State of Texas HHSC FINANCIAL STATISTICAL REPORT (FSR) HHSC Medicaid/CHIP Division - Finance

MMP name: MMP self-reported data, subject to audit

State Fiscal Year: 2017 Program: MMP Dual Demo - Integrated Care Program (STAR+PLUS+Medicare)

Submission Date: 1/2/2017 County: Harris County (Houston) template version 2.2

Submission Type: Yr-End 90-Day Rptg Period End Date: 11/30/2017

Part 1: Summary Income Statement Managed Care contract revenues & costsSFY

Incurred Months: Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 YTD

1 Member Months (per Medicaid) 4,088 3,962 3,855 3,691 6,169 5,427 5,096 4,801 4,592 4,402 4,244 4,220 54,547

2 additional / (fewer) Mbr-Mos in Medicare 0 0 0 0 0 0 0 0 0 0 0 0 0

3 Average Monthly Member Months 1 1 1 1 1 1 1 1 1 1 1 1 4,546

Revenues:

CMS Medicare Premiums:

4 Monthly Capitation Received - Medical 5,739,892 5,544,964 5,362,109 5,152,836 9,724,940 8,116,920 7,517,846 6,944,403 6,520,329 6,237,077 6,029,462 6,080,442 78,971,219

5 Monthly Capitation Withheld - Medical 59,016 56,961 55,152 53,003 196,392 164,083 152,083 140,456 132,035 127,240 123,078 123,070 1,382,570

6 Gross Total (before withhold) - Medical 5,798,908 5,601,925 5,417,261 5,205,839 9,921,332 8,281,003 7,669,929 7,084,859 6,652,364 6,364,317 6,152,540 6,203,512 80,353,789

7 Gross Total (no withholding) - Pharmacy 267,789 365,761 355,408 (205,332) 631,453 518,158 549,478 414,699 425,167 253,878 359,190 309,000 4,244,649

8 Sub-total: Medicare Capitation 6,066,697 5,967,686 5,772,669 5,000,507 10,552,785 8,799,161 8,219,407 7,499,558 7,077,531 6,618,195 6,511,730 6,512,512 84,598,438

Medicaid Premiums:

9 Monthly Capitation Received - Medical 3,933,009 3,781,501 3,669,297 3,481,386 6,013,599 5,293,449 4,956,113 4,618,671 4,325,683 4,136,496 3,957,553 3,893,261 52,060,018

10 Monthly Capitation Received - Pharmacy 18,330 17,784 17,304 16,609 27,508 24,195 22,729 21,462 20,570 19,727 19,031 18,941 244,190

11 Monthly Capitation Withheld - Medical 0 0 0 0 0 0 0 0 0 0 0 0 0

12 Monthly Capitation Withheld - Pharmacy 0 0 0 0 0 0 0 0 0 0 0 0 0

13 Gross Total (before withhold) - Medical 3,933,009 3,781,501 3,669,297 3,481,386 6,013,599 5,293,449 4,956,113 4,618,671 4,325,683 4,136,496 3,957,553 3,893,261 52,060,018

14 Gross Total (before withhold) - Pharmacy 18,330 17,784 17,304 16,609 27,508 24,195 22,729 21,462 20,570 19,727 19,031 18,941 244,190

15 Sub-total: Medicaid Capitation 3,951,339 3,799,285 3,686,601 3,497,995 6,041,107 5,317,644 4,978,842 4,640,133 4,346,253 4,156,223 3,976,584 3,912,202 52,304,208

16 Investment Income 21,810 21,810 21,810 21,810 21,810 21,810 21,810 21,810 21,810 21,810 21,810 21,810 261,721

17 Other Revenue 0 0 0 0 0 0 0 0 0 0 0 0 0

18 Total Gross Revenues 10,039,846 9,788,781 9,481,080 8,520,312 16,615,702 14,138,615 13,220,059 12,161,501 11,445,594 10,796,228 10,510,124 10,446,524 137,164,367

