Common use of Rate Setting Methodology Clause in Contracts

Rate Setting Methodology. a) Capitation rates shall be determined prospectively and shall not be retroactively adjusted to reflect actual Medicaid fee-for-service data or Contractor experience for the time period covered by the rates. Capitated rates in effect as of April 1, 2006 and thereafter, shall be certified to be actuarially sound in accordance with 42 CFR Section 438.6(c). b) Notwithstanding the provisions set forth in Section 3.3(a) above, the DOHMH reserves the right to terminate this Agreement, in its entirety or in specified counties of the Contractor’s service area as set forth in Appendix M, pursuant to Section 2.7 of this Agreement, upon determination by SDOH that the aggregate monthly Capitation Rates are not cost effective.

Rate Setting Methodology. a) Capitation rates shall be determined prospectively and shall not be retroactively adjusted to reflect actual Medicaid fee-for-service data or Contractor experience for the time period covered by the rates. Capitated rates in effect as of April 1, 2006 and thereafter, shall be certified to be actuarially sound in accordance with 42 CFR Section 438.6(c). b) Notwithstanding the provisions set forth in Section 3.3(a) above, the DOHMH SDOH reserves the right to terminate this Agreement, in its entirety entirety, or for the Contractor’s MMC product in specified counties of the Contractor’s service area as set forth in Appendix Marea, pursuant to Section 2.7 of this Agreement, upon determination by SDOH that the aggregate monthly Capitation Rates are not cost effective.