Managed Long Term Care Medicaid Managed Care Operations Report

Transcription

1 Managed Long Term Care Medicaid Managed Care Operations Report Aetna Better Health MLTC Report Period Ending : 6/30/2017 : NYC Metro DCN : Created : Monday, August 14, 2017

2 Identification Information - Medicaid Managed Care Operating Report - For Managed Long Term Care Plans Name of Plan 0010 Aetna Better Health MLTC Counties of Operation: 0004 NASSAU 0005 SUFFOLK 0006 KINGS (BROOKLYN) 0007 NY (MANHATTAN) 0008 QUEENS Report Period (MM/DD/YYYY): Begin Date: /1/2017 End Date: /30/2017 Date Operations Started (MM/DD/YYYY): /01/2012 Mailing Address: W 125th St 0067 Suite New York NY Contact Person: Name: 0070 Dennis Nesta Title: 0071 Chief Financial Officer Telephone Number: Fax Number: Address: 0082 NestaD@aetna.com Chief Executive Officer or Executive Director: Role 0098 CEO Name: 0074 Kevin Nelson Title: 0075 Chief Executive Officer Telephone Number: Fax Number: Address: 0083 NelsonK8@aetna.com Chief Financial Officer: Role 0099 CFO Name: 0078 Dennis Nesta Title: 0079 Chief Financial Officer Telephone Number: Fax Number: Address: 0084 NestaD@aetna.com MLTC Only 0101 Page 1

3 CURRENT ASSETS Schedule A Balance Sheet Current Period Current Period Current Period Previous Period Assets Nonadmitted Assets Net Admitted Assets Net Admitted Assets As of 12/ Cash 0001 $15,033,805 $15,033,805 $4,223,453 Short-Term Investments 0002 $512 $512 $1,176,496 Premiums Receivable-net 0003 $32,854,611 $1,894,809 $30,959,802 $21,194,324 Interest Receivable 0004 $257,467 $257,467 $283,810 NYS Medicaid Reinsurance Recovery Receivable 0140 Other Receivables - Net 0006 $346,633 $327,572 $19,061 $1,107,099 Prepaid Expenses 0007 Risk Share Receivable 0200 Aggregate Write-Ins for Current Assets (list below) 0008 $13,596 $13,596 $886,162 Federal Income Tax Recoverable 0009 $826,110 Local Income Tax Receivable 0010 $46,456 Net Deferred Tax Asset 0011 $13,596 $13,596 $13, TOTAL CURRENT ASSETS 0015 $48,506,624 $2,222,381 $46,284,243 $28,871,344 OTHER ASSETS NYS Escrow Account Balance 0016 $12,069,572 $12,069,572 $9,080,091 Amounts Due from Affiliates 0018 Loan Escrow 0019 Long-Term Investments 0020 $22,086,512 $22,086,512 $33,830,868 Intangible Investments and Goodwill 0111 Other Restricted Assets 0017 Aggregate Write-Ins for Other Assets (list below) TOTAL OTHER ASSETS 0030 $34,156,084 $34,156,084 $42,910,959 PROPERTY AND EQUIPMENT Land 0031 Building and Improvements 0032 Construction In Progress 0035 Furniture and Equipment 0033 Leasehold Improvments 0034 Aggregate Write-Ins for Other Equipment (list below) 0137 TOTAL PROPERTY AND EQUIPMENT TOTAL ASSETS 0050 $82,662,708 $2,222,381 $80,440,327 $71,782,303 Page 2

4 CURRENT LIABILITIES Schedule A Balance Sheet (continued) Current Year Previous Calendar Year as of 12/ Accounts Payable 0051 $28,977 $813,165 Claims Payable 0052 $41,496,679 $39,460,542 Accrued Inpatient Claims (Not Reported) 0054 Accrued Physician Claims (Not Reported) 0055 Accrued Referral Claims (Not Reported) 0056 Accrued Other Medical 0057 $2,001,423 Accrued Medical Incentive Pool 0058 $600,308 Unearned Premiums 0059 $128,834 Loans and Notes Payable 0060 Risk Share Payable 0201 Aggregate Write-Ins for Current Liabilities (list below) 0162 $949,106 $741,547 Unpaid Claims Adj Exp (LAE) 0062 $610,846 $651,248 Part D 0063 $60,438 $58,875 Provider Refunds 0064 $21,158 $31,424 Escheat Payable 0065 $152,913 Tax Payable on Capital Gains 0066 $103,751 TOTAL CURRENT LIABILITES 0070 $44,605,019 $41,615,562 OTHER LIABILITIES Loans and Notes 0071 Amounts Due to Affiliates 0072 $9,286,833 $3,796,271 Aggregate Write-Ins for Other Liabilities (list below) 0173 $2,945,278 Investment Purchase Payable 0073 $2,945,278 TOTAL OTHER LIABILITIES 0079 $9,286,833 $6,741,549 TOTAL LIABILITIES 0080 $53,891,852 $48,357,111 NET WORTH Donated Capital 0121 Capital 0122 $50 $50 Paid In Surplus 0123 $20,999,950 $20,999,950 NYS Contingent Reserve Requirement 0081 $10,710,131 $10,710,131 Aggregate Write-Ins For Other Net Worth Items (List Below) 0183 $1,100 Estimated Health Insurer Fee 0083 $1,100 Unassigned Surplus $5,162,756 -$8,284,939 TOTAL NET WORTH EXCLUDING NON ADMITTED ASSETS 0105 $26,548,475 $23,425,192 TOTAL LIABILITIES AND NET WORTH EXCLUDING NON ADMITTED ASSETS 0110 $80,440,327 $71,782,303 TOTAL NET WORTH INCLUDING NON ADMITTED ASSETS 0090 $28,770,856 $25,295,496 TOTAL LIABILITIES AND NET WORTH INCLUDING NON ADMITTED ASSETS 0100 $82,662,708 $73,652, Page 3

5 Schedule A1 - Net Worth Reconciliation Net Worth Last Year 0001 $23,425,192 Total Net Income 0002 $3,475,364 Change in nonadmitted assets $352,081 Dividends to stockholders 0003 Withdrawals of equity 0004 Change in Net unrealized capital gains & losses less capital gains tax 0019 Adjusted Net Worth 0005 $26,548,475 Current Net Worth 0006 $26,548,475 Difference 0007 $0 Explanations: Total Explanations 0018 Page 4

