1. Provider Re-Enrollment

2. 1 St Year Implementation Schedule Year 1- Primarily Institutional Providers 6405 Providers scheduled for reenrollment Providers will be notified when reenrollment is due –Important: Providers should not submit documentation before being notified –Schedule is subject to change 1

3. Number of Providers 2

4. Year 1 Schedule (Per Week) DateProvider Type/ NameTotal Providers FeeSite Visit In Progress 01/18/201350- Adult Foster Care50NN 01/25/201350- Adult Foster Care48NN 02/01/201340- Attendant Care150YN 02/08/201340- Attendant Care101YN 02/15/201397- Air Transportation35YN 27- Adult Day care19YN 74- Alternative Res. Fac.66YN 02/22/201374- Alternative Res. Fac.150YN 03/01/201343*-Ambulatory Surg. Ctr147* 03/08/201349- Assisted Living Center 56- Boarding Home B7- Crisis Service Provider 81- EPD HCBS 83- Free standing Birthing Ctr. 55- Hotels 128 3 2 11 1 3 YN * Medicare (fee and site visit performed at federal level ) Moderate categorical risk 3

5. Schedule Continued… DateProvider Type/ NameTotal ProvidersFeeSite Visit 03/15/201336- Assisted Living Homes150YN 03/22/201336- Assisted Living Homes150YN 03/29/201336- Assisted Living Homes150YN 04/05/201336- Assisted Living Homes150YN 04/12/201336- Assisted Living Homes150YN 04/19/201336- Assisted Living Homes150YN 04/26/201336- Assisted Living Homes150YN 05/03/201336- Assisted Living Homes A5- Behav. Hlth Therapeutic Home 65 109 YN 05/10/2013A5- Behav. Hlth Therapeutic Home150YN 05/17/2013A5- Behav. Hlth Therapeutic Home150YN 05/24/2013A5- Behav. Hlth Therapeutic Home 05- Clinic 55 95 YN 05/31/201205- Clinic 71*- Psychiatric Hospital 129 21* YN *Medicare (fee and site visit performed at federal level ) 4

6. Schedule Continued… DateProvider Type/ NameTotal ProvidersFeeSite Visit 06/07/201341*- Dialysis Center 70- Home Delivered Meals 122* 20 YN 06/14/201332- Medical Foods 78- Mental Hlth Res. Treat. Ctr. 72- Regional Beh. Hlth. Auth. B2- Resid Trtm. Ctr-non-secure B3- Resid Trtment Ctr-non-secure E1- Independent Testing Fac. A2- Level III Behav. Health 6 12 5 1 57 70 YN 06/21/2013B1- Resid. Trtment Ctr. secure 57- Residential Treatment Fac. A6- Rural Substance Abuse Tra B5- Subacute facility (1-16 beds) B6- Subacute facility (17+beds) 79- Vision Center 02*- Hospital 11 1 8 19 4 11 103* YN 06/28/201302*- Hospital150* * Medicare (fee and site visit performed at federal level ) 5

7. Schedule Continued… DateProvider Type/ NameTotal ProvidersFeeSite Visit 07/05/201302*- Hospital150* 07/12/201302*- Hospital150* 07/19/201302*- Hospital150* 07/26/201302*- Hospital150* 08/02/201302*- Hospital150* 08/09/201302*- Hospital150* 08/16/201302*- Hospital 28- Non-Emerg Trans. 81* 69 YN 08/23/201328- Non-Emerg Trans.150YN 08/30/201330- DME Supplier250YY 09/06/201330- DME Supplier207YY 22*- Nursing Home43* 09/13/201322*- Nursing Home 03- Pharmacy 103* 47YN High categorical risk * Medicare (fee and site visit performed at federal level ) 6

8. Schedule Continued… DateProvider Type/ NameTotal ProvidersFeeSite Visit 09/20/201303*- Pharmacy250YN 09/27/201303*- Pharmacy250YN 10/04/201303*- Pharmacy281YN 10/11/201303*- Pharmacy280YN 10/18/201303*- Pharmacy150YN 7

9. Year 1- Documents Collected – Provider Participation Agreement – Disclosure of Ownership Form- Companies and Facilities – Criminal Offense Form – Address Verification Form/W-9 – Provider Type Profiles Attendant Care Independent Testing Facility Non-Emergency Transportation Provider 8