42 C.F.R. § 423.2470

Current through September 30, 2024
Section 423.2470 - Remittance to CMS if the applicable MLR requirement is not met
(a)General requirement. For each contract year, a Part D sponsor must provide a remittance to CMS if the contract's MLR does not meet the minimum percentage required by § 423.2410(b) .
(b)Amount of remittance. For each contract that does not meet MLR requirement for a contract year, the Part D sponsor must remit to CMS the amount by which the MLR requirement exceeds the contract's actual MLR multiplied by the total revenue of the contract, as provided in § 423.2420(c) , for the contract year.
(c)Timing of remittance. CMS will deduct the remittance from plan payments in a timely manner after the MLR is reported, on a schedule determined by CMS.
(d)Treatment of remittance. Payment to CMS must not be included in the numerator or denominator of any year's MLR.

42 C.F.R. §423.2470