CCO/PHP Reimbursement Rates Type A and Type B Hospitals

Effective: January 1, 2017

Fiscal CBR/APM Inpatient Outpatient Hospital Name Year End Frontier * Rate ** Rate ** Asante Ashland Community Hospital 7/31 APM 65% 47% 6/30 CBR/FRNT 70% 50% Columbia Memorial Hospital 12/31 APM 66% 42% Coquille Valley Hospital 6/30 APM 63% 46% 6/30 CBR 97% 64% Good Shepherd Medical Center 6/30 APM 85% 37% 4/30 APM 81% 56% Harney District Hospital 6/30 CBR/FRNT 98% 61% 6/30 CBR/FRNT 95% 57% Lower Umpqua Hospital 6/30 CBR 77% 56% Mid-Columbia Medical Center 12/31 CBR 49% 31% PeaceHealth Cottage Grove Community Hospital 6/30 CBR 77% 77% PeaceHealth Peace Harbor Hospital 6/30 CBR 86% 73% Pioneer Memorial Hospital-Heppner 6/30 CBR/FRNT 58% 81% Pioneer Memorial Hospital-Prineville 12/31 CBR 54% 36% Providence Hood River Memorial Hospital 12/31 APM 93% 62% Providence Newberg Medical Center 12/31 APM 71% 34% Providence Seaside Hospital 12/31 CBR 100% 45% Samaritan Lebanon Community Hospital 12/31 CBR 60% 41% Samaritan North Lincoln Hospital 12/31 CBR 59% 46% Samaritan Pacific Communities Hospital 12/31 APM 77% 41% Santiam Memorial Hospital 12/31 CBR 82% 36% Silverton Hospital 9/30 APM 63% 33% Southern Coos Hospital and Health Center 6/30 CBR 81% 61% St. Alphonsus Medical Center-Baker City 6/30 CBR/FRNT 74% 41% St. Alphonsus Medical Center-Ontario 6/30 CBR/FRNT 48% 32% St. Anthony Hospital 6/30 APM 68% 40% St. Charles Medical Center-Madras 12/31 CBR 70% 48% St. Charles Medical Center-Redmond 12/31 APM 56% 39% Tillamook Regional Medical Center 12/31 APM 83% 56% Wallowa Memorial Hospital 6/30 CBR/FRNT 86% 62% West Valley Community Hospital 9/30 CBR 100% 44%

* CBR = Remains on Cost Based Reimbursement * CBR/FRNT = Remains on Cost Based Reimbursement due to location in a Frontier County * APM = Alternative Payment Methodology ** Based on Filed Medicaid Cost Report (DMAP 42). APM Hospitals adjusted for Rate Cap.

Type A B Hospital Rates