 554.83 $ 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% 0.00% ================================================================================================= Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 554.83 $ 386.59 $1,584.83 $ 730.00 $ 9,355.58 - -------------------------------------------------------------------------------------------------
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 $ 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(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] 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] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ---------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $ 361.00 $ 87.78 $ 151.60 $ 107.87 $ 304.79 $ 229.93 $ 458.90 - ---------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 5.27 $ 2.45 $ 4.88 $ 4.00 $ 9.58 $ 4.61 $ 13.47 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) ($ 0.38) ($ 0.02) ($ 0.07) ($ 0.04) ($ 0.15) ($ 0.04) ($ 0.18) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 0.62) ($ 0.05) ($ 0.26) ($ 0.33) ($ 1.30) ($ 0.21) ($ 1.79) Premium Tax Implementation Adjustment $ 7.45 $ 1.84 $ 3.19 $ 2.28 $ 6.39 $ 4.78 $ 9.60 - ---------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 11.73 $ 4.21 $ 7.74 $ 5.90 $ 14.52 $ 9.14 $ 21.09 - ---------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 372.73 $ 91.99 $ 159.34 $ 113.77 $ 319.31 $ 239.07 $ 479.99 - ---------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible(2) $ 14.11 $ 0.34 $ 1.54 $ 1.10 $ 1.87 $ 0.42 $ 10.99 ============================================================================================================================ Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 386.84 $ 92.33 $ 160.88 $ 114.88 $ 321.19 $ 239.49 $ 490.98 - ---------------------------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------ [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------ Originally Awarded PMPM $ 15.18 $5,549.77 $ 740.35 - ------------------------------------------------------------------------ Outpatient & Emergency Room Adjustment $ 0.00 ($ 40.24) $ 0.00 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) ($ 0.00) ($ 5.23) ($ 0.00) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) $ 0.00 $ 1.96 $ 0.00 Premium Tax Implementation Adjustment $ 0.31 $ 112.37 $ 15.11 - ------------------------------------------------------------------------ Total Adjustment Impacting Base PMPM $ 0.31 $ 68.86 $ 15.11 - ------------------------------------------------------------------------ Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 15.49 $5,618.63 $ 755.46 - ------------------------------------------------------------------------ Impact of Electing the $35k Reinsurance Deductible(2) $ 0.00 ($ 12.31) $ 0.00 ======================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 15.49 $5,606.32 $ 755.46 - ------------------------------------------------------------------------ - -------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - -------------------------------------------------------------------------------------------------- Originally Awarded PMPM $ 531.41 $ 387.36 $1,521.38 $ 738.34 $9,108.27 - -------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 14.71 $ 10.72 $ 40.31 $ 19.56 $ 126.36 Cost Sharing Proposal Adjustment $ 0.00 ($ 17.56) $ 0.00 $ 38.56 $ 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) ($ 0.31) ($ 0.21) ($ 0.91) ($ 0.42) ($ 21.01) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 2.07) ($ 1.45) ($ 7.05) ($ 3.52) ($ 45.15) Premium Tax Implementation Adjustment $ 11.10 $ 7.73 $ 31.70 $ 14.60 $ 187.11 - -------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 23.42 ($ 0.77) $ 63.45 ($ 8.34) $ 247.32 - -------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 554.83 $ 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 $ 0.00 ================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 554.83 $ 386.59 $ 1,584.83 $ 730.00 $9,355.56 - --------------------------------------------------------------------------------------------------
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] 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 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(3) $ 364.13 $ 88.42 $ 158.83 $ 108.45 $ 345.16 $ 252.75 $ 520.27 - ---------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible 4.10% 0.41% 1.02% 1.07% 0.57% 0.18% 2.23% ============================================================================================================================ Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 379.07 $ 88.78 $ 160.46 $ 109.60 $ 347.12 $ 253.19 $ 531.89 - ---------------------------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------ [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------ Originally Awarded PMPM $ 11.55 $5,402.48 $ 740.35 - ------------------------------------------------------------------------ Outpatient & Emergency Room Adjustment 0.00% -0.73% 0.00% 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) -0.02% -0.09% 0.00% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) 0.00% 0.04% 0.00% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% - ------------------------------------------------------------------------ Total Adjustment Impacting Base PMPM(2) 2.02% 1.24% 2.04% - ------------------------------------------------------------------------ Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 11.78 $5,469.52 $ 755.46 - ------------------------------------------------------------------------ Impact of Electing the $35k Reinsurance Deductible(3) 0.00% -0.24% 0.00% ======================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 11.78 $5,456.54 $ 755.46 - ------------------------------------------------------------------------ - -------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - -------------------------------------------------------------------------------------------------- Originally