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§ 438.6(c). b) Notwithstanding the provisions set forth in Section 3.3(a) above, the SDOH reserves the right to terminate this Agreement, in its entirety for either the Contractor's MMC or FHPlus product, or for either or both products in specified counties of the Contractor's service area, pursuant to Section 2.7 of this Agreement, upon determination by SDOH that the aggregate monthly Capitation Rates are not cost effective. (COMPENSATION) October 1, 2005

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§ CFR Section 438.6(c). b) Notwithstanding the provisions set forth in Section 3.3(a) above, the SDOH DOHMH reserves the right to terminate this Agreement, in its entirety for either the Contractor's MMC or FHPlus productproduct if applicable, or for either or both products in specified counties of the Contractor's service areaarea 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. (COMPENSATION) October 1, 2005.