US · guidance
CMS Pub. 100-16, ch. mc86c17a, § 80.3
Costs in Excess of Annual Capitation Rate
In evaluating the reasonableness of costs for a cost-based HMO/CMP, CMS may take
into account the cost-based HMO/CMP's per capita incurred costs for providing covered
services to Medicare enrollees, in relation to the Adjusted Average Per Capita Cost
(AAPCC) for the geographic areas served by the HMO/CMP or a similar area. The
AAPCC is used as a general guideline to evaluate the reasonableness of a cost-based
HMO/CMP rather than a strict payment limitation.
History
(Rev. 4, 10-01-01)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
c6469d02d7b656a9a92a6420570f1e646beb514501d145736c8de8be1f68b158
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