Awarded PMPM $ 575.97 $ 346.29 $1,559.55 $ 734.64 $9,466.86 - -------------------------------------------------------------------------------------------------- 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 $ 601.35 $ 345.60 $1,624.59 $ 726.34 $9,723.91 - -------------------------------------------------------------------------------------------------- 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 $ 601.35 $ 345.60 $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% 4.60% - ---------------------------------------------------------------------------------------------------------------------------- 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] [ILLEGIBLE] [ILLEGIBLE] - ----------------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $352.67 $84.37 $151.12 $102.82 $329.46 $243.09 $497.41 $11.55 - ----------------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 5.15 $ 2.35 $ 4.87 $ 3.81 $ 10.36 $ 4.87 $ 14.60 $ 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 $ 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) ($ 0.37) ($ 0.02) ($ 0.07) ($ 0.03) ($ 0.16) ($ 0.04) ($ 0.20) ($ 0.00) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 0.61) ($ 0.05) ($ 0.26) ($ 0.32) ($ 1.41) ($ 0.22) ($ 1.04) $ 0.00 Premium Tax Implementation Adjustment $ 7.28 $ 1.77 $ 3.18 $ 2.17 $ 6.90 $ 5.05 $ 10.41 $ 0.24 - ----------------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 11.46 $ 4.05 $ 7.71 $ 5.63 $ 15.70 $ 9.66 $ 22.86 $ 0.23 - ----------------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $364.13 $88.42 $158.83 $108.45 $345.16 $252.75 $520.27 $11.78 - ----------------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible(2) $ 14.94 $ 0.36 $ 1.62 $ 1.16 $ 1.96 $ 0.44 $ 11.61 $ 0.00 =================================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $379.07 $88.78 $160.46 $109.60 $347.12 $253.19 $531.89 $11.78 - ----------------------------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ---------------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $5,402.48 $740.35 $575.97 $346.29 $1,559.55 $734.64 $9,466.66 - ---------------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment ($ 39.18) $ 0.00 $ 15.94 $ 9.58 $ 41.32 $ 19.46 $ 131.33 Cost Sharing Proposal Adjustment $ 0.00 $ 0.00 $ 0.00 ($ 15.70) $ 0.00 ($ 38.36) $ 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) ($ 5.09) $ 0.00 ($ 0.33) ($ 0.19) ($ 0.93) ($ 0.42) ($ 21.83) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) $ 1.91 $ 0.00 ($ 2.25) ($ 1.29) ($ 7.84) ($ 3.51) ($ 46.92) Premium Tax Implementation Adjustment $ 109.39 $ 15.11 $ 12.03 $ 6.91 $ 32.49 $ 14.53 $ 194.48 - ---------------------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 67.04 $ 15.11 $ 25.39 ($ 0.69) $ 65.04 ($ 8.29) $ 257.06 - ---------------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $5,469.52 $755.46 $601.35 $345.60 $1,624.59 $726.34 $9,723.91 - ---------------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible(2) ($ 12.98) $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 ================================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $5,456.54 $755.46 $601.35 $345.60 $1,624.59 $726.34 $9,723.91 - ----------------------------------------------------------------------------------------------------------------------------------
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] - -------------------------------------------------------------------------------- Originally Awarded PMPM $1,163.05 $37.84 $149.42 $120.69 - -------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 16.99 $ 1.05 $ 4.81 $ 4.48 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) ($ 1.21) ($ 0.01) ($ 0.07) ($ 0.04) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 2.00) ($ 0.02) ($ 0.25) ($ 0.37) Premium Tax Implementation Adjustment $ 24.02 $ 0.79 $ 3.14 $ 2.55 - -------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 37.80 $ 1.82 $ 7.63 $ 6.61 - -------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $1,200.85 $39.66 $157.05 $127.30 - -------------------------------------------------------------------------------- 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 $1,200.85 $39.66 $157.05 $127.30 - -------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------------- Originally Awarded PMPM $279.90 $28.95 $77.68 - ------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 8.80 $ 0.58 $ 2.28 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) ($ 1.19) ($ 0.03) ($ 0.30) Premium Tax Implementation Adjustment $ 5.86 $ 0.60 $ 1.63 - ------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 13.34 $ 1.15 $ 3.57 - ------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $293.24 $30.10 $81.25 - ------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible $ 0.00 $ 0.00 $ 0.00 =========================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $293.24 $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] - --------------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $353.70 $88.86 $152.00 $110.35 $310.47 $223.79 - --------------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment 1.46% 2.79% 3.22% 3.71% 3.14% 2.00% Cost Sharing Proposal Adjustment 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% 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% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) -0.17% -0.06% -0.16% -0.30% -0.41% -0.09% Premium Tax Implementation Adjustment 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% - --------------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $365.19 $93.13 $159.76 $116.39 $325.27 $232.68 - --------------------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible(3) 3.80% 0.36% 0.94% 0.93% 0.58% 0.18% =========================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $379.07 $93.46 $161.27 $117.47 $327.10 $233.09 - --------------------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - -------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $449.81 $16.00 $5,610.56 $ 740.35 $ 516.02 - -------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment 2.94% 0.00% -0.73% 0.00% 2.77% Cost Sharing Proposal Adjustment 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% Hospital Inpatient DRI Trend Update Adjustment - (4.0% estimate changed to 3.8% actual) -0.04% -0.02% -0.09% 0.00% -0.06% Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) -0.38% 0.00% 0.04% 0.00% -0.38% Premium Tax Implementation Adjustment 2.04% 2.04% 2.04% 2.04% 2.04% - -------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM(2) 4.60% 2.02% 1.24% 2.04% 4.41% - -------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $470.48 $16.32 $5,680.18 $ 755.46 $ 538.76 - -------------------------------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible(3) 2.29% 0.00% -0.21% 0.00% 0.00% ============================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $481.28 $16.32 $5,668.10 $ 755.46 $ 538.76 - -------------------------------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------------------- Originally Awarded PMPM $405.62 $1,509.89 $742.57 $9,000.32 - ------------------------------------------------------------------------------------------------- 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 $404.81 $1,572.86 $734.18 $9,244.71 - ------------------------------------------------------------------------------------------------- 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 $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 $29.06 $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 $127.3 $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) 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 $ 5.17 $ 2.48 $ 4.90 $ 4.09 $ 9.76 $ 4.49 $ 13.20 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) ($ 0.37) ($ 0.02) ($ 0.07) ($ 0.04) ($ 0.15) ($ 0.04) ($ 0.16) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) ($ 0.61) ($ 0.06) ($ 0.26) ($ 0.34) ($ 1.32) ($ 0.21) ($ 1.76) Premium Tax Implementation Adjustment $ 7.30 $ 1.86 $ 3.20 $ 2.33 $ 6.51 $ 4.65 $ 9.41 - ------------------------------------------------------------------------------------------------------------------------------------ Total Adjustment Impacting Base PMPM $ 11.49 $ 4.27 $ 7.76 $6.04 $ 14.80 $ 8.89 $ 20.67 - ------------------------------------------------------------------------------------------------------------------------------------ Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $365.19 $93.13 $159.76 $116.39 $325.27 $232.68 $470.48 - ------------------------------------------------------------------------------------------------------------------------------------ Impact of Electing the $35k Reinsurance Deductible(2) $ 13.88 $ 0.33 $ 1.51 $ 1.08 $ 1.83 $ 0.41 $ 10.79 ==================================================================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $379.07 $93.46 $161.27 $117.47 $327.10 $233.09 $481.28 - ------------------------------------------------------------------------------------------------------------------------------------ [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------- Originally Awarded PMPM $ 16.00 $5,610.56 $740.35 - ------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 0.00 ($ 40.68) $ 0.00 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 .00) ($ 5.20) $ 0.00 Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) $ 0.00 $ 1.98 $ 0.00 Premium Tax Implementation Adjustment $ 0.33 $ 113.60 $ 15.11 - ------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM $ 0.32 $ 69.62 $ 15.11 - ------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible $ 16.32 $5,680.18 $755.46 - ------------------------------------------------------------------------------------- Impact of Electing the $35k Reinsurance Deductible(2) $ 0.00 ($ 12.07) $ 0.00 ===================================================================================== Adjusted Awarded PMPM for Plans Electing the $35k Reinsurance Deductible $ 16.32 $5,668.10 $755.46 - ------------------------------------------------------------------------------------- [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] [ILLEGIBLE] - ------------------------------------------------------------------------------------------------------------------- Originally Awarded PMPM $516.02 $405.62 $1,509.89 $742.57 $9,000.32 - ------------------------------------------------------------------------------------------------------------------- Outpatient & Emergency Room Adjustment $ 14.28 $ 11.23 $ 40.00 $ 19.67 $ 124.86 Cost Sharing Proposal Adjustment $ 0.00 ($ 18.39) $ 0.00 ($ 38.78) $ 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) ($ 0.30) ($ 0.22) ($ 0.90) ($ 0.42) ($ 20.76) Fee-for-Service Schedule Change (Referral Physician and Lab & X-Ray COS) $ 2.01) ($ 1.51) ($ 7.59) ($ 3.54) ($ 44.61) Premium Tax Implementation Adjustment $ 10.78 $ 8.10 $ 31.46 $ 14.68 $ 184.89 - ------------------------------------------------------------------------------------------------------------------- Total Adjustment Impacting Base PMPM 22.74 ($ 0.81) $ 62.97 ($ 8.38) $ 244.39 - ------------------------------------------------------------------------------------------------------------------- Adjusted Awarded PMPM for Plans Electing the $20k Reinsurance Deductible 538.76 $404.81 $1,572.86 $734.18 $9,244.71 - ------------------------------------------------------------------------------------------------------------------- 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 $538.76 $404.81 $1,572.86 $734.18 $9,244.71 - -------------------------------------------------------------------------------------------------------------------
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 $ 37.66 $ 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