US · guidance
CMS Pub. 100-16, ch. mc86c17a, § 10.1
Reasonable Cost Payments
An HMO/CMP paid on a reasonable cost basis is paid the reasonable cost of the covered
services it furnishes directly to or arranges for its Medicare enrollees. The determination
of reasonable cost is based on the Medicare reimbursement principles which are used to
calculate the reasonable cost of hospitals, Skilled Nursing Facilities (SNFs), Home
Health Agencies (HHAs), and other entities paid by the Medicare program on a cost basis
and also on principles contained in this manual. In addition to the costs directly related to
the provision of health services, the costs incurred by the HMO/CMP such as marketing,
enrollment, and membership expenses are also taken into account in determining
reasonable costs.
The cost payment principles for cost-based HMO/CMPs are discussed in detail in
Chapter 17, Subchapter B.
History
(Rev. 4, 10-01-01)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
e232cf297494db65c87964035566e483e769f2eacd8ecc6a423839bb8c6cf50b
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