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If, however, the state initially elects to certify a rate range for a rate cell, the state is not permitted to use this de minimis change authority but may increase or decrease a capitation rate within a rate range by up to 1% during the rating period without submission of a new rate certification as long as the resulting rate does not fall outside of the 5 percent range limit allow by federal regulations (42 CFR 438.4(c)(2)(iii))

This situation will impair insulin-mediated glucose uptake and metabolic regulation

The practical difference between loading and not loading is 2-3 weeks of saturation time