CMS Pub. 100-16, ch. mc86c17b, § 200

CMS will pay in full the total reasonable cost incurred by the HMO/CMP for services

that are solely for the purposes of the Medicare program and unique to cost-based

organization Medicare provisions. These special costs will be taken into account in the

HMO/CMP’s monthly per capita rate. Special costs must be shown separately in the

organization’s operating budget and approved by CMS in advance of the contract period

for which they are claimed subject to retrospective adjustment at the end of the contract

period. These special costs do not include management service costs or the normal

administrative costs incurred by the organization in obtaining payment from the Medicare

program for example, such as the cost of maintaining and reporting statistical and

actuarial data needed to determine the amount of payment due the organization, costs of

accumulating accretion and deletion data, marketing, enrollment, and the cost of

preparing cost reports. Such costs are apportioned to the Medicare program in accordance

with Chapter 17, Subchapter C as applicable, so that the Medicare program pays its

proportionate share of these costs.

The following types of costs incurred by the HMO/CMP will be paid in full by CMS:

• Medicare Enrollment Data - This is the reasonable cost of reporting individual

Medicare beneficiary enrollment accretion and deletion data;

• Special Program Evaluation and Planning Data - This is the reasonable cost of

special data required by CMS solely for Medicare program evaluation and

planning purposes. However, unless specifically provided for, this data does not

include the data the organization is required to maintain and furnish under other

sections of this manual;

• Certification of Cost Report - This is the reasonable costs of certifying the

organization’s cost report. However, as indicated above, the reasonable cost of

preparing this cost report is apportioned in accordance with Chapter 17,

Subchapter C as applicable. CMS will pay in full under this section only those

additional costs incurred by the organization that are related to the certification of

that report.