CSR Reconciliation (CSR) FAQ
Guidance for FAQ regarding Cost Sharing Reduction (CSR) Reconciliation and Guidance
Program Area: CSR Reconciliation (CSR)
Question: Please describe the Cost-sharing Reduction (CSR) process.
Answer: Section 1402 of the ACA requires Qualified Health Plan (QHP) Issuers to provide CSR to eligible low-income and Indian QHP enrollees and to offer plan variations that meet certain actuarial value and cost-sharing requirements. HHS will make monthly advance payments to QHP Issuers to cover the cost of providing cost-sharing reductions offered under plan variations. CMS will reconcile advance CSR payments against actual CSR paid on behalf of enrollees at the end of the coverage year. For 2014, CMS will calculate a per member per month (PMPM) CSR advance payment rate for each silver plan variation and each zero cost-sharing plan variation. Issuers will receive the same amount for all CSR enrollees within a plan variation. For 2015, CMS will no longer calculate the advance PMPM amount for specific QHP IDs. Additionally, SBMs and FFM issuers will no longer review or validate advance CSR amounts. Instead, upon receiving a certified QHP enrollment, the SBM or Marketplace will calculate the CSR advance payment amount using a formula containing a CSR plan variation multiplier and the total premium amount of the enrollment group. Visit REGTAP at https://www.REGTAP.info for more information on changes to the CSR advance payment calculation for 2015.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: May 21, 2014
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