OREGON HEALTH PLAN MEDICAID DEMONSTRATION

Transcription

1 OREGON HEALTH PLAN MEDIAID DEMONSTRATION Actuary s Letter of ertification oordinated are Organizations January 205 December 205 X. Dennis Tang, ASA, MAAA Principal Actuary Actuarial Services Unit Office of Health Analytics Oregon Health Authority State of Oregon FINAL December 5, 204

2 DATE: December 5, 204 TO: FROM: RE: David Rohrer Administrator Actuarial Services Unit Office of Health Analytics Oregon Health Authority 500 Summer Street N.E. Salem, Oregon 9730 X. Dennis Tang, ASA, MAAA Principal Actuary Actuarial Services Unit Office of Health Analytics Oregon Health Authority 42 SW Oak Street, Suite 850 Portland, Oregon apitation s for the Oregon Health Plan Medicaid Demonstration oordinated are Organizations Effective January, 205 through December 3, 205 Dear David, The actuaries and specialists of the Actuarial Services Unit (ASU), under the Oregon Health Authority (OHA) Office of Health Analytics have developed actuarially sound rate ranges for determining capitation payments to oordinated are Organizations (Os) for providing physical health, mental health, and dental services for eligible Medicaid beneficiaries under the Oregon Health Plan Medicaid Demonstration for the period from January, 205 through December 3, 205. MS capitation rate development guidelines require that capitation payment rates to be within the actuarially sound rate ranges. We have chosen capitation payment rates such that they are within the actuarially sound rate ranges. Federal regulation as stipulated in 42 FR 438.6(c) requires that capitation rates be actuarially sound, that the capitation rates are developed according to generally accepted actuarial methods, that capitation rates are appropriate for the population covered and for the services provided, and that capitation rates are certified by a qualified actuary. The attached January 205 capitation rate report describes the Oregon Medicaid managed care program, the methods used for setting the capitation rate ranges based on encounter data and financial submission data, data review, trend development, adjustments for hospital reimbursement adjustments (HRAs), adjustments for benefit differences between base data period and contract period, network adequacy adjustments, and risk and pent-up

3 demand adjustments for AA newly eligible population. It is being released subsequent to the effective date of the capitation rates developed herein following final approval of the rate ranges by the enters for Medicare and Medicaid Services (MS). I have provided statements of capitation rate certification and my signature on the next page. * * *

4 Actuarial ertification of Oregon Health Plan apitation Ranges January st, 205 through December 3 st, 205 I, X. Dennis Tang, am the Principal Actuary at Oregon Health Authority. I am an Associate of the Society of Actuaries and a Member of the American Academy of Actuaries and meet its qualification standards to certify as to the actuarial soundness of proposed capitation rate ranges for the period January st, 205 through December 3 st, 205 for contracting oordinated are Organizations (Os) under Oregon Medicaid. It is my opinion that all requirements of 42 FR 438.6(c), with respect to the development of Medicaid managed care capitation rates, were satisfied in the development of the proposed capitation rate ranges for contracting Os in Oregon. I believe that the capitation rate ranges are appropriate for the populations to be covered and the services to be furnished under the contract. Detailed descriptions of source data, cost and utilization trend development, adjustments and assumptions in the development of the capitation rate ranges are contained in the report to which this certification is attached. Adjustments have been applied in the rate range development including hospital reimbursement adjustments, adjustments for benefit differences between base data period and contract period, adjustments for network adequacy, and risk adjustments and pent-up demand adjustments for AA newly eligible groups. In developing the proposed capitation rate ranges, I relied upon base year encounter data and financial submission data for the base year. I have overseen the joint data validation and data review efforts by our actuaries and analysts along with our consultants from Optumas. Os have attested to the accuracy of the financial submission data. Both base year encounter data and financial submission data have been reviewed for reasonableness and comprehensiveness; however, I did not perform independent verification and take no responsibility as to the accuracy of submitted data. The capitation rate ranges provided with this certification are considered actuarially sound for purposes of the 42 FR 438.6(c), according to the following criteria: The apitation Ranges were developed in accordance with generally accepted actuarial principles and practices; The apitation Ranges are appropriate for the populations to be covered, and the services to be furnished under the contract; The capitation rate ranges referred to in the accompanying report are a projection of future events. It may be expected that actual experience will vary from the values shown here. Actuarial methods, considerations, and analyses used in developing the capitation rate ranges conform to the appropriate Standards of Practice promulgated from time to time by the Actuarial Standards Board. X. Dennis Tang, ASA, MAAA Member, American Academy of Actuaries December 5, 204

5 Please contact me by phone at or via at if you have any questions. Sincerely, X. Dennis Tang, ASA, MAAA Principal Actuary

6 Oregon Health Plan Medicaid Demonstration 205 apitation Ranges for oordinated are Organizations January 205 December 205 December 5 th, 204

7 Oregon Health Plan 205 apitation Report OHA 205 Oregon Medicaid apitation Ranges This report presents the methods used to develop the lower and upper bounds for rate ranges utilized for determining capitation rates to be paid to oordinated are Organizations (Os) participating in the Oregon Health Plan Medicaid Demonstration for the contract period from January, 205 to December 3, 205. These methods are designed to comply with: The requirements of federal regulations in 42 FR 438.6(c) enforced by the enters for Medicare and Medicaid Services (MS) governing the development of capitation payments for Medicaid managed care programs; and 2 The 5 Demonstration (NUMBER: 2 W 0003/0 and W 0060/0) approved by MS for period July 5, 202 through June 30, 207; and 3 Relevant Oregon statutory requirements. The capitation rate ranges shown in this report also include children covered under Title XXI. 2 Page

8 Oregon Health Plan 205 apitation Report OHA Table of ontents OREGON HEALTH PLAN MEDIAID MANAGED ARE PROGRAM 6 OVERVIEW 6 OORDINATED ARE MODEL 6 BENEFIT OVERAGE AND HANGES IN MEDIAID POPULATIONS OVERED 8 AA ADULTS RATE GROUPS 8 GEOGRAPHI REGIONS 9 GOVERNING REGULATIONS RATE RANGE DEVELOPMENT 0 OREGON S 205 ATUARIALLY SOUND RATE RANGE SETTING METHODOLOGY OVERVIEW 0 BASE DATA DATA SOURES BASE DATA DEVELOPMENT PHYSIAL AND MENTAL HEALTH SERVIES BASE DATA ADJUSTMENTS SUBAPITATION AND OTHER PAYMENT ARRANGEMENTS 2 AVAILABILITY AND QUALITY OF THE ENOUNTER DATA 2 DATA HANGES FROM TREND DEVELOPMENT 3 DATA 3 METHODOLOGY 3 REGIONS, ELIGIBILITY GROUPINGS AND SERVIES DENTAL RATES DEVELOPMENT 6 DENTAL BASE DATA 6 DENTAL RATE DEVELOPMENT AA RATE DEVELOPMENT 7 BENEFIT INREASE ADJUSTMENTS 7 NETWORK ADEQUAY ADJUSTMENT 8 PENT UP DEMAND ADJUSTMENT 8 RISK ADJUSTMENTS 8 RISK MITIGATION STRATEGIES 9 3 Page

9 Oregon Health Plan 205 apitation Report OHA 205 ADDITIONAL RATE OMPONENTS AND METHODOLOGY 20 HOSPITAL REIMBURSEMENT ADJUSTMENTS 20 GRADUATE MEDIAL EDUATION 20 ADMINISTRATIVE ALLOWANES AND TOTAL NON BENEFIT ALLOWANES 20 HEALTH INSURANE FEE 2 MATERNITY ASE RATE 2 BARIATRI SURGERY ASE RATE 2 AT/SE SERVIES 22 ALOHOL AND DRUG RESIDENTIAL SERVIES 22 NON EMERGENT MEDIAL TRANSPORTATION SERVIES (NEMT) 22 MENTAL HEALTH HILDREN S WRAPAROUND SERVIES 23 FAMILY PLANNING REIMBURSEMENT INREASE 24 MENTAL HEALTH SERVIES ONLY 24 SOVALDI PRESRIPTION DRUG ADJUSTMENT PMPM RATES 24 SPEIAL NEEDS RATE GROUP AND RISK SHARING 25 EXHIBITS EXHIBIT OVERED SERVIES BY OORDINATED ARE ORGANIZATIONS 28 EXHIBIT 2A STATEWIDE O ENROLLMENT AS OF APRIL EXHIBIT 2B O PHYSIAL AND MENTAL HEALTH ENROLLMENT AS OF APRIL EXHIBIT 2 O ENROLLMENT BY REGIONS 32 EXHIBIT 3A STATEWIDE RATE RANGES AND OMPARISON OF JANUARY 205 AND OTOBER 204 APITATION RATES; INLUDING DENTAL SERVIES 33 EXHIBIT 3B STATEWIDE RATE RANGES AND OMPARISON OF JANUARY 205 AND OTOBER 204 APITATION RATES; EXLUDING DENTAL SERVIES 34 EXHIBIT 4 OA PLAN SPEIFI APITATION RATE OMPARISON JANUARY 205 AND OTOBER EXHIBIT 5 OB PLAN SPEIFI APITATION RATE OMPARISON JANUARY 205 AND OTOBER EXHIBIT 6 OE PLAN SPEIFI APITATION RATE OMPARISON JANUARY 205 AND OTOBER EXHIBIT 7 OF PLAN SPEIFI APITATION RATE OMPARISON JANUARY 205 AND OTOBER EXHIBIT 8 OG PLAN SPEIFI APITATION RATE OMPARISON JANUARY 205 AND OTOBER EXHIBIT 9A AA ADULT BENEFIT INREASES 5 EXHIBIT 9B BENEFIT INREASE ADJUSTMENT PMPM RATES 6 EXHIBIT 9 TREND FATORS USED IN DEVELOPING BENEFIT ADJUSTMENT PMPM RATES 7 EXHIBIT 0A 205 DENTAL RATE RANGES AND JANUARY 205 APITATION RATES 8 EXHIBIT 0B DENTAL TREND FATORS 9 EXHIBIT PHYSIAL AND MENTAL HEATLH 203 BASE DATA DEVELOPMENT 20 4 Page

10 Oregon Health Plan 205 apitation Report OHA EXHIBIT 2A SUMMARY OF O ANNUAL TREND FATORS 2 EXHIBIT 2B TIERS OF SMALL, MEDIUM, AND LARGE OS AND TREND WIDTHS 22 EXHIBIT 3A MATERNITY ASE RATE TREND FATORS 23 EXHIBIT 3B MATERNITY ASE RATES 24 EXHIBIT 4 BARIATRI ASE RATES 25 EXHIBIT 5A SPEIAL NEEDS RATE GROUP (SNRG) PMPM RATES 26 EXHIBIT 5B SPEIAL NEEDS RATE GROUP (SNRG) TREND FATORS 27 EXHBIT 6A AT/SE PMPM RATES 28 EXHIBIT 6B AT/SE TREND FATORS 29 EXHIBIT 7A ALOHOL AND DRUG RESIDNTIAL SERVIES PMPM RATES 30 EXHIBIT 7B ALOHOL AND DRUG RESIDENTIAL TREND FATORS 3 EXHIBIT 8A NON EMERGENT MEDIAL TRANSPORTATION (NEMT) PMPM RATES 32 EXHIBIT 8B NON EMERGENT MEDIAL TRANSPORTATION TREND FATORS 33 EXHIBIT 9 MENTAL HEALTH HILDRENS WRAP AROUND PMPM RATES 34 EXHIBIT 20 AA RISK ADJUSTMENT 35 EXHIBIT 2 FAMILY PLANNING REIMBURSEMENT INREASE PMPM 36 EXHIBIT 22 BREAKTHROUGH TREATMENTS PMPM RATES 37 APPENDIX 0 : OREGON ENOUNTER DATA & BASE DATA MODEL NARRATIVE (OPTUMAS) APPENDIX : MS MEDIAID MANAGED ARE RATE SETTING REQUIREMENTS NOT ADDRESSED ELSEWHERE APPENDIX 2 : MS HEK LIST 5 Page

11 Oregon Health Plan 205 apitation Report OHA Oregon Health Plan Medicaid Managed are Program Overview The Governor s Office, Oregons Legislature, and the Oregon Health Authority (OHA), through their historical health care transformation efforts, guided the establishment of oordinated are Organizations (Os) to achieve the triple aim of better health, better health care, and lower per capita cost. Since September 202, a total of sixteen Os have been contracted in Oregon to provide managed and coordinated care to Medicaid eligible members. As of September 204, 90% of Oregon Health Plan (OHP) members are enrolled in Os for physical health, mental health, or dental services; and 0% in Fee For Service. Through the coordinated care model, Oregonians are experiencing improved, more integrated care. With a focus on primary care and prevention, health plans using the coordinated care model are able to better manage chronic conditions and keep people healthy and out of the emergency department. Key elements of the coordinated care model include: Best practices to manage and coordinate care; Shared responsibility for health; Performance is measured; Paying for outcomes and health; Transparency and clear information; Maintain costs at a sustainable rate of growth. oordinated are Model The coordinated care model began with the establishement of oordinated are Organizations (Os) in 202. A O is a network of all types of health care providers (physical health care, addictions and mental health care, and sometimes dental care providers) who have agreed to work together in their local communities to serve people who receive health care coverage under the Oregon Health Plan (Medicaid). Os focus on prevention and helping people manage chronic conditions, like diabetes. This helps reduce unnecessary emergency room visits and supports long term health. Before Os, the system separated physical, behavioral and other types of care, making care more difficult for patients and providers and more expensive for the state. Os have the flexibility to support new models of care that are patient centered and team focused, and reduce health disparities. Os are able to better coordinate services and also focus on prevention, chronic illness management and person centered care. They have flexibility within their budgets to 6 Page

12 Oregon Health Plan 205 apitation Report OHA provide services alongside today's OHP medical benefits with the goal of meeting the Triple Aim of better health, better care and lower costs for the population they serve. Across Oregon, Os are working on a local level to transform the health care delivery system for Oregonians. To provide status updates on the state s progress towards these goals, the Oregon Health Authority (OHA) is publishing quarterly reports showing quality and access data, financial data, and progress toward reaching benchmarks. Benefit overage and hanges in 204 Effective January st, 205, Oregon Health Plan (OHP) will contract with sixteen Os to provide integrated physical health, mental health, and dental services. There are different contracts that cover a different mix of services, they include: O A contracts: Physical health, mental health and dental O B contracts: Physical health and mental health O E contracts: Mental health only O F contracts: Dental only O G contracts: Mental health and dental The majority of members are covered under O A contracts, but there are smaller numbers of members who are covered under O B, O E, O F and O G contracts. Exhibit References: Exhibit 2A shows statewide Medicaid physical health enrollment by eligibility categories as of April 204. See Exhibit 2B for O Medicaid enrollment by eligibility categories as of April 204. Exhibit 2 shows O Medicaid physical health enrollment by regions. All enrolled members have the same benefit coverage effective January st, 204. However, prior to January st, 204, two classifications of benefit coverage existed. The OHP Plus population was covered with the full range of health care services, while the OHP Standard population was covered by a limited benefit package. The Standard population was split into two eligibility categories and was formally known as OHP Families and OHP Adults & ouples. This distinction is important to Oregon s 205 capitation rate development since calendar year 203 (which included the OHP standard population) was used as the base data for 205 capitation rate development. A benefit adjustment was applied to account for the increased coverage between the base data and the contract period. As of January st, 204, all 4 eligibility rate groups have the same level of benefit coverage and that will continue into 205. Exhibit Reference: Please see Exhibit for the list of covered services for all members in Page

13 Oregon Health Plan 205 apitation Report OHA Medicaid Populations overed The Oregon Health Plan (OHP) classifies the enrolled population in 4 eligibility rate groups. The rate groups are divided and grouped using specific criteria, such as age, Medicare status, etc. The following are the 205 OHP eligibility rate groups. Figure. OHP Eligibility ategories and Groups OHP Eligibility ategories and Groups. Temporary Assistance to Needy Families (TANF) 2. PLM Adults (Poverty Level Medical) 3. PLM, TANF, and HIP (hilren s Health Insurance Program) hildren Aged 0 < 4. PLM, TANF, and HIP hildren Aged 5 5. PLM, TANF, and HIP hildren Aged OAA with Medicare (Old Age Assistance) 7. AB/AD with Medicare (Blind, Disabled, and General Assistance lient) 8. OAA without Medicare (Old Age Assistance) 9. AB/AD without Medicare (Blind, Disabled, and General Assistance lient) 0. AF hildren (hildren in Adoptive, Substitute or Foster are). AA Adults 9 44 (see section below) 2. AA Adults (see section below) 3. AA Adults (see section below) 4. Special Needs Group (SNRG) AA Adults Groups *HIP stands for hildren s Health Insurance Program In 204, OHP Family and OHP Adults and ouples were renamed AA Adults with hildren and AA Adults without hildren (respectively) and the new AA expansion members were added to these rate groups. Starting January, 205, the Oregon Health Authority (OHA) will redistribute the AA population into age banded rate groups and the former with hildren and without hildren distinction will not be used in 205 rates. These age bands will improve OHA s ability to assess medical risk by age. The new 205 AA rate groups are: AA Adults ages 9 44 AA Adults ages AA Adults ages Page

14 Oregon Health Plan 205 apitation Report OHA Geographic Regions The Oregon Health Plan distinguishes seven geographic regions when setting capitation rates. They are: Figure 2. Geographic Regions Geographic Regions Jackson, Josephine, and Douglas ounties (JJD) Lane ounty (Lane) Linn, Benton, Marion, Polk and Yamhill ounties (LBMPY) lackamas, Multnomah and Washington ounties (Tri ounty) oastal entral Eastern Governing Regulations Federal regulation, as stipulated in 42 FR 438.6(c), requires that capitation rates be actuarially sound and that capitation rates are developed according to generally accepted actuarially methods. The Oregon Health Authority Actuarial Services Unit (ASU) have conducted actuarially sound capitation rate range setting following generally accepted actuarial methods in accordance of federal regulation. Similarly to 204, MS issued managed care capitation rate setting guidelines for states to use in 205 managed care rate development. We have designed our rate range setting process by following MS guidelines. This report describes the key steps in setting the actuarially sound rate ranges for contracting with Os for the period from January st, 205 to December 3 st, Page

15 Oregon Health Plan 205 apitation Report OHA 205 Range Development Oregon s 205 Actuarially Sound Range Setting Methodology Overview OHA, using generally accepted actuarial methods, has developed actuarially sound rate ranges for each O. All applicable Actuarial Standards of Practices (ASOPs) were considered in the development of these rate ranges. OHA required that final capitation contract rates fall within the previously described O level actuarially sound rate ranges. OHA has relied on three sources of data for the 205 rate setting development process:. Experience data submitted by Os through the encounter data submission process; 2. Financial incurred data submissions; and Audited Financial Statements. Note: Data from these three sources were reviewed and validated by the Oregon Health Authority. Any identified differences were reconciled during the review process. See the base data section for more information. OHA developed cost and utilization trend assumptions. The encounter data underwent multiple levels of validation including a comparison with the O Financial submission for 203 incurred and accrual costs and Audited Financial Reports. OHA internally developed all rate adjustments (see following sections for descriptions). OHA developed Ranges with three tiers of range widths for small, medium, and large Os respectively (due to statistical confidence considerations). Financial solvency and reported Medical Loss Ratios are reviewed to ensure accuracy in rate range setting. OHA will establish capitation payment rates within rate ranges through signed contracts with each O. OHA takes into account budget planning directives in deciding the point within the rate ranges as well as considerations for legislative directives in transforming A/B hospital reimbursement from relying on hospital charge masters and cost to charge ratios to alternative payment methods. 0 Page

16 Oregon Health Plan 205 apitation Report OHA Base Data Data Sources The Oregon Health Authority Actuarial Services Unit (ASU) used 203 encounter data experience as the base. The encounter data is the first and primary source of data for rate setting. Encounter data is submitted by Os to the encounter data group at OHA through the regular encounter data submission process. Encounter data is submitted by Os on a regular basis and validated both monthly and quarterly. ASU also used O financial submissions as another data source for encounter data validation purposes and supplemental information. ASU requested that each O submit a financial submission report that was developed by ASU and the consultant firm Optumas. The financial data submitted by Os was for the 203 incurred and accrual cost, and contains reported costs for encounter events, IBNR, subcapitation payments, incentive payments, and alternative payments. Base Data Development Physical and Mental Health Services A key principle for the base data development was to perform data validation and data review to confirm that the data sources used for rate setting were appropriate for the OHP population. The Oregon Health Authority contracted with Optumas, a consulting firm, to provide expertise in data evaluation and actuarial review. Optumas performed a rigorous analysis of Oregon s encounter data, which included creating a validated encounter databook and also the development of a base data model. Appendix Reference: Please see Appendix for Optumas supplemental report describing the base data development. Optumas describes the following elements of the base data development in the report: Data sources Encounter data validation and Databook development Reported financials from Os Base Data Model and development Base Data Adjustments During rate range setting, ASU used the base data model developed by Optumas to perform appropriate adjustments to the encounter data. These types of adjustments are detailed in Optumas s report, Appendix #, and include: Adjustment. Reconciliation and under reporting Factors Adjustment 2. Inclusion of Subcapitation and Supplemental Payments Page

17 Oregon Health Plan 205 apitation Report OHA Adjustment : The reconciliation and under reporting factors were used to account for valid discrepancies that were found. In addition, IBNR was considered under this factor to account for any appropriate run out reported by the plan. Adjustment 2: ASU used a variety of factors to analyze the amount of subcapitation and supplemental payments to include in the base data model. Theythey include ) O supplemental documentation about these arrangements (see next section) and 2) audited financial reports. Exhibit Reference: Exhibit shows base data resulting from data validation and review for each of the sixteen Os. Subcapitation and Other Payment Arrangements As part of the O financial submission, Os were asked to answer a supplemental questionnaire regarding their sub capitation, incentive, and other arrangements. The questions identified the type of payment method (PMPM, etc.), the services covered, the providers involved, and the changes in the agreements from the base year to the contract year. This information was used as informational when developing the base data and identifying the percent of payments in the financials to accept. Optumas and ASU reviewed this information during rate setting to understand the payment arrangements for each O. Note: Western Oregon Advanced Health (WOAH) employs dominant sub capitation arrangements while remaining at risk through risk sharing arrangements. In this case, Optumas performed a shadow pricing of clinical events for WOAH. The results were reviewed and compared with WOAH financial submission data and WOAH Audited financial reports. After this additional work, we were able to prepare base data for rate range setting. Availability and Quality of the Encounter Data ASU is confident that the data validation and rigor in the reconciliation process provided enough information to make sound decisions regarding the base data development. The process required more time than was anticipated and identified a few weaknesses in the architecture of encounter data. In an effort to streamline the process, ASU is planning to start a joint O and OHA workgroup in 205 to discuss how to improve the reconciliation process for future rate setting periods. Data hanges from 204 In previous years, OHA relied on a tool that drove rate development called the ost Template. Starting 205, the ost Template was not used and the encounter data was the primary source of data, as described above. 2 Page

