CMS Pub. 100-16, ch. 8, § 30

and Announcement of Changes in Payment Methodology

(Rev. 89; Issued: 11-02-07; Effective/Implementation: 11-02-07)

Announcement of Calendar Year Medicare Advantage Capitation Rates. As set forth

in 42 CFR 422.312, and 42 CFR 422.312(a)(2), not later than the first Monday in April

each year, CMS announces to MA organizations and other interested parties the following

information for each MA local area for the following calendar year:

(i) The annual MA capitation rate;

(ii) The risk and other factors to be used in adjusting those rates for payments for

months in that year; and

(iii)An explanation of assumptions used to determine the capitation rates and a

description of the risk and other factors.

Advance Notice of Changes in MA Payment Methodology. No later than 45 days before

making the Announcement of Calendar Year Medicare Advantage Capitation Rates, CMS

notifies MA organizations of changes it proposes to make in the factors and the

methodology it used in the previous determination of capitation rates. The MA

organizations have 15 days to comment on the proposed changes.

Regional Benchmark Announcement. Before the beginning of each annual, coordinated

election period (see Chapter 2 of the Manual), CMS will announce the MA regional

benchmark amount for the year for each MA region.