US · guidance
CMS Pub. 100-16, ch. 8, § 20.2
Determination of Annual Capitation Rates
There are two rules for determining annual MA capitation rates for 2005 and subsequent
years.
• The annual MA capitation rate for an MA local area will be the minimum
percentage increase rate, except for years when CMS rebases the FFS rates.
• In rebasing years, the annual MA capitation rate is the greater of the minimum
percentage increase rate or the FFS rate.
Areas with upward growth trends in FFS expenditures in the year(s) since CMS last
rebased the FFS rates could have local FFS growth trends that are larger than the national
MA growth trend for that year. Other counties may see a negative trend from the previous
to the current FFS trend in local expenditure growth, resulting in a decline in the FFS rate.
However, in cases where a county’s FFS rate declines from the previous year, the county
would receive the minimum percentage increase rate.
History
(Rev. 89; Issued: 11-02-07; Effective/Implementation: 11-02-07)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
95f30fc98995d05200a6493253149ba498627024ecb652baba1677061f41c4d4
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