18 Oregon Health Plan 205 apitation Report OHA 205 Trend Development The trend development for 205 capitations rates was developed using the following data and methodology. onsistent with past methodologies, the trend factors are split into two periods: data period and projection period. Data The 205 capitation rates are based on 203 encounter data experience, and the trend calculations used data from both 202 & 203. However, three years of data were observed for trend to check for significant seasonality and to more easily spot jumps in the data. Data were checked for completeness and reasonability by plan and claim type and county to cover the transition between the previous Managed are Organizations to Os. Incomplete Encounters and member months were excluded from the calculations. We have considered MS Market Basket forecasts for hospital costs, BLS medical PI estimates, and OHA s expected changes in FFS payments in forming the basis for inflation that go into the cost trend. Methodology Utilization trends were calculated using geometric regression models based on managed care plan encounter data. Seasonality adjustments were estimated using three years of encounter data. When possible O specific trends were calculated, however some services were estimated at a regional or statewide level based on the volume of claims and the volatility of monthly utilization at a O level. A floor of 0% and a ceiling of 5% were applied to the utilization trend calculations. One notable change from previous unit measure is in prescription drugs. Prescription drugs unit measure is typically scripts; however, there was a noticeable increase in scripts going from 30 day supply to 90 day supply through the data period. Since scripts being filled a little less often at the end of period because of larger supplies than at the beginning of the period, utilization estimates based on just scripts would be negatively biased. Therefore the unit basis was changed to day supply to avoid this bias. Regions, Eligibility Groupings and Services To increase the volume of data underlying individual trend estimates, rate cells with similar utilization were combined. Exceptions to the general population groupings were made when a rate group s utilization was significantly different than the utilization of the rest of the group. Trend estimates were calculated for eight services. For the regional trend estimates, regions were combined based on geography from seven general regions to three regions for trend calculations. Also, due to low volume, mental health inpatient was only calculated at a statewide level. Populations groupings and regional 3 Page

19 Oregon Health Plan 205 apitation Report OHA groupings are summarized below and exceptions to the general population groupings are identified in Figure 3. Trend Regions ) Tri ounty & LBMPY 2) Lane ounty, JJD & oastal 3) entral & Eastern Trend General Groupings ) Adults TANF, PLMA, AA 9 44, AA 45 54, AA ) hildren HILD 00 0, HILD 0 05, HILD 06 8, AF 3) Dual Eligible ABAD with Medicare, OAA with Medicare 4) Disabled ABAD, OAA without Medicare Figure 3. Trend Service Types Service Type Unit Measure Adjustments to Standard Population Groupings Inpatient Hospital Days HILD 00 0 separate Outpatient Hospital Visits Physician Services HILD 00 0 separate Prescription Drug Substance Abuse Disorder Other Physical Health Mental Health Inpatient Mental Health Non Inpatient Day Supply Services Lines Days Services HILD 00 0 & HILD 0 05 excluded, ABADs combined, OAAs with Adults) (ABADs combined, OAAs with Adults, AF separate, HILD 00 0 excluded) (ABADs combined, OAAs with Adults, AF separate, HILD 00 0 excluded) Trend Range Development and Tiers of Os Trend ranges were developed based on low and high trend assumptions for cost trend and for utilization trend. The trend ranges form the basis for the low and high rate ranges. When developing trend ranges, we apply different considerations for the widths of trend ranges for small, medium and large Os. Figure 4 below shows different widths for trend range development. 4 Page

20 Oregon Health Plan 205 apitation Report OHA Figure 4. Trend Ranges for Small, Medium, and Large Os Tiers ost Trend Range End of Range End of Range Utilization Trend Range End of Range End of Range Small 0.5% +.75% 0% +.75% Medium % +0.75% 0% +0.75% Large.5% +0.25% 0% +0.50% Exhibit References: See Exhibit 2A for summary of annual trend range factors for each Os hospital, physician, mental health and other services. See Exhibit 2B for Os by tiers of small, medium, and large and their trend range widths. 5 Page

21 Oregon Health Plan 205 apitation Report OHA 205 Dental s Development Dental Base Data ASU used 203 dental encounter data as the primary data source for 205 rate setting. Historically the Dental s were divided into two regions (Tri ounty and Non Tri ounty). Dental base data are prepared for the Os who operate in the Tri ounty region and all other Os who operate outside the Tri ounty region. The rate ranges are calculated on a regional basis; therefore, all of the Os in a region will have the same rate range. ASU has split the rates between these two regions for a number of years due to a significant difference between the Tri ounty and Non Tri ounty dental fee schedules. Dental Development The January 205 O Dental development utilized an actuarial sound rate range methodology that applied the following process: Data: The utilization for the January 205 dental capitation rates are developed based on the encounter and enrollment data from January 203 through December 203. Fee Schedule: The American Dental Association (ADA) 203 Fee Schedule Survey (Dental Survey) was used to develop the cost component of the O Dental s. A calculated paid amount was developed using the twentieth percentile of the Dental Survey. ASU chose the twentieth percentile because it aligns with our internal fee schedule for dental rates. Then a ost to harge ratio is derived based on the calculated paid amount (ost) and the billed amount in the data (harge). Adjustment Factors: Pent up demand factors were included for the AA rate groups in 204. For 205, we are setting the dental pent up demand factor to zero for all rate cohorts. Trend: Utilization and low and high cost trend are developed based on the data of the selected period. ost trend is also adjusted to reflect the appropriate PI and Medical PI indexes. range are derived based on the selected low and high trends. Regional Setting: Instead of applying geographic factor to the statewide rate in calculating the regional rate, we set the rates for the Tri ounty and the Other ounty separately. Therefore, there are two regional rate ranges: one for the Tri county and one for the Other ounties. The regional rate range low and high are listed Exhibit 0A: Exhibit Reference: Exhibit 0A shows dental rate ranges and 205 dental payment rates by regions. Exhibit 0B shows dental cost and utilization trend factors. 6 Page

22 Oregon Health Plan 205 apitation Report OHA 205 AA Development The AA population rates will be developed using the following data, methodology and adjustments. The rate setting process for this population has significantly changed since the 204 rate setting cycle. Please note that specifics regarding the changes are within the narrative for each adjustment. Base Data: The AA rates will be set using 203 encounter data and O s financial submissions. Adjustments: The following adjustments will be made to the 205 AA rate groups. Benefit adjustment for the contract period Network Adequacy ost Adjustment Pent up Demand Utilization Adjustment Risk adjustment Adjustment changes: The following adjustments were included in the 204 AA rate development will not be included in the 205 O AA rate development: Risk Margin Adjustment Benefit Increase Adjustments Medical: There are benefit level differences between the base year 203 and the 205 contract year for the three AA adult rate groups. OHA developed benefit increase adjustment PMPMs based on Per apita ost analysis for these eligibility categories. Benefit adjustment PMPMs are developed first for 204. A 2.4% cost trend was applied afterward with no utilization trend applied. Since the benefit increases represent a relatively small portion of the medical benefit package, we were able to price out the PMPM values based on a manual credibility weighting. In setting the 205 rates, the manual credibility weightings are 00% TANF for AA Adults 9 44; 85% TANF and 5% ABAD for AA Adults 45 to 54; and 70% TANF and 30% ABAD for AA Adults Exhibit Reference: Exhibit 9A shows benefit differences between base year 203 and the 205 contract year. Exhibit 9B shows benefit increase adjustment PMPM rates. Exhibit 9 shows trend factors in developing the benefit adjustment PMPM rates. Dental: There are no benefit adjustments for dental services. Rather, based on the assessment that dental risks are similar between TANF and AA population, we used 203 TANF dental data as the base for rate range setting. No benefit adjustments are needed since 203 TANF dental data represents full level of dental benefits. 7 Page

23 Oregon Health Plan 205 apitation Report OHA Network Adequacy Adjustment 204 Setting Methodology: In 204, the network adequacy cost adjustments were based on work by Optumas, OHA s consulting firm, with input and feedback from OHA. Optumas estimated ranges of cost adjustments from.004 to.009 for AA Adults with hildren and.04 to.036 for AA Adults without hildren in 204 rate setting. The Optumas report can be provided upon request. We applied the higher end estimate of.009 for Adults with hildren and mid estimate of.025 for Adults without hildren in setting the rates starting January st, 204. These were later modified in July 204 to a single factor of.0086 that was applied to all rate categories, per MS guidance. 205 Setting Methodology: The network adequacy adjustment is intended to be a temporary adjustment for the AA population; however, we do not believe that all of the access issues surrounding the expansion population have been resolved. Therefore, we set network adequacy adjustment at 50% of the 204 [a noun should go here the 204 what?]. As a result, a single attenuated factor of.0043 will be applied to all rate categories in 205 rate range setting. Pent up Demand Adjustment 204 Setting Methodology: In 204, the pent up demand utilization adjustments factors were based on findings of pent up demand in the Standard program expansion in After comparing the effects of the new expansions, adjustment factors of.022 for Adults with hildren and.045 for Adults without hildren were calibrated in setting the rates for 204. The encounter data for the 2009 expansion population and 20 encounter data after the new expansion were used in the calculations of frequency of services as well as the adjustments factors. 205 Setting Methodology: In setting the rate ranges for 205, an attenuated adjustment factor of.0 will be applied to AA Adults 9 44, and attenuated adjustment factor of.0225 will be applied to AA Adults For AA Adults 45 to 54, a weighted average of.0605 by 30% and 70% weighting of the above two attenuated factors respectively will be applied to rate ranges for pent up demand adjustment. The pent up demand adjustment is also a temporary adjustment for the AA population and OHA does not expect to apply this adjustment in 206. Risk Adjustments The AA adult categories were split between two groups for the development of the risk adjustment factor: ) The lottery expansion population which is composed of individuals below 00% FPL and 2) The higher income expansion population within 00 38% FPL. The risk adjustment factors were based on an Oregon specific DPS model, using encounter data with clinical diagnostic information. OHA used the encounter data from the Standard population during the 20 to 202 expansion period for the lottery expansion risk factor (group ). OHA then relied on a study of Supplemental Nutrition Assistance 8 Page

24 Oregon Health Plan 205 apitation Report OHA Program (SNAP) members to pull clinical and diagnostic data for the higher income population (group 2). Due to relatively older historical data in the study of SNAP members, OHA set a floor of for the risk adjustment factors in setting the rates for 204. We are continuing to apply this same floor for 205 rate range setting. The following table outlines the risk adjustment factors by AA rate group. Figure 5. AA Group Risk Adjustment Factors Groups Members Risk Adjustments AA Adults 9 44 Base Lottery Expansion (<00% FPL).05 er Income Expansion (00 38% FPL) AA Adults Base Lottery Expansion (<00% FPL) er Income Expansion (00 38% FPL) AA Adults Base Lottery Expansion (<00% FPL) er Income Expansion (00 38% FPL) Risk Mitigation Strategies Os are required to maintain a Minimum Medical Loss Ratio (MMLR) of at least 80% for the AA Expansion Population (AA Adults 9 44, AA Adults 45 54, and AA Adults 55 64) and are required to rebate any dollar amount by which its performance falls short of this ratio. The MMLR methodology requires Os to submit an annual certified MMLR Report. The current reporting period is July 204 through December Page

25 Oregon Health Plan 205 apitation Report OHA 205 Additional omponents and Methodology Hospital Reimbursement Adjustments Effective October st, 2009, a hospital reimbursement adjustment (HRA) was added to the capitation rates for FHPs, POs, and MHOs to bring DRG hospital reimbursement from 80% of cost to 00% of cost. Per actions taken by the 20 legislative session, thetier HRA is now intended to bring DRG hospital reimbursement from 68% of Medicare to 00% of Medicare. Tier 2 HRA is an additional enhancement in the capitation rates that provides an allowance for additional provider tax instituted by the 20 Oregon legislative session. Tier 2 HRA is considered a provider tax allowance and was originally set at 6% of the total capitation rates but was lowered to 3% in July 204 rate setting. It will remain at 3% for 205 rate range setting. Tier 2 HRA is referred to as the Hospital Provider Tax Allowance in the contract rate sheets. Tier and Tier 2 HRA for Os are calculated in the same way as they are currently calculated for FHPs. ombined with the administrative allowance, which is 8% of the total capitation rates, total administrative allowance including Hospital Provider Tax Allowance is about 2.8% of the total capitation rates for Os. Tier and Tier 2 Hospital Reimbursement Adjustment are intended to be used by the Os to increase payments to hospitals from 68% to 00% and compensate hospitals for administrative expenses associated with the State Hospital Provider Tax. Graduate Medical Education Effective January, 200, the capitation rates include reimbursement to teaching hospitals for graduate medical education (GME) as a separately identified component. However, OHA has made a decision to exclude GME from the capitation rates for Os. For now, GME payments to hospitals are handled outside of capitation rates for Os. Administrative Allowances and Total Non Benefit Allowances Administrative allowances for Os are set at 8% of the capitation rates excluding Tier and Tier 2 HRA. An administrative allowance of 2% is given for Tier HRA. ase management and care coordination costs are included in the administrative allowance for Os. Individual Os have different overall combined administrative allowances according to each O s Tier HRA and administrative load. A summary of the average administrative as a load on base rates without Tier and Tier 2 HRA is shown below. Total non benefit allowances consist of hospital provider tax allowance, HIF allowance, and administrative allowances. Total non benefit allowance as a percentage of total rates is shown in Figure 6 below. 20 Page

26 Oregon Health Plan 205 apitation Report OHA Figure 6. Administrative Allowances O Statewide Administrative Allowance Percentage Load on Base s without Tier and Tier 2 HRA Percentage of Total Total Statewide Non Benefit Allowance Percentage of Total 8.2% 7.3% 9.9% Health Insurance Fee Three Os are subject to the Health Insurance Fee (HIF) tax in 204. For these three Os, ASU calculated HIF allowances in the rates from October 204 to December 204 to provide for tax gross up amounts for these three Os in 204. For 205 rate range setting, we are building the initial HIF allowance load outlined in Figure 7 into the rate ranges. In October 205, we will amend the HIF allowance load so that Os are provided the full amount of HIF that includes applicable tax gross up. Figure 7. Health Insurer Fee O 205 Initial HIF Allowance Load Eastern Oregon oordinated are Organization, LL 0.5% PacificSource ommunity Solutions, Inc..4% Trillium ommunity Health Plans, Inc. 0.8% Maternity ase Statewide maternity case rates were developed based on calendar 203 encounter data and trended forward to the mid of 205 by applying appropriate cost trends for inpatient, outpatient, and physician services. Geographic adjustments were calibrated and applied to O specific maternity case rates. The HRA components of the maternity case rates are calculated in the same way described above in this report. Exhibit References: See Exhibit 3A for trend factors and Exhibit 3B for a comparison of the January 205 maternity case rates and the October 204 maternity case rates. Bariatric Surgery ase 2 Page

27 Oregon Health Plan 205 apitation Report OHA Effective January, 2008, bariatric surgery was added as a covered benefit under the Oregon Health Plan. Pre surgery evaluations, tests, and transportation are part of the Os responsibility. The cost of the surgery itself, post surgery follow up, revisions, and complications will continue to be covered via a case rate payment. Bariatric case rate has not been rebased for 205. Effectively January 205, the bariatric surgery case rate has been trended with an annual cost trend of 2.4%. Exhibit References: See Exhibit 4 for bariatric case rates for Os from January 205 to December 205. AT/SE Services Assertive ommunity Services and Supported Employment Services (AT/SE) were added new services effectively January 203. AT/SE services PMPM rates were calculated for calendar 203 based on FFS data from the period of July 2009 through June 20. They were then trended to 204. ASU will not rebase AT/SE service PMPM rates and will trend by 2.4% cost trend and 0% utilization trend for 205. Exhibit References: See Exhibit 6A for AT/SE services PMPM rates and Exhibit 6B for trend factors for AT/SE services. Alcohol and Drug Residential Services Alcohol and drug residential services were new services effective July 203. Alcohol and drug residential services PMPM rates were calculated for the period from July 203 to December 203 based on FFS data from July 200 to June 202. They were then trended to 204. In Julyrease in chemical dependency rates in 204. The increase in chemical dependency rates w 204, alcohol and drug residential PMPM rates were modified due to a higher mix of medically monitored detox services that had been brought online. Note that this also brought a need for an inc ill continue to be added in 205. For 205, we will not rebase the alcohol and drug residential services PMPM rates and will trend by 2.4% cost trend and 0% utilization trend. Exhibit References: See Exhibit 7A for alcohol and drug residential services PMPM rates and Exhibit 7B for trend factors. Non Emergent Medical Transportation Services (NEMT) NEMT services have been optional services by Os since July 203. As of January 205, ten out of sixteen Os will provide NEMT services as shown below. NEMT services PMPM rates for July 203 through December 203 were developed based on FFS data from July 2009 to June 20. In developing the capitation rates for NEMT services, payment data for services outside of FFS claims such as meals and lodging have been considered, along with NEMT brokerages settlement information to provide a full 22 Page

28 Oregon Health Plan 205 apitation Report OHA picture of cost. These additional considerations are relatively small and amount to about 5% of the overall cost. Exhibit References: See Exhibit 8A for NEMT services PMPM rates and Exhibit 8B for trend factors in developing the 205 NEMT PMPM rates. Figure 8. Non Emergent Medical Transportation Services Os overing NEMT Services ascade Health Alliance, LL olumbia Pacific O, LL (As a new service starting in January 205) Eastern Oregon oordinated are Org., LL Familyare, Inc (As a new service staring in January 205) Health Share of Oregon (As a new service starting in January 205) Interommunity Health Network, Inc Jackson ounty O, LL Mid Rogue Independent Physician Association, Inc Trillium ommunity Health Plan, Inc Willamette Valley ommunity Health, LL Mental Health hildren s Wraparound Services Mental Health children s wraparound services have been optional services by Os since July 200. urrently, the following thirteen out of sixteen Os cover this service. The services are for hildren in Adoptive, Substitute or Foster are (AF) only. We have trended unit cost by 2.4% and estimated 205 utilizaiton per,000 based on projected number of children served in 205. PMPM rates have been derived from unit cost and utilization estimates for January 205 to December 205. Figure 9. Mental Health hildren s Wraparound Services Os overing MH hildren's Wraparound Services ascade Health Alliance, LL DIPA, LL Eastern Oregon oordinated are Org., LL Familyare, Inc Health Share of Oregon Interommunity Health Network, Inc Jackson ounty O, LL Mid Rogue Independent Physician Association, Inc Primary Health of Josephine ounty, LL Trillium ommunity Health Plan, Inc 23 Page

29 Oregon Health Plan 205 apitation Report OHA Os overing MH hildren's Wraparound Services Western Oregon Advanced Health, LL Willamette Valley ommunity Health, LL Yamhill ounty are Organization, Inc Exhibit References: See Exhibit 9 for mental health children s wraparound services PMPM rates. Family Planning Reimbursement Increase OHA instituted an increase in family planning fee schedules for FFS clients effective July st, 204. Reimbursement for procedure code T05 increased from $78 to $35. While Os are encouraged to obtain cost effective agreements with providers for cost reduction and savings, OHA has directed us to price into the capitation rate the reimbursement increase effective July st, 204. We have trended the family planning reimbursement increase PMPM to 205 by 2.4% cost trend and no utilization trend was applied. Exhibit References: Exhibit 2 shows family planning reimbursement increase PMPM rates from January 205 to December 205. Mental Health Services Only Before Os went into effect on August st, 202, some of the Medicaid beneficiaries were covered by Mental Health Organizations (MHOs) for mental health services while at the same time they were on a Fee For Services basis for physical health services. This group of beneficiaries is being transferred to Os. The capitation rates for this transitional group of beneficiaries are set for mental health services only. apitation rate ranges for mental health services are adopted as capitation rate ranges for these members. Exhibit References: Exhibit 6 shows comparisons between 205 Mental Health services only capitation rates to October 204 capitation rates. In addition, Exhibit 7 shows Dental servicesonly capitation rates, and Exhibit 8 shows Mental Health and Dental services capitation rates. Sovaldi Prescription Drug Adjustment PMPM s OHA has decided to provide Os Sovaldi prescription drug adjustments in setting the 205 rate ranges. We have estimated total number of patients for the treatment of late stage Hepatitis diseases by each O based on clinical criteria for potential patients. Scripts per patient and cost per script were estimated based on available Sovaldi prescription claims data. Exhibit References: Exhibit 22 shows Sovaldi prescription drug adjustment PMPM rates from January 205 to Decmember 205 and cost per script and utilization per,000 estimates. 24 Page

30 Oregon Health Plan 205 apitation Report OHA Special Needs Group and Risk Sharing End Stage Renal Disease (ESRD), HIV, Breast ancer and ervical ancer Program (BP), and Medically Fragile hildren (MF) who are Medicaid eligible but not dually eligible for Medicare are enrolled into Os as Special Needs Group (SNRG) with risk sharing agreement between OHA and Os effective from January st, 205 through December 3 st, 205. Oregon Medical Insurance Program (OMIP) members had also become part of SNRG since January st, 204. SNRG PMPM rates had been developed for contract year 203 based on FFS data from January 200 to December 20. Non OMIP SNRG PMPM rates were not rebased for 204 and were trended from 203. For 204 rate setting, OMIP SNRG PMPM rates were calculated separately and then combined into the overall SNRG PMPM rates based on projected member counts for both OMIP and non OMIP members. For 205 rate range setting, SNRG PMPM rates have been rebased upon calendar 203 encounter data and have been added dental PMPM rates for O A integrated physical health, mental health and dental contracts. Exhibit References: Exhibit 5A shows SNRG PMPM rates from January 205 to December 205. Exhibit 5B shows trend factors in developing the SNRG PMPM rates. Risk sharing agreements with Os dictate that after the end of the contracting period, Os will submit settlement reports based on actual encounter data as agreed to in their contracts with OHA. According to the following risk sharing agreements in three risk bands, settlement payments by Os to OHA, or by OHA to Os will be determined: Figure 0. Special Needs Group Risk Sharing Model Risk Bands Adjusted Expenses 0% to 5% 95% 00% of Target 00% to 05% of Target 5% to 0% 90% 95% of Target O Share of Risk 00% Adjusted Expenses minus 95% Target 00% of Adjusted Expenses minus Target 50% of 95% Target minus Adjusted Expenses OHA Share of Risk 0% Adjusted Expenses minus 95% Target 0% of Adjusted Expenses minus Target 50% of 95% Target minus Adjusted Expenses Settlement Payment None None From O to OHA the amount of 50% of 95% Target minus Adjusted Expenses 05% to 0% of Target 50% of Adjusted Expenses minus 05% Target 50% of Adjusted Expenses minus 05% Target From OHA to O the amount of 50% Adjusted Expenses 25 Page

