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

Issue Date: July 18, 2016

Program Area: ACA Financial Appeals (ACA FA)

Question: On page 23 of the final Cost-sharing Reduction (CSR) Reconciliation guidance, the Centers for Medicare & Medicaid Services (CMS) states that 'in the rare event that the simplified actuarial value methodology calculation of what enrollees would have paid in the standard plan suggests a negative amount.' Will CMS charge issuers who use the Simplified Actuarial Value (AV) methodology if the CSR reconciliation calculation totals a negative amount?

Answer: Issuers with negative CSR amounts at the issuer, policy and plan levels received a zero (0) amount. If an issuer does not believe the negative amounts were calculated correctly, CMS recommends that the issuer file a discrepancy.

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