CMS Pub. 100-16, ch. mc86c17a, § 20

In addition to the annual budget and enrollment forecast, the cost-based HMO/CMP is

required to submit interim reports and enrollment data on a cumulative quarterly basis.

CMS, in accordance with 42 CFR 417.572(c)(2), may reduce the frequency of the interim

reporting requirements if it is determined that the HMO/CMP has an adequate ongoing

accounting and enrollment data system that furnishes the records needed to verify the

interim per capita rate. Generally, CMS would require, at a minimum, 1 year of operating

experience under a Medicare contract before waiving any quarterly interim cost reporting

requirements. The interim cost and enrollment reports, unless waived, must be submitted

to CMS within 60 days of the end of each HMO/CMP fiscal quarter. The reports may be

used to adjust the interim rate. If the reports are not submitted timely, CMS may adjust

the interim rate based on the best available information. An adjustment to the interim rate

will remain in effect until such time as the required reports are submitted. If there is not

enough data available, interim payments will not be made.

The last interim cost and enrollment report submitted for a specific contract period will

be the basis for an interim settlement with the HMO/CMP. (See section 20.1.2.)