31 Oregon Health Plan 205 apitation Report OHA Risk Bands Adjusted Expenses O Share of Risk OHA Share of Risk Settlement Payment minus 05% Target 0% to 20% Up to 90% of Target 20% of 90% Target minus Adjusted Expenses 80% of 90% Target minus Adjusted Expenses From O to OHA the amount of 80% of 90% Target minus Adjusted Expenses 0% to 20% of Target 20% of Adjusted Expenses minus 0% Target 80% of Adjusted Expenses minus 0% Target From OHA to O the amount of 80% Adjusted Expenses minus 0% Target Over 20% Up to 80% of Target 0% of 80% Target minus Adjusted Expenses 00% of 80% Target minus Adjusted Expenses From O to OHA the amount of 00% of 80% Target minus Adjusted Expenses Above 20% of Target 0% of Adjusted Expenses minus 20% Target 00% of Adjusted Expenses minus 20% Target From OHA to O the amount of 00% Adjusted Expenses minus 20% Target Note: Hospital reimbursement adjustments (HRAs) and one half of the administrative allowances are not included in the target amount even though they are part of the pre set and fixed PMPM rates. Please also note that the adjusted expenses above are O medical and mental health service expenses excluding off set amounts such as reinsurance payments after accounting for attributed reinsurance premiums, as defined in O risk sharing agreements with OHA. 26 Page

32 Oregon Health Plan 205 apitation Report OHA This page is intentionally left blank. 27 Page

33 Oregon Health Plan Medicaid Demonstration EXHIBIT apitation Range Development for January 205 through December 205 overed Services by oordinated are Organizations (O) Detail Service ategory PHYSIAL HEALTH ANESTHESIA EXEPT NEEDS ARE OORDINATION FP - IP HOSP FP - OP HOSP FP - PHYS HYSTERETOMY - ANESTHESIA HYSTERETOMY - IP HOSP HYSTERETOMY - OP HOSP HYSTERETOMY - PHYS IP HOSP - AUTE DETOX IP HOSP - MATERNITY IP HOSP - MATERNITY / STERILIZATION IP HOSP - MEDIAL/SURGIAL IP HOSP - NEWBORN IP HOSP - POST HOSP EXTENDED ARE LAB & RAD - DIAGNOSTI X-RAY LAB & RAD - LAB LAB & RAD - THERAPEUTI X-RAY OP ER - SOMATI MH OP HOSP - BASI OP HOSP - EMERGENY ROOM OP HOSP - LAB & RAD OP HOSP - MATERNITY OP HOSP - POST HOSP EXTENDED ARE OP HOSP - PRES DRUGS BASI OP HOSP - PRES DRUGS MH/D OP HOSP - SOMATI MH OTH MED - DME OTH MED - HH/PDN OTH MED - HOSPIE OTH MED - MATERNITY MGT OTH MED - SUPPLIES PHYS ONSULTATION, IP & ER VISITS PHYS HOME OR LONG-TERM ARE VISITS PHYS MATERNITY PHYS NEWBORN PHYS OFFIE VISITS PHYS OTHER PHYS SOMATI MH PRES DRUGS - BASI PRES DRUGS - FP STERILIZATION - ANESTHESIA FEMALE STERILIZATION - ANESTHESIA MALE STERILIZATION - IP HOSP FEMALE STERILIZATION - IP HOSP MALE STERILIZATION - OP HOSP FEMALE STERILIZATION - OP HOSP MALE STERILIZATION - PHY FEMALE STERILIZATION - PHY MALE O Page 28

34 SURGERY TRANSPORTATION - AMBULANE VISION ARE - EXAMS & THERAPY VISION ARE - MATERIALS & FITTING ALOHOL AND DRUG RESIDENTIAL SERVIES NON-EMERGENT MEDIAL TRANSPORTATION Optional DENTAL DENTAL - ADJUNTIVE GENERAL DENTAL - ANESTHESIA SURGIAL DENTAL - DIAGNOSTI DENTAL - ENDODONTIS DENTAL - I/P FIXED DENTAL - MAXILLOFAIAL PROS DENTAL - ORAL SURGERY DENTAL - ORTHODONTIS DENTAL - PERIODONTIS DENTAL - PREVENTIVE DENTAL - PROS REMOVABLE DENTAL - RESTORATIVE HEMIAL DEPENDENY D SERVIES - ALTERNATIVE TO DETOX D SERVIES - METHADONE D SERVIES - OP MENTAL HEALTH MH SERVIES AUTE INPATIENT MH SERVIES ALTERNATIVE TO IP MH SERVIES ANILLARY SERVIES MH SERVIES ASSESS & EVAL MH SERVIES ASE MANAGEMENT MH SERVIES ONS ASSESS MH SERVIES ONSULTATION MH SERVIES FAMILY SUPPORT MH SERVIES INTENSIVE TREATMENT SVS MH SERVIES MED MANAGEMENT MH SERVIES OP TREATMENT MH SERVIES OTHER OP MH SERVIES PEO MH SERVIES PHYS IP MH SERVIES PHYS OP MH SERVIES SUPPORT DAY PROGRAM MH SERVIES ASSERTIVE OMMUNITY TREATMENT AND SUPPORTED EMPLOYMENT MH SERVIES HILDREN'S WRAPAROUND SERVIES Optional Page 29

35 Oregon Health Plan Medicaid Demonstration apitation Range Development for January 205 through December 205 oordinated are Organization (O) Enrollment as of April 204 Exhibit 2A Eligibility ategory Statewide Enrollment O-A (Physical Health, Mental Health, and Dental) O-B (Physical Health, and Mental Health) O-A or O-B (Physical Health) O-E (Mental Health Only) Temporary Assistance to Needy Families - Adults 44,96 4,999 59,95 40 Poverty Level Medical - Adults 9,62 3,048 2, hildren 0- (HIP, PLM, TANF hildren) 7,473 6,80 23, hildren -5 (HIP, PLM, TANF hildren) 80,24 27,096 07, hildren 6-8 (HIP, PLM, TANF hildren) 67,748 53,936 22,685,52 ABAD and OAA with Medicare 29,946 6,7 36,657 3,68 ABAD and OAA without Medicare 37,32 9,664 46, Foster hildren (AF) 9,908 3,77 3, AA Adults ,84 32,03 62, AA Adults ,308,706 56,04 85 AA Adults ,432 9,526 44, Total 606,999 78, ,072 8,973 Page 30

36 Oregon Health Plan Medicaid Demonstration apitation Range Development for January 205 through December 205 Physical Health and Mental Health Enrollment (O A or O B) as of April 204 Exhibit 2B O TANF PLMA hildren 0 hildren 5 hildren 6 8 Dual Eligible ABAD & OAA Non Dual ascade Health Alliance, LL, ,826 3, ,373 olumbia-pacific O, LL, ,922 6,30 626, ,957 2,02,78 22,789 DIPA, LL. Abn Umpqua Health Alliance 2, ,733 5,746,392, ,08,890,587 23,862 Eastern Oregon oordinated are Org., LL 3, ,598 6,97 2,978,350 2, ,5 2,698 2,3 4,9 Familyare, Inc 6,040,778 3,276 3,560 24,027,327 3,02,436 26,47 7,905 6,036 94,823 Health Share of Oregon 4,895 2,883 5,65 27,544 60,563 4,737 4,849 2,864 38,68 2,882 0,00 205,550 Interommunity Health Network, Inc 3,95 70,384 6,343 2,758 2,93 3, ,677 3,566 2,885 48,626 Jackson ounty O, LL 2, ,529 7, , ,824,733,473 25,736 Mid-Rogue Independent Physician Association, Inc 3,87 885,429 5,630 0,5,804 2, ,528 3,69 3,68 43,545 PacificSource ommunity Solutions, Inc (entral) 3, ,369 5,953 3,736,78, ,364 3,674 3,08 46,859 PacificSource ommunity Solutions, Inc (Gorge) ,667 3, , ,084 Primary Health of Josephine ounty, LL , , ,44 Trillium ommunity Health Plan, Inc 5,620,337 2,086 8,88 8,892 3,63 5,523,877 7,36 5,663 4,726 75,293 Western Oregon Advanced Health, LL, ,96 4,04,55, ,964,790,505 8,467 Willamette Valley ommunity Health, LL 6,474,324 2,843 3,898 28,278 4,08 4,647,383 5,326 5,4 3,694 87,086 Yamhill ounty are Organization, Inc, ,063 6, ,894,378,03 9,626 Total 59,95 2,669 23,652 07,336 22,685 36,657 46,976 3,085 62,845 56,04 44, ,072 AF AA 9 44 AA AA Total Page 3

37 Oregon Health Plan Medicaid Demonstration apitation Range Development for January 205 through December 205 Physical Health and Mental Health Enrollment (O A or O B) as of April 204 Exhibit 2B O Jackson, Josephine, and Douglas ounties (JJD) Lane ounty Linn, Benton, Marion, Polk and Yamhill ounties (LBMPY) lackamas, Multnomah and Washington ounties (Tri ounty) oastal entral Eastern Total ascade Health Alliance, LL ,373 0,373 olumbia-pacific O, LL, , ,789 DIPA, LL. Abn Umpqua Health Alliance 23, ,862 Eastern Oregon oordinated are Org., LL ,9 4,9 Familyare, Inc , ,823 Health Share of Oregon , ,550 Interommunity Health Network, Inc ,823-0, ,626 Jackson ounty O, LL 25, ,736 Mid-Rogue Independent Physician Association, Inc 4, , ,545 PacificSource ommunity Solutions, Inc (entral) , ,859 PacificSource ommunity Solutions, Inc (Gorge) ,084 -,084 Primary Health of Josephine ounty, LL 9, ,44 Trillium ommunity Health Plan, Inc - 75, ,293 Western Oregon Advanced Health, LL , ,467 Willamette Valley ommunity Health, LL , ,086 Yamhill ounty are Organization, Inc - - 9, ,626 Total 02,23 75,293 44, ,373 52,520 57,552 52, ,072 Page 32

38 Oregon Health Plan Medicaid Demonstration 205 Statewide Ranges and omparison of January 205 and October 204 apitation s Excludes Maternity; Includes Dental Services s Exhibit 3A Statewide Ranges and Payment s Eligibility ategory January 205 End January 205 End January 205 October 204 Temporary Assistance to Needy Families - Adults $ $ $ $ % Poverty Level Medical - Adults $ $ $ $ % hildren 0- (HIP, PLM, TANF hildren) $ $68.9 $ $ % hildren -5 (HIP, PLM, TANF hildren) $32.98 $39.85 $34.99 $ % hildren 6-8 (HIP, PLM, TANF hildren) $52.79 $6.28 $55.64 $ % ABAD and OAA, with Medicare $ $ $ $ % ABAD and OAA, without Medicare $,246.4 $,35.07 $, $, % Foster hildren (AF) $57.62 $54.24 $ $ % AA - Adults 9-44 $ $ $ $ % AA - Adults $ $79.0 $693.2 $ % AA - Adults $ $ $ $ % Weighted Average $ $48.57 $ $ % Weighted average capitation rates are based on April 204 enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 33

39 Oregon Health Plan Medicaid Demonstration omparison of January 205 and October 204 apitation s Excludes Maternity; Excludes Dental Services Exhibit 3B Statewide Ranges and Payment s Eligibility ategory January 205 End January 205 End January 205 October 204 Temporary Assistance to Needy Families - Adults $ $420.2 $ $ % Poverty Level Medical - Adults $ $ $ $ % hildren 0- (HIP, PLM, TANF hildren) $ $68.58 $ $ % hildren -5 (HIP, PLM, TANF hildren) $4.06 $20.07 $5.60 $4.47.0% hildren 6-8 (HIP, PLM, TANF hildren) $30.00 $36.86 $3.74 $ % ABAD and OAA, with Medicare $2.9 $ $23.43 $ % ABAD and OAA, without Medicare $,22.62 $, $, $, % Foster hildren (AF) $ $56.52 $ $ % AA - Adults 9-44 $ $ $ $ % AA - Adults $ $ $ $ % AA - Adults $ $ $742.6 $ % Weighted Average $ $ $ $ % Weighted average capitation rates are based on April 204 enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 34

40 Oregon Health Plan Medicaid Demonstration Exhibit 4 omparison of January 205 and October 204 apitation s Physical Health Services, Mental Health Services, and Dental Services (O-A) ascade Health Alliance, LL. Aid ategory Eastern Temporary Assistance to Needy Families - Adults $ $ 37.0 $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ 56.3 $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 85.9 $ 97.3 $ $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $,58.04 $, $,26.46 $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 8.7% 205 Range vs. #N/A 205 vs. 2.7% 205 vs. #N/A 205 vs. -6.7% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 35

41 Oregon Health Plan Medicaid Demonstration Exhibit 4 omparison of January 205 and October 204 apitation s Physical Health Services, Mental Health Services, and Dental Services (O-A) olumbia-pacific O, LL. Aid ategory oastal JJD Temporary Assistance to Needy Families - Adults $ $ $ $ % $ $ $ $ % Poverty Level Medical - Adults $ $ $ $ % $ $ $ $ % hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % hildren -5 (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % ABAD and OAA, with Medicare $ $ $ $ % $ $ $ $ % ABAD and OAA, without Medicare $, $, $, $, % $, $, $, $, % Foster hildren (AF) $ $ $ $ % $ $ $ $ % AA - Adults 9-44 $ $ $ $ % $ $ $ $ % AA - Adults $ $ $ $ % $ $ $ $ % AA - Adults $ $ $ $ % $ $ $ $ % Weighted Average $ $ 4.50 $ $ % $ $ $ $ % 205 Range vs. 8.5% 205 Range vs. 8.6% 205 vs..2% 205 vs..3% 205 vs. -7.2% 205 vs. -7.2% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 36

42 Oregon Health Plan Medicaid Demonstration Exhibit 4 omparison of January 205 and October 204 apitation s Physical Health Services, Mental Health Services, and Dental Services (O-A) DIPA, LL. Abn Umpqua Health Alliance Aid ategory JJD Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ 476. $ 50.3 $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 38.7 $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 80.8 $ 9.22 $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ 53.9 $ 6.38 $ 59.9 $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $,66.82 $,292.9 $, $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $,040.2 $, $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ 39.0 $ $ 47.5 $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 8.3% 205 Range vs. #N/A 205 vs. 6.7% 205 vs. #N/A 205 vs. -.5% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 37

43 Oregon Health Plan Medicaid Demonstration Exhibit 4 omparison of January 205 and October 204 apitation s Physical Health Services, Mental Health Services, and Dental Services (O-A) Eastern Oregon oordinated are Org., LL. Aid ategory Eastern Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 56.4 $ $ 59.8 $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ 8.27 $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $, $, $, $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 5.7% 205 Range vs. #N/A 205 vs. 2.4% 205 vs. #N/A 205 vs. -3.2% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 38

44 Oregon Health Plan Medicaid Demonstration Exhibit 4 omparison of January 205 and October 204 apitation s Physical Health Services, Mental Health Services, and Dental Services (O-A) Familyare, Inc. Aid ategory Tri-ounty Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ 53.7 $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ 5.8 $ $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ 64.6 $ 6.60 $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $,05.3 $,3.48 $,8.93 $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 5.2% 205 Range vs. #N/A 205 vs. 3.8% 205 vs. #N/A 205 vs. -.4% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 39

45 Oregon Health Plan Medicaid Demonstration Exhibit 4 omparison of January 205 and October 204 apitation s Physical Health Services, Mental Health Services, and Dental Services (O-A) Health Share of Oregon Aid ategory Tri-ounty Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 37.3 $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $,340.5 $, $, $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ 49.4 $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 5.6% 205 Range vs. #N/A 205 vs..2% 205 vs. #N/A 205 vs. -4.3% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 40

46 Oregon Health Plan Medicaid Demonstration Exhibit 4 omparison of January 205 and October 204 apitation s Physical Health Services, Mental Health Services, and Dental Services (O-A) Interommunity Health Network, Inc. Aid ategory LBMPY oastal Temporary Assistance to Needy Families - Adults $ 44.0 $ $ $ % $ 44.0 $ $ $ % Poverty Level Medical - Adults $ $ $ $ % $ $ $ $ % hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % hildren -5 (HIP, PLM, TANF hildren) $.98 $ 7.26 $ 2.68 $ % $.98 $ 7.26 $ 2.68 $ % hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % ABAD and OAA, with Medicare $ $ $ $ % $ $ $ $ % ABAD and OAA, without Medicare $, $, $, $, % $, $, $, $, % Foster hildren (AF) $ $ $ $ % $ $ $ $ % AA - Adults 9-44 $ $ $ $ % $ $ $ $ % AA - Adults $ $ $ $ % $ $ $ $ % AA - Adults $ $ $ $ % $ $ $ $ % Weighted Average $ $ $ $ % $ $ $ $ % 205 Range vs. 6.% 205 Range vs. 6.2% 205 vs..6% 205 vs..7% 205 vs. -4.4% 205 vs. -4.5% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 4

47 Oregon Health Plan Medicaid Demonstration Exhibit 4 omparison of January 205 and October 204 apitation s Physical Health Services, Mental Health Services, and Dental Services (O-A) Jackson ounty O, LL. Aid ategory JJD Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ 0.75 $ 0.83 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $,95.94 $, $, $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 8.7% 205 Range vs. #N/A 205 vs. 8.7% 205 vs. #N/A 205 vs. 0.0% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 42

48 Oregon Health Plan Medicaid Demonstration Exhibit 4 omparison of January 205 and October 204 apitation s Physical Health Services, Mental Health Services, and Dental Services (O-A) Mid-Rogue Independent Physician Association, Inc. abn Allare Health Plan, Inc. Aid ategory JJD oastal Temporary Assistance to Needy Families - Adults $ 404. $ $ $ % $ 404. $ $ $ % Poverty Level Medical - Adults $ $ $ $ % $ $ $ $ % hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % hildren -5 (HIP, PLM, TANF hildren) $ $ 43.3 $ 43.2 $ % $ $ 43.3 $ 43.2 $ % hildren 6-8 (HIP, PLM, TANF hildren) $ 64.3 $ $ $ % $ 64.3 $ $ $ % ABAD and OAA, with Medicare $ $ $ $ % $ $ $ $ % ABAD and OAA, without Medicare $,79.80 $,284.3 $, $, % $,79.88 $,284.2 $, $, % Foster hildren (AF) $ $ $ $ % $ $ $ $ % AA - Adults 9-44 $ $ $ $ % $ $ $ $ % AA - Adults $ $ $ $ % $ $ $ $ % AA - Adults $ $ $ $ % $ $ $ $ % Weighted Average $ $ $ $ % $ $ $ $ % 205 Range vs. 6.% 205 Range vs. 6.5% 205 vs. 6.% 205 vs. 6.5% 205 vs. 0.0% 205 vs. 0.0% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 43

49 Oregon Health Plan Medicaid Demonstration Exhibit 4 omparison of January 205 and October 204 apitation s Physical Health Services, Mental Health Services, and Dental Services (O-A) PacificSource ommunity Solutions, Inc. (entral Oregon) Aid ategory entral Eastern Temporary Assistance to Needy Families - Adults $ $ $ $ % $ $ $ $ % Poverty Level Medical - Adults $ $ $ $ % $ $ $ $ % hildren 0- (HIP, PLM, TANF hildren) $ 6.97 $ $ 6.98 $ % $ 6.97 $ $ 6.98 $ % hildren -5 (HIP, PLM, TANF hildren) $ 39.2 $ $ $ % $ 39.2 $ $ $ % hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % ABAD and OAA, with Medicare $ $ $ $ % $ $ 7.75 $ 64.8 $ % ABAD and OAA, without Medicare $, $, $,59.25 $, % $, $, $,58.60 $, % Foster hildren (AF) $ $ $ $ % $ $ $ $ % AA - Adults 9-44 $ $ $ $ % $ $ $ $ % AA - Adults $ $ $ $ % $ $ $ $ % AA - Adults $ $ $ $ % $ $ $ $ % Weighted Average $ $ $ $ % $ $ $ $ % 205 Range vs. 6.5% 205 Range vs. 7.6% 205 vs..9% 205 vs. 2.9% 205 vs. -4.5% 205 vs. -4.6% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 44

50 Oregon Health Plan Medicaid Demonstration Exhibit 4 omparison of January 205 and October 204 apitation s Physical Health Services, Mental Health Services, and Dental Services (O-A) PacificSource ommunity Solutions, Inc. (olumbia Gorge) Aid ategory entral Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ 76.8 $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $, $, $, $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 2.3% 205 Range vs. #N/A 205 vs. 4.7% 205 vs. #N/A 205 vs. -7.3% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 45

51 Oregon Health Plan Medicaid Demonstration Exhibit 4 omparison of January 205 and October 204 apitation s Physical Health Services, Mental Health Services, and Dental Services (O-A) Primary Health of Josephine ounty, LL Aid ategory JJD Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ 33.9 $ $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $ 974. $,66.4 $,43.83 $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ 3.5 $ 33.7 $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ 6.8 $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 0.4% 205 Range vs. #N/A 205 vs. 8.3% 205 vs. #N/A 205 vs. -2.0% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 46

52 Oregon Health Plan Medicaid Demonstration Exhibit 4 omparison of January 205 and October 204 apitation s Physical Health Services, Mental Health Services, and Dental Services (O-A) Trillium ommunity Health Plan, Inc. Aid ategory Lane Temporary Assistance to Needy Families - Adults $ $ 4.72 $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ 34. $ $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ 6.69 $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $,80.8 $, $,23.54 $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 5.5% 205 Range vs. #N/A 205 vs..5% 205 vs. #N/A 205 vs. -3.9% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 47

