Special Costs Paid In Full

200 - Special Costs Paid In Full (Rev. 4, 10-01-01) CMS will pay in full the total reasonable cost incurred by the HMO/CMP for services that are solely for the purposes of the Medicare program and unique to cost-based organization Medicare provisions. These special costs will be taken into account in the HMO/CMP’s monthly per capita rate. Special costs must be shown separately in the organization’s operating budget and approved by CMS in advance of the contract period for which they are claimed subject to retrospective adjustment at the end of the contract period. These special costs do not include management service costs or the normal administrative costs incurred by the organization in obtaining payment from the Medicare program for example, such as the cost of maintaining and reporting statistical and actuarial data needed to determine the amount of payment due the organization, costs of accumulating accretion and deletion data, marketing, enrollment, and the cost of preparing cost reports. Such costs are apportioned to the Medicare program in accordance with Chapter 17, Subchapter C as applicable, so that the Medicare program pays its proportionate share of these costs. The following types of costs incurred by the HMO/CMP will be paid in full by CMS: • Medicare Enrollment Data - This is the reasonable cost of reporting individual Medicare beneficiary enrollment accretion and deletion data; • Special Program Evaluation and Planning Data - This is the reasonable cost of special data required by CMS solely for Medicare program evaluation and planning purposes. However, unless specifically provided for, this data does not include the data the organization is required to maintain and furnish under other sections of this manual; • Certification of Cost Report - This is the reasonable costs of certifying the organization’s cost report. However, as indicated above, the reasonable cost of preparing this cost report is apportioned in accordance with Chapter 17, Subchapter C as applicable. CMS will pay in full under this section only those additional costs incurred by the organization that are related to the certification of that report.