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Electronic Code of Federal Regulations

e-CFR data is current as of February 19, 2020

Title 42Chapter IVSubchapter BPart 422Subpart X → §422.2460


Title 42: Public Health
PART 422—MEDICARE ADVANTAGE PROGRAM
Subpart X—Requirements for a Minimum Medical Loss Ratio


§422.2460   Reporting requirements.

(a) For each contract year, from 2014 through 2017, each MA organization must submit to CMS, in a timeframe and manner specified by CMS, a report that includes but is not limited to the data needed by the MA organization to calculate and verify the MLR and remittance amount, if any, for each contract, under this part, such as incurred claims, total revenue, expenditures on quality improving activities, non-claims costs, taxes, licensing and regulatory fees, and any remittance owed to CMS under §422.2410.

(b) For contract year 2018 and for each subsequent contract year, each MA organization must submit to CMS, in a timeframe and manner specified by CMS, the following information:

(1) Fully credible and partially credible contracts. For each contract under this part that has fully credible or partially credible experience, as determined in accordance with §422.2440(d), the MA organization must report to CMS the MLR for the contract and the amount of any remittance owed to CMS under §422.2410.

(2) Non-credible contracts. For each contract under this part that has non-credible experience, as determined in accordance with §422.2440(d), the MA organization must report to CMS that the contract is non-credible.

(c) Total revenue included as part of the MLR calculation must be net of all projected reconciliations.

(d) The MLR is reported once, and is not reopened as a result of any payment reconciliation processes.

[83 FR 16736, Apr. 16, 2018]

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