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

Issue Date: January 30, 2019

Program Area: CSR Reconciliation (CSR)

Question: How will Issuers account for additional Cost-sharing Reduction (CSR) payments in the CSR Reconciliation process for the 2015 benefit year? How will additional CSR advanced payments be accounted for against the annual reconciliation?

Answer: Issuers will not continue to receive advance payments for CSRs after those CSRs have been reconciled regardless of enrollment restatements that may result in changes in PTC payments for past benefit years. For the 2015 benefit year, claims incurred during 2015 that did not result in a final payment and re-adjudication using CMS methodologies by April 30, 2016 may be submitted by April 30, 2017 in the next reconciliation cycle.

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