42 CFR 417.401 - Definitions.
As used in this subpart and subparts K through R of this part, unless the context indicates otherwise -
Adjusted average per capita cost (AAPCC) means an actuarial estimate made by CMS in advance of an HMO's or CMP's contract period that represents what the average per capita cost to the Medicare program would be for each class of the HMO's or CMP's Medicare enrollees if they had received covered services other than through the HMO or CMP in the same geographic area or in a similar area.
Adjusted community rate (ACR) is the equivalent of the premium that a risk HMO or CMP would charge Medicare enrollees independently of Medicare payments if the HMO or CMP used the same rates it charges non- Medicare enrollees for a benefit package limited to covered Medicare services.
Benefit stabilization fund means a fund established by CMS, at the request of a risk HMO or CMP, to withhold a portion of the per capita payments available to the HMO or CMP and pay that portion in a subsequent contract period for the purpose of stabilizing fluctuations in the availability of the additional benefits the HMO or CMP provides to its Medicare enrollees.
Demonstration project means a demonstration project under section 402 of the Social Security Amendments of 1967 ( 42 U.S.C. 1395b-1) or section 222(a) of the Social Security Amendments of 1972 ( 42 U.S.C. 1395b-1 (note)), relating to the provision of services for which payment is made under Medicare on a prospectively determined basis.
(1) Are needed immediately because of an injury or sudden illness.
Medicare enrollee means a Medicare beneficiary who has been identified on CMS records as an enrollee of an HMO or CMP that has a contract with CMS under section 1876 of the Act and subpart L of this part.
(1) Are required in order to prevent serious deterioration of the enrollee's health as a result of unforeseen injury or illness; and
- 42 CFR 417.440 — Entitlement to Health Care Services From an HMO or CMP.
- 42 CFR 417.448 — Restriction on Payments for Services Received by Medicare Enrollees of Risk HMOs or CMPs.
- 42 CFR 423.120 — Access to Covered Part D Drugs.
- 42 CFR 413.40 — Ceiling on the Rate of Increase in Hospital Inpatient Costs.
- 42 CFR 417.436 — Rules for Enrollees.
- 42 CFR 417.414 — Qualifying Condition: Range of Services.
- 42 CFR 423.458 — Application of Part D Rules to Certain Part D Plans on and After January 1, 2006.
- 42 CFR 406.21 — Individual Enrollment.