Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 41
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57amount reported on the 2014 MLR Form. Therefore, issuers will report a total reinsurance
payment amount that reflects: the reinsurance payment amount for the 2015 benefit year
(as reported to the issuer by CMS on the June 30, 2016 report), minus the difference
between the reinsurance payment amount reported by the issuer for the 2014 benefit year
on the 2014 MLR Form and the reinsurance amount that was actually paid to the issuer for
the 2014 benefit year. There are no adjustments for pending appeals unless the appeal has
been resolved (in which case payment would have been made).
Line 1.6 – Net Federal Risk Adjustment Program payments or charges
PY1 Column – 2014 MLR Form, Part 2, Line 1.10, Columns 3/31 + Deferred PY1 – Deferred CY.
Restate amounts to reflect any changes or updates to transfer amounts for the 2014 benefit
year communicated by HHS after June 30, 2015, including any changes communicated
after the filing of the 2014 MLR Form.
CY Column – Part 2, Line 1.10, Columns 3/31 + Deferred PY1 – Deferred CY
RC Column – Part 2, Line 1.10, Column [RC] 3/31. The issuer can adjust for differences in risk
adjustment transfers that were actually paid or received after June 30, 2015, that differ
from the amount reported on the 2014 MLR Form. Therefore, issuers will report a total
risk adjustment amount that reflects: the risk adjustment transfer amount for the 2015
benefit year (as reported to the issuer by CMS on the June 30, 2016 report), minus the
difference between the risk adjustment amount reported by the issuer for the 2014 benefit
year on the 2014 MLR Form and the amount that was actually paid to the issuer for the
2014 benefit year. There are no adjustments for pending appeals unless the appeal has
been resolved (in which case a payment would have been made).
Line 1.7 – Federal Risk Corridors Program Payments or Charges
PY1 Column –
Charges: 2014 MLR Form, Part 2, Line 1.11, Columns 3/31 + Deferred PY1 – Deferred
CY
Payments: (2014 MLR Form, Part 2, Line 1.11, Columns 3/31 + Deferred PY1 – Deferred
CY) x (Risk corridors payments for the 2014 benefit year received from HHS
as of the filing date of the 2015 MLR Form) / (2014 Risk Corridors Plan-Level
Data Form, Tab 3, Line 6)
CY Column – Part 2, Line 1.11, Columns 3/31 + Deferred PY1 – Deferred CY
Line 1.8 – MLR numerator
PY2 Column – Lines 1.2 + 1.3
PY1 and CY Columns – Lines 1.2 + 1.3 – 1.4 – 1.5 – 1.6 – 1.7
Total Column – Lines 1.2 + 1.3 – 1.4 – 1.5 – 1.6 – 1.7
40
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