CMS Pub. 100-16, ch. 8, § 60.6

CMS will make the following two types of payments for MSA plan enrollees. See §70.2

for ESRD enrollee payment rules and §70.3 for payment rules for enrollees who have

elected hospice.

• Monthly prospective capitation payment, which is the plan’s bid for coverage of

original Medicare benefits under a high-deductible health plan. These payments

must be adjusted by the enrollee’s risk score, as required under §1853(a)(1)(B)(iii)

of the Act and 42 CFR 422.304(c)(2).

• Annual lump-sum deposit to the enrollees’ MSA, calculated as the difference

between the plan A/B bid and plan A/B/ benchmark, annualized, reflects the plan’s

projected average level of risk. The monthly value of the MSA deposit is the same

for each plan member. CMS transmits to MA organizations the annual MSA

amounts to be deposited into enrollees’ accounts.

MSA plan capitation payment aged and disabled enrollees: (Standardized benchmark *

enrollee’s risk factor) minus monthly deposit amount.

Annual Lump Sum Deposit Payment. Monthly deposit amount * number months of

enrollment.

Payment calculation in CMS’ systems are determined separately for Part A and Part B.

Part-B only plans are paid the Part B portion of the payment.