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

Issue Date: May 03, 2016

Program Area: CSR Reconciliation (CSR)

Question: Please explain the financial impact of negative Cost-sharing Reduction (CSR) amounts to the issuer at each of the three record levels?

Answer: Negative CSR amounts at the policy level (03) will be subtracted from positive CSR amounts when CSR amounts are aggregated to the plan level. Negative CSR amounts at the QHP level (02) will be equated to zero when CSR amounts are aggregated at the issuer level. Because of this, the reconciled CSR amount for the issuer will never be calculated based on a negative CSR amount provided at the issuer level. Issuers with zero CSR amounts (or negative CSR provided for all plans) will be billed the amount of their advance payment.

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