adjusted average per capita cost

(4)For purposes of this section, the term “adjusted average per capita cost” means the average per capita amount that the Secretary estimates in advance (on the basis of actual experience, or retrospective actuarial equivalent based upon an adequate sample and other information and data, in a geographic area served by an eligible organization or in a similar area, with appropriate adjustments to assure actuarial equivalence) would be payable in any contract year for services covered under parts A and B, or part B only, and types of expenses otherwise reimbursable under parts A and B, or part B only (including administrative costs incurred by organizations described in), if the services were to be furnished by other than an eligible organization or, in the case of services covered only undersection 1395x(s)(2)(H) of this title, if the services were to be furnished by a physician or as an incident to a physician’s service.

Source

42 USC § 1395mm(a)(4)


Scoping language

For purposes of this section
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