Announcement of annual capitation rate, benchmarks, and methodology changes.

  1. Law
  2. CFR 42
  3. Public Health
  4. Centers for Medicare & Medicaid Services, Department of Health and Human Services
  5. Medicare Program
  6. Medicare Advantage Program
  7. Payments to Medicare Advantage Organizations
  8. Announcement of annual capitation rate, benchmarks, and methodology changes.

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§ 422.312 Announcement of annual capitation rate, benchmarks, and methodology changes.

(a) Capitation rates -

(1) Initial announcement. Not later than the first Monday in April each year, CMS announces to MA organizations and other interested parties the following information for each MA payment area for the following calendar year:

(i) The annual MA capitation rate.

(ii) The risk and other factors to be used in adjusting those rates under § 422.308 for payments for months in that year.

(2) CMS includes in the announcement an explanation of assumptions used and a description of the risk and other factors.

(3) Regional benchmark announcement. Before the beginning of each annual, coordinated election period under § 422.62(a)(2), CMS will announce to MA organizations and other interested parties the MA region-specific non-drug monthly benchmark amount for the year involved for each MA region and each MA regional plan for which a bid was submitted under § 422.256.

(b) Advance notice of changes in methodology.

(1) No later than 60 days before making the announcement under paragraph (a)(1) of this section, CMS notifies MA organizations of changes it proposes to make in the factors and the methodology it used in the previous determination of capitation rates.

(2) The MA organizations have 30 days to comment on the proposed changes.

[70 FR 4729, Jan. 28, 2005, as amended at 85 FR 33908, June 2, 2020]


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