S.D. Admin. R. 20:06:58:37

Current through Register Vol. 51, page 67, December 16, 2024

Section 20:06:58:37 - Formula

The formula to be used to make the determination under § 20:06:58:36 is expressed mathematically as [(E₁ -- E₀)/T₀] -- D>k. The components mean:

(1) E₁ is the actual total cost of coverage with respect to mental health and substance use disorder benefits for the base period, including claims paid by the plan or issuer with respect to mental health and substance use disorder benefits and administrative costs, amortized over time, attributable to providing these benefits consistent with the requirements of §§ 20:06:58:01 to 20:06:58:45, inclusive;

(2) E₀ is the actual total cost of coverage with respect to mental health and substance use disorder benefits for the length of time immediately before the base period and that is equal in length to the base period, including claims paid by the plan or issuer with respect to mental health and substance use disorder benefits and administrative costs, amortized over time, attributable to providing these benefits;

(3) T₀ is the actual total cost of coverage with respect to all benefits during the base period;

(4) k is the applicable percentage of increased cost specified in paragraph § 20:06:58:35 that is expressed as a fraction for purposes of this formula; and

(5) D is the average change in spending that is calculated by applying the formula (E₁ -- E₀)/T₀ to mental health and substance use disorder spending in each of the five years and then calculating the average change in spending.

S.D. Admin. R. 20:06:58:37

41 SDR 93, effective 12/3/2014.

General Authority: SDCL 58-17-87, 58-18-79, 58-18-79(15).

Law Implemented: SDCL 58-17-87, 58-18-79, 58-18-80.