Common use of Payment of Direct Capitation for Coverage of Integrated Medicaid Benefits (FIDE) Clause in Contracts

Payment of Direct Capitation for Coverage of Integrated Medicaid Benefits (FIDE). AHCCCS agrees to pay MAO (as per and to this Agreement’s “Participant” representing the sole Arizona corporate legal entity [corporation] under common direction and control) monthly capitated rates per enrolled ALTCS E-PD Dual Eligible Member, and calculated as full compensation (incorporating reinsurance provisions) for ALTCS Health Plan integrated goods and services provided hereunder, including integrated managed long-term supports and services (MLTSS), in that month under this Agreement as per:  Contract Year Ending 2020 ALTCS E-PD Program Capitation Rates xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ALTC S/ALTCSEPD2020RateEffectiveOct12019andJan12020.pdf  AHCCCS Capitation Risk Pool to Eligibility Category to Rate Code Matrix xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/RiskP ooltoEligibilityCategorytoRateCode.pdf  Contract Year Ending 2020 ALTCS E-PD Program Capitation Rate Certification xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ALTC S/CYE20ALTCSEPDCapitationRateCertificationSOF.pdf Note: This annual ALTCS E-PD Capitation Rate Certification includes all specific and usual and customary Medicaid covered service reimbursement requirements and adjustments by specific rate cell and capitation rate. Such components include but are not limited to: institutional and MLTSS eligibility, institutional and MLTSS covered services, demographic characteristics, etc. Specific rate cell categories are assigned prospectively based on eligibility for the next available month. For FIDE status purposes under this Agreement, there are no carved out AHCCCS covered services.

Payment of Direct Capitation for Coverage of Integrated Medicaid Benefits (FIDE). AHCCCS agrees to pay MAO (as per and to this Agreement’s “Participant” representing the sole Arizona corporate legal entity [corporation] under common direction and control) monthly capitated rates per each enrolled ALTCS E-PD Full Benefit Dual Eligible Member, and calculated as full compensation (incorporating reinsurance provisions) for ALTCS Health Plan integrated goods and services provided hereunder, including integrated Medicaid managed long-long- term supports and services (MLTSS), in that month under this Agreement as per:  • Contract Year Ending 2020 2022 ALTCS E-PD Program Capitation Rates xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ALTC S/ALTCSEPD2020RateEffectiveOct12019andJan12020.pdf  ALTCSEPDRatesEffectiveOct12021.pdf; • AHCCCS Capitation Risk Pool to Eligibility Category to Rate Code Matrix xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/RiskP ooltoEligibilityCategorytoRateCode.pdf  ooltoEligibilityCategorytoRateCode.pdf; • Contract Year Ending 2020 2022 ALTCS E-PD Program Capitation Rate Certification xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ALTC S/CYE20ALTCSEPDCapitationRateCertificationSOF.pdf CYE22ALTCSEPDCapitationRateCertificationSOF.pdf. Note: This annual ALTCS E-PD Capitation Rate Certification includes all specific and usual and customary Medicaid covered service reimbursement requirements and adjustments by specific rate cell and capitation rate. Such components include include, but are not limited to: institutional and MLTSS eligibility, institutional and MLTSS covered services, demographic characteristics, etc. Specific rate cell categories are assigned prospectively based on eligibility for the next available month. For FIDE SNP status purposes under this Agreement, there are no carved out AHCCCS covered services.

Payment of Direct Capitation for Coverage of Integrated Medicaid Benefits (FIDE). AHCCCS agrees to pay MAO (as per and to this Agreement’s “Participant” representing the sole Arizona corporate legal entity [corporation] under common direction and control) monthly capitated rates per enrolled ALTCS E-PD Dual Eligible Member, and calculated as full compensation (incorporating reinsurance provisions) for ALTCS Health Plan integrated goods and services provided hereunder, including integrated managed long-term supports and services (MLTSS), in that month under this Agreement as per:  Contract Year Ending 2020 ALTCS E-PD Program Capitation Rates xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ALTC Sxxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ ALTCS/ALTCSEPD2020RateEffectiveOct12019andJan12020.pdf  AHCCCS Capitation Risk Pool to Eligibility Category to Rate Code Matrix xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/RiskP ooltoEligibilityCategorytoRateCode.pdf xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ RiskPooltoEligibilityCategorytoRateCode.pdf  Contract Year Ending 2020 ALTCS E-PD Program Capitation Rate Certification xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ALTC Sxxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ ALTCS/CYE20ALTCSEPDCapitationRateCertificationSOF.pdf Note: This annual ALTCS E-PD Capitation Rate Certification includes all specific and usual and customary Medicaid covered service reimbursement requirements and adjustments by specific rate cell and capitation rate. Such components include but are not limited to: institutional and MLTSS eligibility, institutional and MLTSS covered services, demographic characteristics, etc. Specific rate cell categories are assigned prospectively based on eligibility for the next available month. For FIDE status purposes under this Agreement, there are no carved out AHCCCS covered services.