6 Schedule B - Revenue and Expense Statement - Total Line of Business Total Plan Amount Medicaid Enrollees Amount Other Enrollees Amount Total Plan PMPM Medicaid PMPM Other PMPM Total Plan Previous Year PMPM (as of 12/31) Total Member Months ,547 24,547 $44, Revenue Medicare Part C Premium Revenue 0401 Medicare Part D Premium Revenue 0402 Medicaid Premium Revenue 0003 $119,401,038 $119,401,038 $4, $4, $4, Other Payor Premium Revenue 0004 Spenddown and NAMI 0013 $1,499,508 $1,499,508 $61.00 $61.00 $52.00 Coordination of Benefits(COB) 0014 Reinsurance Recoveries 0077 Net Investment Income (Schedule G) 0016 $278,335 $278,335 $11.00 $11.00 $11.00 HR&R Revenue 0018 Quality Incentive Pool Award 0416 Quality Incentive VAPP 0417 Other Revenue (Double click Below) TOTAL PREMIUM REVENUE 0010 $120,900,546 $120,900,546 $4, $4, $4, TOTAL REVENUE 0030 $121,178,881 $121,178,881 $4, $4, $4, Expenses Medical and Hospital Expenses Inpatient:Acute Medical/Surgical 0031 Inpatient:Mental Health/Substance/Abuse 0032 Inpatient Maternity Delivery 0403 Total Hospital Inpatient Care 0404 Other Medical and Hospital: Primary Care Physician 0034 Specialty Care 0035 Prenatal/Postpartum Maternity Services 0405 Ambulatory Surgery 0036 Outpatient/Physical Rehab/Therapy 0406 $13,707 $13,707 $1.00 $1.00 $1.00 Other Professional Services 0037 $29,164 $29,164 $1.00 $1.00 Emergency Room 0038 Outpatient Mental Health 0039 Outpatient Drug and Alcohol Treatment 0040 Dental 0041 $320,676 $320,676 $13.00 $13.00 $11.00 Pharmacy-Part D 0407 Pharmacy-Non-Part D 0408 Home Health Care 0409 $4,865,398 $4,865,398 $ $ $2, Nursing Facility 0033 $18,266,787 $18,266,787 $ $ $ Transportation - Emergent 0410 Transportation - Non Emergent 0411 $5,029,272 $5,029,272 $ $ $ Diagnostic Test/Lab/X-Ray 0048 Family Planning 0412 Vision Care Inc. Eyeglasses 0049 Foot Care 0050 $219,683 $219,683 $9.00 $9.00 $3.00 Durable Medical Equipment & Supplies 0060 $4,331,884 $4,331,884 $ $ $70.00 Personal Care 0057 $54,377,843 $54,377,843 $2, $2, $3.00 CDPAP 0125 $9,698,514 $9,698,514 $ $ $ Personal Emergency Response Services 0062 $61 $61 $0.00 $0.00 Home Delivered and Congregate Meals 0064 $23,123 $23,123 $1.00 $1.00 $1.00 Adult Day Health Care 0044 $893,289 $893,289 $36.00 $36.00 $ Social Day Care 0045 $6,962,111 $6,962,111 $ $ $50.00 Other Medical Services 0413 $83,960 $83,960 $3.00 $3.00 $5.00 GROSS MEDICAL & HOSPITAL EXPENSES 0075 $105,115,472 $105,115,472 $4, $4, $4, PLUS: Reinsurance Premium Cost(1) 0015 Global Capitation Surplus/(Loss) 0415 Quality Incentive VAPP 0418 Incentive Pool Adjustment 0076 TOTAL MEDICAL & HOSPITAL EXPENSES 0080 $105,115,472 $105,115,472 $4, $4, $4, Care Management (Schedule D-2) 0047 $6,459,130 $6,459,130 $ $ $ Administration Allowable Administration Expenses (Schedule D-3) 0081 $7,951,920 $7,951,920 $ $ $ $ TOTAL EXPENSES 0085 $119,526,522 $119,526,522 $4, $4, $4, Premium Income(Loss) 0086 $1,374,024 $1,374,024 $56.00 $56.00 $ Nonallowable Administrative Expenses $89,153 -$89,153 -$4.00 -$4.00 $40.00 Operating Incomes(Loss) 0090 $1,741,512 $1,741,512 $71.00 $71.00 $ Aggregate Write-ins for Other Expenses 0095 Prior Period Adjustments and Extraordinary Items 0096 Provision for Taxes 0093 $1,085,469 $1,085,469 $44.00 $ $4.00 Adj. For Prior Period IBNR Adjustment $3,575,922 -$3,575,922 -$ $ $32.00 NET INCOME (LOSS) 0100 $4,231,965 $4,231,965 $ $ $ $51.00 Page 5

