C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 417—HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS › Subpart O—Medicare Payment: Cost Basis

42 C.F.R. § 417.552

Cost apportionment: General provisions

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(a) Basic rule. The HMO or CMP must apportion its total allowable direct and indirect costs among its Medicare enrollees, its other enrollees, and its nonenrolled patients—

(1) In accordance with this subpart; and

(2) Using methods approved by CMS.

(b) Purpose of apportionment. The purpose of apportionment is to ensure that—

(1) The cost of services furnished to Medicare enrollees is not borne by other enrollees and nonenrolled patients; and

(2) The cost of the services furnished to other enrollees and nonenrolled patients is not borne by Medicare.

[50 FR 1346, Jan. 10, 1985, as amended at 58 FR 38082, July 15, 1993; 60 FR 46230, Sept. 6, 1995]
Notes of Decisions
Cited in 1 case (1 in the last 5 years), 2023–2023 · leading case: Scott & White Health Plan v. Becerra (D.D.C. 2023).
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Scott & White Health Plan v. Becerra (D.D.C. 2023). “See 42 C.F.R. § 417.552 (a) (requiring that plans use “methods approved by CMS” when apportioning costs).”
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