Common use of Actuarially Sound Payments Clause in Contracts

Actuarially Sound Payments. All payments for which the STATE receives Federal Financial Participation under this Contract, including risk adjusted payments and any risk sharing methodologies, must be actuarially sound pursuant to 42 CFR § 438.6. The STATE’s contracted actuary must meet the independence requirements under the professional code for fellows in the Society of Actuaries and must not have provided actuarial services to a MCO during the period in which the actuarial services are being provided to the STATE. The certification and attestation of actuarial soundness provided by the actuary must be auditable. Financial Audit. As outlined in Minnesota Statutes, § 256B.69, subd. 9d, as revised by Laws of Minnesota, Ch. 71, Art. 11, Secs. 36 and 37, the Office of the Legislative Auditor (OLA) will conduct or contract with third-party vendors to conduct independent third-party financial audits of the MCO’s information identified in Minnesota Statutes, §256B.69, subd. 9c, (b). The auditor will be required to determine compliance with the Medicaid managed care rate certification process, and whether the administrative expenses and investment income reported by the MCO are compliant with state and federal law. The audits shall be conducted in accordance with generally accepted government auditing standards issued by the United States Government Accountability Office. The MCO shall submit data to and fully cooperate with the auditor, and provide the STATE and the auditor access to all data required to complete the audits. STATE Request for Data. In accordance with Minnesota Rules, Part 9500.1460, subpart 16, the MCO shall comply with requests for data from the STATE or its actuary for rate-setting purposes. The MCO shall make the data available within thirty (30) days from the date of the request and in accordance with the STATE’s specifications, including providing a data certification in accordance with section 9.10 under this Contract.

Actuarially Sound Payments. All payments for which the STATE receives Federal Financial Participation under this Contract, including risk adjusted payments and any risk sharing methodologies, methodologies must be actuarially sound pursuant to 42 CFR § 438.6438.6 and 434.6. The STATE’s contracted actuary must meet the independence requirements under the professional code for fellows in the Society of Actuaries and must not have provided actuarial services to a MCO during the period in which the actuarial services are being provided to the STATE. The certification and attestation of actuarial soundness provided by the actuary must be auditable. auditable.‌ Financial Audit. As outlined in Minnesota Statutes, § § 256B.69, subd. 9d9e and 3.972, as revised by Laws of Minnesota, Chsubd. 71, Art. 11, Secs. 36 and 37, the 2,the Office of the Legislative Auditor (OLA) will conduct or contract with third-party vendors to conduct independent third-party financial audits of OLA)shall audit the MCO’s information identified in Minnesota Statutes, §256B.69, subd. 9c, (b). The auditor will be required MCO to determine if the MCO used the public money in compliance with the Medicaid managed care rate certification processfederal and state laws, rules, and whether the administrative expenses and investment income reported by the MCO are compliant with state and federal law. The audits shall be conducted in accordance with generally accepted government auditing standards issued by the United States Government Accountability Officeprovisions of this Contract. The MCO shall submit data to and fully cooperate with the auditor, and provide the STATE and the auditor access OLA with all data, documents, and other information, regardless of classification, that the OLA requests to all data required to complete conduct the audits. audit.‌ STATE Request for Data. In accordance with Minnesota Rules, Part 9500.1460, subpart 16, the MCO shall comply with the STATE’s requests for data from the STATE or its actuary for rate-setting purposes. The MCO shall make the data available within thirty (30) days from the date of the request and in accordance with to the STATE’s specifications, including providing a data certification in accordance with section 9.10 under of this Contract.Contract.‌