7 Schedule B Consolidated Revenue and Expense Summary All Lines of Business PACE Partial Medicare Advantage Medicaid Advantage Plus FIDA DISCO HARP Other Total Members , ,281 Member Months , ,817 Revenue Medicare Part C Premium Revenue 0401 $448,657 $448,657 Medicare Part D Premium Revenue 0402 $70,369 $70,369 Medicaid Premium Revenue 0003 $119,401,038 $1,402,197 $120,803,235 Other Payor Premium Revenue 0004 Spenddown and NAMI 0013 $1,499,508 -$3,554 $1,495,954 Coordination of Benefits(COB) 0014 Reinsurance Recoveries 0077 Net Investment Income (Schedule G) 0016 $278,335 $3,269 $281,604 HR&R Revenue 0018 Quality Incentive Pool Award 0416 Quality Incentive VAPP 0417 Other Revenue TOTAL PREMIUM REVENUE 0010 $120,900,546 $1,917,669 $122,818,215 TOTAL REVENUE 0030 $121,178,881 $1,920,938 $123,099,819 Expenses Medical and Hospital Expenses Inpatient:Acute Medical/Surgical 0031 $48,413 $48,413 Inpatient:Mental Health/Substance/Abuse 0032 Inpatient Maternity Delivery 0403 Total Hospital Inpatient Care 0404 $48,413 $48,413 Other Medical and Hospital: Primary Care Physician 0034 Specialty Care 0035 $14,012 $14,012 Prenatal/Postpartum Maternity Services 0405 Ambulatory Surgery 0036 $559 $559 Outpatient/Physical Rehab/Therapy 0406 $13,707 $386 $14,093 Other Professional Services 0037 $29,164 $16,388 $45,552 Emergency Room 0038 $1,616 $1,616 Outpatient Mental Health 0039 Outpatient Drug and Alcohol Treatment 0040 Dental 0041 $320,676 $3,721 $324,397 Pharmacy-Part D 0407 $67,216 $67,216 Pharmacy-Non-Part D 0408 $1,752 $1,752 Home Health Care 0409 $4,865,398 $32,272 $4,897,670 Nursing Facility 0033 $18,266,787 $125,094 $18,391,881 Transportation - Emergent 0410 Transportation - Non Emergent 0411 $5,029,272 $17,345 $5,046,617 Diagnostic Test/Lab/X-Ray 0048 $1,721 $1,721 Family Planning 0412 Vision Care Inc. Eyeglasses 0049 $64 $64 Foot Care 0050 $219,683 $1,006 $220,689 Durable Medical Equipment & Supplies 0060 $4,331,884 $351,357 $4,683,241 Personal Care 0057 $54,377,843 $1,094,050 $55,471,893 CDPAP 0125 $9,698,514 $154,954 $9,853,468 Personal Emergency Response Services 0062 $61 $4,024 $4,085 Home Delivered and Congregate Meals 0064 $23,123 $23,123 Adult Day Health Care 0044 $893,289 $893,289 Social Day Care 0045 $6,962,111 $19,708 $6,981,819 Supplemental Benefits 0099 Other Medical Services 0413 $83,960 $4,011 $87,971 GROSS MEDICAL & HOSPITAL EXPENSES 0075 $105,115,472 $1,959,669 $107,075,141 PLUS: Reinsurance Premium Cost(1) 0015 Global Capitation Surplus/(Loss) 0415 Quality Incentive VAPP 0418 Incentive Pool Adjustment 0076 TOTAL MEDICAL & HOSPITAL EXPENSES 0080 $105,115,472 $1,959,669 $107,075,141 Care Management 0047 $6,459,130 $169,977 $6,629,107 Administration Allowable Administration Expenses 0081 $7,951,920 $749,478 $8,701,398 TOTAL EXPENSES 0085 $119,526,522 $2,879,124 $122,405,646 Premium Income(Loss) 0086 $1,374,024 -$961,455 $412,569 Nonallowable Administrative Expenses $89,153 $10,374 -$78,779 Operating Incomes(Loss) 0090 $1,741,512 -$968,560 $772,952 Aggregate Write-ins for Other Expenses 0095 Prior Period Adjustments and Extraordinary Items 0096 Provision for Taxes 0093 $1,085,469 $16,964 $1,102,433 Adj. For Prior Period IBNR Adjustment $3,575,922 -$228,923 -$3,804,845 NET INCOME (LOSS) 0100 $4,231,965 -$756,601 $3,475,364 Page 6

8 Schedule B-1 - Medicaid Revenue and Expense Analysis Community (1) Plans purchasing reinsurance should enter its reinsurance costs on this line. Medicaid Current YTD Medicaid Current YTD PMPM Medicaid Previous Calendar Year PMPM as of 12/ Medicaid Member Months ,578 Revenue Medicare Part C Premium Revenue 0501 Medicare Part D Premium Revenue 0502 Medicaid Premium Revenue 0103 $109,822,313 $4, Other Payor Premium Revenue 0104 Spenddown and NAMI 0113 $499,836 $22.00 Coordination of Benefits(COB) 0114 Reinsurance Recoveries 0177 Net Investment Income 0116 $256,006 $11.00 HR&R Revenue 0118 Quality Incentive Pool Award 0416 Quality Incentive VAPP 0417 Other Revenue (Double Click Below) TOTAL PREMIUM REVENUE 0110 $110,322,149 $4, TOTAL REVENUE 0130 $110,578,155 $4, Expenses Medical and Hospital Expenses Inpatient Acute Medical Surgical 0131 Inpatient Mental Health & Substance Abuse 0132 Inpatient Maternity Delivery 0503 Total Hospital Inpatient Care 0504 Other Medical and Hospital: Primary Care Physician 0134 Specialty Care 0135 Prenatal/Postpartum Maternity Services 0505 Ambulatory Surgery 0136 Outpatient/Physical Rehab/Therapy 0506 $13,707 $1.00 Other Professional Services 0137 $29,116 $1.00 Emergency Room (In/Out of Area) 0138 Outpatient: Mental Health 0139 Outpatient Drug & Alcohol Treatment 0140 Dental 0141 $320,676 $14.00 Pharmacy-Part D 0507 Pharmacy-Non-Part D 0508 Home Health Care 0509 $4,861,967 $ Nursing Facility 0133 $3,852,292 $ Transportation - Emergent 0510 Transportation - Non Emergent 0511 $5,029,272 $ Diagnostic Testing, Lab & X-Ray 0148 Family Planning 0512 Vision Care Inc. Eyeglasses 0149 Foot Care 0150 $219,258 $10.00 Durable Medical Equipment & Other 0160 $4,325,288 $ Personal Care 0157 $54,211,757 $2, CDPAP 0125 $9,695,006 $ Personal Emergency Response Services 0162 $61 $0.00 Home Delivered and Congregate Meals 0164 $23,123 $1.00 Adult Day Care 0144 $892,987 $40.00 Social Day Care 0145 $6,960,824 $ Other Medical Services: (Enter labels on Exhibit B) Other Medical 0513 $83,598 $4.00 Total: Other Medical Services 0530 $83,598 $4.00 GROSS MEDICAL & HOSPITAL EXPENSES 0175 $90,518,932 $4, PLUS: Reinsurance Premium Cost 0115 Global Capitation Surplus/(Loss) 0415 Quality Incentive VAPP 0418 Incentive Pool Adjustment 0176 TOTAL MEDICAL & HOSPITAL EXPENSES 0180 $90,518,932 $4, Care Management (Schedule D-2) 0147 $5,562,203 $ Administration Allowable Administration Expenses (Schedule D-3) 0181 $7,314,069 $ TOTAL EXPENSES 0185 $103,395,204 $4, Premium Income(Loss) 0186 $6,926,945 $ Nonallowable Expense $82,002 -$4.00 Operating Incomes(Loss) 0190 $7,264,953 $ Aggregate Write-ins for Other Expenses 0195 Prior Period Adjustments and Extraordinary Items 0196 Provision for Taxes 0193 Adj. For Prior Period IBNR Adjustment 0194 NET INCOME (LOSS) Page 7

