The Center for Consumer Information & Insurance Oversight

CCIIO

The Center for Consumer Information & Insurance Oversight

Advance Payments of the Premium Tax Credit (APTC) Audits

Sections 1401 of the Patient Protection and Affordable Care Act (ACA) established the Advance Payments of the Premium Tax Credit (APTC) program to lower the monthly premium for eligible individuals. Section 1311 of the ACA allows the Federally-Facilitated Exchanges (FFEs) to charge participating issuers user fees to support FFE operations. Additionally, Office of Management and Budget (OMB) Circular A-25 allows the FFEs and State-based Exchanges on the Federal platform (SBE-FPs) to calculate, collect, and expend user fees.

Regulations at 45 CFR §§ 156.480, 156.705, and 156.715 allow the Department of Health and Human Services (HHS) to conduct audits of issuers that offer a Qualified Health Plan (QHP) in the individual market through an Exchange to assess compliance with the APTC and FFE user fee program requirements.  The goals of these audits are to:

  • Safeguard Federal funds;
  • Instill confidence in payment data quality among regulated entities;
  • Evaluate health insurance issuer compliance with program rules and regulations; and
  • Efficiently use taxpayer resources while minimizing the unnecessary burdens on issuers and consumers.

CMS APTC Audit Reports

The CMS APTC Audit program commenced in 2017 with review of data reported for the 2014 FFE reporting year.  This page contains CMS APTC reports that are organized by the reporting year.  Reports will be uploaded as each audit year is completed for each audit type.

CMS APTC Audit Reports by Reporting Year:

FFE Audit Summary Reports

2019 FFE

2018 FFE

2017 FFE

2016 FFE

2015 FFE

2014 FFE

Page Last Modified:
10/03/2024 08:42 AM
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