TITLE 42 - PUBLIC HEALTH

CHAPTER IV - CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER B - MEDICARE PROGRAM

PART 422 - MEDICARE ADVANTAGE PROGRAM

subpart g - PAYMENTS TO MEDICARE ADVANTAGE ORGANIZATIONS

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 45 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 15 days to comment on the proposed changes.