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ACA Financial Appeals (ACA FA) FAQ

Guidance for FAQ regarding Request for Reconsideration and Timing

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

Issue Date: June 07, 2016

Program Area: ACA Financial Appeals (ACA FA)

Question: When must a company file a request for reconsideration (that is, the first level of administrative appeal) for the Risk Adjustment (RA) and Reinsurance (RI) programs for the 2016 Benefit Year?

Answer: For a RA payment or charge (including an assessment of RA user fees), a RA default charge, or a RI payment, a company must file a request for reconsideration within 30 calendar days of the June 30, 2017 notification. Therefore, if a company/issuer would like to file an administrative appeal for the RA and RI programs for the 2016 Benefit Year, it must complete the ACA Financial Appeals - Request for Reconsideration (Risk Adjustment and Reinsurance) Web Form by Monday, July 31, 2017.

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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.