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CMS Leadership

Parts C & D Actuarial Group

Paul Spitalnic, Director

Richard Coyle, Deputy Director

John Shatto, Deputy Director


Functional Statement

  • Develops the payment rates and benchmarks for the annual update of the Medicare Advantage (MA) program.
  • Reviews actuarial basis for adjusted community rate submissions by private Medicare health plans and (in 2006 and later) all bids by MA plans.
  • Estimates the financial impact of MA demonstrations conducted by CMS.
  • Develops and conducts studies to estimate and model health expenditures of the Part D prescription drug program.
  • Determines key benefit formula factors for the Part D prescription drug benefit.
  • Reviews actuarial basis for all bids (in 2006 and later) by Part D prescription drug plans (PDPs) and MA PDP plans.
  • Serves as technical consultant throughout the Government on MA and PDP cost estimate issues, including assistance to HHS, Treasury Department, OMB, the White House, Congress, and national advisory committees.
  • Evaluates the financial status of the Medicare Prescription Drug Account in the Federal Supplementary Medical Insurance (SMI) Trust Fund and the contingency reserve fund established for prompt payment of benefits under Part D and administrative expenses.
  • Prepares cost estimates for the MA and Part D prescription drug benefit programs.
  • Estimates the financial effects on proposed Medicare and Medicaid legislation that involve the MA and Part D prescription drug benefits programs.
  • Provides actuarial consultation to other organizations in the research of managed care payment methodology.


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Page Last Modified: 07/25/2008 2:27:50 PM
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