Qualifying Payment Amount Calculation Methodology

Qualifying Payment Amount Calculation Methodology45 CFR 2021 Disclaimers and Notifications The information provided in this presentation is intended only to be a general informal summary of technical legal standards. It is not intended to take the place of the statutes, regulations, or formal policy guidance upon which it is based. This presentation summarizes current policy and operations as of the date it was presented. We encourage readers to refer to the applicable statutes, regulations, and other interpretive materials for complete and current information. The contents of this document do not have the force and effect of law and are not meant to bind the public in any way, unless specifically incorporated into a document is intended only to provide clarity to the public regarding existing requirements under the law.

• QPA methodology establishes an approach for calculating a median contracted rate where payment for an item or service is not fully on a feefor--service basis (e.g., under bundled and fully- or partially -capitated arrangements). • General approach: The plan or issuer must calculate a median contracted rate for each item or service using the

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  Methodology, Calculating, For calculating

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