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

Issue Date: May 03, 2016

Program Area: CSR Reconciliation (CSR)

Question: Since reporting on the plan level is optional, what will the Centers for Medicare & Medicaid Services (CMS) do if issuers elect not to report a Qualified Health Plan (QHP) with a negative amount of Cost-sharing Reduction (CSR)?

Answer: Issuers that do not report negative CSRs at the 02 level will receive a policy-level aggregation of the CSR provided (negative QHP amounts will be subtracted from their issuer-level advance payments.) In such a case, the amount issuers will see on their final CSR report will be less than or equal to the amount they would be reimbursed. Although QHP-level reports are optional, CMS encourages issuers with negative CSRs at the QHP level to file 02 reports so that CMS may adjust CSR provided to zero (0) prior to aggregation.

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