Reinsurance (RP) FAQ
Guidance for FAQ regarding Payment and Parameters / Schedule
Program Area: Reinsurance (RP)
Question: Can issuers submit claims as paid and then do the Maximum Out-Of-Pocket (MOOP) adjustment, which will account for the Cost-Sharing Reduction (CSR) amount?
Answer: No, issuers should not carve out any advance CSR payments remitted by CMS for the applicable benefit year. The reinsurance payments calculation methodology applies the CSR MOOP adjustment to account for these advance CSR payments. For more information, please see the Reinsurance (RI) Calculation Guide located in REGTAP Library under the Reinsurance program area.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: November 24, 2014
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