General SRC #10, Attachment 1: Expanded Benefits Actuarial Support

Summary

General SRC #10, Attachment 1: Expanded Benefits Actuarial Support SummaryMagellan Florida MHS, Inc. dba Magellan Complete CareNutritional Counseling and Discharge Meals

ITN Bid Amount: PMPMNutritional Counseling 0.02$ Discharge Meals 0.31$

Assuming negligible prospective trendSource data from a partnering vendor, Independent Living Systems, LLC ("ILS")Data based on actual utilization from historical experience period

CY 2016 Experience Period:

2016 Paid 2016 MMs 2016 PMPMNutritional Counseling 14,696$ 671,807 0.02$ Discharge Meals 205,376$ 671,807 0.31$

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General SRC #10, Attachment 1: Expanded Benefits Actuarial Support SummaryMagellan Florida MHS, Inc. dba Magellan Complete CareCopay Waivers

ITN Bid Valuation ITN Bid Mbrs PMPMNon-Dual 58,077Total ITN Bid Membership Value of Copay Waiver PMPM: 68,635 $2.08

From 2H 2016 Historical Experience: PMPMNon-Dual Total excl Transportation: $1.82Total Membership Transportation: $0.54

Service 2H 2016 Utilization Copay Fee Total FeesChiropractor services, per provider or group provider, per day 683 $1.00 $683Community behavioral health services, per provider, per day 65,594 $2.00 $131,188Home health services, per provider, per day 29,748 $2.00 $59,496Hospital outpatient services, per visit 26,905 $3.00 $80,715Federally qualified health center visit, per clinic, per day 4,516 $3.00 $13,548Independent laboratory services, per provider, per day 20,556 $1.00 $20,556Nurse practitioner services, per provider or group provider, per day 11,733 $2.00 $23,466Optometrist services, per provider or group provider, per day 139 $2.00 $278Physician and physician assistant, per provider or group provider, per day 86,111 $2.00 $172,222Podiatrist services, per provider or group provider, per day 2,056 $2.00 $4,112Portable x-ray services, per provider, per day 0 $1.00 $0Rural health clinic visit, per clinic, per day 206 $3.00 $618Use of the hospital emergency department for non-emergency services 0 5% of the first $30 $0

Non-Dual Total Waived Copay Expense: $506,882Non - Dual MMs During Experience Period: 278,245

Non-emergency transportation services, per each one-way trip 188,099 $1.00 $188,099Total Non-Dual and Dual MMs During Experience Period: 348,468

Data MethodologySource Data; FL MCC Paid Claims and Encounter Database -- 6 months of data, ending DOS 12/31/2016 paid through 9/2017 -- No provision for IBNR -- Excludes <21 year olds

Used the following state data source to identified service categories subject to copayhttp://ahca.myflorida.com/medicaid/review/General/59G_1056_Copayments_Coinsurance.pdf

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General SRC #10, Attachment 1: Expanded Benefits Actuarial Support SummaryLimited data based on the following criteria:Service Data MethodologyChiropractor services, per provider or group provider, per day Provider Specialty = ChiropractorCommunity behavioral health services, per provider, per day POS = 53Home health services, per provider, per day POS = 12Hospital outpatient services, per visit POS = 22Federally qualified health center visit, per clinic, per day POS = 50Independent laboratory services, per provider, per day POS = 81Non-emergency transportation services, per each one-way trip LOC_Subcat = TransportationNurse practitioner services, per provider or group provider, per day Provider Specialty = Nurse PractitionerOptometrist services, per provider or group provider, per day Provider Specialty = OptometristPhysician and physician assistant, per provider or group provider, per day POS = 11Podiatrist services, per provider or group provider, per day Provider Specialty = PodiatristPortable x-ray services, per provider, per day Negligible volumeRural health clinic visit, per clinic, per day POS = 72Use of the hospital emergency department for non-emergency services Negligible volume

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General SRC #10, Attachment 1: Expanded Benefits Actuarial Support SummaryMagellan Florida MHS, Inc. dba Magellan Complete CareIntensive Outpatient (IOP) Benefit for Mental Health and Substance Abuse

ITN Bid Valuation ITN Bid Mbrs PMPMNon-Dual 58,077Total 68,635 -- Remixing at Projected Total ITN MembershipIOP Substance Abuse $ 0.04 IOP Mental Health $ 0.56

CY 2016 DOS Experience

2016 Incurred*

2016 Non-Dual MMs PMPM

IOP Substance Abuse $ 25,540 548,799 $ 0.05 IOP Mental Health n/a n/a n/a -- IOP MH is a new benefit for 2018; no historical experience

To approximate a value for IOP Mental Health, utilizing a relativity of IP admits/k for Mental Health : Substance Abuse to apply to IOP SA PMPM2H 2016 Admits/KMental Health: 309Substance Abuse: 22MH:SA IP Admit Relativity: 14.3

Assumed IOP Mental Health PMPM: $ 0.67

*IBNR; DOS 2016 paid through Sep, 2017. Projected to be 99.4% complete

Source Data; FL MCC Paid Claims Database for Proc Code = H0015

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General SRC #10, Attachment 1: Expanded Benefits Actuarial Support Summary

Magellan Florida MHS, Inc. dba Magellan Complete CareCollaborative Care Model

ITN Bid Total Membership 68,635ITN Bid PMPM 0.19$

Membership Universe: 24,729 -- Members with assigned capitated providers at FQHCs and PCMHs

Targeted Membership %: 93.0% -- Members with Low or Moderate risk identification

Year 1 Provider Adoption Rate: 5.0% -- Internal Clinical assumption

Total Utilization (count): 1,150

Assumed Unit Cost: 135.00$

Total Annual Cost: 155,236$

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