Payment of Direct Capitation for Coverage of Integrated Medicaid Benefits (FIDE). AHCCCS agrees to pay MAO (as per and to this Agreement’s “Participant” representing the sole Arizona corporate legal entity [corporation] under common direction and control) monthly capitated rates per each enrolled ALTCS E-PD Full Benefit Dual Eligible Member, and calculated as full compensation (incorporating reinsurance provisions) for ALTCS Health Plan integrated goods and services provided hereunder, including integrated Medicaid managed long-long- term supports and services (MLTSS), in that month under this Agreement as per:  Contract Year Ending 2020 2022 ALTCS E-PD Program Capitation Rates xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ALTC S/ALTCSEPD2020RateEffectiveOct12019andJan12020.pdf  ALTCSEPDRatesEffectiveOct12021.pdf; AHCCCS Capitation Risk Pool to Eligibility Category to Rate Code Matrix xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/RiskP ooltoEligibilityCategorytoRateCode.pdf  ooltoEligibilityCategorytoRateCode.pdf; Contract Year Ending 2020 2022 ALTCS E-PD Program Capitation Rate Certification xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ALTC S/CYE20ALTCSEPDCapitationRateCertificationSOF.pdf CYE22ALTCSEPDCapitationRateCertificationSOF.pdf. Note: This annual ALTCS E-PD Capitation Rate Certification includes all specific and usual and customary Medicaid covered service reimbursement requirements and adjustments by specific rate cell and capitation rate. Such components include include, but are not limited to: institutional and MLTSS eligibility, institutional and MLTSS covered services, demographic characteristics, etc. Specific rate cell categories are assigned prospectively based on eligibility for the next available month. For FIDE SNP status purposes under this Agreement, there are no carved out AHCCCS covered services.

Payment of Direct Capitation for Coverage of Integrated Medicaid Benefits (FIDE). AHCCCS agrees to pay MAO (as per and to this Agreement’s “Participant” representing the sole Arizona corporate legal entity [corporation] under common direction and control) monthly capitated rates per enrolled ALTCS E-PD Dual Eligible Member, and calculated as full compensation (incorporating reinsurance provisions) for ALTCS Health Plan integrated goods and services provided hereunder, including integrated managed long-term supports and services (MLTSS), in that month under this Agreement as per:  Contract Year Ending 2020 ALTCS E-PD Program Capitation Rates xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ALTC S(xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ALT CS/ALTCSEPD2020RateEffectiveOct12019andJan12020.pdf ALTCSEPD2020RateEffectiveOct12019andJan12020.pdf)  AHCCCS Capitation Risk Pool to Eligibility Category to Rate Code Matrix xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/RiskP ooltoEligibilityCategorytoRateCode.pdf (xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/Risk PooltoEligibilityCategorytoRateCode.pdf)  Contract Year Ending 2020 ALTCS E-PD Program Capitation Rate Certification xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ALTC S(xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ALT CS/CYE20ALTCSEPDCapitationRateCertificationSOF.pdf CYE20ALTCSEPDCapitationRateCertificationSOF.pdf) Note: This annual ALTCS E-PD Capitation Rate Certification includes all specific and usual and customary Medicaid covered service reimbursement requirements and adjustments by specific rate cell and capitation rate. Such components include but are not limited to: institutional and MLTSS eligibility, institutional and MLTSS covered services, demographic characteristics, etc. Specific rate cell categories are assigned prospectively based on eligibility for the next available month. For FIDE status purposes under this Agreement, there are no carved out AHCCCS covered services.