9 Schedule B-1 - Medicaid Revenue and Expense Analysis Nursing Home Permanent Placement (1) Plans purchasing reinsurance should enter its reinsurance costs on this line. Medicaid Current YTD Medicaid Current YTD PMPM Medicaid Previous Calendar Year PMPM as of 12/ Medicaid Member Months ,969 Revenue Medicare Part C Premium Revenue 0501 Medicare Part D Premium Revenue 0502 Medicaid Premium Revenue 0103 $9,578,725 $4, Other Payor Premium Revenue 0104 Spenddown and NAMI 0113 $999,672 $ Coordination of Benefits(COB) 0114 Reinsurance Recoveries 0177 Net Investment Income 0116 $22,329 $11.00 HR&R Revenue 0118 Quality Incentive Pool Award 0416 Quality Incentive VAPP 0417 Other Revenue (Double Click Below) TOTAL PREMIUM REVENUE 0110 $10,578,397 $5, TOTAL REVENUE 0130 $10,600,726 $5, Expenses Medical and Hospital Expenses Inpatient Acute Medical Surgical 0131 Inpatient Mental Health & Substance Abuse 0132 Inpatient Maternity Delivery 0503 Total Hospital Inpatient Care 0504 Other Medical and Hospital: Primary Care Physician 0134 Specialty Care 0135 Prenatal/Postpartum Maternity Services 0505 Ambulatory Surgery 0136 Outpatient/Physical Rehab/Therapy 0506 Other Professional Services 0137 $48 $0.00 Emergency Room (In/Out of Area) 0138 Outpatient: Mental Health 0139 Outpatient Drug & Alcohol Treatment 0140 Dental 0141 Pharmacy-Part D 0507 Pharmacy-Non-Part D 0508 Home Health Care 0509 $3,431 $2.00 Nursing Facility 0133 $14,414,495 $7, Transportation - Emergent 0510 Transportation - Non Emergent 0511 Diagnostic Testing, Lab & X-Ray 0148 Family Planning 0512 Vision Care Inc. Eyeglasses 0149 Foot Care 0150 $425 $0.00 Durable Medical Equipment & Other 0160 $6,596 $3.00 Personal Care 0157 $166,086 $84.00 CDPAP 0125 $3,508 $2.00 Personal Emergency Response Services 0162 Home Delivered and Congregate Meals 0164 Adult Day Care 0144 $302 $0.00 Social Day Care 0145 $1,287 $1.00 Other Medical Services: (Enter labels on Exhibit B) Other Medical 0513 $362 $0.00 Total: Other Medical Services 0530 $362 $0.00 GROSS MEDICAL & HOSPITAL EXPENSES 0175 $14,596,540 $7, PLUS: Reinsurance Premium Cost 0115 Global Capitation Surplus/(Loss) 0415 Quality Incentive VAPP 0418 Incentive Pool Adjustment 0176 TOTAL MEDICAL & HOSPITAL EXPENSES 0180 $14,596,540 $7, Care Management (Schedule D-2) 0147 $896,927 $ Administration Allowable Administration Expenses (Schedule D-3) 0181 $637,851 $ TOTAL EXPENSES 0185 $16,131,319 $8, Premium Income(Loss) $5,552,922 -$2, Nonallowable Expense $7,151 -$4.00 Operating Incomes(Loss) $5,523,441 -$2, Aggregate Write-ins for Other Expenses 0195 Prior Period Adjustments and Extraordinary Items 0196 Provision for Taxes 0193 Adj. For Prior Period IBNR Adjustment 0194 NET INCOME (LOSS) Page 8

10 Direct Costs Direct Costs Contracted Costs Contracted Costs Schedule D-2 - Care Management *F.T.E.s Salary and Fringes *F.T.E.s Salary and Fringes Total **Staffing Ratios Care Management Supervisor :8 Care Manager :65 Other - (Double click Below) CMA UM Mgr UM Staff Director of CM SW Total CM 0013 $6,459,130 $6,459,130 1:1 TOTAL CARE MANAGEMENT $6,459,130 $6,459, PACE Center Staff 0026 Non-PACE Center Staff 0027 * Total actual hours paid during the report period. (Includes vacation, sick and holiday time)/(weeks in report period x standard hrs. per workweek) ** Care Management Supervisor ratio is to CM EMPLOYEES, not to enrollees. Page 9

11 DIRECT EXPENSE CONTRACTED EXPENSE TOTAL EXPENSE Schedule D-3 - Administration Expense - Total Total Direct Expense Total Contracted Expense Total Administration Expense Rent ($0 for Occupancy of Own Building) 0001 Salaries and Fringe Benefits (Schedule D-3B) 0002 $3,332,528 $3,332,528 Legal Fees amd Expenses 0003 $7,305 $7,305 Utilization Management/Quality Improvement 0004 Traveling Expense 0005 $37,537 $37,537 Advertising 0006 $1,231 $1,231 Marketing 0026 $148,754 $148,754 Finance, Auditing & Actuarial 0007 Claims Processing 0008 $673,601 $673,601 Provider Relations, Recruitment & Contracting 0009 Member Services 0010 Management Information System(MIS) 0011 Telephone, Postage, Express & Telegraph 0012 $94,901 $94,901 Printing & Stationary 0013 $100,724 $100,724 Occupancy, Depreciation & Amortization 0014 $619,264 $619,264 Rental of Equipment 0015 $309,684 $309,684 Boards, Bureaus and Association Fees 0016 Insurance, Except for Real Estate 0017 Collection and Bank Service Charge 0018 Payroll Taxes 0019 $369,110 $369,110 Other Taxes (Excluding Fed. Inc. Tax & RE Tax) 0020 $259 $259 Intake and Enrollment 0022 Employee Recruitment and Retention 0024 Franchise Tax 0045 Aggregate Write-in for Other Expenses 0099 $2,257,022 $2,257,022 (Double click on lines Below) Total Allowable Administration Expense 0030 $7,951,920 $7,951,920 Nonallowable Administration Contributions and Donations 0032 Lobbying Expenses 0033 Entertainment costs 0034 Interest, Fines and Penalties 0035 Uncollectible Spenddown and NAMI $89,153 -$89,153 State Income Taxes 0061 Other Nonallowable expenses 0036 Total Nonallowable expenses $89,153 -$89,153 Total Administration Expense 0100 $7,862,767 $7,862,767 Other Mgmt and Administration 0051 $2,257,022 $2,257, Summary of Items on the Note Pad 0097 Total of Items (Line 0099 Above) 0098 $2,257,022 $2,257,022 Statewide Member Months 0096 $24,547 Page 10

