Actuarially Sound Payments Clause Samples

Actuarially Sound Payments. All payments for which the STATE receives Federal Financial Participation under this Contract, including risk adjusted payments and any risk sharing methodologies must be actuarially sound pursuant to 42 CFR § 438.
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Actuarially Sound Payments. ‌ All payments for which the STATE receives Federal Financial Participation under this Contract, including risk adjusted payments and any risk sharing methodologies must be actuarially sound. The STATE’s contracted actuary must meet the independence requirements under the professional code for fellows in the Society of Actuaries and must not have provided actuarial services to a MCO during the period in which the actuarial services are being provided to the STATE. The certification and attestation of actuarial soundness provided by the actuary must be auditable. [42 CFR §§438.6 and 438.4; Minnesota Statutes, §256B.69, subd. 9d]
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Actuarially Sound Payments. All payments for which the STATE receives Federal Financial Participation under this Contract, including risk adjusted payments and any risk sharing methodologies, must be actuarially sound pursuant to 42 CFR § 438.6. The STATE’s contracted actuary must meet the independence requirements under the professional code for fellows in the Society of Actuaries and must not have provided actuarial services to a MCO during the period in which the actuarial services are being provided to the STATE. The certification and attestation of actuarial soundness provided by the actuary must be auditable. Financial Audit. As outlined in Minnesota Statutes, § 256B.69, subd. 9d, as revised by Laws of Minnesota, Ch. 71, Art. 11, Secs. 36 and 37, the Office of the Legislative Auditor (OLA) will conduct or contract with third-party vendors to conduct independent third-party financial audits of the MCO’s information identified in Minnesota Statutes, §256B.69, subd. 9c, (b). The auditor will be required to determine compliance with the Medicaid managed care rate certification process, and whether the administrative expenses and investment income reported by the MCO are compliant with state and federal law. The audits shall be conducted in accordance with generally accepted government auditing standards issued by the United States Government Accountability Office. The MCO shall submit data to and fully cooperate with the auditor, and provide the STATE and the auditor access to all data required to complete the audits. STATE Request for Data. In accordance with Minnesota Rules, Part 9500.1460, subpart 16, the MCO shall comply with requests for data from the STATE or its actuary for rate-setting purposes. The MCO shall make the data available within thirty (30) days from the date of the request and in accordance with the STATE’s specifications, including providing a data certification in accordance with section 9.10 under this Contract.
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Actuarially Sound Payments. All payments for which the STATE receives Federal Financial Participation under this Contract, including risk adjusted payments and any risk sharing methodologies, must be actuarially sound pursuant to 42 CFR § 438.6. The STATE’s contracted actuary must meet the independence requirements under the professional code for fellows in the Society of Actuaries and must not have provided actuarial services to a MCO during the period in which the actuarial services are being provided to the STATE. The certification and attestation of actuarial soundness provided by the actuary must be auditable.
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Actuarially Sound Payments. All payments for which the STATE receives Federal Financial Participation under this Contract, including risk adjusted payments and any risk sharing methodologies, must be actuarially sound pursuant to 42 CFR § 438.6. This requires that the payments must be: 4.8.1 Developed in accordance with generally accepted actuarial principles and practice; 4.8.2 Appropriate for the populations to be covered, and the services to be furnished under the Contract; and 4.8.3 Certified by actuaries who meet the qualification standards established by the American Academy of Actuaries and follow the practice standards established by the Actuarial Standards Board.
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Related to Actuarially Sound Payments

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