Medicare Managed Care Manual (Pub. 100-16), Ch. 18b § 90
Special Costs Paid In Full
90 - Special Costs Paid In Full
(Rev. 30, 09-05-03)
The CMS will pay in full the total reasonable cost incurred by the HCPP 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
HCPP'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
8
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 18, Subchapter C, as applicable, so that the Medicare program
pays its proportionate share of these costs.
The following types of costs incurred by the HCPP 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.