12 Note: Report all contracts, such as management contracts, legal services, claims processing, financial services, actuarial, etc., for services that are reported as administrative expenses by the plan. (1) Under Type of Affiliation, enter the number code of all that apply. 1. None 2. Common Ownership 3. Common Board of Directors 4. Part of same Holding Company System 5. Share Key Personnel Schedule D-3A - Administrative Expense - Contracted Services Service Performed (1) Type of Affiliation Name of Contractor (Double click Below) MLTC Expense Aetna Medicaid Administrators 0001 Administration and Management $7,862, Total (Should equal Schedule D-3, Column 00716, line 100) 0050 $7,862,767 Page 11

13 Schedule D-3B - Administrative Expense - Personnel Expense Administrative Category Direct Expenses Direct Expenses Contracted Expenses MLTC FTEs MLTC Salaries and Fringe Benefits MLTC FTEs Contracted Expenses MLTC Salaries and Fringe Benefits Total MLTC FTEs Total MLTC Salaries and Fringe Benefits Executive Management $504, $504,877 Administrative Support $151, $151,584 Employee Recruitment and Retention 0002 Medical Director $377, $377,888 Legal Services 0004 Utilization Management/Quality Improvement $296, $296,505 Advertising 0006 Marketing $588, $588,040 Finance, Auditing and Actuarial 0007 $1 $1 Claims Processing 0008 $1 $1 Provider Relations, Cre. & Contr $373, $373,733 Member Services $488, $488,748 Management Information Sys $180, $180,789 Intake and Enrollment $370, $370,361 Aggregate Write-in for Other Admin Totals $3,332, $3,332,528 Detail; Aggregate Write-in (Double click Below) Summary of Write-ins From Notepad 0030 Totals (Lines ) To Line Page 12

14 Schedule D-6 Claims Analysis A. Claims Incurred During Current Period Category of Service A. Total Expenses (B+C+D) B. Claims Paid C. Claims Reported But Not Paid D. Claims Incurred But Not Reported (IBNR) E. IBNR as a Percent of Total(D/A) Inpatient 0001 Nursing Home 0002 $18,266,787 $9,577,333 $8,689, % Physician(s) 0003 Emergency Room 0005 Home Health Care 0013 $4,865,398 $3,556,794 $1,308, % Personal Care 0014 $54,377,843 $40,157,542 $14,220, % CDPAP 0120 $9,698,514 $7,446,760 $2,251, % Other Medical Services 0007 $17,906,931 $12,384,211 $5,522, % TOTAL 0025 $105,115,473 $73,122,640 $31,992, % Total Expenses - Capitated 0051 $363,426 Total Expenses - Paid FFS 0052 $104,752, % Number of Claims Processed ,698 Page 13

15 B. Claims Unpaid Category of Service Schedule D-6 Claims Analysis (continued)1 Reported Claims That Are Unpaid A. On Claims Incurred During Prior Years Reported Claims That Are Unpaid B. On Claims Incurred During Current Year Incurred But Not Reported C. On Claims Incurred During Prior Years Incurred But Not Reported D. On Claims Incurred During Current Year E. Total Unpaid Claims (A+B+C+D) Inpatient 0026 Nursing Home 0027 $1,249,432 $8,689,454 $9,938,886 Physician(s) 0028 Emergency Room 0030 Home Health Care 0038 $1,396,622 $1,308,604 $2,705,226 Personal Care 0039 $3,009,957 $14,220,301 $17,230,258 CDPAP 0125 $2,251,754 $2,251,754 Other Medical Services 0032 $170,014 $5,522,720 $5,692,734 TOTAL 0050 $5,826,025 $31,992,833 $37,818,858 Page 14

16 C. Summary of Prior Period IBNR Category of Service Schedule D-6 Claims Analysis (continued)2 A. IBNR On Claims Incurred 4 Years Prior to the Reporting Period B. IBNR On Claims Incurred 3 Years Prior to the Reporting Period C. IBNR on Claims Incurred 2 Years Prior to the Reporting Period D. IBNR on Claims Incurred 1 Year Prior to the Reporting Period E. Total Prior Period IBNR (A+B+C+D) Inpatient 0026 Nursing Home ,551 1,231,264 1,249,432 Physician(s) 0028 Emergency Room 0030 Home Health Care ,929 97, ,360 1,396,622 Personal Care , ,698 3,297,413 3,009,957 CDPAP 0130 Other Medical Services ,376 30, , ,014 TOTAL , ,838 5,294,171 5,826,025 Page 15

17 Schedule D-6 - Claims Analysis (continued)3 D. Global Capitation Reconciliation (Total Plan) Current Period Year 1 Prior to the Reporting Period Year 2 Prior to the Reporting Period Member Months 0009 Premium Revenue 0010 Total Global Capitation Paid 0001 Additional Plan Payments 0006 Total Global Capitation Payments 0007 Actual Claims Paid 0002 Claims Reported but Not Paid 0003 Claims Incurred but Not Reported 0004 Total Global Capitation Expenses 0008 IPA/Providers' Surplus or (Loss) 0005 Page 16

18 Premium Receivables Categories Schedule D-7 Premium Receivables Total Dollars in the Category Up to 30 Days 30 Days to 59 Days 60 Days to 89 Days 90 Days to Days to 365 Days Over One Year Medicaid ,812,692 21,419,858 1,595,124 1,517, , ,168 4,715,541 Medicare 0002 Private Pay 0003 Spenddown/NAMI ,041, , , , , ,985 1,667,164 Allowance for Doubtful Accounts (Entered as Negative) ,894, , ,057-85, , ,510-1,071,322 HR & R Revenue 0011 Other - (Double click Below) Total By Aging Category ,959,802 21,556,416 1,703,145 1,573, , ,643 5,311,383 Page 17

