US · guidance
CMS Pub. 100-16, ch. mc86c18a, § 20.1
Adjustment of Payments
In order to maintain the interim payments at the level of current reasonable costs, CMS
will adjust the interim per capita rate on the basis of adequate data supplied by the HCPP
in the interim estimated cost and enrollment report or such other evidence that CMS may
have which indicates that the rate based on actual costs is more or less than the current
rate. Adjustments may also be made when there is:
• A material variation from the costs estimated when the annual operating budget
was prepared;
• A significant change in the use of covered services by the HCPP's Medicare
enrollees; or
• A change in the number of Medicare enrollees in the HCPP, and the per capita
cost rate is affected.
The interim per capita rate is flexible and may be adjusted if the HCPP submits a revised
budget and enrollment forecast indicating that an adjustment is needed to maintain
payments at the level of current costs.
History
(Rev. 30, 09-05-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
4b562a9d67439eb4e195c74f0654a78410eea3a37339693abd223ce745b6fc0f
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.