53 Oregon Health Plan Medicaid Demonstration Exhibit 4 omparison of January 205 and October 204 apitation s Physical Health Services, Mental Health Services, and Dental Services (O-A) Western Oregon Advanced Health, LL Aid ategory oastal Temporary Assistance to Needy Families - Adults $ $ 4.47 $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ $ 4.92 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 6.76 $ 7.67 $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $,35.98 $, $,89.96 $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $, $, $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 8.6% 205 Range vs. #N/A 205 vs. 2.4% 205 vs. #N/A 205 vs. -6.0% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 48

54 Oregon Health Plan Medicaid Demonstration Exhibit 4 omparison of January 205 and October 204 apitation s Physical Health Services, Mental Health Services, and Dental Services (O-A) Willamette Valley ommunity Health, LL Aid ategory LBMPY Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ 64.6 $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 2.37 $ $ 23. $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ 4.37 $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $,4.78 $,222.7 $,83.48 $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 5.3% 205 Range vs. #N/A 205 vs. 2.2% 205 vs. #N/A 205 vs. -3.0% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 49

55 Oregon Health Plan Medicaid Demonstration Exhibit 4 omparison of January 205 and October 204 apitation s Physical Health Services, Mental Health Services, and Dental Services (O-A) Yamhill ounty are Organization, Inc. Aid ategory LBMPY Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 53.4 $ 65.9 $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $, $,58.79 $,4.55 $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ 74.2 $ 8.22 $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 8.7% 205 Range vs. #N/A 205 vs..4% 205 vs. #N/A 205 vs. -7.2% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 50

56 Oregon Health Plan Medicaid Demonstration Exhibit 5 omparison of January 205 and October 204 apitation s Physical Health Services and Mental Health Services (O-B) ascade Health Alliance, LL. Aid ategory Eastern Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $,35.24 $, $,9.67 $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ 54.4 $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 8.7% 205 Range vs. #N/A 205 vs..4% 205 vs. #N/A 205 vs. -7.2% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 5

57 Oregon Health Plan Medicaid Demonstration Exhibit 5 omparison of January 205 and October 204 apitation s Physical Health Services and Mental Health Services (O-B) olumbia-pacific O, LL. Aid ategory oastal JJD Temporary Assistance to Needy Families - Adults $ $ $ $ % $ $ $ $ % Poverty Level Medical - Adults $ $ $ $ % $ $ $ $ % hildren 0- (HIP, PLM, TANF hildren) $ $ 86.9 $ $ % $ $ 86.9 $ $ % hildren -5 (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % ABAD and OAA, with Medicare $ $ $ $ % $ $ 27.4 $ $ % ABAD and OAA, without Medicare $,28.3 $,40.03 $,30.54 $, % $,28.40 $,40. $,30.63 $, % Foster hildren (AF) $ $ $ $ % $ $ $ $ % AA - Adults 9-44 $ $ $ $ % $ $ $ $ % AA - Adults $ $ $ $ % $ $ $ $ % AA - Adults $ $ $ $ % $ $ $ $ % Weighted Average $ $ $ 36.3 $ % $ $ $ $ % 205 Range vs. 8.6% 205 Range vs. 8.7% 205 vs. 0.8% 205 vs..0% 205 vs. -7.7% 205 vs. -7.7% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 52

58 Oregon Health Plan Medicaid Demonstration Exhibit 5 omparison of January 205 and October 204 apitation s Physical Health Services and Mental Health Services (O-B) DIPA, LL. Abn Umpqua Health Alliance Aid ategory JJD Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ 4.02 $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $,44.00 $, $, $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $, $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 8.3% 205 Range vs. #N/A 205 vs. 6.5% 205 vs. #N/A 205 vs. -.6% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 53

59 Oregon Health Plan Medicaid Demonstration Exhibit 5 omparison of January 205 and October 204 apitation s Physical Health Services and Mental Health Services (O-B) Eastern Oregon oordinated are Org., LL. Aid ategory Eastern Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ 52.5 $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ 0.24 $ $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ 4.72 $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $, $, $, $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ 84.0 $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ 35.5 $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 5.7% 205 Range vs. #N/A 205 vs. 2.% 205 vs. #N/A 205 vs. -3.5% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 54

60 Oregon Health Plan Medicaid Demonstration Exhibit 5 omparison of January 205 and October 204 apitation s Physical Health Services and Mental Health Services (O-B) Familyare, Inc. Aid ategory Tri-ounty Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ 67.7 $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 24.7 $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 3.86 $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ 23.6 $ 2.8 $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $, $,02.90 $,09.97 $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 5.2% 205 Range vs. #N/A 205 vs. 4.% 205 vs. #N/A 205 vs. -.0% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 55

61 Oregon Health Plan Medicaid Demonstration Exhibit 5 omparison of January 205 and October 204 apitation s Physical Health Services and Mental Health Services (O-B) Health Share of Oregon Aid ategory Tri-ounty Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 7.74 $ $ 7.74 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 5.58 $ $ 5.58 $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $,33.6 $, $,35.48 $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 5.5% 205 Range vs. #N/A 205 vs..3% 205 vs. #N/A 205 vs. -4.2% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 56

62 Oregon Health Plan Medicaid Demonstration Exhibit 5 omparison of January 205 and October 204 apitation s Physical Health Services and Mental Health Services (O-B) Interommunity Health Network, Inc. Aid ategory LBMPY oastal Temporary Assistance to Needy Families - Adults $ $ $ $ % $ $ $ $ 4.7.4% Poverty Level Medical - Adults $ $ $ $ % $ $ $ $ % hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % hildren -5 (HIP, PLM, TANF hildren) $ $ 98.8 $ $ % $ $ 98.8 $ $ % hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % ABAD and OAA, with Medicare $ $ $ $ % $ $ $ $ % ABAD and OAA, without Medicare $, $, $, $, % $, $, $,269.2 $, % Foster hildren (AF) $ $ $ $ % $ $ $ $ % AA - Adults 9-44 $ $ $ $ % $ $ $ $ % AA - Adults $ $ $ $ % $ $ $ $ % AA - Adults $ $ $ $ % $ $ $ $ % Weighted Average $ $ $ $ % $ $ 405. $ $ % 205 Range vs. 6.% 205 Range vs. 6.2% 205 vs..3% 205 vs..4% 205 vs. -4.7% 205 vs. -4.7% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 57

63 Oregon Health Plan Medicaid Demonstration Exhibit 5 omparison of January 205 and October 204 apitation s Physical Health Services and Mental Health Services (O-B) Jackson ounty O, LL. Aid ategory JJD Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 87.3 $ 9.67 $ 9.67 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ 22.9 $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $,73.29 $,33.2 $,33.2 $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 8.7% 205 Range vs. #N/A 205 vs. 8.7% 205 vs. #N/A 205 vs. 0.0% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 58

64 Oregon Health Plan Medicaid Demonstration Exhibit 5 omparison of January 205 and October 204 apitation s Physical Health Services and Mental Health Services (O-B) Mid-Rogue Independent Physician Association, Inc. abn Allare Health Plan, Inc. Aid ategory JJD oastal Temporary Assistance to Needy Families - Adults $ $ $ $ % $ $ $ $ % Poverty Level Medical - Adults $ $ $ $ % $ $ $ $ % hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % hildren -5 (HIP, PLM, TANF hildren) $ 8.5 $ $ $ % $ 8.5 $ $ $ % hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % ABAD and OAA, with Medicare $ $ $ $ % $ $ $ $ % ABAD and OAA, without Medicare $,56.83 $, $, $, % $,56.87 $, $, $, % Foster hildren (AF) $ $ $ $ % $ $ $ $ % AA - Adults 9-44 $ $ 407. $ 407. $ % $ $ 407. $ 407. $ % AA - Adults $ $ $ $ % $ $ $ $ % AA - Adults $ $ $ $ % $ $ $ $ % Weighted Average $ $ $ $ % $ $ $ $ % 205 Range vs. 6.0% 205 Range vs. 6.5% 205 vs. 6.0% 205 vs. 6.5% 205 vs. 0.0% 205 vs. 0.0% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 59

65 Oregon Health Plan Medicaid Demonstration Exhibit 5 omparison of January 205 and October 204 apitation s Physical Health Services and Mental Health Services (O-B) PacificSource ommunity Solutions, Inc. (entral Oregon) Aid ategory entral Eastern Temporary Assistance to Needy Families - Adults $ $ $ $ % $ $ $ $ % Poverty Level Medical - Adults $ $ $ $ % $ $ $ $ % hildren 0- (HIP, PLM, TANF hildren) $ 6.70 $ $ 6.70 $ % $ 6.70 $ $ 6.70 $ % hildren -5 (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % hildren 6-8 (HIP, PLM, TANF hildren) $ $ 63.8 $ $ % $ $ 63.8 $ $ % ABAD and OAA, with Medicare $ $ $ $ % $ 45.7 $ $ 45.7 $ % ABAD and OAA, without Medicare $,47.02 $, $,494.5 $, % $,46.72 $, $, $, % Foster hildren (AF) $ $ $ $ % $ $ $ $ % AA - Adults 9-44 $ $ $ $ % $ $ $ $ % AA - Adults $ $ $ $ % $ $ $ $ % AA - Adults $ $ $ $ % $ $ $ $ % Weighted Average $ $ $ $ % $ $ $ $ % 205 Range vs. 6.5% 205 Range vs. 7.6% 205 vs..6% 205 vs. 2.7% 205 vs. -4.9% 205 vs. -4.8% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 60

66 Oregon Health Plan Medicaid Demonstration Exhibit 5 omparison of January 205 and October 204 apitation s Physical Health Services and Mental Health Services (O-B) PacificSource ommunity Solutions, Inc. (olumbia Gorge) Aid ategory entral Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 38.2 $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ 74.7 $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $, $, $,75.03 $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ 77.5 $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ 69.2 $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ 37.0 $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 2.6% 205 Range vs. #N/A 205 vs. 4.4% 205 vs. #N/A 205 vs. -7.8% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 6

67 Oregon Health Plan Medicaid Demonstration Exhibit 5 omparison of January 205 and October 204 apitation s Physical Health Services and Mental Health Services (O-B) Primary Health of Josephine ounty, LL Aid ategory JJD Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 08.5 $ 4. $.54 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ 3.9 $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $ $,4.80 $,9. $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ 58.2 $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 0.6% 205 Range vs. #N/A 205 vs. 8.2% 205 vs. #N/A 205 vs. -2.2% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 62

68 Oregon Health Plan Medicaid Demonstration Exhibit 5 omparison of January 205 and October 204 apitation s Physical Health Services and Mental Health Services (O-B) Trillium ommunity Health Plan, Inc. Aid ategory Lane Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ 4.88 $ 0.00 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $,57.64 $, $,88.66 $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 5.4% 205 Range vs. #N/A 205 vs..% 205 vs. #N/A 205 vs. -4.2% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 63

69 Oregon Health Plan Medicaid Demonstration Exhibit 5 omparison of January 205 and October 204 apitation s Physical Health Services and Mental Health Services (O-B) Western Oregon Advanced Health, LL Aid ategory oastal Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ 48.8 $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $,3.6 $, $,65.6 $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $, $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 8.6% 205 Range vs. #N/A 205 vs. 2.% 205 vs. #N/A 205 vs. -6.4% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 64

70 Oregon Health Plan Medicaid Demonstration Exhibit 5 omparison of January 205 and October 204 apitation s Physical Health Services and Mental Health Services (O-B) Willamette Valley ommunity Health, LL Aid ategory LBMPY Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ 63.3 $ $ 69.2 $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 02.9 $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 3.52 $ 8.5 $ 4.58 $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $,8.92 $,97.72 $,58.93 $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 5.3% 205 Range vs. #N/A 205 vs..9% 205 vs. #N/A 205 vs. -3.3% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 65

71 Oregon Health Plan Medicaid Demonstration Exhibit 5 omparison of January 205 and October 204 apitation s Physical Health Services and Mental Health Services (O-B) Yamhill ounty are Organization, Inc. Aid ategory LBMPY Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 5.38 $ $ 5.38 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 3.89 $ $ 3.89 $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $,332.6 $, $,387.0 $, % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ 7.6 $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 8.9% 205 Range vs. #N/A 205 vs..0% 205 vs. #N/A 205 vs. -7.8% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 66

72 Oregon Health Plan Medicaid Demonstration Exhibit 6 omparison of January 205 and October 204 apitation s Mental Health Services (O-E) Includes NEMT Services ascade Health Alliance, LL. Aid ategory Eastern Temporary Assistance to Needy Families - Adults $ 42.0 $ $ 43.4 $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ 8. $ 9.89 $ 8.56 $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $.29 $.4 $.32 $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 5.2 $ 5.72 $ 5.34 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ 27.4 $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ 9.06 $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ 47.9 $ 5.84 $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ 5.72 $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 9.8% 205 Range vs. #N/A 205 vs. 2.5% 205 vs. #N/A 205 vs. -7.2% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 67

73 Oregon Health Plan Medicaid Demonstration Exhibit 6 omparison of January 205 and October 204 apitation s Mental Health Services (O-E) Includes NEMT Services as Newly Added Services olumbia-pacific O, LL. Aid ategory oastal JJD Temporary Assistance to Needy Families - Adults $ $ $ $ % $ $ $ $ % Poverty Level Medical - Adults $ 22.9 $ $ $ % $ 22.9 $ $ $ % hildren 0- (HIP, PLM, TANF hildren) $.33 $.45 $.34 $ % $.33 $.45 $.34 $ % hildren -5 (HIP, PLM, TANF hildren) $ 6.97 $ 7.57 $ 7.03 $ % $ 6.97 $ 7.57 $ 7.03 $ % hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % ABAD and OAA, with Medicare $ $ $ 96.8 $ % $ $ $ $ % ABAD and OAA, without Medicare $ $ $ $ % $ $ $ $ % Foster hildren (AF) $ 377. $ $ $ % $ 377. $ $ $ % AA - Adults 9-44 $ $ $ 58.9 $ % $ $ $ 58.9 $ % AA - Adults $ $ $ 76.9 $ % $ $ $ 76.9 $ % AA - Adults $ $ $ 84.5 $ % $ $ $ 84.5 $ % Weighted Average $ $ $ $ % $ $ $ $ % 205 Range vs. 8.6% 205 Range vs. 8.6% 205 vs. 0.8% 205 vs. 0.9% 205 vs. -7.7% 205 vs. -7.6% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 68

74 Oregon Health Plan Medicaid Demonstration Exhibit 6 omparison of January 205 and October 204 apitation s Mental Health Services (O-E) DIPA, LL. Abn Umpqua Health Alliance Aid ategory JJD Temporary Assistance to Needy Families - Adults $ $ 42.3 $ 4.64 $ % #N/A Poverty Level Medical - Adults $ 5.58 $ 6.99 $ 6.72 $ % hildren 0- (HIP, PLM, TANF hildren) $ 0.45 $ 0.50 $ 0.49 $ % hildren -5 (HIP, PLM, TANF hildren) $ 5.70 $ 6.2 $ 6. $ % hildren 6-8 (HIP, PLM, TANF hildren) $ $ 33.2 $ $ % ABAD and OAA, with Medicare $ $ $ $ % ABAD and OAA, without Medicare $ $ $ $ % Foster hildren (AF) $ $ $ $ % AA - Adults 9-44 $ $ $ 49.0 $ % AA - Adults $ $ $ 6.46 $ % AA - Adults $ $ 68.6 $ $ % Weighted Average $ $ $ $ % 205 Range vs. 9.0% 205 vs. 7.3% 205 vs. 205 vs. -.6% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 69

75 Oregon Health Plan Medicaid Demonstration Exhibit 6 omparison of January 205 and October 204 apitation s Mental Health Services (O-E) Includes NEMT Services Eastern Oregon oordinated are Org., LL. Aid ategory Eastern Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A Poverty Level Medical - Adults $ 8.9 $ 9.22 $ 8.57 $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $.07 $.3 $.09 $ % #N/A hildren -5 (HIP, PLM, TANF hildren) $ 6.44 $ 6.8 $ 6.58 $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A ABAD and OAA, with Medicare $ 9.95 $ 97.6 $ $ % #N/A ABAD and OAA, without Medicare $ 78.2 $ $ 8.88 $ % #N/A Foster hildren (AF) $ $ $ $ % #N/A AA - Adults 9-44 $ $ $ 56.5 $ % #N/A AA - Adults $ $ $ $ % #N/A AA - Adults $ $ $ $ % #N/A Weighted Average $ $ $ 5.0 $ % 205 Range vs. 5.7% 205 Range vs. 205 vs. 2.% 205 vs. 205 vs. -3.5% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 70

76 Oregon Health Plan Medicaid Demonstration Exhibit 6 omparison of January 205 and October 204 apitation s Mental Health Services (O-E) Includes NEMT Services as Newly Added Services Familyare, Inc. Aid ategory Tri-ounty Temporary Assistance to Needy Families - Adults $ 40.6 $ $ 4.79 $ % #N/A Poverty Level Medical - Adults $ 7.08 $ 7.96 $ 7.78 $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $. $.7 $.6 $ % #N/A hildren -5 (HIP, PLM, TANF hildren) $ 4.98 $ 5.24 $ 5.8 $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ 26.7 $ % #N/A ABAD and OAA, with Medicare $ $ 8.60 $ $ % #N/A ABAD and OAA, without Medicare $ $ $ 64.8 $ % #N/A Foster hildren (AF) $ $ $ $ % #N/A AA - Adults 9-44 $ $ $ $ % #N/A AA - Adults $ 6.20 $ $ $ % #N/A AA - Adults $ $ $ $ % #N/A Weighted Average $ $ 40.9 $ $ % 205 Range vs. 5.2% 205 Range vs. 205 vs. 4.% 205 vs. 205 vs. -.0% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 7

77 Oregon Health Plan Medicaid Demonstration Exhibit 6 omparison of January 205 and October 204 apitation s Mental Health Services (O-E) Includes NEMT Services as Newly Added Services Health Share of Oregon Aid ategory Tri-ounty Temporary Assistance to Needy Families - Adults $ 4.00 $ $ 4.52 $ % #N/A Poverty Level Medical - Adults $ 7.5 $ 8.48 $ 7.73 $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $. $.7 $.3 $ % #N/A hildren -5 (HIP, PLM, TANF hildren) $ 5.0 $ 5.39 $ 5.7 $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A ABAD and OAA, without Medicare $ 6. $ $ 63.3 $ % #N/A Foster hildren (AF) $ $ $ $ % #N/A AA - Adults 9-44 $ 46.8 $ $ $ % #N/A AA - Adults $ $ $ $ % #N/A AA - Adults $ 68.7 $ 7.95 $ $ % #N/A Weighted Average $ 49.8 $ 5.9 $ $ % 205 Range vs. 5.5% 205 Range vs. 205 vs..3% 205 vs. 205 vs. -4.2% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 72

78 Oregon Health Plan Medicaid Demonstration Exhibit 6 omparison of January 205 and October 204 apitation s Mental Health Services (O-E) Includes NEMT Services Interommunity Health Network, Inc. Aid ategory LBMPY oastal Temporary Assistance to Needy Families - Adults $ 5.0 $ 54.2 $ 5.68 $ % $ 5.0 $ 54.2 $ 5.68 $ % Poverty Level Medical - Adults $ 2.50 $ $ 2.78 $ % $ 2.50 $ $ 2.78 $ % hildren 0- (HIP, PLM, TANF hildren) $.38 $.46 $.40 $ % $.38 $.46 $.40 $ % hildren -5 (HIP, PLM, TANF hildren) $ 7.3 $ 7.57 $ 7.23 $ % $ 7.3 $ 7.57 $ 7.23 $ % hildren 6-8 (HIP, PLM, TANF hildren) $ 36. $ 38.3 $ $ % $ 36. $ 38.3 $ $ % ABAD and OAA, with Medicare $ $ 4.44 $ $ % $ $ 4.44 $ $ % ABAD and OAA, without Medicare $ $ $ $ % $ $ $ $ % Foster hildren (AF) $ $ $ $ % $ $ $ $ % AA - Adults 9-44 $ $ $ 6.30 $ % $ $ $ 6.30 $ % AA - Adults $ $ 84.8 $ $ % $ $ 84.8 $ $ % AA - Adults $ $ 92.5 $ $ % $ $ 92.5 $ $ % Weighted Average $ $ $ $ % $ $ 68.6 $ $ % 205 Range vs. 6.% 205 Range vs. 6.% 205 vs..3% 205 vs..2% 205 vs. -4.7% 205 vs. -4.8% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 73

79 Oregon Health Plan Medicaid Demonstration Exhibit 6 omparison of January 205 and October 204 apitation s Mental Health Services (O-E) Includes NEMT Services Jackson ounty O, LL. Aid ategory JJD Temporary Assistance to Needy Families - Adults $ $ 59.3 $ 59.3 $ % #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $.33 $.46 $.46 $ % #N/A hildren -5 (HIP, PLM, TANF hildren) $ 7.09 $ 7.75 $ 7.75 $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ 40. $ 40. $ % #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A ABAD and OAA, without Medicare $ $ $ $ % #N/A Foster hildren (AF) $ $ $ $ % #N/A AA - Adults 9-44 $ 6.58 $ $ $ % #N/A AA - Adults $ $ $ $ % #N/A AA - Adults $ $ $ $ % #N/A Weighted Average $ $ $ $ % 205 Range vs. 9.3% 205 Range vs. 205 vs. 9.3% 205 vs. 205 vs. 0.0% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 74

80 Oregon Health Plan Medicaid Demonstration Exhibit 6 omparison of January 205 and October 204 apitation s Mental Health Services (O-E) Includes NEMT Services Mid-Rogue Independent Physician Association, Inc. abn Allare Health Plan, Inc. Aid ategory JJD oastal Temporary Assistance to Needy Families - Adults $ $ 5.4 $ 5.4 $ % $ $ 5.4 $ 5.4 $ % Poverty Level Medical - Adults $ $ 2.76 $ 2.76 $ % $ $ 2.76 $ 2.76 $ % hildren 0- (HIP, PLM, TANF hildren) $.27 $.35 $.35 $ % $.27 $.35 $.35 $ % hildren -5 (HIP, PLM, TANF hildren) $ 6.26 $ 6.64 $ 6.64 $ % $ 6.26 $ 6.64 $ 6.64 $ % hildren 6-8 (HIP, PLM, TANF hildren) $ 32.9 $ 34.4 $ 34.4 $ % $ 32.9 $ 34.4 $ 34.4 $ % ABAD and OAA, with Medicare $ 84.2 $ $ $ % $ 84.2 $ $ $ % ABAD and OAA, without Medicare $ $ $ $ % $ $ $ 79.3 $ % Foster hildren (AF) $ $ $ $ % $ $ $ $ % AA - Adults 9-44 $ $ $ $ % $ $ $ $ % AA - Adults $ 72.7 $ $ $ % $ 72.7 $ $ $ % AA - Adults $ $ $ $ % $ $ $ $ % Weighted Average $ $ $ $ % $ $ 60.0 $ $ % 205 Range vs. 6.0% 205 Range vs. 6.0% 205 vs. 6.0% 205 vs. 6.% 205 vs. 0.0% 205 vs. 0.0% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 75

