At Reconciliation, an overpayment may exist on an application for the following reasons: the sum of previous payment request(s) exceeds the current subsidy amount based on the most recent Allowable Retiree Costs and/or the Mandatory Payment Reduction.
In addition, if a Plan Sponsor fails to meet the Reconciliation Deadline for an application and has received interim payments, the sum of those payments will become overpayments.
When there is an overpayment, CMS will initiate immediate overpayment recovery action.
Note: For explanations and examples of common circumstances causing a Plan Sponsor to be in an overpayment situation at the completion of Reconciliation, refer to Avoid an Overpayment at Reconciliation in the RDS User Guide.
Answer ID
5000-01