Medical Loss Ratio Adjustment. Annually on a state fiscal year basis, the total annual Capitation Payment made to the Contractor for the combined ACA and Non-ACA populations and their associated healthcare costs shall be evaluated against a ninety (90) percent Minimum Medical Loss Ratio (MLR) Requirement to determine whether a Payment Adjustment is warranted (determined pursuant to Appendix E “Medical Loss Ratio Calculation.” A Payment Adjustment (premium refund) shall occur if:
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