81 Oregon Health Plan Medicaid Demonstration Exhibit 6 omparison of January 205 and October 204 apitation s Mental Health Services (O-E) PacificSource ommunity Solutions, Inc. (entral Oregon) Aid ategory entral Eastern Temporary Assistance to Needy Families - Adults $ 4.30 $ $ 4.94 $ % $ 4.30 $ $ 4.94 $ % Poverty Level Medical - Adults $ 6.69 $ 7.78 $ 6.95 $ % $ 6.69 $ 7.78 $ 6.95 $ % hildren 0- (HIP, PLM, TANF hildren) $ 0.49 $ 0.52 $ 0.49 $ % $ 0.49 $ 0.52 $ 0.49 $ % hildren -5 (HIP, PLM, TANF hildren) $ 6.0 $ 6.50 $ 6.20 $ % $ 6.0 $ 6.50 $ 6.20 $ % hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % ABAD and OAA, with Medicare $ $ 53.9 $ 5.4 $ % $ $ 53.9 $ $ % ABAD and OAA, without Medicare $ 5.98 $ 6.85 $ $ % $ 5.98 $ 6.85 $ $ % Foster hildren (AF) $ $ $ $ % $ $ $ $ % AA - Adults 9-44 $ $ 5.82 $ $ % $ $ 5.82 $ $ % AA - Adults $ 6.0 $ $ $ % $ 6.0 $ $ $ % AA - Adults $ $ 7.03 $ $ % $ $ 7.03 $ $ % Weighted Average $ 42.9 $ $ $ % $ $ 63.9 $ $ % 205 Range vs. 6.5% 205 Range vs. 6.5% 205 vs..6% 205 vs..3% 205 vs. -4.9% 205 vs. -5.% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 76

82 Oregon Health Plan Medicaid Demonstration Exhibit 6 omparison of January 205 and October 204 apitation s Mental Health Services (O-E) PacificSource ommunity Solutions, Inc. (olumbia Gorge) Aid ategory entral Temporary Assistance to Needy Families - Adults $ 4.6 $ 45.2 $ 4.94 $ % #N/A Poverty Level Medical - Adults $ 6.64 $ 8.28 $ 6.95 $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $ 0.48 $ 0.53 $ 0.49 $ - 0.0% #N/A hildren -5 (HIP, PLM, TANF hildren) $ 6.08 $ 6.68 $ 6.20 $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A ABAD and OAA, with Medicare $ $ 55.6 $ 5.59 $ % #N/A ABAD and OAA, without Medicare $ 5.38 $ $ $ % #N/A Foster hildren (AF) $ $ $ $ % #N/A AA - Adults 9-44 $ $ $ $ % #N/A AA - Adults $ $ $ $ % #N/A AA - Adults $ $ $ $ % #N/A Weighted Average $ $ $ $ % 205 Range vs. 9.9% 205 Range vs. 205 vs..9% 205 vs. 205 vs. -7.8% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 77

83 Oregon Health Plan Medicaid Demonstration Exhibit 6 omparison of January 205 and October 204 apitation s Mental Health Services (O-E) Primary Health of Josephine ounty, LL Aid ategory JJD Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A Poverty Level Medical - Adults $ 8.32 $ $ $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $ 0.53 $ 0.60 $ 0.58 $ % #N/A hildren -5 (HIP, PLM, TANF hildren) $ 6.70 $ 7.49 $ 7.33 $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ 39. $ % #N/A ABAD and OAA, with Medicare $ $ 58.7 $ $ % #N/A ABAD and OAA, without Medicare $ $ 8.96 $ 78. $ % #N/A Foster hildren (AF) $ $ $ $ % #N/A AA - Adults 9-44 $ $ 59.9 $ $ % #N/A AA - Adults $ $ 75.8 $ $ % #N/A AA - Adults $ $ $ $ % #N/A Weighted Average $ $ $ $ % 205 Range vs..9% 205 Range vs. 205 vs. 9.5% 205 vs. 205 vs. -2.2% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 78

84 Oregon Health Plan Medicaid Demonstration Exhibit 6 omparison of January 205 and October 204 apitation s Mental Health Services (O-E) Includes NEMT Services Trillium ommunity Health Plan, Inc. Aid ategory Lane Temporary Assistance to Needy Families - Adults $ 47.0 $ $ $ % #N/A Poverty Level Medical - Adults $ 9.73 $ $ 9.96 $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $ 2.05 $ 2.6 $ 2.07 $ % #N/A hildren -5 (HIP, PLM, TANF hildren) $ 6.8 $ 7.8 $ 6.89 $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A ABAD and OAA, with Medicare $ 99.6 $ 04.5 $ $ % #N/A ABAD and OAA, without Medicare $ $ 93.6 $ $ % #N/A Foster hildren (AF) $ $ $ $ % #N/A AA - Adults 9-44 $ 56. $ 59.4 $ $ % #N/A AA - Adults $ $ $ 74.3 $ % #N/A AA - Adults $ $ $ 8.3 $ % #N/A Weighted Average $ $ $ $ % 205 Range vs. 5.4% 205 Range vs. 205 vs..% 205 vs. 205 vs. -4.2% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 79

85 Oregon Health Plan Medicaid Demonstration Exhibit 6 omparison of January 205 and October 204 apitation s Mental Health Services (O-E) Western Oregon Advanced Health, LL Aid ategory oastal Temporary Assistance to Needy Families - Adults $ $ 37.6 $ $ % #N/A Poverty Level Medical - Adults $ 3.6 $ 4.90 $ 4.0 $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $ 0.40 $ 0.43 $ 0.4 $ % #N/A hildren -5 (HIP, PLM, TANF hildren) $ 4.98 $ 5.45 $ 5.2 $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A ABAD and OAA, with Medicare $ $ 46.9 $ 44.0 $ % #N/A ABAD and OAA, without Medicare $ $ $ 3.66 $ % #N/A Foster hildren (AF) $ $ $ $ % #N/A AA - Adults 9-44 $ $ 44.8 $ 4.54 $ % #N/A AA - Adults $ $ $ 5.97 $ % #N/A AA - Adults $ $ $ $ % #N/A Weighted Average $ $ $ 5.73 $ % 205 Range vs. 9.5% 205 Range vs. 205 vs. 2.9% 205 vs. 205 vs. -6.4% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 80

86 Oregon Health Plan Medicaid Demonstration Exhibit 6 omparison of January 205 and October 204 apitation s Mental Health Services (O-E) Includes NEMT Services Willamette Valley ommunity Health, LL Aid ategory LBMPY Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A Poverty Level Medical - Adults $ 8.94 $ 9.94 $ 9.30 $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $.6 $.22 $.8 $ % #N/A hildren -5 (HIP, PLM, TANF hildren) $ 6.45 $ 6.79 $ 6.57 $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A ABAD and OAA, without Medicare $ 75.3 $ $ $ % #N/A Foster hildren (AF) $ $ $ $ % #N/A AA - Adults 9-44 $ $ $ $ % #N/A AA - Adults $ 7.26 $ 75.0 $ 72.6 $ % #N/A AA - Adults $ $ $ $ % #N/A Weighted Average $ 5.07 $ $ $ % 205 Range vs. 5.3% 205 Range vs. 205 vs..9% 205 vs. 205 vs. -3.3% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 8

87 Oregon Health Plan Medicaid Demonstration Exhibit 6 omparison of January 205 and October 204 apitation s Mental Health Services (O-E) Yamhill ounty are Organization, Inc. Aid ategory LBMPY Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A Poverty Level Medical - Adults $ 9. $ 20.8 $ 9.30 $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $.7 $.27 $.8 $ % #N/A hildren -5 (HIP, PLM, TANF hildren) $ 6.50 $ 7.08 $ 6.57 $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 33.3 $ $ $ % #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A ABAD and OAA, without Medicare $ $ $ $ % #N/A Foster hildren (AF) $ $ $ $ % #N/A AA - Adults 9-44 $ $ $ $ % #N/A AA - Adults $ 7.88 $ $ 72.6 $ % #N/A AA - Adults $ $ $ $ % #N/A Weighted Average $ 45.6 $ 49.7 $ 45.6 $ % 205 Range vs. 8.9% 205 Range vs. 205 vs..0% 205 vs. 205 vs. -7.8% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 82

88 Oregon Health Plan Medicaid Demonstration Exhibit 7 omparison of January 205 and October 204 apitation s Dental Services (O-F) Includes NEMT Services ascade Health Alliance, LL. Aid ategory Eastern Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $.20 $.2 $.2 $.8 2.8% #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 8.9 $ 9.53 $ 9.6 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 22.3 $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ 6.89 $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $ $ 54.2 $ 54.3 $ % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ 26.4 $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ 4.4 $ $ 43.0 $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ 3.0 $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 4.6% 205 Range vs. #N/A 205 vs. 5.0% 205 vs. #N/A 205 vs. 0.3% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 83

89 Oregon Health Plan Medicaid Demonstration Exhibit 7 omparison of January 205 and October 204 apitation s Dental Services (O-F) Includes NEMT Services as Newly Added Services olumbia-pacific O, LL. Aid ategory oastal JJD Temporary Assistance to Needy Families - Adults $ $ 32.5 $ $ % $ $ 32.5 $ $ % Poverty Level Medical - Adults $ 33.8 $ $ $ % $ 33.8 $ $ $ % hildren 0- (HIP, PLM, TANF hildren) $.0 $. $. $ % $.0 $. $. $ % hildren -5 (HIP, PLM, TANF hildren) $ 9.04 $ 9.66 $ 9.74 $ % $ 9.04 $ 9.66 $ 9.74 $ % hildren 6-8 (HIP, PLM, TANF hildren) $ 22.6 $ $ $ % $ 22.6 $ $ $ % ABAD and OAA, with Medicare $ $ $ $ % $ $ $ 64.5 $ % ABAD and OAA, without Medicare $ $ $ $ % $ $ $ $ % Foster hildren (AF) $ 26.4 $ 27.9 $ $ % $ 26.4 $ 27.9 $ $ % AA - Adults 9-44 $ 3.95 $ 33.7 $ 34.0 $ % $ 3.95 $ 33.7 $ 34.0 $ % AA - Adults $ 38.0 $ $ $ % $ 38.0 $ $ $ % AA - Adults $ $ 45.3 $ $ % $ $ 45.3 $ $ % Weighted Average $ $ 29.3 $ $ % $ $ 3.5 $ 3.62 $ % 205 Range vs. 5.0% 205 Range vs. 4.7% 205 vs. 5.3% 205 vs. 5.% 205 vs. 0.4% 205 vs. 0.4% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 84

90 Oregon Health Plan Medicaid Demonstration Exhibit 7 omparison of January 205 and October 204 apitation s Dental Services (O-F) DIPA, LL. Abn Umpqua Health Alliance Aid ategory JJD Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ 30.6 $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ 0.27 $ 0.28 $ 0.28 $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 8.46 $ 9.08 $ 9.6 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 2.25 $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ 9.00 $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ 24.2 $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ 27.7 $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ 29.5 $ 3.74 $ 3.80 $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ 2.7 $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 6.6% 205 Range vs. #N/A 205 vs. 7.2% 205 vs. #N/A 205 vs. 0.5% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 85

91 Oregon Health Plan Medicaid Demonstration Exhibit 7 omparison of January 205 and October 204 apitation s Dental Services (O-F) Includes NEMT Services Eastern Oregon oordinated are Org., LL. Aid ategory Eastern Temporary Assistance to Needy Families - Adults $ $ 3.72 $ 3.84 $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ 0.88 $ 0.88 $ 0.89 $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 8.99 $ 9.6 $ 9.69 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 22.5 $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ 6.59 $ 62.9 $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ 27.8 $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 5.0% 205 Range vs. #N/A 205 vs. 5.4% 205 vs. #N/A 205 vs. 0.4% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 86

92 Oregon Health Plan Medicaid Demonstration Exhibit 7 omparison of January 205 and October 204 apitation s Dental Services (O-F) Includes NEMT Services as Newly Added Services Familyare, Inc. Aid ategory Tri-ounty Temporary Assistance to Needy Families - Adults $ 38.8 $ $ 38.3 $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ 38.5 $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $.5 $.6 $.5 $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 9.86 $ 2.3 $ 9.95 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $ 66.9 $ $ $ % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ 38.3 $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ 49.7 $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ 3.03 $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 5.0% 205 Range vs. #N/A 205 vs. 0.4% 205 vs. #N/A 205 vs. -4.6% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 87

93 Oregon Health Plan Medicaid Demonstration Exhibit 7 omparison of January 205 and October 204 apitation s Dental Services (O-F) Includes NEMT Services as Newly Added Services Health Share of Oregon Aid ategory Tri-ounty Temporary Assistance to Needy Families - Adults $ $ 39.7 $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $.2 $.3 $.2 $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 9.85 $ 2.2 $ 9.93 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 25.8 $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ 6.95 $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $ 65.2 $ $ $ % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ 34.8 $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 4.5% 205 Range vs. #N/A 205 vs. 0.4% 205 vs. #N/A 205 vs. -4.% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 88

94 Oregon Health Plan Medicaid Demonstration Exhibit 7 omparison of January 205 and October 204 apitation s Dental Services (O-F) Includes NEMT Services Interommunity Health Network, Inc. Aid ategory LBMPY oastal Temporary Assistance to Needy Families - Adults $ 3.43 $ $ $ % $ 3.43 $ $ $ % Poverty Level Medical - Adults $ 3.95 $ 34. $ $ % $ 3.95 $ 34. $ $ % hildren 0- (HIP, PLM, TANF hildren) $.4 $.4 $.5 $ % $.4 $.4 $.5 $ % hildren -5 (HIP, PLM, TANF hildren) $ 9.0 $ 9.62 $ 9.7 $ % $ 9.0 $ 9.62 $ 9.7 $ % hildren 6-8 (HIP, PLM, TANF hildren) $ 22.2 $ $ $ % $ 22.2 $ $ $ % ABAD and OAA, with Medicare $ $ 75.9 $ $ % $ $ $ $ % ABAD and OAA, without Medicare $ $ $ $ % $ $ $ $ % Foster hildren (AF) $ $ $ $ % $ $ $ $ % AA - Adults 9-44 $ $ 34.6 $ $ % $ $ 34.6 $ $ % AA - Adults $ $ 4.45 $ 4.48 $ % $ $ 4.45 $ 4.48 $ % AA - Adults $ $ $ 47.0 $ % $ $ $ 47.0 $ % Weighted Average $ $ $ $ % $ $ 3.3 $ 3.24 $ % 205 Range vs. 4.5% 205 Range vs. 4.7% 205 vs. 4.8% 205 vs. 5.% 205 vs. 0.3% 205 vs. 0.3% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 89

95 Oregon Health Plan Medicaid Demonstration Exhibit 7 omparison of January 205 and October 204 apitation s Dental Services (O-F) Includes NEMT Services Jackson ounty O, LL. Aid ategory JJD Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ 33.3 $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $.4 $.5 $.5 $.2 2.9% #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 8.88 $ 9.50 $ 9.58 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ 60.8 $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ 25.5 $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ 35.0 $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ 40.7 $ 42.2 $ 42.5 $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 4.9% 205 Range vs. #N/A 205 vs. 5.3% 205 vs. #N/A 205 vs. 0.4% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 90

96 Oregon Health Plan Medicaid Demonstration Exhibit 7 omparison of January 205 and October 204 apitation s Dental Services (O-F) Includes NEMT Services Mid-Rogue Independent Physician Association, Inc. abn Allare Health Plan, Inc. Aid ategory JJD oastal Temporary Assistance to Needy Families - Adults $ $ $ $ % $ $ $ $ % Poverty Level Medical - Adults $ 33.2 $ $ 35.5 $ % $ 33.2 $ $ 35.5 $ % hildren 0- (HIP, PLM, TANF hildren) $.3 $.4 $.4 $.2.5% $.3 $.4 $.4 $ % hildren -5 (HIP, PLM, TANF hildren) $ 8.88 $ 9.50 $ 9.58 $ % $ 8.88 $ 9.50 $ 9.58 $ % hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % ABAD and OAA, with Medicare $ $ $ $ % $ $ $ 60.5 $ % ABAD and OAA, without Medicare $ $ 5.89 $ $ % $ $ 5.94 $ $ % Foster hildren (AF) $ $ $ 26. $ % $ $ $ 26. $ % AA - Adults 9-44 $ $ $ $ % $ $ $ $ % AA - Adults $ $ 4.77 $ 4.80 $ % $ $ 4.77 $ 4.80 $ % AA - Adults $ $ 47.3 $ $ % $ $ 47.3 $ $ % Weighted Average $ 29.2 $ 30.5 $ $ % $ $ $ $ % 205 Range vs. 4.8% 205 Range vs. 4.9% 205 vs. 5.% 205 vs. 5.2% 205 vs. 0.3% 205 vs. 0.3% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 9

97 Oregon Health Plan Medicaid Demonstration Exhibit 7 omparison of January 205 and October 204 apitation s Dental Services (O-F) PacificSource ommunity Solutions, Inc. (entral Oregon) Aid ategory entral Eastern Temporary Assistance to Needy Families - Adults $ $ $ 27.0 $ % $ $ $ 27.0 $ % Poverty Level Medical - Adults $ $ 3.04 $ 3.8 $ % $ $ 3.04 $ 3.8 $ % hildren 0- (HIP, PLM, TANF hildren) $ 0.28 $ 0.28 $ 0.29 $ % $ 0.28 $ 0.28 $ 0.29 $ % hildren -5 (HIP, PLM, TANF hildren) $ 8.72 $ 9.35 $ 9.43 $ % $ 8.72 $ 9.35 $ 9.43 $ % hildren 6-8 (HIP, PLM, TANF hildren) $ 2.55 $ 23.8 $ $ % $ 2.55 $ 23.8 $ $ % ABAD and OAA, with Medicare $ 8.84 $ 20.8 $ $ % $ 7.73 $ 9.0 $ 9.09 $ % ABAD and OAA, without Medicare $ $ $ 25.0 $ % $ $ $ $ % Foster hildren (AF) $ $ $ $ % $ $ $ $ % AA - Adults 9-44 $ $ $ $ % $ $ $ $ % AA - Adults $ 26.2 $ 28. $ 28.2 $ % $ 26.2 $ 28. $ 28.2 $ % AA - Adults $ $ 32.9 $ $ % $ $ 32.9 $ $ % Weighted Average $ 2.8 $ $ $ % $ 2.82 $ $ $ % 205 Range vs. 6.6% 205 Range vs. 6.9% 205 vs. 7.2% 205 vs. 7.4% 205 vs. 0.5% 205 vs. 0.5% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 92

98 Oregon Health Plan Medicaid Demonstration Exhibit 7 omparison of January 205 and October 204 apitation s Dental Services (O-F) PacificSource ommunity Solutions, Inc. (olumbia Gorge) Aid ategory entral Temporary Assistance to Needy Families - Adults $ $ $ 27.0 $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ 3.04 $ 3.8 $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ 0.28 $ 0.28 $ 0.29 $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 8.72 $ 9.35 $ 9.43 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 2.55 $ 23.8 $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ 9.04 $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ 27. $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ 26.2 $ 28. $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ 32.9 $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ 22.3 $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 6.5% 205 Range vs. #N/A 205 vs. 7.% 205 vs. #N/A 205 vs. 0.5% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 93

99 Oregon Health Plan Medicaid Demonstration Exhibit 7 omparison of January 205 and October 204 apitation s Dental Services (O-F) Primary Health of Josephine ounty, LL Aid ategory JJD Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ 30.6 $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ 0.27 $ 0.28 $ 0.28 $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 8.46 $ 9.08 $ 9.6 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 2.25 $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ 8.9 $ 9.49 $ 9.57 $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ 24.2 $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ 27.7 $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ 29.5 $ 3.74 $ 3.80 $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ 2.4 $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 6.7% 205 Range vs. #N/A 205 vs. 7.3% 205 vs. #N/A 205 vs. 0.5% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 94

100 Oregon Health Plan Medicaid Demonstration Exhibit 7 omparison of January 205 and October 204 apitation s Dental Services (O-F) Includes NEMT Services Trillium ommunity Health Plan, Inc. Aid ategory Lane Temporary Assistance to Needy Families - Adults $ $ 32.2 $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ 3.54 $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $.84 $.85 $.85 $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 9.25 $ 9.87 $ 9.95 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ 26.0 $ $ 26.9 $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ 3.83 $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ 42.7 $ $ 45.0 $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ 3.86 $ 3.97 $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 4.6% 205 Range vs. #N/A 205 vs. 5.0% 205 vs. #N/A 205 vs. 0.4% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 95

101 Oregon Health Plan Medicaid Demonstration Exhibit 7 omparison of January 205 and October 204 apitation s Dental Services (O-F) Western Oregon Advanced Health, LL Aid ategory oastal Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ 30.6 $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ 0.27 $ 0.28 $ 0.28 $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 8.46 $ 9.08 $ 9.6 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 2.25 $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ 8.04 $ 9.33 $ 9.42 $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ 24.2 $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ 27.7 $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ 29.5 $ 3.74 $ 3.80 $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ 2.5 $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 6.6% 205 Range vs. #N/A 205 vs. 7.2% 205 vs. #N/A 205 vs. 0.5% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 96

102 Oregon Health Plan Medicaid Demonstration Exhibit 7 omparison of January 205 and October 204 apitation s Dental Services (O-F) Includes NEMT Services Willamette Valley ommunity Health, LL Aid ategory LBMPY Temporary Assistance to Needy Families - Adults $ 30.9 $ 3.97 $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ $ 33.2 $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ 0.96 $ 0.97 $ 0.97 $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 8.88 $ 9.49 $ 9.58 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 2.89 $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ 65.9 $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $ 50.9 $ 5.78 $ 5.88 $ % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ 26.3 $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ 3.32 $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ 4.89 $ 44.2 $ 44.5 $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ 27. $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 5.0% 205 Range vs. #N/A 205 vs. 5.3% 205 vs. #N/A 205 vs. 0.4% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 97

