US · guidance
CMS Pub. 100-16, ch. mc86c18b, § 230
Alternative Method for Cost Report Treatment of Employer
Health Plans
(Rev. 30, 09-05-03)
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 HCPP 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 HCPP 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
HCPP in writing on a timely submitted budget.
35
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. 30, 09-05-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
b8b1a9916e6b5d9c1731a07261ff74f9d11c1ea8e8f0ece34fd338c5ddf24474
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.