19 Premium Taxes (on Medicaid) 69,148 66,487 64,516 61,215 105,719 93,059 87,130 81,202 76,059 72,734 69,590 68,464 915,324

20 Maintenance Taxes 282 273 266 255 426 374 352 331 317 304 293 291 3,764

21 Net Revenues 9,970,415 9,722,020 9,416,298 8,458,842 16,509,557 14,045,182 13,132,578 12,079,967 11,369,218 10,723,190 10,440,241 10,377,769 136,245,279

Expenses:

Medicare Expenses:

22 Fee-For-Service 3,658,073 3,711,575 3,421,904 3,138,755 7,474,849 5,067,326 6,091,622 5,116,531 4,911,347 4,850,351 4,776,797 4,650,146 56,869,276

23 Capitated Services 43,949 42,595 41,444 39,681 66,322 58,345 54,786 51,615 49,368 47,325 45,626 45,368 586,424

24 Net Reinsurance cost 0 0 0 0 0 0 0 0 0 0 0 0 0

25 IBNR Accrual - Medical (3,203) 49,576 2,161 1,927 25,282 29,993 36,401 98,959 78,210 121,852 (228,897) 277,952 490,213

26 Other Medicare Medical Expenses 153,058 210,637 202,173 141,370 328,108 219,578 255,759 53,523 243,850 300,682 258,051 233,239 2,600,028

27 Total Medicare Medical Expenses 3,851,877 4,014,383 3,667,682 3,321,733 7,894,561 5,375,242 6,438,568 5,320,628 5,282,775 5,320,210 4,851,577 5,206,705 60,545,941

28 Medicare Gross Rx Exp (excl PBM Admin) 576,582 530,226 471,934 177,312 968,247 763,522 861,614 719,357 702,721 609,491 557,220 509,402 7,447,627

29 Medicare Rx Rebates 339,546 328,039 266,305 289,511 508,115 360,628 392,512 380,482 397,538 361,812 329,120 312,562 4,266,168

30 Sub-total: Medicare Medical & Rx Expenses 4,088,913 4,216,570 3,873,312 3,209,534 8,354,694 5,778,136 6,907,670 5,659,503 5,587,958 5,567,889 5,079,677 5,403,545 63,727,400

Medicaid Expenses:

31 Fee-For-Service 2,862,560 2,935,955 2,680,640 2,658,030 4,530,784 3,629,238 3,857,498 3,401,856 3,421,774 3,106,180 3,026,202 2,930,913 39,041,630

32 Capitated Services 0 0 0 0 0 0 0 0 0 0 0 0 0

33 Net Reinsurance cost 0 0 0 0 0 0 0 0 0 0 0 0 0

34 IBNR Accrual - Medical (2,507) 39,216 1,693 1,632 15,324 21,481 23,051 65,795 54,490 78,034 (145,011) 175,189 328,387

35 Minimum Payment Amount Program (MPAP) 0 0 0 0 0 0 0 0 0 0 0 0 0

36 Other Medicaid Medical Expenses 895,267 864,112 999,388 1,075,792 992,068 893,834 1,015,098 844,188 956,862 919,616 943,542 1,002,551 11,402,318

37 Total Medicaid Medical Expenses 3,755,320 3,839,283 3,681,721 3,735,454 5,538,176 4,544,553 4,895,647 4,311,839 4,433,126 4,103,830 3,824,733 4,108,653 50,772,335

38 Medicaid Prescription Exp (excl PBM Admin) 26,859 21,501 23,334 22,636 26,256 26,087 22,349 23,978 24,496 19,610 20,854 21,296 279,257

39 Sub-total: Medicaid Medical & Rx Expenses 3,782,179 3,860,784 3,705,055 3,758,090 5,564,432 4,570,640 4,917,996 4,335,817 4,457,622 4,123,440 3,845,587 4,129,949 51,051,592

40 Total Medical & Prescription Expenses 7,871,092 8,077,353 7,578,366 6,967,624 13,919,126 10,348,776 11,825,666 9,995,320 10,045,580 9,691,330 8,925,264 9,533,493 114,778,992