19 Description Schedule F IBNR Reserve Calculation A Claims Reported (Paid and Unpaid) B Percent Complete C Estimated Expense (A/B) D Adjustment E Projected Expense (C + D) F IBNR Reserve (E-A) December 0001 November 0002 October 0003 September 0004 August 0005 July 0006 June 0007 $1,141, % 19,850,748-7,406 $19,843,342 $18,701,924 May 0008 $12,266, % 18,181,279 $18,181,279 $5,914,370 April 0009 $14,685, % 16,789,304 $16,789,304 $2,103,700 March 0010 $15,709, % 17,517,577 $17,517,577 $1,807,814 February 0011 $14,024, % 15,974,661 $15,974,661 $1,950,506 January 0012 $15,294, % 16,809,310 $16,809,310 $1,514,519 CURRENT YEAR TOTAL 0020 $73,122, ,122,879-7,406 $105,115,473 $31,992,833 PERCENT COMPLETED Yes=1,No=2 Historical Experience Authorized Claims Other (Explain on Notepad) Page 18

20 INVESTMENT INCOME Schedule G Schedule of Net Investment Income Amount Accrued During the Year Interest Income 0001 $384,442 Dividend and Real Estate Income 0002 Net Realized Capital Gains or Losses $106,107 Other Investment Income 0004 TOTAL INVESTMENT INCOME 0010 $278,335 DEDUCTIONS Investment Expenses 0011 Interest Expense 0012 Interest on Claims Paid after 45 Days 0014 Other Deductions 0013 TOTAL DEDUCTIONS 0020 NET INVESTMENT INCOME 0025 $278,335 Page 19

21 Details of Adj for Prior Period IBNR on line 94 cc 112 Schedule G-1 Schedule of Adjustments for Prior Period IBNR Amount of Write-off Year Prior to the Reporting Period $4,058,643 2 Years Prior to the Reporting Period 0002 $493,705 3 Years Prior to the Reporting Period $10,984 4 Years Prior to the Reporting Period 0004 TOTAL ADJUSTMENTS FOR PRIOR PERIOD IBNR $3,575,922 Page 20

22 Details of Write-ins aggregated on line 0095 from Schedule B: Schedule G-2 Total Plan Schedule of Aggregate Write-ins for Other Expenses Amount of Write-off Non-State Plan Services 0006 Increase in Reserves for A&H Contracts 0007 TOTAL PLAN SCHEDULE OF AGGREGATE WRITE-INS Page 21

23 Details of Extraordinary Items on line 0096 from Schedule B: Schedule G-3 Total Plan Schedule of Prior Period Revenue Adjustments and Extraordinary Items Amount of Write-off Adjustment for Prior Period Revenue 0001 Adjustment for Prior Period HR & R Revenue 0002 All Other 0010 TOTAL EXTRAORDINARY ITEMS Page 22

24 Schedule G-4 Schedule of Recovered Provider Payments For Services Provided in Prior Periods Details of Prior Period Provider Recoveries included in the Prior Period IBNR Schedule: Amount of Recovered Payments Year Prior to Reporting Period Years Prior to Reporting Period Years Prior to the Reporting Period Years Prior to the Reporting Period 0004 TOTAL RECOVERIES INCLUDED IN PRIOR PERIOD IBNR ADJUSTMENT 0099 Page 23

25 Schedule H Claims Payable Aging Analysis of Unpaid Claims Individually list all health care creditors of $5,000 or more or 10% of total claims payable (reported, excluding amounts withheld), whichever is larger. See additional directions in the report instructions Days Days Days 91 + Days Total Claims Payable (Reported) Detail Below 0001 LTSS 0002 $19,796,959 $6,259,600 $2,227,588 $11,782,904 $40,067, Sum of Individually Listed Claims Payable 0026 $19,796,959 $6,259,600 $2,227,588 $11,782,904 $40,067,051 Aggregate Accounts Not Individually Listed 0028 $363,507 $134,750 $123,814 $807,557 $1,429,628 Totals 0029 $20,160,466 $6,394,350 $2,351,402 $12,590,461 $41,496,679 Page 24

26 Schedule I - Schedule of Plan's Transactions with Any Affiliate (1) TYPE OF AFFILIATION (Enter number code for type of affiliation) 1. Common Ownership 2. Common Board of Directors 3. Part of the Same Holding Company System 4. Share Key Personnel (1) Type of Affiliatio n Capital Contributions Purchases, Sales, or Exchanges of Loans, Securities, Real Estate, Mortgage Loans or Other Investments Income/(Disbursements ) Incurred in Connection with Guarantees or Undertakings for the Benefit of any Affiliate(s) Management Agreements and Administrative Service Contracts Medical Services Any Other Material Activity Not in the Ordinary Course of the Insurer's Business Names of Insurers and Parent, Subsidiaries or Affiliates (Double click Below) TOTAL 0999 TOTALS Page 25

27 Schedule J - Schedule of Claims and Interest Penalties Paid During the Year Account Description Total Claim Count Total Dollar Value Number of Clean Claims Paid in Excess of 45 Days Dollar Value of Clean Claims Paid in Excess of 45 Days Number of Clean Claims in Excess of 45 Days For Which Interest Was Paid Interest Paid During Year Inpatient 0001 Nursing Facility ,491 $9,577,333 Physicians ,795 Home Health Care ,119,027 $3,475,476 Personal Care ,486,144 $47,604,302 CDPAP ,184 $1,209,920 Other Medical Services 0005 TOTAL ,042,641 $61,867,031 Page 26

28 PREMIUM GROUP Exhibit A1 - Analysis of Enrolled Population a) Disenrollments should be entered as positive numbers. The program will automatically reduce the totals. Total Enrollees (End of Prior Period) Net Shifts Among Groups YTD New Enrollees YTD Disenrollments YTD Total Enrollment Community , ,887 Nursing Home Permanent Placement Other Medicaid Enrollees: (Double click Below) Total Medicaid Members , ,226 Non-Medicaid Enrollees 0021 TOTALS , ,226 Page 27

