Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: July 18, 2016

Program Area: ACA Financial Appeals (ACA FA)

Question: An issuer submitted multiple markets during the initial Cost-sharing Reduction (CSR) reconciliation submission and determined that approximately $110,000 were not accepted during the submission. However, when the issuer reviewed the June 30, 2016 payment report, the issuer identified money that was accepted for states that did not submit money for the CSR reconciliation submission. Can the Centers for Medicare & Medicaid Services (CMS) clarify the issuer's discrepancy?

Answer: There are various reasons as to why an issuer's CSR reconciliation amount is higher than predicted. One (1) reason being the issuer may have negative CSR values within the issuer, plan or policy levels. Also, CMS may have reprocessed the issuer's CSR file resulting in an updated amount. CMS recommends issuers contact the CSRReconquestions@cms.hhs.gov mailbox for questions regarding CSR reconciliation amounts.

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