103 Oregon Health Plan Medicaid Demonstration Exhibit 7 omparison of January 205 and October 204 apitation s Dental Services (O-F) Yamhill ounty are Organization, Inc. Aid ategory LBMPY Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ $ 30.6 $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $ 0.27 $ 0.28 $ 0.28 $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 8.46 $ 9.08 $ 9.6 $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 2.25 $ $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ 8.2 $ 9.42 $ 9.50 $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ 24.2 $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ 27.7 $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ 29.5 $ 3.74 $ 3.79 $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ 20.7 $ $ 22.7 $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 6.6% 205 Range vs. #N/A 205 vs. 7.% 205 vs. #N/A 205 vs. 0.5% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 98

104 Oregon Health Plan Medicaid Demonstration Exhibit 8 omparison of January 205 and October 204 apitation s Mental Health and Dental Services (O-G) Includes NEMT Services ascade Health Alliance, LL. Aid ategory Eastern Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Poverty Level Medical - Adults $ 48.0 $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 0- (HIP, PLM, TANF hildren) $.56 $.72 $.60 $ % #N/A #N/A #N/A #N/A #N/A hildren -5 (HIP, PLM, TANF hildren) $ 23.9 $ $ $ % #N/A #N/A #N/A #N/A #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ 50.0 $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, with Medicare $ $ 3.06 $ $ % #N/A #N/A #N/A #N/A #N/A ABAD and OAA, without Medicare $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Foster hildren (AF) $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults 9-44 $ $ $ $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ 92.5 $ % #N/A #N/A #N/A #N/A #N/A AA - Adults $ $ $ $ % #N/A #N/A #N/A #N/A #N/A Weighted Average $ $ $ $ % #N/A #N/A #N/A #N/A #N/A 205 Range vs. 9.8% 205 Range vs. #N/A 205 vs. 2.5% 205 vs. #N/A 205 vs. -7.2% 205 vs. #N/A Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 99

105 Oregon Health Plan Medicaid Demonstration Exhibit 8 omparison of January 205 and October 204 apitation s Mental Health and Dental Services (O-G) Includes NEMT Services as Newly Added Services olumbia-pacific O, LL. Aid ategory oastal JJD Temporary Assistance to Needy Families - Adults $ $ $ 76.4 $ % $ $ $ 76.4 $ % Poverty Level Medical - Adults $ $ 57.9 $ 53. $ % $ $ 57.9 $ 53. $ % hildren 0- (HIP, PLM, TANF hildren) $.6 $.75 $.63 $ % $.6 $.75 $.63 $ % hildren -5 (HIP, PLM, TANF hildren) $ $ $ 26.9 $ % $ $ $ 26.9 $ % hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ 58.7 $ % $ $ $ 58.7 $ % ABAD and OAA, with Medicare $ 6.58 $ $ 7.55 $ % $ 6.58 $ $ 7.96 $ % ABAD and OAA, without Medicare $ $ $ $ % $ $ $ $ % Foster hildren (AF) $ $ $ $ % $ $ $ $ % AA - Adults 9-44 $ $ 92.2 $ $ % $ $ 92.2 $ $ % AA - Adults $ $ 2.70 $ $ % $ $ 2.70 $ $ % AA - Adults $ 5.00 $ $ 5.96 $ % $ 5.00 $ $ 5.96 $ % Weighted Average $ 8.79 $ $ $ % $ 87.7 $ $ $ % 205 Range vs. 8.6% 205 Range vs. 8.6% 205 vs. 0.8% 205 vs. 0.9% 205 vs. -7.7% 205 vs. -7.6% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 00

106 Oregon Health Plan Medicaid Demonstration Exhibit 8 omparison of January 205 and October 204 apitation s Mental Health and Dental Services (O-G) DIPA, LL. Abn Umpqua Health Alliance Aid ategory JJD Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $ 0.72 $ 0.78 $ 0.77 $ % #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 5.78 $ $ $ % #N/A ABAD and OAA, with Medicare $ $ $ 69.5 $ % #N/A ABAD and OAA, without Medicare $ $ $ $ % #N/A Foster hildren (AF) $ $ $ $ % #N/A AA - Adults 9-44 $ $ $ $ % #N/A AA - Adults $ 83.6 $ $ 89.2 $ % #N/A AA - Adults $ 92.7 $ $ $ % #N/A Weighted Average $ 7.85 $ $ $ % 205 Range vs. 9.0% 205 Range vs. 205 vs. 7.3% 205 vs. 205 vs. -.6% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 0

107 Oregon Health Plan Medicaid Demonstration Exhibit 8 omparison of January 205 and October 204 apitation s Mental Health and Dental Services (O-G) Includes NEMT Services Eastern Oregon oordinated are Org., LL. Aid ategory Eastern Temporary Assistance to Needy Families - Adults $ 7.89 $ $ $ % #N/A Poverty Level Medical - Adults $ $ 5.9 $ $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $.35 $.42 $.38 $ % #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A ABAD and OAA, with Medicare $.46 $ 7.78 $ 3.8 $ % #N/A ABAD and OAA, without Medicare $ $ $ $ % #N/A Foster hildren (AF) $ $ $ $ % #N/A AA - Adults 9-44 $ 8.62 $ $ $ % #N/A AA - Adults $ $ $ 0.82 $ % #N/A AA - Adults $ 0.57 $ 6.84 $ 2.90 $ % #N/A Weighted Average $ 7.50 $ $ 73.0 $ % 205 Range vs. 5.7% 205 Range vs. 205 vs. 2.% 205 vs. 205 vs. -3.5% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 02

108 Oregon Health Plan Medicaid Demonstration Exhibit 8 omparison of January 205 and October 204 apitation s Mental Health and Dental Services (O-G) Includes NEMT Services as Newly Added Services Familyare, Inc. Aid ategory Tri-ounty Temporary Assistance to Needy Families - Adults $ $ 7.95 $ 7.2 $ % #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $.48 $.56 $.54 $ % #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A ABAD and OAA, without Medicare $ $ $ 9.76 $ % #N/A Foster hildren (AF) $ $ $ $ % #N/A AA - Adults 9-44 $ $ 77.9 $ 77. $ % #N/A AA - Adults $ $ $ $ % #N/A AA - Adults $ $ $ 0.6 $ % #N/A Weighted Average $ 6.67 $ $ 64.9 $ % 205 Range vs. 5.2% 205 Range vs. 205 vs. 4.% 205 vs. 205 vs. -.0% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 03

109 Oregon Health Plan Medicaid Demonstration Exhibit 8 omparison of January 205 and October 204 apitation s Mental Health and Dental Services (O-G) Includes NEMT Services as Newly Added Services Health Share of Oregon Aid ategory Tri-ounty Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A Poverty Level Medical - Adults $ 5.33 $ 54.7 $ 5.97 $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $.49 $.57 $.5 $ % #N/A hildren -5 (HIP, PLM, TANF hildren) $ 24.5 $ $ $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 5.35 $ 54.9 $ 5.99 $ % #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A ABAD and OAA, without Medicare $ $ 98.9 $ 90.6 $ % #N/A Foster hildren (AF) $ $ 37.5 $ $ % #N/A AA - Adults 9-44 $ $ $ $ % #N/A AA - Adults $ $ $ $ % #N/A AA - Adults $ $ 05.0 $ $ % #N/A Weighted Average $ 73.3 $ $ $ % 205 Range vs. 5.5% 205 Range vs. 205 vs..3% 205 vs. 205 vs. -4.2% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 04

110 Oregon Health Plan Medicaid Demonstration Exhibit 8 omparison of January 205 and October 204 apitation s Mental Health and Dental Services (O-G) Includes NEMT Services Interommunity Health Network, Inc. Aid ategory LBMPY oastal Temporary Assistance to Needy Families - Adults $ 77.3 $ 82.0 $ 78.3 $ % $ 77.3 $ 82.0 $ 78.3 $ % Poverty Level Medical - Adults $ 5.84 $ $ $ % $ 5.84 $ $ $ % hildren 0- (HIP, PLM, TANF hildren) $.66 $.76 $.68 $ % $.66 $.76 $.68 $.6 4.2% hildren -5 (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % ABAD and OAA, with Medicare $ 28.3 $ $ $ % $ 28.3 $ $ $ % ABAD and OAA, without Medicare $ $ $ $ % $ $ $ $ % Foster hildren (AF) $ $ $ $ % $ $ $ $ % AA - Adults 9-44 $ $ 92. $ $ % $ $ 92. $ $ % AA - Adults $ $ 3.22 $ 08.2 $ % $ $ 3.22 $ 08.2 $ % AA - Adults $ 8.25 $ $ 9.78 $ % $ 8.25 $ $ 9.78 $ % Weighted Average $ 87.8 $ $ 88.3 $ % $ $ $ $ % 205 Range vs. 6.% 205 Range vs. 6.% 205 vs..3% 205 vs..2% 205 vs. -4.7% 205 vs. -4.8% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 05

111 Oregon Health Plan Medicaid Demonstration Exhibit 8 omparison of January 205 and October 204 apitation s Mental Health and Dental Services (O-G) Includes NEMT Services Jackson ounty O, LL. Aid ategory JJD Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A Poverty Level Medical - Adults $ 50.9 $ $ $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $.59 $.74 $.74 $ % #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ 26.9 $ 26.9 $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A ABAD and OAA, with Medicare $ $ 7.98 $ 7.98 $ % #N/A ABAD and OAA, without Medicare $ $ $ $ % #N/A Foster hildren (AF) $ $ $ $ % #N/A AA - Adults 9-44 $ $ $ $ % #N/A AA - Adults $ $ 5.74 $ 5.74 $ % #N/A AA - Adults $ 7.5 $ $ $ % #N/A Weighted Average $ $ $ $ % 205 Range vs. 9.3% 205 Range vs. 205 vs. 9.3% 205 vs. 205 vs. 0.0% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 06

112 Oregon Health Plan Medicaid Demonstration Exhibit 8 omparison of January 205 and October 204 apitation s Mental Health and Dental Services (O-G) Includes NEMT Services Mid-Rogue Independent Physician Association, Inc. abn Allare Health Plan, Inc. Aid ategory JJD oastal Temporary Assistance to Needy Families - Adults $ $ $ $ % $ $ $ $ % Poverty Level Medical - Adults $ 49.5 $ $ $ % $ 49.5 $ $ $ % hildren 0- (HIP, PLM, TANF hildren) $.54 $.63 $.63 $ % $.54 $.63 $.63 $.7-4.7% hildren -5 (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % hildren 6-8 (HIP, PLM, TANF hildren) $ $ 57.0 $ 57.0 $ % $ $ 57.0 $ 57.0 $ % ABAD and OAA, with Medicare $ $ $ $ % $ $ $ 0.22 $ % ABAD and OAA, without Medicare $ 92.3 $ $ $ % $ 92.3 $ $ $ % Foster hildren (AF) $ $ $ $ % $ $ $ $ % AA - Adults 9-44 $ $ $ $ % $ $ $ $ % AA - Adults $ $ $ $ % $ $ $ $ % AA - Adults $ $ 5.55 $ 5.55 $ % $ $ 5.55 $ 5.55 $ % Weighted Average $ $ $ $ % $ $ $ $ % 205 Range vs. 6.0% 205 Range vs. 6.0% 205 vs. 6.0% 205 vs. 6.% 205 vs. 0.0% 205 vs. 0.% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 07

113 Oregon Health Plan Medicaid Demonstration Exhibit 8 omparison of January 205 and October 204 apitation s Mental Health and Dental Services (O-G) PacificSource ommunity Solutions, Inc. (entral Oregon) Aid ategory entral Eastern Temporary Assistance to Needy Families - Adults $ $ 72.3 $ $ % $ $ 72.3 $ $ % Poverty Level Medical - Adults $ $ $ 48.3 $ % $ $ $ 48.3 $ % hildren 0- (HIP, PLM, TANF hildren) $ 0.77 $ 0.82 $ 0.78 $ % $ 0.77 $ 0.82 $ 0.78 $ % hildren -5 (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % $ $ $ $ % ABAD and OAA, with Medicare $ $ 75.7 $ 7.68 $ % $ $ 75.7 $ $ % ABAD and OAA, without Medicare $ $ 88.7 $ $ % $ $ 88.7 $ $ % Foster hildren (AF) $ $ $ 3.72 $ % $ $ $ 3.72 $ % AA - Adults 9-44 $ $ 80.6 $ $ % $ $ 80.6 $ $ % AA - Adults $ $ $ 90.7 $ % $ $ $ 90.7 $ % AA - Adults $ $ $ $ % $ $ $ $ % Weighted Average $ $ $ $ % $ $ $ $ % 205 Range vs. 6.5% 205 Range vs. 6.5% 205 vs..6% 205 vs..% 205 vs. -4.9% 205 vs. -5.3% Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 08

114 Oregon Health Plan Medicaid Demonstration Exhibit 8 omparison of January 205 and October 204 apitation s Mental Health and Dental Services (O-G) PacificSource ommunity Solutions, Inc. (olumbia Gorge) Aid ategory entral Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A Poverty Level Medical - Adults $ $ 5.88 $ 48.3 $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $ 0.77 $ 0.84 $ 0.78 $ % #N/A hildren -5 (HIP, PLM, TANF hildren) $ 25.5 $ $ $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A ABAD and OAA, with Medicare $ $ $ $ % #N/A ABAD and OAA, without Medicare $ 75.9 $ $ $ % #N/A Foster hildren (AF) $ $ $ 3.72 $ % #N/A AA - Adults 9-44 $ $ $ $ % #N/A AA - Adults $ $ 97.5 $ 90.2 $ % #N/A AA - Adults $ $ $ $ % #N/A Weighted Average $ $ $ $ % 205 Range vs. 9.9% 205 Range vs. 205 vs..9% 205 vs. 205 vs. -7.8% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 09

115 Oregon Health Plan Medicaid Demonstration Exhibit 8 omparison of January 205 and October 204 apitation s Mental Health and Dental Services (O-G) Primary Health of Josephine ounty, LL Aid ategory JJD Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A Poverty Level Medical - Adults $ $ 5.90 $ $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $ 0.79 $ 0.88 $ 0.87 $ % #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ 63.4 $ $ % #N/A ABAD and OAA, with Medicare $ $ 78.7 $ $ % #N/A ABAD and OAA, without Medicare $ $ $ $ % #N/A Foster hildren (AF) $ $ $ $ % #N/A AA - Adults 9-44 $ $ 87.5 $ 85.3 $ % #N/A AA - Adults $ $ $ 0.34 $ % #N/A AA - Adults $ $ 4.55 $ 2.3 $ % #N/A Weighted Average $ $ $ 87.6 $ % 205 Range vs..9% 205 Range vs. 205 vs. 9.5% 205 vs. 205 vs. -2.2% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 0

116 Oregon Health Plan Medicaid Demonstration Exhibit 8 omparison of January 205 and October 204 apitation s Mental Health and Dental Services (O-G) Includes NEMT Services Trillium ommunity Health Plan, Inc. Aid ategory Lane Temporary Assistance to Needy Families - Adults $ $ $ $ % #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $ 2.33 $ 2.45 $ 2.35 $ % #N/A hildren -5 (HIP, PLM, TANF hildren) $ 25.9 $ 27.3 $ $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A ABAD and OAA, with Medicare $ 9.87 $ $ 2.23 $ % #N/A ABAD and OAA, without Medicare $ $ $ $ % #N/A Foster hildren (AF) $ $ $ $ % #N/A AA - Adults 9-44 $ $ 87.9 $ $ % #N/A AA - Adults $ $ $ $ % #N/A AA - Adults $.9 $ 7.94 $ 3.8 $ % #N/A Weighted Average $ $ $ $ % 205 Range vs. 5.4% 205 Range vs. 205 vs..% 205 vs. 205 vs. -4.2% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page

117 Oregon Health Plan Medicaid Demonstration Exhibit 8 omparison of January 205 and October 204 apitation s Mental Health and Dental Services (O-G) Western Oregon Advanced Health, LL Aid ategory oastal Temporary Assistance to Needy Families - Adults $ $ $ 6.99 $ % #N/A Poverty Level Medical - Adults $ $ $ $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $ 0.67 $ 0.73 $ 0.69 $ % #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A ABAD and OAA, with Medicare $ 6.70 $ $ $ % #N/A ABAD and OAA, without Medicare $ 5.99 $ $ $ % #N/A Foster hildren (AF) $ $ $ $ % #N/A AA - Adults 9-44 $ $ $ 68.2 $ % #N/A AA - Adults $ $ $ $ % #N/A AA - Adults $ $ 94. $ $ % #N/A Weighted Average $ $ 79.4 $ 74.4 $ % 205 Range vs. 9.5% 205 Range vs. 205 vs. 2.9% 205 vs. 205 vs. -6.4% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 2

118 Oregon Health Plan Medicaid Demonstration Exhibit 8 omparison of January 205 and October 204 apitation s Mental Health and Dental Services (O-G) Includes NEMT Services Willamette Valley ommunity Health, LL Aid ategory LBMPY Temporary Assistance to Needy Families - Adults $ 72.9 $ $ $ % #N/A Poverty Level Medical - Adults $ 49. $ 5.70 $ $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $.43 $.5 $.46 $.5-3.4% #N/A hildren -5 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ $ $ $ % #N/A ABAD and OAA, with Medicare $ 2.6 $ 8.53 $ 4.73 $ % #N/A ABAD and OAA, without Medicare $ 99.4 $ $ $ % #N/A Foster hildren (AF) $ $ $ $ % #N/A AA - Adults 9-44 $ $ $ $ % #N/A AA - Adults $ $ $ $ % #N/A AA - Adults $ 09.7 $ 4.9 $.23 $ % #N/A Weighted Average $ $ $ $ % 205 Range vs. 5.3% 205 Range vs. 205 vs..9% 205 vs. 205 vs. -3.3% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 3

119 Oregon Health Plan Medicaid Demonstration Exhibit 8 omparison of January 205 and October 204 apitation s Mental Health and Dental Services (O-G) Yamhill ounty are Organization, Inc. Aid ategory LBMPY Temporary Assistance to Needy Families - Adults $ $ 8.04 $ 75.7 $ % #N/A Poverty Level Medical - Adults $ $ 54.4 $ $ % #N/A hildren 0- (HIP, PLM, TANF hildren) $ 0.85 $ 0.92 $ 0.86 $ % #N/A hildren -5 (HIP, PLM, TANF hildren) $ 26. $ $ $ % #N/A hildren 6-8 (HIP, PLM, TANF hildren) $ 60.8 $ $ 6.42 $ % #N/A ABAD and OAA, with Medicare $ $ 82.4 $ $ % #N/A ABAD and OAA, without Medicare $ $ $ $ % #N/A Foster hildren (AF) $ $ $ $ % #N/A AA - Adults 9-44 $ $ $ $ % #N/A AA - Adults $ $ $ $ % #N/A AA - Adults $ $ 8.96 $ 0.34 $ % #N/A Weighted Average $ $ $ $ % 205 Range vs. 8.9% 205 Range vs. 205 vs..0% 205 vs. 205 vs. -7.8% 205 vs. Weighted average capitation rates are based on calendar year 203 physical health enrollment distribution. Note: October 204 AA rates are shown as a single composite rates due to rate group changes to three age bands. Page 4

120 Oregon Health Plan Medicaid Demonstration apitation Development for January 205 through December 205 Benefit Increases for AA Adults 9-44, AA Adults 45-54, and AA Adults EXHIBIT 9A Benefit Line Item Benefit hange in Jan 204 PHYSIAL HEALTH Hearing aid and exam Self-administrated hemo Agent Home Health are DME Prosthetic Podiatry Elective Sterilization Services Tobacco essation services Human Organ Transplant services Vision Services DENTAL Dental Services From None to overed From Limited to overed From Limited to overed From Limited to overed From None to overed From Limited to overed From Limited to overed From None to overed From Limited to overed From None to Limited From Limited to overed Page 5

121 Oregon Health Plan Medicaid Demonstration apitation Development for January 205 through December 205 Benefit Increases Adjustment PMPM s EXHIBIT 9B Base Data Period to 205 ontract Year Benefit Increase PMPM Without Administrative Allowance With Administrative Allowance AA 9 44 AA AA AA 9 44 AA AA PHYSIAL HEALTH $5.50 $8.6 $24.4 $6.85 $20.23 $26.53 Page 6

122 Oregon Health Plan Medicaid Demonstration apitation Development for January 205 through December 205 Trend Factors in Developing Benefit Increases Adjustment PMPM s EXHIBIT 9 Annual ost Trend Annual Utilization Trend AA 9 44 AA AA AA 9 44 AA AA PHYSIAL HEALTH From Per apita ost to % 2.0% 2.0% 0% 0% 0% From 203 to % 2.0% 2.0% 0.5% 0.5% 0.5% From 204 to % 2.4% 2.4% 0% 0% 0% Page 7

123 Oregon Health Plan Medicaid Demonstration 205 Ranges and omparison of January 205 and October 204 apitation s Dental Services Including Administrative Allowances Exhibit 0A Tri-ounty Other Regions Eligibility ategory 205 End 205 End January 205 October End 205 End January 205 October 204 Temporary Assistance to Needy Families - Adults $29.29 $3.0 $29.29 $ % $24.74 $26.52 $26.52 $ % Poverty Level Medical - Adults $34.0 $36.33 $34.0 $ % $28.45 $30.6 $30.6 $ % hildren 0- (HIP, PLM, TANF hildren) $0.38 $0.39 $0.38 $ % $0.27 $0.28 $0.28 $ % hildren -5 (HIP, PLM, TANF hildren) $9.57 $20.84 $9.57 $9.25.6% $8.46 $9.08 $9.08 $ % hildren 6-8 (HIP, PLM, TANF hildren) $25.2 $26.85 $25.2 $ % $2.25 $22.86 $22.86 $ % ABAD with Medicare $27.26 $29.03 $27.26 $ % $23.4 $24.74 $24.74 $ % ABAD without Medicare $27.26 $29.03 $27.26 $ % $23.4 $24.74 $24.74 $ % OAA with Medicare $9.32 $20.57 $9.32 $ % $3.60 $4.62 $4.62 $ % OAA without Medicare $9.32 $20.57 $9.32 $ % $3.60 $4.62 $4.62 $ % Foster hildren (AF) $24.97 $25.56 $24.97 $ % $23.43 $24.2 $24.2 $ % AA Adults 9-44 $28.86 $30.63 $28.86 $ % $24.57 $26.33 $26.33 $ % AA Adults $32.64 $34.78 $32.64 $ % $25.76 $27.7 $27.7 $ % AA Adults $3.77 $33.84 $3.77 $ % $29.5 $3.74 $3.74 $ % Weighted Average $25.69 $27.3 $25.69 $ % $22.05 $23.55 $23.55 $ % Weighted average capitation rates are based on April 204 enrollment distribution. Page 8