41 Administrative Expenses 610,875 632,908 506,793 401,313 623,877 529,933 625,786 711,833 647,346 582,518 672,942 691,004 7,237,130

42 Total Expenses 8,481,968 8,710,262 8,085,160 7,368,937 14,543,003 10,878,709 12,451,452 10,707,154 10,692,926 10,273,848 9,598,207 10,224,497 122,016,123

43 Total Net Income Before Taxes 1,488,447 1,011,758 1,331,138 1,089,905 1,966,554 3,166,473 681,126 1,372,813 676,292 449,342 842,034 153,272 14,229,156

44 Net Income EXCL Medicare Rx 1,486,150 874,530 1,205,852 1,208,891 1,866,703 3,083,467 633,949 1,326,865 586,090 470,646 737,145 68,401 13,548,691

United HealthCare / UnitedHealth GroupTexas Financial Alignment Demonstration

Part 1 Summary Income Statement 4/18/2018

State of Texas HHSC FINANCIAL STATISTICAL REPORT (FSR) HHSC Medicaid/CHIP Division - Finance

MMP name: MMP self-reported data, subject to audit

State Fiscal Year: 2017 Program: MMP Dual Demo - Integrated Care Program (STAR+PLUS+Medicare)

Submission Date: 1/2/2017 County: Harris County (Houston) template version 2.2

Submission Type: Yr-End 90-Day Rptg Period End Date: 11/30/2017

Part 1: Summary Income Statement Managed Care contract revenues & costsSFY

Incurred Months: Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 YTD

United HealthCare / UnitedHealth GroupTexas Financial Alignment Demonstration

45 % total Medical Exp to Net Revenues 76.3% 80.8% 78.0% 83.4% 81.4% 70.6% 86.3% 79.7% 85.5% 87.9% 83.1% 89.8% 81.7%

46 % total Prescription Exp to Net Revenues 2.6% 2.3% 2.4% -1.1% 2.9% 3.1% 3.7% 3.0% 2.9% 2.5% 2.4% 2.1% 2.5%

47 % Total Medical & Rx to Net Rev. (MLR) 78.9% 83.1% 80.5% 82.4% 84.3% 73.7% 90.0% 82.7% 88.4% 90.4% 85.5% 91.9% 84.2%

48 % Admin Exp to Net Revenues 6.1% 6.5% 5.4% 4.7% 3.8% 3.8% 4.8% 5.9% 5.7% 5.4% 6.4% 6.7% 5.3%

49 % Total Net Income to Net Revenues 14.9% 10.4% 14.1% 12.9% 11.9% 22.5% 5.2% 11.4% 5.9% 4.2% 8.1% 1.5% 10.4%

50 % Adj. Admin to Adj. Net Revenues 6.0% 6.5% 5.3% 4.3% 3.5% 3.7% 4.7% 5.8% 5.6% 5.3% 6.4% 6.6% 5.2%

(excludes Prescription pass-through)

51 % Net Income EXCL Medicare Rx 15.3% 9.3% 13.3% 14.0% 11.8% 22.8% 5.0% 11.4% 5.4% 4.5% 7.3% 0.7% 10.3%

Memo: QWP withholdings and recoupments

52 Total Medicare Capitation Withheld 59,016 56,961 55,152 53,003 196,392 164,083 152,083 140,456 132,035 127,240 123,078 123,070 1,382,570

53 Total Medicaid Capitation Withheld 0 0 0 0 0 0 0 0 0 0 0 0 0

54 Medicare Payments against Withholding 0 0

55 Medicaid Payments against Withholding 0 0

56 Net Amount Not Received by MMP 59,016 56,961 55,152 53,003 196,392 164,083 152,083 140,456 132,035 127,240 123,078 123,070 1,382,570

memo:

