§ 56101.1. Actuarial Method.

Actuarial method means any reasonable and adequate method of determining prospective per capita rates of payment for PCCM plan members that is based on actual expenditures for fee-for-service Medi-Cal beneficiaries and recent comparable data from each PCCM plan and other prepaid populations. This data may include:

(a) Experience data to determine the expected costs of services and other requirements for which the rates will serve as payment.

(b) Experience data to determine the expected utilization of each service and other requirements for which the rates will serve as payment by the aid category, age and sex of the Medi-Cal members.

(c) Projected inflation in the costs of the services and other requirements during the period to be covered by the rates.

(d) Costs of any new services or requirements that will be required during the year for which the rates are determined but were not required during the previous year.

HISTORY

1. New section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 7-9-90.

2. New section refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed by operation of law on 11-6-90.

3. Request to readopt section on an emergency basis pursuant to Government Code section 11346.1 granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No. 6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or emergency language will be repealed by operation of law on the following day.

4. Certificate of Compliance as to 11-6-90 order transmitted to OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).

5. New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No. 18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or emergency language will be repealed by operation of law on the following day.

6. Certificate of Compliance as to 3-25-91 order including amendment of first paragraph transmitted to OAL 7-19-91 and filed 8-19-91 (Register 92, No. 1).

Note

Note: Authority cited: Sections 14105 and 14124.5, Welfare and Institutions Code. Reference: Section 14088.16, Welfare and Institutions Code.