---
kind: "section"
citation: "45 C.F.R. § 153.530"
title: "45"
number: "153.530"
heading: "Risk corridors data requirements."
url: "https://uscodex.org/cfr/45/153.530"
---

# §153.530. Risk corridors data requirements.

- (a) **Premium data.** A QHP issuer must submit to HHS data on the premiums earned with respect to each QHP that the issuer offers in a manner specified by HHS.
- (b) **Allowable costs.** A QHP issuer must submit to HHS data on the allowable costs incurred with respect to the QHP issuer's non-grandfathered health plans in a market within a State in a manner specified by HHS. For purposes of this subpart, allowable costs must be —
  - (1) Increased by any risk adjustment charges paid by the issuer for the non-grandfathered health plans under the risk adjustment program established under subpart D of this part.
  - (2) **Reduced by—**
    - (i) Any risk adjustment payments received by the issuer for the non-grandfathered health plans under the risk adjustment program established pursuant to subpart D of this part;
    - (ii) Any reinsurance payments received by the issuer for the non-grandfathered health plans under the transitional reinsurance program established under subpart C of this part;
    - (iii) A cost-sharing reduction amount equal to the amount of cost-sharing reductions for the benefit year as calculated under [§ 156.430(c)](/cfr/45/156.430.md?p=c) of this subchapter, to the extent not reimbursed to the provider furnishing the item or service.
    - (iv) **For the 2015 and 2016 benefit years, any difference between—**
      - (A) The sum of unpaid claims reserves and claims incurred but not reported, as set forth in §§ [158.103](/cfr/45/158.103.md) and [158.140(a)(2)](/cfr/45/158.140.md?p=a-2) and [(3)](/cfr/45/158.140.md?p=a-3) of this subchapter, that were reported on the MLR and Risk Corridors Annual Reporting Form for the year preceding the benefit year; and
      - (B) The actual claims incurred during the year preceding the benefit year and paid between March 31 of the benefit year and March 31 of the year following the benefit year.
- (c) **Allowable administrative costs.** A QHP issuer must submit to HHS data on the allowable administrative costs incurred with respect to the QHP issuer's non-grandfathered health plans in a market within a State in a manner specified by HHS.
- (d) **Timeframes.** For each benefit year, a QHP issuer must submit all information required under [paragraphs (a) through (c)](#a..c) of this section by July 31 of the year following the benefit year.
- (e) **Requirement to submit enrollment data for risk corridors adjustment.** A health insurance issuer in the individual or small group market of a transitional State must submit, in a manner and timeframe specified by HHS, the following:
  - (1) A count of its total enrollment in the individual market and small group market; and
  - (2) A count of its total enrollment in individual market and small group market policies that meet the criteria for transitional policies outlined in the CMS letter dated November 14, 2013.

## Notes

### Amendments

[77 FR 17248, Mar. 23, 2012, as amended at 78 FR 15531, Mar. 11, 2013; 78 FR 65094, Oct. 30, 2013; 79 FR 13836, Mar. 11, 2014; 79 FR 37662, July 2, 2014; 81 FR 12334, Mar. 8, 2016]

### Authority

Authority: 42 U.S.C. 18031, 18041, and 18061 through 18063.

### Source

Source: 77 FR 17245, Mar. 23, 2012, unless otherwise noted.

### Amendments

[77 FR 17248, Mar. 23, 2012, as amended at 78 FR 15531, Mar. 11, 2013; 78 FR 65094, Oct. 30, 2013; 79 FR 13836, Mar. 11, 2014; 79 FR 37662, July 2, 2014; 81 FR 12334, Mar. 8, 2016]