57 total Net Revenues (from Line 21) 9,970,415 9,722,020 9,416,298 8,458,842 16,509,557 14,045,182 13,132,578 12,079,967 11,369,218 10,723,190 10,440,241 10,377,769 136,245,279

58 Medicare portion (incls interest income) 6,079,842 5,980,831 5,785,814 5,013,652 10,565,930 8,812,306 8,232,552 7,512,703 7,090,676 6,631,340 6,524,875 6,525,657 84,756,175

59 Medicaid portion (excls Prem tax; incls interest inc) 3,890,574 3,741,190 3,630,485 3,445,191 5,943,627 5,232,876 4,900,026 4,567,265 4,278,542 4,091,851 3,915,366 3,852,113 51,489,105

60 add-check (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (1)

61 total Net Income (from Line 43) 1,488,447 1,011,758 1,331,138 1,089,905 1,966,554 3,166,473 681,126 1,372,813 676,292 449,342 842,034 153,272 14,229,156

62 Medicare portion 1,646,276 1,408,543 1,626,186 1,574,580 1,840,770 2,731,884 970,052 1,453,017 1,137,650 734,636 1,067,769 734,385 16,925,749

63 Medicaid portion (157,828) (396,785) (295,047) (484,674) 125,784 434,589 (288,926) (80,203) (461,359) (285,294) (225,734) (581,113) (2,696,590)

64 add-check (0) (1) (0) (0) (0) (0) (0) (0) (0) 0 (0) 0 (3)

Note: Except where stated otherwise, reporting is on an incurred basis (that is, reported in the period corresponding to dates of service, rather than to date paid). With each new FSR submission, all prior quarters' data must be updated to reflect, in the column pertaining to

the appropriate past month, the most recent revised IBNR estimates, the most recent Medicare capitation premium adjustments, and the most recent Medicare and Medicaid payment file data.

Part 1 Summary Income Statement 4/18/2018

Updated August 2012

TERMS USED IN FINANCIAL STATISTICAL REPORTS (FSRs)

Total Member Months - Number of members enrolled in each month. YTD is the sum of the

individual month’s membership.

Revenues:

• Premiums – Capitation payments paid to MCOs (Managed Care Organization) by HHSC.

• Delivery Supplemental Payments – A one-time per pregnancy supplemental payment made by HHSC to STAR, CHIP MCOs.

• Pharmacy Premiums - Pharmacy capitation payments paid to MCOs by HHSC • Investment Income – All interest and dividend income resulting from investment of

funds received. • Other Revenue – Any and all income generated from other sources. • Premium Taxes – Premium taxes incurred by MCOs for premiums applicable to the

reported period. • Maintenance Taxes – Maintenance taxes incurred by MCOs for premiums applicable to

the reported period.

Medical Expenses:

• Fee for Service – Non-capitated payments for services rendered to the members. • Capitated Services – Includes PCPs and Hospitals capitation payments which are

amounts paid to providers that do not pay claims to other providers from the capitation payments and also the capitation paid to subcontractors in which the capitation is the funding source for paying claims for healthcare services performed in each Texas service area.

• Net Reinsurance Cost – Total reinsurance premiums paid by the MCO net of reinsurance recoveries.

• IBNR Accrual – Incurred But Not Reported (IBNR) accrual medical expenses are an estimate of the expected healthcare expenses incurred, but not paid, based on claims lag schedules and completion factors, as well as any counts of services rendered but not billed, e.g., pre-authorized hospital days.

Administrative Expenses – includes those expenses that are directly or indirectly in support of

the Texas Medicaid/CHIP operations of the MCO. Administrative expenses include Salaries,

Wages and other benefits, Payroll taxes, Utilities and Maintenance, Auditing and other

consulting expenses etc.

Performance Assessment – Amount of at-risk premium recouped by HHSC for failure to meet

the performance expectation for which the MCO is at risk.

Quality Challenge Award – Amount awarded to the MCO for superior clinical quality, service

delivery, access to care or member satisfaction.

Liquidated Damages - Amount assessed by HHSC as penalty for non-compliance with

contract requirements.