Budget and Enrollment Forecast

10.3.1 - Budget and Enrollment Forecast (Rev. 4, 10-01-01) Cost-based HMO/CMPs must submit an annual operating budget and enrollment forecast at least 90 days before the start of each contract year. The operating budget uses estimated costs. The budget and enrollment forecast must reflect the HMO/CMP's past experience and present the HMO/CMP's anticipated enrollment and costs (both total and Medicare) for the coming year. The reports are then used to compute the interim per capita rate. Its other purpose is to establish Medicare deductible and coinsurance premiums, including determining past over or under collections of such premiums and the budget period's voluntary undercollection of premium. If the annual budget and enrollment forecast is not submitted on a timely basis, CMS may: • Establish an interim per capita rate of payment on the basis of the best available data and adjust payments based on such a rate until such time as the required reports are submitted and the new interim per capita rate can be established, or • Advise the HMO/CMP if there is not enough data on which to base an interim rate, then interim payments will not be made until the required reports are submitted. CMS reserves the right to examine all records and statistical data used by the HMO/CMP in completing these reports. To the extent the annual operating budget and enrollment forecast is accurate, interim payments will approximate the total CMS obligation.