[Code of Federal Regulations]
[Title 42, Volume 2]
[Revised as of October 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR422.10]

[Page 834-835]
 
                         TITLE 42--PUBLIC HEALTH
 
                             HUMAN SERVICES
 
PART 422--MEDICARE+CHOICE PROGRAM--Table of Contents
 
                      Subpart A--General Provisions
 
Sec. 422.10  Cost-sharing in enrollment-related costs (M+C user fee).

    (a) Basis and scope. This section implements that portion of section 
1857 of the Act that pertains to cost-sharing in enrollment-related 
costs. It sets forth the procedures that CMS follows to determine the 
aggregate annual ``user fee'' to be contributed by M+C organizations and 
to assess the required user fees for M+C plans offered by M+C 
organizations.
    (b) Purpose of assessment. Section 1857(e)(2) of the Act authorizes 
CMS to charge and collect from each M+C plan offered by an M+C 
organization its pro rate share of fees for administering section 1851 
of the Act, relating to dissemination of enrollment information; and 
section 4360 of the Omnibus Budget Reconciliation Act of 1990, relating 
to the health insurance counseling and assistance program.
    (c) Applicability. The fee assessment also applies to those 
demonstrations for which enrollment is effected or coordinated under 
section 1851 of the Act.
    (d) Collection of fees. (1) Timing of collection. CMS collects the 
fees over 9 consecutive months beginning with January of each fiscal 
year.
    (2) Amount to be collected. The aggregate amount of fees for a 
fiscal year is the lesser of--
    (i) The estimated costs to be incurred by CMS in that fiscal year to 
carry out the activities described in paragraph (b) of this section; or
    (ii) For fiscal year 2000, $100 million and for fiscal year 2001 and 
each succeeding year, the M+C portion (as defined in paragraph (e) of 
this section) of $100 million.
    (e) M+C portion. In this section, the term ``M+C portion'' means, 
for a fiscal year, the ratio, as estimated by the Secretary of the 
average number of individuals enrolled in M+C plans during the fiscal 
year to the average number of individuals entitled to benefits under 
part A, and enrolled under part B, during the fiscal year.
    (f) Assessment methodology. (1) The amount of the M+C portion of the 
user fee each M+C organization must pay is assessed as a percentage of 
the total Medicare payments to each organization. CMS determines this 
percentage rate using the following formula:


[[Page 835]]


    A times B divided by C where--
    A is the total estimated January payments to all organizations 
subject to the assessment;
    B is the 9-month (January through September) assessment period; and
    C is the total fiscal year M+C user fee assessment amount determined 
in accordance with paragraph (d)(2) of this section.

    (2) CMS determines each organization's pro rata share of the annual 
fee on the basis of the organization's calculated monthly payment amount 
during the 9 consecutive months beginning with January. CMS calculates 
each organization's monthly pro rata share by multiplying the 
established percentage rate by the total monthly calculated Medicare 
payment amount to the organization as recorded in CMS's payment system 
on the first day of the month.
    (3) CMS deducts the organization's fee from the amount of Federal 
funds otherwise payable to the organization for that month under the M+C 
program.
    (4) If assessments reach the amount authorized for the year before 
the end of September, CMS discontinues assessment.
    (5) If there are delays in determining the amount of the annual 
aggregate fees specified in paragraph (d)(2) of this section, or the fee 
percentage rate specified in paragraph (f)(2), CMS may adjust the 
assessment time period and the fee percentage amount.

[65 FR 40315, June 29, 2000]