124 Oregon Health Plan Medicaid Demonstration apitation Range Development for January 205 through December 205 Trend Factors in Developing Dental apitation Ranges Exhibit 0B Tri-ounty Other Regions Annual ost Trend Annual Utilization Trend Annual ost Trend Annual Utilization Trend Eligibility ategory End of Range End of Range End of Range End of Range End of Range End of Range End of Range End of Range Temporary Assistance to Needy Families - Adults Poverty Level Medical - Adults hildren 0- (HIP, PLM, TANF hildren) hildren -5 (HIP, PLM, TANF hildren) hildren 6-8 (HIP, PLM, TANF hildren) ABAD with Medicare ABAD without Medicare OAA with Medicare OAA without Medicare Foster hildren (AF) AA 9-44 AA AA % 2.7% 0.0% 0.5% 0.2% 2.7% 0.0%.0% 0.0% 2.7% 0.0% 0.5% 0.0% 2.7% 0.0%.0% 2.0% 2.7% 3.0% 3.5% 2.0% 2.7% 3.8% 4.8% 0.0% 2.7% 3.0% 3.5% 2.0% 2.7% 3.8% 4.8% 0.0% 2.7% 3.0% 3.5% 0.0% 2.7% 0.0%.0% 0.0% 2.7% 3.0% 3.5% 0.3% 2.7% 0.0%.0% 0.0% 2.7% 3.0% 3.5% 0.3% 2.7% 0.0%.0% 0.0% 2.7% 3.5% 4.0% 0.0% 2.7% 3.8% 4.8% 0.0% 2.7% 3.5% 4.0% 0.0% 2.7% 3.8% 4.8% 2.0% 2.7% 3.0% 3.5% 2.0% 2.7% 3.8% 4.8% 0.2% 2.7% 0.0% 0.5% 0.2% 2.7% 0.0%.0% 0.0% 2.7% 0.0% 0.5% 0.0% 2.7% 0.0%.0% 0.0% 2.7%.5% 2.0% 0.0% 2.7%.7% 2.7% Page 9

125 Oregon Health Plan Medicaid Demonstration Exhibit apitation Range Development for January 205 through December 205 Physical Health and Mental Health 203 Base Data Development Base Data Development Financial Submission Data omparison of Base Data vs Financial Submission O Physical Health Avg Enrollment Encounter Data Encounter Reconciled Step * % hange Encounter Reconciled Step 2** % hange Sub- apitation & Alternative Payments Total Encounter Events Sub- apitation & Alternative Payments Total Encounter Data Sub- apitation & Alt. Payments Total ascade Health Alliance, LL 27,793 $8,47,95 $8,47,95 0.0% $8,47,95 0.0% $8,435,926 $26,853,84 $9,762,043 $8,435,926 $28,97, % 0.0% -4.8% olumbia-pacific O, LL 76,64 $39,633,860 $38,08, % $38,08, % $9,05,956 $47,24,709 $39,904,474 $9,05,956 $49,00, % 0.0% -3.7% DIPA, LL. Abn Umpqua Health Alliance 97,25 $23,86,765 $22,764, % $23,999, % $27,434,52 $5,433,233 $23,92,74 $27,434,52 $5,355, % 0.0% 0.2% Eastern Oregon oordinated are Org., LL 357,994 $70,92,57 $67,970, % $72,973, % $0,44,752 $83,388,9 $72,973,389 $0,44,752 $83,388,40 0.0% 0.0% 0.0% Familyare, Inc 600,857 $95,524,058 $97,697, % $99,87, % $22,370,259 $22,24,808 $09,94,627 $22,370,259 $3,564, % 0.0% -7.% Health Share of Oregon,825,366 $388,439,080 $388,439, % $394,379,772.5% $3,557,052 $425,936,824 $435,622,350 $3,557,052 $467,79, % 0.0% -8.8% Interommunity Health Network, Inc 400,835 $90,67,942 $86,97,7-4.0% $93,383, % $3,920,76 $07,304,354 $92,68,583 $3,920,76 $06,602, % 0.0% 0.7% Jackson ounty O, LL 229,924 $4,5,979 $4,5, % $4,732,78.5% $,86,897 $52,99,66 $42,770,466 $,86,897 $53,957, % 0.0% -.9% Mid-Rogue Independent Physician Association, Inc 334,595 $50,645,364 $59,742,8 8.0% $59,742,8 0.0% $9,67,879 $78,90,690 $57,674,949 $9,67,879 $76,842, % 0.0% 2.7% PacificSource ommunity Solutions, Inc (entral) 362,778 $68,320,465 $65,354, % $68,453,64 4.7% $2,986,94 $90,440,05 $68,38,50 $2,986,94 $90,305, % 0.0% 0.% PacificSource ommunity Solutions, Inc (Gorge) 87,929 $6,244,79 $5,850, % $6,498,786 4.% $5,26,02 $2,74,807 $7,48,84 $5,26,02 $22,634,86-5.3% 0.0% -4.% Primary Health of Josephine ounty, LL 72,764 $9,909,443 $9,909, % $,037,020.4% $6,872,65 $7,909,85 $,043,840 $6,872,65 $7,96,005-0.% 0.0% 0.0% Trillium ommunity Health Plan, Inc 605,263 $39,958,732 $39,958, % $43,20, % $5,382,375 $58,583,84 $43,20,472 $5,69,595 $58,82, % -.5% -0.% Willamette Valley ommunity Health, LL 770,220 $20,677,274 $20,677, % $20,677, % $33,66,593 $54,293,867 $30,609,52 $33,66,593 $64,226,5-7.6% 0.0% -6.0% Western Oregon Advanced Health, LL 42,090 $48,842,39 $0-00.0% $0 0.0% $40,78,494 $40,78,494 $0 $42,846,35 $42,846,35 n/a -5.0% -5.0% Yamhill ounty are Organization, Inc 67,339 $29,028,803 $29,028, % $29,028, % $7,720,476 $36,749,279 $27,602,24 $7,720,476 $35,322, % 0.0% 4.0% Total 6,459,639,25,384,53,202,008,95-3.9%,23,506, % 285,06,698,56,62,772,292,699, ,47,739,580,7, % -0.8% -4.0% *: Step reconciliation corrects data reporting errors at the service category level. Results may be positive or negative adjustments. **: Step 2 reconcilation reflects under reporting and IBNR. Results are always positive adjustments. Page 20

126 Oregon Health Plan Medicaid Demonstration apitation Range Development for January 205 through December 205 Summary of Annual Trend Factors Exhibit 2A Hospital Physician Rx, D, and Other Mental Health Eligibility ategory ost Trend ( End) ost Trend ( End) Util Trend ( End) Util Trend ( End) ost Trend ( End) ost Trend ( End) Util Trend ( End) Util Trend ( End) ost Trend ( End) ost Trend ( End) Util Trend ( End) Util Trend ( End) ost Trend ( End) ost Trend ( End) Util Trend ( End) Util Trend ( End) ascade Health Alliance, LL.6% 3.9% 2.3% 4.%.7% 4.0%.3% 3.0% 2.3% 4.5% 2.7% 4.3%.7% 3.9% 2.2% 3.9% olumbia-pacific O, LL 2.3% 4.6%.% 2.9%.7% 4.0% 0.2% 2.0% 2.3% 4.5% 3.2% 5.0%.7% 3.9% 0.9% 2.6% DIPA, LL. Abn Umpqua Health Alliance.7% 3.9%.8% 3.6%.7% 3.9%.% 2.8% 2.2% 4.4% 0.2%.7%.7% 3.9%.0% 2.8% Eastern Oregon oordinated are Org., LL 2.0% 3.7% 0.6%.3%.2% 3.0%.7% 2.5%.8% 3.5% 2.0% 2.7%.2% 2.9% 0.0% 0.8% Familyare, Inc 0.6% 2.4% 2.4% 2.9% 0.7% 2.5% 0.9%.4%.3% 3.0% 2.5% 3.0% 0.7% 2.4% 2.5% 3.0% Health Share of Oregon 0.6% 2.4%.0%.5% 0.7% 2.5% 3.2% 3.7%.3% 3.0% 4.4% 4.9% 0.7% 2.4% 2.5% 3.0% Interommunity Health Network, Inc.6% 3.3%.%.8%.2% 3.0% 0.2%.0%.8% 3.6% 0.6%.4%.2% 2.9% 2.7% 3.5% Jackson ounty O, LL.7% 4.0% 0.2%.9%.7% 4.0%.5% 3.3% 2.2% 4.4% 4.9% 6.6%.7% 3.9%.0% 2.7% Mid-Rogue Independent Physician Association, Inc.3% 3.0% 3.% 3.9%.2% 3.0% 2.8% 3.5%.7% 3.4% 3.% 3.8%.2% 2.9%.4% 2.% PacificSource ommunity Solutions, Inc (entral).7% 3.4% 0.5%.3%.2% 3.0%.%.8%.9% 3.6% 3.% 3.9%.2% 2.9%.0%.8% PacificSource ommunity Solutions, Inc (Gorge) 2.6% 4.9% 3.7% 5.4%.7% 3.9%.2% 2.9% 2.3% 4.6% 2.3% 4.%.7% 3.9% 0.7% 2.5% Primary Health of Josephine ounty, LL.6% 3.9%.0% 2.8%.7% 4.0%.2% 2.9% 2.4% 4.6% 0.4% 2.%.7% 3.9%.% 2.8% Trillium ommunity Health Plan, Inc 0.8% 2.5% 0.3% 0.8% 0.7% 2.4% 0.0% 0.5%.3% 3.%.0%.5% 0.7% 2.4%.2%.7% Western Oregon Advanced Health, LL.8% 4.% 2.2% 4.0%.7% 4.0%.8% 3.5%.7% 4.0% 2.4% 4.2%.7% 3.9%.% 2.9% Willamette Valley ommunity Health, LL 0.8% 2.6%.3%.8% 0.7% 2.5% 0.5%.0%.% 2.9%.8% 2.2% 0.7% 2.4% 2.8% 3.3% Yamhill ounty are Organization, Inc 2.0% 4.3%.6% 3.4%.7% 4.0%.3% 3.% 2.3% 4.5%.6% 3.3%.7% 3.9% 2.8% 4.5% Page 2

127 Oregon Health Plan Medicaid Demonstration apitation Range Development for January 205 through December 205 Three Tiers of Small, Medium, and Large Os in Range Development Exhibit 2B ost Trend Range Utilization Trend Range Eligibility ategory Tiers End of Range End of Range End of Range End of Range ascade Health Alliance, LL Small -0.5% +.75% -0% +.75% olumbia-pacific O, LL Small -0.5% +.75% -0% +.75% DIPA, LL. Abn Umpqua Health Alliance Small -0.5% +.75% -0% +.75% Eastern Oregon oordinated are Org., LL Medium -% +0.75% -0% +0.75% Familyare, Inc Large -.5% +0.25% -0% +0.50% Health Share of Oregon Large -.5% +0.25% -0% +0.50% Interommunity Health Network, Inc Medium -% +0.75% -0% +0.75% Jackson ounty O, LL Small -0.5% +.75% -0% +.75% Mid-Rogue Independent Physician Association, Inc Medium -% +0.75% -0% +0.75% PacificSource ommunity Solutions, Inc (entral) Medium -% +0.75% -0% +0.75% PacificSource ommunity Solutions, Inc (Gorge) Small -0.5% +.75% -0% +.75% Primary Health of Josephine ounty, LL Small -0.5% +.75% -0% +.75% Trillium ommunity Health Plan, Inc Large -.5% +0.25% -0% +0.50% Western Oregon Advanced Health, LL Small -0.5% +.75% -0% +.75% Willamette Valley ommunity Health, LL Large -.5% +0.25% -0% +0.50% Yamhill ounty are Organization, Inc Small -0.5% +.75% -0% +.75% Page 22

128 Oregon Health Plan Medicaid Demonstration Maternity ase s for January 205 through December 205 Trend Factors in Developing Maternity ase s Exhibit 3A Annual ost Trend Annual Utilization Trend O Region Inpatient Outpatient Inpatient Outpatient Physician Hospital Hospital Hospital Hospital Physician ascade Health Alliance, LL Eastern 2.2% 2.2% 2.2% 0% 0% 0% olumbia-pacific O, LL oastal 2.7% 2.7% 2.2% 0% 0% 0% olumbia-pacific O, LL JJD 2.2% 2.2% 2.2% 0% 0% 0% DIPA, LL JJD 2.2% 2.2% 2.2% 0% 0% 0% Eastern Oregon oordinated are Org., LL Eastern 2.7% 3.% 2.2% 0% 0% 0% Familyare, Inc Tri-ounty 2.3% 2.2% 2.2% 0% 0% 0% Health Share of Oregon Tri-ounty 2.2% 2.2% 2.2% 0% 0% 0% Interommunity Health Network, Inc oastal 2.8% 2.7% 2.2% 0% 0% 0% Interommunity Health Network, Inc LBMPY 2.5% 2.4% 2.2% 0% 0% 0% Jackson ounty O, LL JJD 2.4% 2.3% 2.2% 0% 0% 0% Mid-Rogue Independent Physician Association, Inc oastal 2.5% 2.8% 2.2% 0% 0% 0% Mid-Rogue Independent Physician Association, Inc JJD 2.3% 2.3% 2.2% 0% 0% 0% PacificSource ommunity Solutions, Inc (entral) entral 2.5% 2.5% 2.2% 0% 0% 0% PacificSource ommunity Solutions, Inc (Gorge) entral 2.8% 2.8% 2.2% 0% 0% 0% Primary Health of Josephine ounty, LL JJD 2.3% 2.2% 2.2% 0% 0% 0% Trillium ommunity Health Plan, Inc Lane 2.3% 2.3% 2.2% 0% 0% 0% Western Oregon Advanced Health, LL oastal 2.3% 2.4% 2.2% 0% 0% 0% Willamette Valley ommunity Health, LL LBMPY 2.5% 2.4% 2.2% 0% 0% 0% Yamhill ounty are Organization, Inc LBMPY 2.5% 2.4% 2.2% 0% 0% 0% Page 23

129 Oregon Health Plan Medicaid Demonstration Maternity s for January 205 through December 205 Exhibit 3B O Region Inpatient Hospital Outpatient Hospital Physician Bae HRA Admin Allowance Hospital Admin Allowance (Tier 2 HRA) Total ase Total ase % Increase ascade Health Alliance, LL Eastern $3, $968.2 $3, $2,25.50 $792.5 $ $, $, % olumbia-pacific O, LL oastal $6, $,48.29 $3, $868.2 $, $49.90 $3, $3, % olumbia-pacific O, LL JJD $4,96.4 $, $3, $2,265.0 $86.27 $369.8 $2, $2,86.5.0% DIPA, LL JJD $4,7.80 $, $3, $2,265.0 $83.64 $368.6 $2, $2, % Eastern Oregon oordinated are Org., LL Eastern $7,28.70 $, $3, $9.47 $, $48.09 $3, $3, % Familyare, Inc Tri-ounty $4,53.79 $,07.64 $3, $2,2.67 $87.98 $ $2, $2, % Health Share of Oregon Tri-ounty $4,56.57 $,3.4 $3, $2,29.86 $89.08 $ $2, $2, % Interommunity Health Network, Inc oastal $0,42.20 $,420.8 $3, $ $,328.2 $59.58 $7,39.49 $5, % Interommunity Health Network, Inc LBMPY $5, $,5.95 $3, $, $ $ $2, $2, % Jackson ounty O, LL JJD $4, $,020.3 $3, $,89.73 $84.09 $ $,983.4 $, % Mid-Rogue Independent Physician Association, Inc oastal $5, $, $3, $, $97.24 $ $3, $2, % Mid-Rogue Independent Physician Association, Inc JJD $4,22.74 $, $3, $,935.0 $ $ $, $, % PacificSource ommunity Solutions, Inc (entral) entral $5, $,236.8 $3, $,55.43 $ $ $3, $3, % PacificSource ommunity Solutions, Inc (Gorge) entral $8, $, $3, $97.52 $, $ $5,69.24 $3, % Primary Health of Josephine ounty, LL JJD $3, $, $3, $2,002.8 $ $35.56 $,78.57 $, % Trillium ommunity Health Plan, Inc Lane $4,07.36 $,098.2 $3, $2,8.8 $80.0 $ $2,0.6 $2, % Western Oregon Advanced Health, LL oastal $5,60.77 $, $3, $2,50.7 $ $40.48 $3, $3, % Willamette Valley ommunity Health, LL LBMPY $5,3.08 $,53.78 $3, $, $ $ $2,82.57 $2, % Yamhill ounty are Organization, Inc LBMPY $6,05.93 $, $3, $, $, $ $4, $4, % Page 24

130 Oregon Health Plan Medicaid Demonstration Exhibit 4 Bariatric ase s for January 205 through December 205 Total ase Including Administrative Aid ategory Allowances Temporary Assistance to Needy Families - Adults $ 8, Poverty Level Medical - Adults $ 8, hildren 0- (HIP, PLM, TANF hildren) $ 8, hildren -5 (HIP, PLM, TANF hildren) $ 8, hildren 6-8 (HIP, PLM, TANF hildren) $ 8, ABAD and OAA with Medicare $, ABAD and OAA without Medicare $ 8, OAA without Medicare $ 8, Foster hildren (AF) $ 8, AA Adults 9-44 $ 8, AA Adults $ 8, AA Adults $ 8, Page 25

131 Oregon Health Plan Medicaid Demonstration Exhibit 5 apitation Range Development for January 205 through December 205 Special Needs Group (SNRG) PMPM s Including Mental Health osts, Excluding Maternity osts Including Transfers from OMIP, Excluding Hemophilia lients oordinated are Organization Inpatient Hospital Outpatient Hospital hemical Dependency All Other Physical Health Mental Health Dental NEMT AT/SE Alcohol & Drug Residential Hospital Reimburse ment Adjustment Admin Allowance ascade Health Alliance, LL. $36.7 $ $26.56 $94.04 $8.80 $22.70 $27.05 $8.83 $3.77 $ $74.33 $2, olumbia Pacific O, LL. $ $ $25.09 $889. $77.28 $22.76 $28.4 $8.93 $.68 $ $70.53 $2,370.2 DIPA, LL. Abn Umpqua Health Alliance $36.40 $ $25.09 $889. $77.28 $22.72 $0.00 $6.47 $3.02 $ $65.87 $2, Eastern Oregon oordinated are Org., LL. $ $ $25.09 $889. $77.28 $22.6 $26.4 $8.75 $3.77 $53.56 $80.39 $2, Familyare, Inc. $ $ $25.22 $ $77.68 $24.69 $36.7 $9.77 $4.29 $39.0 $70.32 $2, Health Share of Oregon $ $ $26.95 $ $83.0 $24.75 $35.09 $9.86 $4.76 $425.8 $8.4 $2,60.45 Interommunity Health Network, Inc. $ $486.4 $25.32 $ $77.97 $22.65 $3.37 $7.8 $.9 $233.8 $75.80 $2, Jackson ounty O, LL. $35.87 $44.2 $25.09 $889. $77.28 $22.55 $25.26 $6.35 $3.02 $ $65.99 $2,36.4 Mid-Rogue Independent Physician Association, Inc. $ $445.8 $25.09 $889. $77.28 $22.60 $25.04 $6.38 $3.02 $ $66.53 $2, PacificSource ommunity Solutions, Inc. (entral) $ $ $25.09 $889. $77.28 $22.67 $0.00 $8.80 $2.38 $ $72.40 $2,427.4 PacificSource ommunity Solutions, Inc. (Gorge) $506.7 $ $25.59 $ $78.80 $22.58 $0.00 $8.73 $2.38 $02.0 $83.64 $2, Primary Health of Josephine ounty, LL $352.3 $44.52 $25.09 $889. $77.28 $22.65 $0.00 $6.42 $3.02 $ $64.08 $2,344.4 Trillium ommunity Health Plan, Inc. $ $ $25.09 $889. $77.28 $22.6 $28.27 $7.67 $3.9 $ $67.47 $2, Western Oregon Advanced Health, LL $ $ $25.09 $889. $77.28 $22.72 $0.00 $.2 $.68 $ $72.34 $2,40.45 Willamette Valley ommunity Health, LL $ $ $29.90 $, $92.07 $22.50 $25.03 $7.07 $.9 $ $98.75 $2, Yamhill ounty are Organization, Inc. $40.29 $65.72 $25.09 $889. $77.28 $22.39 $0.00 $6.98 $0.96 $244.4 $8.62 $2, Total Page 26

132 Oregon Health Plan Medicaid Demonstration apitation Range Development for January 205 through December 205 Trend Factors in Developing Special Needs Group (SNRG) PMPM s Exhibit 5B OMIP Population Non-OMIP Population Annual ost Trend Annual Utilization Trend Annual ost Trend Annual Utilization Trend oordinated are Organization Hosp D Phys & Misc Rx MH Hosp D Phys & Misc Rx MH Hosp D Phys & Misc Rx MH Hosp D Phys & Misc Rx MH ascade Health Alliance, LL 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 2.0% 2.0% 2.0% 2.0% 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 0.0% 0.0% 0.0% 0.0% olumbia-pacific O, LL 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 2.0% 2.0% 2.0% 2.0% 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 0.0% 0.0% 0.0% 0.0% DIPA, LL 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 2.0% 2.0% 2.0% 2.0% 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 0.0% 0.0% 0.0% 0.0% Eastern Oregon oordinated are Org., LL 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 2.0% 2.0% 2.0% 2.0% 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 0.0% 0.0% 0.0% 0.0% Familyare, Inc 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 2.0% 2.0% 2.0% 2.0% 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 0.0% 0.0% 0.0% 0.0% Health Share of Oregon 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 2.0% 2.0% 2.0% 2.0% 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 0.0% 0.0% 0.0% 0.0% Interommunity Health Network, Inc 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 2.0% 2.0% 2.0% 2.0% 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 0.0% 0.0% 0.0% 0.0% Jackson ounty O, LL 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 2.0% 2.0% 2.0% 2.0% 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 0.0% 0.0% 0.0% 0.0% Mid-Rogue Independent Physician Association, Inc 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 2.0% 2.0% 2.0% 2.0% 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 0.0% 0.0% 0.0% 0.0% PacificSource ommunity Solutions, Inc (entral) 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 2.0% 2.0% 2.0% 2.0% 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 0.0% 0.0% 0.0% 0.0% PacificSource ommunity Solutions, Inc (Gorge) 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 2.0% 2.0% 2.0% 2.0% 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 0.0% 0.0% 0.0% 0.0% Primary Health of Josephine ounty, LL 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 2.0% 2.0% 2.0% 2.0% 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 0.0% 0.0% 0.0% 0.0% Trillium ommunity Health Plan, Inc 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 2.0% 2.0% 2.0% 2.0% 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 0.0% 0.0% 0.0% 0.0% Western Oregon Advanced Health, LL 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 2.0% 2.0% 2.0% 2.0% 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 0.0% 0.0% 0.0% 0.0% Willamette Valley ommunity Health, LL 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 2.0% 2.0% 2.0% 2.0% 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 0.0% 0.0% 0.0% 0.0% Yamhill ounty are Organization, Inc 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 2.0% 2.0% 2.0% 2.0% 2.2% 2.2% 2.4% 3.% 2.4% 0.0% 0.0% 0.0% 0.0% 0.0% Page 27