29 Exhibit A2 - Analysis of Enrolled Population By County Community Nursing Home Permanent Placement MEMBER MONTHS BREAKDOWN BY COUNTY Region/County TOTAL MEDICAID MEMBER MONTHS TO DATE NON-MEDICAID ENROLLEE MONTHS TOTAL MEMBER MONTHS TO DATE One/New York City , ,723 18,723 One/Nassau , ,619 2,619 One/Rockland 0003 One/Suffolk , ,205 3,205 One/Westchester 0005 Two/Monroe 0006 Two/Onondaga 0007 Two/Orange 0008 Three/Erie 0009 Three/Herkimer 0010 Three/Oneida 0011 Three/Schenectady 0012 Other Enrollees: (Double click Below) Total Member Months to Date ,578 1,969 24,547 24,547 Page 28

30 HOSPITAL AND NURSING FACILIITY DAYS PACE plans should only complete rows 2 and 13. Exhibit A3 - Hospital and Nursing Facility Utilization First Quarter Second Quarter Third Quarter Fourth Quarter Hospital Days For Period 0001 Total Number of Enrollees Receiving Nursing Facility Care During Quarter, Excl. Respite Total Number of Admissions to Nursing Facility during Quarter, excluding respite , ,581 Breakdown of Nursing Facility Days, Excl. Respite: Total Number of Days Covered 100% by Medicare 0003 Total Number of Days Covered by Medicare & MLTC Plan (Medicaid Co-Pay days) 0004 Total Number of Days Covered 100% by MLTC Plan ,157 30,277 61,434 Total Number of Days Covered by Other Payors 0006 Total Number of Nursing Facility Days of Care, Excl. Respite ,157 30,277 61,434 Total Number of Enrollees Receiving Nursing Facility Care During Quarter For Respite 0011 Total Number of Nursing Facility Days for Respite 0012 TOTAL Y-T-D Page 29

31 Number of enrollees discharged from Nursing facility, by length of Medicaid stay Number of enrollees discharged from Nursing facility, by length of Medicaid stay Number of enrollees discharged from Nursing facility, by length of Medicaid stay Number of enrollees discharged from Nursing facility, by length of Medicaid stay Number of enrollees discharged from Nursing facility, by length of Medicaid stay Number of enrollees discharged from Nursing facility, by length of Medicaid stay Number of enrollees discharged from Nursing facility, by length of Medicaid stay Exhibit A4 - Nursing Facility Discharges TOTAL FIRST QUARTER: Death Other Total SECOND QUARTER: Death Other: Total THIRD QUARTER: Death 0007 Other 0008 Total 0009 FOURTH QUARTER: Death 0010 Other 0011 Total 0012 TOTAL Y-T-D: Death Other Total Page 30

32 Exhibit A5 - Personal Care Hours Year-to-Date Member Months Total Number of Hours MEMBER BREAKDOWN BY USE Category Based on Hours per Month 700+ hours per month , hours per month , hours per month , hours per month , , hours per month , , hours per month , , hours per month , ,043 TOTALS ,721 3,010,059 Page 31

33 Exhibit A6 - Home Health Care and PCA Hours Year-to-Date Member Months Total Number of Hours MEMBER BREAKDOWN BY USE Category Based on Hours per Month 700+ hours per month , hours per month , hours per month , hours per month , , hours per month , , hours per month , , hours per month , ,555 TOTALS ,570 3,235,541 Page 32

34 Exhibit A7 - CDPAP Hours Year-to-Date Member Months Total Number of Hours MEMBER BREAKDOWN BY USE Category Based on Hours per Month 700+ hours per month , hours per month , hours per month , hours per month , hours per month , hours per month , , hours per month ,021 38,923 TOTALS , ,951 Page 33

35 Exhibit B - Utilization of Services: Total Medicaid Service Units Total Number Of Service Units (Actual) Total Number of Service Units (Accrued) Unit Cost Avg. Number Of Service Units Used Per Enrollee Per Year Inpatient Medical/Surgical 0001 Days Inpatient Medical/Surgical 0051 Discharges Inpatient Mental Health/Substance Abuse 0002 Days Inpatient Mental Health/Substance Abuse 0052 Discharges Inpatient: Maternity Delivery 0047 Days Inpatient: Maternity Delivery 0048 Discharges Primary Care Physician 0004 Visits Specialty Care 0033 Visits Prenatal/Postpartum Maternity Services 0049 Visits Ambulatory Surgery 0005 Procedures Outpatient/Physical Rehab/Therapy 0050 Visits 1,581 2,145 $ Other Professional Services 0053 Visits 2,130 2,632 $ Emergency Room 0006 Visits Outpatient Mental Health 0007 Visits Outpatient Drug & Alcohol Treatment 0008 Visits Dental 0009 Visits 1 1 $320, Pharmacy - Part D 0054 Pharmacy - Non Part D 0055 Home Health Care 0056 Hours 165, ,471 $ Home Health Care 0083 Visits 26,391 36,326 $ Nursing Facility 0003 Days 61, ,817 $ Transportation - Emergent 0057 One Way Trips Transportation - Non Emergent 0058 One Way Trips 85, ,726 $ Diagnostic Testing, Lab & X-Ray 0016 Family Planning 0059 Visits Vision Care Inc. Eyeglasses 0017 Visits Foot Care 0018 Visits 3,975 17,744 $ Durable Medical Equipment & Other 0028 Personal Care 0025 Hours 2,222,480 3,010,058 $ , CDPAP 0045 Hours 429, ,944 $ Personal Emergency Response Services 0030 No. Of Units 5 5 $ Home Delivered and Congregate Meals 0032 No. Of Meals 2,384 3,198 $ Adult Day Care 0012 Days 10,827 12,074 $ Social Day Care 0013 Days 87, ,000 $ Other Medical Services: (Double click below) $41, Page 34

