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Maximum Reimbursement Rate Formula * Base CAH Type 20% Independent 20% Payer

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Maximum Reimbursement Rate Formula * Base CAH Type 20% Independent 20% Payer Maximum Reimbursement Rate Formula * Base 155% CAH 20% Independent Type 20% Payer Mix (share of Medicare and Medicaid patients) Payer Mix up to 30% Managing cost of care (Expenses, Price, and Margin) Efficiency up to 40% * For a detailed description of the factors included in the hospital reimbursement formula, please see page 12 of the February 21, 2020, actuarial report prepared by Wakely Consulting Group, LLC, available at: https://www.colorado. gov/pacific/sites/default/files/Wakely%20Colorado%20Public%20Option%20Report.pdf Maximum Hospital Type Reimbursement Rate Animas Surgical Hospital Independent 175% Arkansas Valley Regional Medical Center Independent, Critical Access 236% Aspen Valley Hospital Independent, Critical Access 195% Avista Adventist Hospital System 181% Banner Fort Collins Medical Center System 177% Boulder Community Health Independent 193% Castle Rock Adventist Hospital System 178% Children's Hospital Colorado Independent 179% Colorado Canyons Hospital and Medical Center Independent, Critical Access 208% Colorado Plains Medical Center System 168% Community Hospital Independent 207% Delta County Memorial Hospital Independent 214% Denver Health Medical Center Independent 208% East Morgan County Hospital System, Critical Access 210% Estes Park Health Independent, Critical Access 205% Good Samaritan Medical Center System 163% Grand River Hospital District Independent, Critical Access 205% Gunnison Valley Health Independent, Critical Access 198% Haxtun Hospital District Independent, Critical Access 195% Heart of the Rockies Regional Medical Center Independent, Critical Access 216% Keefe Memorial Health Service District Independent, Critical Access 205% Kit Carson County Health Service District Independent, Critical Access 227% Lincoln Community Hospital Independent, Critical Access 230% Littleton Adventist Hospital System 166% Longmont United Hospital System 185% Lutheran Medical Center System 176% McKee Medical Center System 172% Medical Center of the Rockies System 156% Melissa Memorial Hospital Independent, Critical Access 219% Memorial Hospital Central System 174% Memorial Regional Health Independent, Critical Access 223% Mercy Regional Medical Center System 160% Middle Park Medical Center - Kremmling Independent, Critical Access 211% Montrose Memorial Hospital Independent 212% Mt. San Rafael Hospital Independent, Critical Access 226% National Jewish Health Independent 206% North Colorado Medical Center System 175% North Suburban Medical Center System 178% OrthoColorado Hospital System 155% Pagosa Springs Medical Center Independent, Critical Access 227% Parker Adventist Hospital System 156% Parkview Medical Center Independent 213% Penrose-St. Francis Health Services System 175% Pikes Peak Regional Hospital System, Critical Access 199% Pioneers Medical Center Independent, Critical Access 216% Platte Valley Medical Center System 158% Porter Adventist Hospital System 177% Poudre Valley Hospital System 157% Presbyterian/St. Luke's Medical Center System 155% Prowers Medical Center Independent, Critical Access 237% Rangely District Hospital Independent, Critical Access 215% Rio Grande Hospital Independent, Critical Access 238% Rose Medical Center System 159% San Luis Valley Health Conejos County Hospital Independent, Critical Access 225% San Luis Valley Health Regional Medical Center Independent 205% Sedgwick County Health Center Independent, Critical Access 218% Sky Ridge Medical Center System 156% Southeast Colorado Hospital District Independent, Critical Access 236% Southwest Health System, Inc. Independent, Critical Access 225% Spanish Peaks Regional Health Center Independent, Critical Access 235% St. Anthony Hospital System 161% St. Anthony North Health Campus System 187% St. Anthony Summit Medical Center System 157% St. Joseph Hospital System 159% St. Mary-Corwin Medical Center System 196% St. Mary's Hospital & Medical Center, Inc. System 164% St. Thomas More Hospital System, Critical Access 211% St. Vincent General Hospital District Independent, Critical Access 225% Sterling Regional MedCenter System 174% Swedish Medical Center System 159% The Medical Center of Aurora System 168% University of Colorado Hospital System 156% Vail Health Hospital Independent 175% Valley View Hospital Independent 184% Weisbrod Memorial County Hospital Independent, Critical Access 200% Wray Community District Hospital Independent, Critical Access 222% Yampa Valley Medical Center System 155% Yuma District Hospital Independent, Critical Access 237%.
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