133 Oregon Health Plan Medicaid Demonstration apitation Range Development for January 205 through December 205 AT/SE Services PMPM s Includes Administrative Allowance Exhibit 6A O Region TANF DUAL ABAD & ELIGIBLE OAA AA 9-44 AA AA ascade Health Alliance, LL Eastern $ 0.53 $ 6.09 $ 9.60 $ 0.53 $ 0.53 $ 0.53 olumbia-pacific O, LL oastal $ 0.7 $ 6.09 $ 9.62 $ 0.69 $ 0.66 $ 0.66 olumbia-pacific O, LL JJD $ 0.7 $ 6.28 $ 9.7 $ 0.69 $ 0.66 $ 0.66 DIPA, LL JJD $ 0.8 $ 4.02 $ 7.03 $ 0.8 $ 0.8 $ 0.8 Eastern Oregon oordinated are Org., LL Eastern $ 0.53 $ 5.5 $ 9.5 $ 0.53 $ 0.53 $ 0.53 Familyare, Inc Tri-ounty $ 0.25 $ 4.8 $ 0.62 $ 0.25 $ 0.25 $ 0.25 Health Share of Oregon Tri-ounty $ 0.25 $ 5.8 $ 0.72 $ 0.25 $ 0.25 $ 0.25 Interommunity Health Network, Inc oastal $ 0.36 $ 3.52 $ 7.8 $ 0.36 $ 0.36 $ 0.36 Interommunity Health Network, Inc LBMPY $ 0.36 $ 4.56 $ 7.8 $ 0.36 $ 0.36 $ 0.36 Jackson ounty O, LL JJD $ 0.8 $ 3.66 $ 6.90 $ 0.8 $ 0.8 $ 0.8 Mid-Rogue Independent Physician Association, Inc oastal $ 0.8 $ 3.9 $ 6.97 $ 0.8 $ 0.8 $ 0.8 Mid-Rogue Independent Physician Association, Inc JJD $ 0.8 $ 3.28 $ 6.94 $ 0.8 $ 0.8 $ 0.8 PacificSource ommunity Solutions, Inc (entral) entral $ 0.53 $ 5.64 $ 9.56 $ 0.53 $ 0.53 $ 0.53 PacificSource ommunity Solutions, Inc (entral) Eastern $ 0.53 $ 4.68 $ 9.28 $ 0.53 $ 0.53 $ 0.53 PacificSource ommunity Solutions, Inc (Gorge) entral $ 0.53 $ 5.8 $ 9.49 $ 0.53 $ 0.53 $ 0.53 Primary Health of Josephine ounty, LL JJD $ 0.8 $ 3.42 $ 6.98 $ 0.8 $ 0.8 $ 0.8 Trillium ommunity Health Plan, Inc Lane $ 0.4 $ 5.0 $ 8.34 $ 0.4 $ 0.4 $ 0.4 Western Oregon Advanced Health, LL oastal $.4 $ 6.33 $ 2.09 $.4 $.4 $.4 Willamette Valley ommunity Health, LL LBMPY $ 0.36 $ 4.0 $ 7.68 $ 0.36 $ 0.36 $ 0.36 Yamhill ounty are Organization, Inc LBMPY $ 0.36 $ 3.78 $ 7.59 $ 0.36 $ 0.36 $ 0.36 Page 28

134 Oregon Health Plan Medicaid Demonstration apitation Range Development for January 205 through December 205 Trend Factors in Developing AT/SE Services PMPM s Exhibit 6B Annual ost Trend Annual Utilization Trend Eligibility ategory FROM Jul 2009 to Jun 20 TO 203 FROM 203 TO 204 FROM 204 TO 205 FROM Jul 2009 to Jun 20 TO 203 FROM 203 TO 204 FROM 204 TO 205 TANF 2.% 2.0% 2.4% 2.8%.5% 0% ABAD & OAA with MEDIARE 2.% 2.0% 2.4% 3.0%.5% 0% ABAD & OAA without MEDIARE 2.% 2.0% 2.4% 3.0%.5% 0% AA % 2.0% 2.4% 2.8%.5% 0% AA % 2.0% 2.4% 2.8%.5% 0% AA % 2.0% 2.4% 2.8%.5% 0% Page 29

135 Oregon Health Plan Medicaid Demonstration apitation Range Development for January 205 through December 205 Alcohol and Drug Residential Services PMPM s Includes Administrative Allowance Exhibit 7A O TANF PLMA HILD DUAL ABAD & AA AA AA AF 06-8 ELIGIBLE OAA ascade Health Alliance, LL $ 7.72 $ 9.56 $.37 $ 0.4 $ 4.0 $ 2.9 $ 0.37 $ 6.07 $ 2.7 olumbia-pacific O, LL $ 6.73 $ 6.44 $.45 $ 0.37 $.83 $ 4.66 $ 0.7 $ 4.83 $ 0.3 DIPA, LL $ 5.2 $ 2.03 $ 2.22 $ 0.47 $ 3.28 $ 8.60 $ 7.30 $ 4.3 $.27 Eastern Oregon oordinated are Org., LL $ 7.72 $ 9.56 $.37 $ 0.4 $ 4.0 $ 2.9 $ 0.37 $ 6.07 $ 2.7 Familyare, Inc $ 0.07 $.66 $ 0.57 $ 0.42 $ 4.66 $ 0.23 $ 3.7 $ 0.29 $ 2.7 Health Share of Oregon $ 0.35 $.76 $ 0.54 $ 0.39 $ 5.8 $ 0.57 $ 4.33 $ 0.96 $ 2.85 Interommunity Health Network, Inc $ 6.54 $ 7.45 $.9 $ 0.25 $ 2.08 $ 5.23 $ 7.30 $ 5.82 $.46 Jackson ounty O, LL $ 5.2 $ 2.03 $ 2.22 $ 0.47 $ 3.28 $ 8.60 $ 7.30 $ 4.3 $.27 Mid-Rogue Independent Physician Association, Inc $ 5.2 $ 2.03 $ 2.22 $ 0.47 $ 3.28 $ 8.60 $ 7.30 $ 4.3 $.27 PacificSource ommunity Solutions, Inc (entral) $ 7.59 $ 5.70 $.9 $.09 $ 2.58 $ 33.0 $ 9.59 $ 7.78 $ 3.5 PacificSource ommunity Solutions, Inc (Gorge) $ 7.59 $ 5.70 $.9 $.09 $ 2.58 $ 33.0 $ 9.59 $ 7.78 $ 3.5 Primary Health of Josephine ounty, LL $ 5.2 $ 2.03 $ 2.22 $ 0.47 $ 3.28 $ 8.60 $ 7.30 $ 4.3 $.27 Trillium ommunity Health Plan, Inc $ 8.7 $ 3.90 $ 0.25 $ 0.68 $ 4.25 $ 8.09 $ 2.35 $ 2.90 $ 3.68 Western Oregon Advanced Health, LL $ 6.73 $ 6.44 $.45 $ 0.37 $.83 $ 4.66 $ 0.7 $ 4.83 $ 0.3 Willamette Valley ommunity Health, LL $ 6.54 $ 7.45 $.9 $ 0.25 $ 2.08 $ 5.23 $ 7.30 $ 5.82 $.46 Yamhill ounty are Organization, Inc $ 0.56 $ 3.68 $ 2.07 $ 0.38 $.04 $ $ 2.32 $ 9.83 $ 2.46 Page 30

136 Oregon Health Plan Medicaid Demonstration apitation Range Development for January 205 through December 205 Trend Factors in Developing Alcohol and Drug Residential PMPM s Exhibit 7B Annual ost Trend Annual Utilization Trend Eligibility ategory FROM Jul 200 to Jun 202 TO 204* FROM 204 TO 205 FROM Jul 200 to Jun 202 TO 204 FROM 204 TO 205 TANF 0.0% 2.4%.0% 0% PLMA 0.0% 2.4%.0% 0% HILD % 2.4%.0% 0% ABAD & OAA with MEDIARE 0.0% 2.4%.0% 0% ABAD & OAA without MEDIARE 0.0% 2.4%.0% 0% AF 0.0% 2.4%.0% 0% AA % 2.4%.0% 0% AA % 2.4%.0% 0% AA % 2.4%.0% 0% * Note, unit costs were obtained at level of during year 204, and therefore required no cost trend to 204. Page 3

137 Oregon Health Plan Medicaid Demonstration apitation Range Development for January 205 through December 205 Non-Emergent Medical Transportation Services PMPM s Including Administrative Allowance Exhibit 8A O Region TANF PLMA HILD HILD HILD DUAL ABAD & AA AA AA AF ELIGIBLE OAA ascade Health Alliance, LL Eastern $ 9.9 $ 5.6 $ 0.93 $ 0.45 $.06 $ $ $.82 $ 9.5 $ 5.37 $ 7.0 olumbia-pacific O, LL oastal $ 5.97 $ 4.7 $ 0.83 $ 0.58 $.36 $ $ $ 2.96 $ 7.29 $ 2.24 $ 3.55 olumbia-pacific O, LL JJD $ 5.97 $ 4.7 $ 0.83 $ 0.58 $.36 $ $ $ 2.96 $ 7.29 $ 2.24 $ 3.55 DIPA, LL JJD $ 9.94 $ 5.8 $ 0.93 $ 0.45 $.06 $ $ $.82 $ 9.8 $ 5.42 $ 7.06 Eastern Oregon oordinated are Org., LL Eastern $ 5.03 $.76 $ 0.60 $ 0.43 $ 0.79 $ $ $.89 $ 7.40 $ 2.42 $ 3.74 Familyare, Inc Tri-ounty $ 8.85 $ 4.39 $ 0.77 $ 0.29 $ 0.64 $ $ $ 4.70 $ 8.89 $ 4.94 $ 6.53 Health Share of Oregon Tri-ounty $ 8.57 $ 4.34 $ 0.73 $ 0.28 $ 0.60 $ $ 38.4 $ 4.50 $ 8.48 $ 4.24 $ 5.76 Interommunity Health Network, Inc oastal $ 6.67 $ 3.49 $ 0.86 $ 0.54 $ 0.96 $ $ 34.0 $ 3.32 $ 8.8 $ 3.73 $ 5.9 Interommunity Health Network, Inc LBMPY $ 6.67 $ 3.49 $ 0.86 $ 0.54 $ 0.96 $ $ 34.0 $ 3.32 $ 8.8 $ 3.73 $ 5.9 Jackson ounty O, LL JJD $ 9.29 $ 4.84 $ 0.87 $ 0.42 $.00 $ 40.7 $ $.7 $ 8.57 $ 4.40 $ 5.93 Mid-Rogue Independent Physician Association, Inc oastal $ 9.05 $ 4.75 $ 0.85 $ 0.42 $.00 $ $ $.78 $ 8.36 $ 4.04 $ 5.54 Mid-Rogue Independent Physician Association, Inc JJD $ 9.05 $ 4.75 $ 0.85 $ 0.42 $.00 $ $ $.78 $ 8.36 $ 4.04 $ 5.54 PacificSource ommunity Solutions, Inc (entral) entral $ 4.8 $ 2.34 $ 0.95 $ 0.42 $ 0.86 $ $ $ 5.98 $ 6.40 $ 0.75 $.89 PacificSource ommunity Solutions, Inc (entral) Eastern $ 4.8 $ 2.34 $ 0.95 $ 0.42 $ 0.86 $ $ $ 5.98 $ 6.40 $ 0.75 $.89 PacificSource ommunity Solutions, Inc (Gorge) entral $ 6.37 $ 3.09 $. $ 0.50 $.0 $ 6.27 $ $ 7.36 $ 7.8 $ 3.2 $ 4.5 Primary Health of Josephine ounty, LL JJD $ 9.26 $ 4.83 $ 0.87 $ 0.42 $ 0.99 $ $ $.70 $ 8.55 $ 4.36 $ 5.90 Trillium ommunity Health Plan, Inc Lane $ 5.32 $ 2.83 $.55 $ 0.63 $ 0.89 $ $ $ 2.36 $ 6.9 $.60 $ 2.84 Western Oregon Advanced Health, LL oastal $ 4.54 $ 3.4 $ 0.6 $ 0.44 $.04 $ $ $ 2.49 $ 5.48 $ 9.20 $ 0.8 Willamette Valley ommunity Health, LL LBMPY $ 5.43 $ 2.46 $ 0.69 $ 0.4 $ 0.64 $ 45.7 $ 27.2 $ 2.69 $ 6.66 $.8 $ 2.37 Yamhill ounty are Organization, Inc LBMPY $ 5.45 $ 2.49 $ 0.69 $ 0.4 $ 0.64 $ $ $ 2.69 $ 6.67 $.20 $ 2.39 Page 32

138 Oregon Health Plan Medicaid Demonstration apitation Range Development for January 205 through December 205 Trend Factors in Developing NEMT PMPM s Exhibit 8B Annual ost Trend Annual Utilization Trend Eligibility ategory FROM Jul 200 to Jun 20 TO 203 FROM 203 TO 204 FROM 204 TO 205 FROM Jul 200 to Jun 20 TO 203 FROM 203 TO 204 FROM 204 TO 205 TANF.3%.3% 2.4%.2%.2% 0% PLMA.3%.3% 2.4%.6%.6% 0% HILD %.3% 2.4%.4%.4% 0% HILD %.3% 2.4%.0%.0% 0% HILD %.3% 2.4%.0%.0% 0% ABAD with Medicare.3%.3% 2.4% 3.3% 3.3% 0% ABAD without Medicare.3%.3% 2.4% 3.0% 3.0% 0% OAA with Medicare.3%.3% 2.4% 3.3% 3.3% 0% OAA without Medicare.3%.3% 2.4% 2.5% 2.5% 0% AF.3%.3% 2.4%.6%.6% 0% AA 9-44 n/a* n/a* 2.4% n/a* n/a* 0% AA n/a* n/a* 2.4% n/a* n/a* 0% AA n/a* n/a* 2.4% n/a* n/a* 0% * Note, NEMT PMPM rates were not developed from its own FFS data due to the lack of experience data. Page 33

139 Oregon Health Plan Medicaid Demonstration Exhibit 9 apitation Range Development for January 205 through December 205 Mental Health hildren's Wraparound Services PMPM s 204 to 205 Annual ost Trend Est. 205 Util / 000 PMPM w/o Admin PMPM w/ Admin Projected 205 Member Month Projected hildren Serviced per Month O 204 Unit ost 205 Unit ost ascade Health Alliance, LL $ % $84.95,076 $73.0 $ DIPA, LL $ % $84.95,076 $73.0 $ Eastern Oregon oordinated are Org., LL $ % $84.95,076 $73.0 $ Familyare, Inc $ % $ $45.03 $ ,035 2 Health Share of Oregon $ % $ $45.03 $ , Interommunity Health Network, Inc $ % $84.95,002 $68.07 $73.99,54 96 Jackson ounty O, LL $ % $ $34.90 $ Mid Rogue Independent Physician Association, Inc $ % $ $34.90 $ Primary Health of Josephine ounty, LL $ % $ $34.90 $ Trillium ommunity Health Plan, Inc $ % $ $37.3 $ , Western Oregon Advanced Health, LL $ % $84.95,086 $73.73 $ Willamette Valley ommunity Health, LL $ % $84.95,002 $68.07 $73.99, Yamhill ounty are Organization, Inc $ % $84.95,002 $68.07 $ Page 34

140 Oregon Health Plan Medicaid Demonstration Exhibit 20 apitation Range Development for January 205 through December 205 Risk Adjustments for AA Adults 9 44, AA Adults 45 54, and AA Adults Risk Adjustments O AA 9 44 AA AA ascade Health Alliance, LL olumbia-pacific O, LL DIPA, LL. Abn Umpqua Health Alliance Eastern Oregon oordinated are Org., LL Familyare, Inc Health Share of Oregon Interommunity Health Network, Inc Jackson ounty O, LL Mid-Rogue Independent Physician Association, Inc PacificSource ommunity Solutions, Inc (entral) PacificSource ommunity Solutions, Inc (Gorge) Primary Health of Josephine ounty, LL Trillium ommunity Health Plan, Inc Western Oregon Advanced Health, LL Willamette Valley ommunity Health, LL Yamhill ounty are Organization, Inc Page 35

141 Oregon Health Plan Medicaid Demonstration EXHIBIT 2 apitation Range Development for January 205 through December 205 Family Planning Reimbursement Increase PMPM s O Region TANF PLMA HILD ABAD & AA AF 06-8 OAA 9-44 ascade Health Alliance, LL Eastern $ 0.20 $ 0.32 $ 0.07 $ 0.03 $ 0.06 $ 0.20 olumbia-pacific O, LL JJD $ 0.5 $ 0.25 $ 0.06 $ 0.02 $ 0.05 $ 0.5 olumbia-pacific O, LL oastal $ 0.5 $ 0.25 $ 0.06 $ 0.02 $ 0.05 $ 0.5 DIPA, LL JJD $ 0.06 $ 0. $ 0.02 $ 0.0 $ 0.02 $ 0.06 Eastern Oregon oordinated are Org., LL Eastern $ 0.40 $ 0.66 $ 0.5 $ 0.06 $ 0.3 $ 0.40 Familyare, Inc Tri-ounty $ 0.03 $ 0.04 $ 0.0 $ 0.00 $ 0.0 $ 0.03 Health Share of Oregon Tri-ounty $ 0.04 $ 0.07 $ 0.0 $ 0.0 $ 0.0 $ 0.04 Interommunity Health Network, Inc LBMPY $ 0.02 $ 0.03 $ 0.0 $ 0.00 $ 0.0 $ 0.02 Interommunity Health Network, Inc oastal $ 0.02 $ 0.03 $ 0.0 $ 0.00 $ 0.0 $ 0.02 Jackson ounty O, LL JJD $ 0.6 $.00 $ 0.23 $ 0.09 $ 0.9 $ 0.6 Mid-Rogue Independent Physician Association, Inc JJD $ 0.33 $ 0.54 $ 0.2 $ 0.05 $ 0.0 $ 0.33 Mid-Rogue Independent Physician Association, Inc oastal $ 0.33 $ 0.54 $ 0.2 $ 0.05 $ 0.0 $ 0.33 PacificSource ommunity Solutions, Inc (entral) entral $ 0.6 $.0 $ 0.23 $ 0.09 $ 0.9 $ 0.6 PacificSource ommunity Solutions, Inc (entral) Eastern $ 0.6 $.0 $ 0.23 $ 0.09 $ 0.9 $ 0.6 PacificSource ommunity Solutions, Inc (Gorge) entral $ 0.6 $.0 $ 0.23 $ 0.09 $ 0.9 $ 0.6 Primary Health of Josephine ounty, LL JJD $ 0.22 $ 0.36 $ 0.08 $ 0.03 $ 0.07 $ 0.22 Trillium ommunity Health Plan, Inc Lane $ 0.09 $ 0.4 $ 0.03 $ 0.0 $ 0.03 $ 0.09 Western Oregon Advanced Health, LL oastal $ 0.09 $ 0.5 $ 0.03 $ 0.0 $ 0.03 $ 0.09 Willamette Valley ommunity Health, LL LBMPY $ 0.4 $ 0.23 $ 0.05 $ 0.02 $ 0.04 $ 0.4 Yamhill ounty are Organization, Inc LBMPY $ 0.9 $ 0.3 $ 0.07 $ 0.03 $ 0.06 $ 0.9 Page 36

142 Oregon Health Plan Medicaid Demonstration EXHIBIT 22 apitation Range Development for January 205 through December 205 Sovaldi Prescription Drug Adjustment PMPM s TANF and AA 9 44 ABAD and OAA without Medicare AA and AA w/ Admin Projected 205 Member Month Projected 205 Number of Patients w/ Admin Projected 205 Member Month Projected 205 Number of Patients w/ Admin Projected 205 Member Month Projected 205 Number of Patients O 205 ost per Script* Est. 205 Util / 000 Est. 205 Util / 000 Est. 205 Util / 000 ascade Health Alliance, LL $23, $ , $54.3 9, $7.78 8,29 2 olumbia-pacific O, LL $23, $.6 89, $ , $ ,0 4 DIPA, LL. Abn Umpqua Health Alliance $23, $ , $ , $5.0 47,845 8 Eastern Oregon oordinated are Org., LL $23, $.04 38, $ , $5.2 69,374 4 Familyare, Inc $23, $ , $ , $ ,467 8 Health Share of Oregon $23, $ , $ , $ , Interommunity Health Network, Inc $23, $ , $ , $ ,066 0 Jackson ounty O, LL $23, $ , $54.9 7, $4.2 45,756 7 Mid-Rogue Independent Physician Association, Inc $23, $0.4 75,855.8 $ , $ ,234 4 PacificSource ommunity Solutions, Inc (entral) $23, $0.40 8, $ , $ ,399 0 PacificSource ommunity Solutions, Inc (Gorge) $23, $ , $ , $ ,72 2 Primary Health of Josephine ounty, LL $23, $ , $6.69 7, $4.5 24,892 4 Trillium ommunity Health Plan, Inc $23, $. 260, $ , $ ,60 2 Western Oregon Advanced Health, LL $23, $3.4 69,0 2.6 $ , $ ,46 3 Willamette Valley ommunity Health, LL $23, $.24 29, $ , $.56 24,983 6 Yamhill ounty are Organization, Inc $23, $0.00 7, $ , $ ,422 4 Note, estimated scripts per patient is 3.69 per patient per year and estimated cost per patient is $85,626. Page 37