Cal. Code Regs. Tit. 22, § 53101.1 - Actuarial Method

Actuarial method means any reasonable and adequate method of determining prospective per capita rates of payment for plan members that is based on recent comparable data from each prepaid health plan and other prepaid populations, as determined by the Department, where data is available including:

(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 which were not required during the previous year.

Notes

Cal. Code Regs. Tit. 22, § 53101.1

1. New section filed 7-5-78; effective thirtieth day thereafter (Register 78, No. 27).

Note: Authority cited: Sections 14124.5 and 14312, Welfare and Institutions Code. Reference: Sections 14201, 14251, 14256, 14261, 14262(a) (b) (c), 14300, 14301, 14302, 14303, 14303.1, 14303.2, 14304, 14308, 14312, 14402, 14405, 14406(a) (b), 14408(d), 14409(a) (b), 14410, 14411(a) (b), 14412, 14413, 14450, 14451, 14451.5(a) (b), 14452, 14452.5, 14454, 14455, 14456, 14459, 14460, 14475, 14476, 14477 14478, 14479, 14480, 14481 and 14482, Welfare and Institutions Code.

1. New section filed 7-5-78; effective thirtieth day thereafter (Register 78, No. 27).