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

Issue Date: January 30, 2019

Program Area: CSR Reconciliation (CSR)

Question: Is the Cost-Sharing Reduction (CSR) Reconciliation amount on error reports to issuers the final calculation for cost-sharing reductions provided? If not, how will issuers know the final amount?

Answer: The difference between the advance payment ("2014 or 2015 CSR amount") and the "VALID CSR amount at the Policy Detail Level" listed on the issuer's data submission error report can be used as a preliminary calculation of the issuer's reconciled CSR amount. Amounts listed on error reports are not final, since issuers may resubmit files through the June 3, 2016 data submission deadline, and may also be asked by the Centers for Medicare & Medicaid Services (CMS) to resubmit after the data submission deadline in order to correct for missing or invalid data. CMS will also be conducting separate validation of the actual CSR amounts requested by issuers. This validation will occur after the June 3, 2016 final submission date, and CMS will notify data outliers of next steps. CMS will send a final report of reconciled CSR amounts beginning June 30, 2016 to those issuers who have successfully submitted data by June 3, 2016, and have not been flagged as part of CMS's validation efforts.

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