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

Issue Date: January 30, 2019

Program Area: CSR Reconciliation (CSR)

Question: What changes did CMS make to the final Manual for Reconciliation of the Cost-sharing Reduction (CSR) Component of Advance Payments for Benefit Years 2014 and 2015?

Answer: In the final manual, CMS added material on reporting policies in the case of gaps in coverage and changes in plan, instructions on how to account for State subsidy wraps and coordinated benefits, and made minor clarifying changes throughout. The guidance expands on the claims run-out period and how issuers should handle 2014 claims remaining after the deadline for CSR reconciliation. The final manual adds a REGTAP link to an Excel example of re-adjudication of claims for the simplified methodology, clarifies who may sign an attestation, and removes two (2) data elements - "Total Annual Premium" and "Total Monthly Premium", which are not needed for the calculation of CSR provided. We incorporated and provided links to FAQs published on REGTAP and final technical specifications.

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