Payment of Direct Capitation for Coverage of Integrated Medicaid Benefits (FIDE). AHCCCS agrees to pay MAO (as per and to this Agreement’s “Participant” representing the sole Arizona corporate legal entity [corporation] under common direction and control) monthly capitated rates per each enrolled ALTCS E-PD Full Benefit Dual Eligible Member, and calculated as full compensation (incorporating reinsurance provisions) for ALTCS Health Plan integrated goods and services provided hereunder, including integrated Medicaid managed long-long- term supports and services (MLTSS), in that month under this Agreement as per:  • Contract Year Ending 2020 2022 ALTCS E-PD Program Capitation Rates xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ALTC S/ALTCSEPD2020RateEffectiveOct12019andJan12020.pdf  ALTCSEPDRatesEffectiveOct12021.pdf; MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND Participant Health Choice Arizona, Inc. d/b/a Health Choice Pathway AHCCCS AGREEMENT # YH23-0010-03 • AHCCCS Capitation Risk Pool to Eligibility Category to Rate Code Matrix xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/RiskP ooltoEligibilityCategorytoRateCode.pdf  ooltoEligibilityCategorytoRateCode.pdf; • Contract Year Ending 2020 2022 ALTCS E-PD Program Capitation Rate Certification xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ALTC S/CYE20ALTCSEPDCapitationRateCertificationSOF.pdf CYE22ALTCSEPDCapitationRateCertificationSOF.pdf. Note: This annual ALTCS E-PD Capitation Rate Certification includes all specific and usual and customary Medicaid covered service reimbursement requirements and adjustments by specific rate cell and capitation rate. Such components include include, but are not limited to: institutional and MLTSS eligibility, institutional and MLTSS covered services, demographic characteristics, etc. Specific rate cell categories are assigned prospectively based on eligibility for the next available month. For FIDE SNP status purposes under this Agreement, there are no carved out AHCCCS covered services.

Payment of Direct Capitation for Coverage of Integrated Medicaid Benefits (FIDE). AHCCCS agrees to pay MAO (as per and to this Agreement’s “Participant” representing the sole Arizona corporate legal entity [corporation] under common direction and control) monthly capitated rates per enrolled ALTCS E-PD Dual Eligible Member, and calculated as full compensation (incorporating reinsurance provisions) for ALTCS Health Plan integrated goods and services provided hereunder, including integrated managed long-term supports and services (MLTSS), in that month under this Agreement as per:  • Contract Year Ending 2020 ALTCS E-PD Program Capitation Rates xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ALTC S/ALTCSEPD2020RateEffectiveOct12019andJan12020.pdf  • AHCCCS Capitation Risk Pool to Eligibility Category to Rate Code Matrix xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/RiskP ooltoEligibilityCategorytoRateCode.pdf  • Contract Year Ending 2020 ALTCS E-PD Program Capitation Rate Certification xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ALTC S/CYE20ALTCSEPDCapitationRateCertificationSOF.pdf Note: This annual ALTCS E-PD Capitation Rate Certification includes all specific and usual and customary Medicaid covered service reimbursement requirements and adjustments by specific rate cell and capitation rate. Such components include but are not limited to: institutional and MLTSS eligibility, institutional and MLTSS covered services, demographic characteristics, etc. Specific rate cell categories are assigned prospectively based on eligibility for the next available month. For FIDE status purposes under this Agreement, there are no carved out AHCCCS covered services.

Payment of Direct Capitation for Coverage of Integrated Medicaid Benefits (FIDE). AHCCCS agrees to pay MAO XXX (as per and to this Agreement’s “Participant” representing the sole Arizona corporate legal entity [corporation] under common direction and control) monthly capitated rates per each enrolled ALTCS E-PD Full Benefit Dual Eligible Member, and calculated as full compensation (incorporating reinsurance provisions) for ALTCS Health Plan integrated goods and services provided hereunder, including integrated Medicaid managed long-long- term supports and services (MLTSS), in that month under this Agreement as per:  • Contract Year Ending 2020 2022 ALTCS E-PD Program Capitation Rates xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ALTC S/ALTCSEPD2020RateEffectiveOct12019andJan12020.pdf  ALTCSEPDRatesEffectiveOct12021.pdf; • AHCCCS Capitation Risk Pool to Eligibility Category to Rate Code Matrix xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/RiskP ooltoEligibilityCategorytoRateCode.pdf  ooltoEligibilityCategorytoRateCode.pdf; • Contract Year Ending 2020 2022 ALTCS E-PD Program Capitation Rate Certification xxxxx://xxx.xxxxxxxx.xxx/PlansProviders/Downloads/CapitationRates/ALTC S/CYE20ALTCSEPDCapitationRateCertificationSOF.pdf CYE22ALTCSEPDCapitationRateCertificationSOF.pdf. Note: This annual ALTCS E-PD Capitation Rate Certification includes all specific and usual and customary Medicaid covered service reimbursement requirements and adjustments by specific rate cell and capitation rate. Such components include include, but are not limited to: institutional and MLTSS eligibility, institutional and MLTSS covered services, demographic characteristics, etc. Specific rate cell categories are assigned prospectively based on eligibility for the next available month. For FIDE SNP status purposes under this Agreement, there are no carved out AHCCCS covered services.