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

Issue Date: January 30, 2019

Program Area: CSR Reconciliation (CSR)

Question: Pursuant to 45 CFR 156.1220(a)(1)(v) and 45 CFR 156.1220(a)(3)(v), an issuer may file a request for reconsideration within 60 calendar days of the date of the notification of the Cost-sharing Reduction (CSR) reconciliation payment or charge to contest a processing error by the Department of Health and Human Services (HHS), HHS's incorrect application of the relevant methodology, or HHS's mathematical error only with respect to the amount of a reconciliation payment or charge for CSRs for a benefit year. What is the date that the the Centers for Medicare & Medicaid Services (CMS) will permit issuers to file a request for reconsideration?

Answer: CMS will permit issuers to request reconsideration starting Thursday, June 30, 2016 related to the amount of a reconciliation payment or charge for CSRs for the 2014 and 2015 Benefit Years. Issuers have 60 calendar days to file a request for reconsideration; as such, all requests must be submitted no later than 11:59p.m. EST on Monday, August 29, 2016, and reconsideration requests after this deadline will not be considered. CMS will issue future guidance at a later date on how to file a request for reconsideration. Any issuer filing an appeal is strongly encouraged to file a discrepancy in order to permit CMS to work with the issuer to resolve the dispute outside the formal administrative appeals process. CMS issued FAQ 16488 regarding the CSR reconciliation discrepancy reporting process. If an issuer files a discrepancy and requests reconsideration on the same issue and the discrepancy process resolves the issue, we ask that the issuer withdraw its appeal by contacting ACAfinancialappeals@cms.hhs.gov.

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