US · guidance
CMS Pub. 100-16, ch. mc86c17a, § 10.3.2
Interim Per Capita Rate
The interim per capita rate for a cost-based HMO/CMP is determined by dividing
estimated reimbursable costs of providing Medicare-covered services to the HMO/CMP's
Medicare enrollees by projected Medicare enrollee months for the contract period.
Estimated reimbursable costs and the projected number of Medicare enrollee months are
derived from the HMO/CMP's annual operating budget and enrollment forecast. The
number of Medicare enrollees may be compared to CMS’s latest updated records of
enrollment for reasonableness. These records will identify the number of Medicare
beneficiaries CMS has identified as enrollees of the HMO/CMP.
History
(Rev. 4, 10-01-01)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
f7726948e2f1644ca690f4feb7dacca054139cfda7ba33ca3b95d4a8c8a74ddb
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