Common use of Rating Period Clause in Contracts

Rating Period. A period selected by the Department for which the actuarially sound Capitation rates are developed and documented in the rate certification submitted to CMS as required by §438.7 (a) For the second, fourth and fifth rating periods, the Department will adjust Capitation rates, if necessary, to maintain actuarial soundness based upon a material and demonstrated impact caused by any or all of the following: Changes in medical costs; 1. Changes in utilization patterns; or 2. Programmatic changes that affect the Primary Contractor and/or its BH- MCO's delivery or coverage of benefits. In the event that no adjustments are made, pursuant to C.1), 2) or 3) above, the rates applicable to the previous rating period will apply. The Department will disclose to the Primary Contractor the basis and assumptions of its determination with respect to adjustments to the second, fourth and fifth rating period rates. At the Department’s discretion, Capitation rates may be negotiated for the third rating period. In the event the Department does not negotiate Capitation rates for the third rating period, the Department will adjust Capitation rates, if necessary, as provided for the second, fourth and fifth rating period. If agreement is not reached prior to the start of an Agreement period, the rates applicable to the previous rating period will continue to apply until new rates are agreed upon and effective. If the Department exercises its option to renew the Agreement for an additional three-year period, pursuant to Part I-4, rate negotiations will commence promptly after notice of same for the sixth rating period. Capitation rates will be adjusted for the seventh and eighth rating period. The Department reserves the right to expand or contract the scope of the HealthChoices Program during the term of the Agreement to include additional services or reduce services, or covered populations.