---
kind: "section"
citation: "42 C.F.R. § 423.315"
title: "42"
number: "423.315"
heading: "General payment provisions."
url: "https://uscodex.org/cfr/42/423.315"
---

# §423.315. General payment provisions.

- (a) **Source of payments.** CMS payments under this section are made from the Medicare Prescription Drug Account.
- (b) **Monthly payments.** CMS provides a direct subsidy in the form of advance monthly payments equal to the Part D plan's standardized bid, risk adjusted for health status as provided in [§ 423.329(b)](/cfr/42/423.329.md?p=b), minus the monthly beneficiary premium as determined in [§ 423.286](/cfr/42/423.286.md).
- (c) **Reinsurance subsidies.** CMS provides reinsurance subsidy payments described in [§ 423.329(c)](/cfr/42/423.329.md?p=c) on a monthly basis during a year based on either estimated or incurred allowable reinsurance costs as provided under [§ 423.329(c)(2)(i)](/cfr/42/423.329.md?p=c-2-i), and final reconciliation to actual allowable reinsurance costs as provided in [§ 423.343(c)](/cfr/42/423.343.md?p=c).
- (d) **Low-income subsidies.** CMS makes payments for premium and cost sharing subsidies, including additional coverage above the initial coverage limit, on behalf of certain subsidy-eligible individuals as provided in §§ [423.780](/cfr/42/423.780.md) and [423.782](/cfr/42/423.782.md). CMS provides low-income cost-sharing subsidy payments described in [§ 423.782](/cfr/42/423.782.md) through interim payments of amounts as provided under [§ 423.329(d)(2)(i)](/cfr/42/423.329.md?p=d-2-i) and reconciliation to actual allowable reinsurance costs as provided in [§ 423.343(d)](/cfr/42/423.343.md?p=d).
- (e) **Risk-sharing arrangements.** CMS may issue lump-sum payments or adjust monthly payments in the following payment year based on the relationship of the Part D plan's adjusted allowable risk corridor costs to predetermined risk corridor thresholds in the coverage year as provided in [§ 423.336](/cfr/42/423.336.md).
- (f) **Retroactive adjustments and reconciliations.** CMS reconciles payment year disbursements with updated enrollment and health status data, actual low-income cost-sharing costs and actual allowable reinsurance costs as provided in [§ 423.343](/cfr/42/423.343.md).
- (g) **Special rules for private fee-for-service plans—**
  - (1) **Application of reinsurance.** For private fee-for-service plans (as defined by [§ 422.4(a)(3)](/cfr/42/422.4.md?p=a-3) of this chapter) offering qualified prescription drug coverage, CMS determines the amount of reinsurance payments as provided under [§ 423.329(c)(3)](/cfr/42/423.329.md?p=c-3).
  - (2) **Exemption from risk corridor provisions.** The provisions of [§ 423.336](/cfr/42/423.336.md) regarding risk sharing do not apply.
- (h) **Selected drug subsidy.** CMS provides selected drug subsidy payments described in [§ 423.329(e)](/cfr/42/423.329.md?p=e) on a monthly basis during a year based on either estimated or incurred allowable reinsurance costs as provided under [§ 423.329(e)(2)(i)](/cfr/42/423.329.md?p=e-2-i), and final reconciliation to actual allowable reinsurance costs as provided in [§ 423.343(e)](/cfr/42/423.343.md?p=e).

## Notes

### Amendments

[70 FR 4525, Jan. 28, 2005, as amended at 91 FR 17589, Apr. 6, 2026]

### Authority

Authority: 42 U.S.C. 1302, 1306, 1395w-101 through 1395w-152, and 1395hh.

### Source

Source: 70 FR 4525, Jan. 28, 2005, unless otherwise noted.

### Amendments

[70 FR 4525, Jan. 28, 2005, as amended at 91 FR 17589, Apr. 6, 2026]