36 Exhibit B-1 - Medicaid Utilization of Services Community Service Units Total Number Of Service Units (Actual) Total Number of Service Units (Accrued) Unit Cost Avg. Number Of Service Units Used Per Enrollee Per Year Inpatient Medical/Surgical 0101 Days Inpatient Medical/Surgical 0151 Discharges Inpatient Mental Health/Substance Abuse 0102 Days Inpatient Mental Health/Substance Abuse 0152 Discharges Inpatient: Maternity Delivery 0147 Days Inpatient: Maternity Delivery 0148 Discharges Primary Care Physician 0104 Visits Specialty Care 0133 Visits Prenatal/Postpartum Maternity Services 0149 Visits Ambulatory Surgery 0105 Procedures Outpatient/Physical Rehab/Therapy 0150 Visits 1,581 2,145 $ Other Professional Services 0153 Visits 2,129 2,631 $ Emergency Room 0106 Visits Outpatient Mental Health 0107 Visits Outpatient Drug & Alcohol Treatment 0108 Visits Dental 0109 Visits 1 1 $320, Pharmacy - Part D 0154 Pharmacy - Non Part D 0155 Home Health Care 0156 Hours 165, ,260 $ Home Health Care 0183 Visits 26,361 36,289 $ Nursing Facility 0103 Days 13,424 20,201 $ Transportation - Emergent 0157 One Way Trips Transportation - Non Emergent 0158 One Way Trips 85, ,726 $ Diagnostic Testing, Lab & X-Ray 0116 Family Planning 0159 Visits Vision Care Inc. Eyeglasses 0117 Visits Foot Care 0118 Visits 3,931 17,680 $ Durable Medical Equipment & Other 0128 Personal Care 0125 Hours 2,216,550 3,003,467 $ , CDPAP 0145 Hours 429, ,708 $ Personal Emergency Response Services 0130 No. Of Units 5 5 $ Home Delivered and Congregate Meals 0132 No. Of Meals 2,384 3,198 $ Adult Day Care 0112 Days 10,823 12,070 $ Social Day Care 0113 Days 87, ,983 $ Other Medical Services: (Enter labels on Exhibit B) Other $83, Page 35

37 Exhibit B-1 - Medicaid Utilization of Services Nursing Home Permanent Placement Service Units Total Number Of Service Units (Actual) Total Number of Service Units (Accrued) Unit Cost Avg. Number Of Service Units Used Per Enrollee Per Year Inpatient Medical/Surgical 0101 Days Inpatient Medical/Surgical 0151 Discharges Inpatient Mental Health/Substance Abuse 0102 Days Inpatient Mental Health/Substance Abuse 0152 Discharges Inpatient: Maternity Delivery 0147 Days Inpatient: Maternity Delivery 0148 Discharges Primary Care Physician 0104 Visits Specialty Care 0133 Visits Prenatal/Postpartum Maternity Services 0149 Visits Ambulatory Surgery 0105 Procedures Outpatient/Physical Rehab/Therapy 0150 Visits Other Professional Services 0153 Visits 1 1 $ Emergency Room 0106 Visits Outpatient Mental Health 0107 Visits Outpatient Drug & Alcohol Treatment 0108 Visits Dental 0109 Visits Pharmacy - Part D 0154 Pharmacy - Non Part D 0155 Home Health Care 0156 Hours $ Home Health Care 0183 Visits $ Nursing Facility 0103 Days 48,009 98,616 $ Transportation - Emergent 0157 One Way Trips Transportation - Non Emergent 0158 One Way Trips Diagnostic Testing, Lab & X-Ray 0116 Family Planning 0159 Visits Vision Care Inc. Eyeglasses 0117 Visits Foot Care 0118 Visits $ Durable Medical Equipment & Other 0128 Personal Care 0125 Hours 5,930 6,591 $ CDPAP 0145 Hours $ Personal Emergency Response Services 0130 No. Of Units Home Delivered and Congregate Meals 0132 No. Of Meals Adult Day Care 0112 Days 4 4 $ Social Day Care 0113 Days $ Other Medical Services: (Enter labels on Exhibit B) Other $ Page 36

38 Exhibit B-2 - Medicaid Utilization of HHC Services Community Service Units MEDICAID MEDICAID MEDICAID MEDICAID MEDICAID Medicaid Total Number of Service Units (Actual) Medicaid Total Number of Service Units (Accrued) Medicaid Total Cost Medicaid Unit Cost Medicaid Avg. Number of Service Units Used Per Enrollee Per Year Home Health Care Aide 0500 Hours 165, ,260 $4,283,809 $ Home Health Care-Other 0501 Visits 26,361 36,289 $578,158 $ Total Home Health Care 0502 $4,861,967 Page 37

39 Exhibit B-2 - Medicaid Utilization of HHC Services Nursing Home Permanent Placement Service Units MEDICAID MEDICAID MEDICAID MEDICAID MEDICAID Medicaid Total Number of Service Units (Actual) Medicaid Total Number of Service Units (Accrued) Medicaid Total Cost Medicaid Unit Cost Medicaid Avg. Number of Service Units Used Per Enrollee Per Year Home Health Care Aide 0500 Hours $2,922 $ Home Health Care-Other 0501 Visits $508 $ Total Home Health Care 0502 $3,430 Page 38

40 Exhibit C - Number of Enrollees Utilizing Services Number of Enrollees Identify the number of enrollees during the quarter that used the following services: NURSING FACILITY (NF) ONLY Enrollees that were in a nursing facility for the entire quarter PACE CENTER SOCIAL DAY CARE PROGRAM Count only enrollees who used the PACE Social Day Care Program but did not use personal care, home health care or NF Count only enrollees who used the PACE Social Day Care Program and personal care and/or home health care Total PACE Center Care Program 0012 PERSONAL CARE (PC) ONLY Count only enrollees who used personal care but did not use NF, PACE Social Day, or Home Health Care CDPAP ONLY Count only enrollees who used only CDPAP CDPAP HOME HEALTH CARE (HHC) ONLY Count only enrollees who used home health care service but did not use NF, PACE Social Day Care, or PC. Nursing and Therapies only 0007 HHA and Nursing and/or Therapies Total Home Health Care PERSONAL CARE AND HOME HEALTH CARE ONLY Count only enrollees that used PC and HHC but did not use NF or PACE Social Day ,605 NURSING FACILITY AND PERSONAL CARE OR HOME HEALTH CARE Count enrollees who were in a NF AND used personal care or Home Health Care care Number of enrollees who did not use PACE Social Day, Personal Care, Home Health Care, or any Nursing Facility Total Number of Enrollees ,345 Page 39