Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 4
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57Changes to the 2015 MLR Annual Reporting Form
The MLR Form has been updated to incorporate provisions in 45 CFR Part 158 and 45 CFR Part 153 that
are effective for the 2015 MLR reporting year. Below are the most significant changes.
Re-designated Column: Replaced the Aggregate 2% Rule column (column 42 on Parts 1 and 2) with the
Medicare MLR Business column (informational only).
Risk Corridors: Deleted lines on Part 3 related to transitional adjustment percentage (the 2% adjustment
effective for the 2015 benefit year has been incorporated into the existing formulas). Added lines on Part
3 to correctly calculate profit and administrative costs without adjustment, and to effectuate true-up of
prior year risk corridors claims liabilities and reserves. Renumbered the remaining Part 3, Section 3 lines
accordingly.
Calculation: Updated Student Health Plans formulas in Part 3, Total Column to reflect the three-year
aggregation effective for the 2015 and later reporting years.
Deferral of newer business: For the 2015 MLR reporting year, enforcement action will not be taken if an
issuer defers reporting of experience of newly issued policies with 12 months or less of experience in
2015 (rather than only policies with less than 12 months of experience), if 50% or more of the issuer’s
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total earned premium for 2015 is attributable to such policies.
Accounting for risk corridors amounts in MLR calculation:
-
Risk Corridors Charges: For the 2015 and later reporting years, in Part 3, Line 1.7 of the MLR Form,
issuers should continue to report the risk corridors charges as calculated on the Risk Corridors Plan-
Level Data Form, Tab 3, Line 10 for the applicable year.
-
Risk Corridors Payments: For the 2015 and later reporting years, in Part 3 of the MLR Form, issuers
should only report the risk corridors payments actually paid as of the filing date of the MLR Form.
For example, if an issuer files the 2015 MLR Form on July 31, 2016, and by that date the issuer has
received 12.6% of the risk corridors payment calculated for the 2014 benefit year, then the issuer
should report the following amounts on its 2015 MLR Form, Part 3, Line 1.7 (Federal Risk Corridors
Program net payments / (charges)):
o For 2014 (Column PY1): 12.6% of the amount from the issuer’s 2014 Risk Corridors Plan-
Level Data Form, Tab 3, Line 10 (Risk corridors payment or charge amount used for MLR
calculation (Tab 3, Line 1 x Line 9));
o For 2015 (Column CY): $0.
Similarly, if an issuer files its 2016 MLR Form on July 31, 2017, then the issuer should report the
following amounts on its 2016 MLR Form, Part 3, Line 1.7:
o For 2014 (Column PY2): 12.6% plus any additional percentage the issuer has received by July
31, 2017 toward the amount from the issuer’s 2014 Risk Corridors Plan-Level Data Form, Tab
3, Line 10;
o For 2015 (Column PY1): the percentage, if any, that the issuer has received by July 31, 2017
toward the amount from the issuer’s 2015 Risk Corridors Plan-Level Data Form, Tab 3, Line
10;
o For 2016 (Column CY): $0.
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As detailed in technical guidance, CMS will not initiate an enforcement action against an issuer who elects to defer
.
experience of “newer business” for the 2015 reporting year in this manner
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