US · guidance
CMS Pub. 100-16, ch. mc86c17b, § 390
Alternative Method for Cost Report Treatment of Employer
Health Plans
(Rev. 4, 10-01-01)
In the case of benefits covered by an employer plan for a Medicare member who is also a
group member under the employer’s plan, the Medicare cost-based HMO/CMP may elect
to identify the cost or charge for the service covered under that plan. However, instead of
specifically identifying those services for which an employer health plan is primarily
liable for payment, the HMO/CMP may elect to utilize a member month ratio to establish
Medicare’s liability. This election must be made in writing at the time of a timely
submitted budget. In addition, this election must be made for the groups of Medicare
beneficiaries subject to the MSP provisions as described in this chapter.
Once the election is made, the election will remain in effect until it is revoked by the
Medicare cost-based HMO/CMP in writing on a timely submitted budget.
The member month ratio is developed by dividing the Medicare member months by the
total Medicare member months. This ratio would then be applied to covered Medicare
service costs resulting in those costs for which Medicare is the primary payer.
History
(Rev. 4, 10-01-01)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
6ba5493c1277ba17e1b35d02a398f1eb308e1e64fb84547384254f812a9c0b7e
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