Vendor Management, Payments, and Collections (VMPC) FAQ
Guidance for FAQ regarding Payment Processing and General Information
Program Area: Vendor Management, Payments, and Collections (VMPC)
Question: John and Mary had a baby on 1/5, and the baby was added to John and Mary's QHP with issuer 56789 effective 1/5. With the addition of the baby to the family, the enrollment group is now eligible and therefore receives additional APTC and CSR. However, issuer 56789 was not paid this additional APTC and CSR in January because the data was not available in the December template submission to CMS. How will issuer 56789 receive the additional APTC and CSR for that enrollment group?
Answer: Issuer 56789 will restate January effectuated enrollment data in the January template submission. The January restatement will include all enrollments effective in January as of 1/15, including the change to John and Mary's enrollment group data. Issuer 56789 will therefore be paid the additional full month January APTC and CSR amounts for the baby in February.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 16, 2014
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