The Centers for Medicare and Medicaid Services (CMS) is implementing changes to the Retiree Drug Subsidy (RDS) Second Level Informal Hearing Appeals process.
Starting today, January 16, 2023, Retiree Drug Subsidy (RDS) Plan Sponsors will now utilize the new CMS Office of Hearings Case and Document Management System (OH CDMS) for their Second Level Appeals. The OH CDMS is a web-based portal for RDS Plan Sponsors to submit and maintain their Second Level Informal Hearing Appeals and to correspond with the CMS Hearing Officer. Access to specific cases is limited to the parties of the case, including party representatives.
In support of this change, CMS’ RDS Center has published updated educational materials as well. Please refer to the following Program Website (PWS) pages for guidance on this new process:
- RDS User Guide: Appeal an Initial Determination
- Common Questions: Appealing an Initial Determination
Appropriate RDS Secure Website (SWS) system email notifications have been updated as well.
This information is only relevant to Plan Sponsors who pursue an RDS Second Level Appeal. Only Plan Sponsors who have submitted a First Level Reconsideration that was subsequently denied, and who wish to request an Informal Hearing, are affected by this process change.
This Second Level Appeal process change will not be relevant to First Level Reconsiderations or to Third Level Administrator Reviews. RDS Plan Sponsors will continue to use the RDS Secure Website to submit First Level Appeals and will continue to follow the existing process for Third Level Appeals, which is communicated to Plan Sponsors through email during the Appeals process. Please refer to Appeal an Initial Determination for additional information on RDS Appeals.
Please refer to the September 1, 2022 Announcement, “Coming Soon – Changes to Second Level Informal Hearing Appeals Process”, the November 1, 2022 Announcement, “Coming Soon – Second Level Informal Hearing Appeals Portal”, and the January 9, 2023 Announcement, “Coming Next Week – OH CDMS Portal For Second Level Appeals” for details on this change in process.
IMPORTANT: An Informal Hearing Request filed in the Second Level Appeal must be filed with the CMS Office of Hearings within 15 calendar days after receipt of the CMS Reconsideration Denial Decision in order to be considered. Therefore, to help ensure the Plan Sponsor meets the 15 day deadline, the CMS Office of Hearings requests that all Plan Sponsors and any outside representative organizations complete the one-time OH CDMS registration process as soon as Plan Sponsors receive the CMS Reconsideration Denial Decision, even if an organization is unsure whether it will appeal its CMS Reconsideration Denial. It is the Plan Sponsor’s responsibility to contact the OH CDMS Help Desk if they are experiencing any issues accessing or using the OH CDMS portal, especially during critical timeframes related to their Appeal(s). Plan Sponsors will continue to use the RDS Secure Website (SWS) to submit First Level Appeal Reconsiderations.
Please note that CMS’ RDS Center does not maintain the Office of Hearings Case and Document Management System. Because the OH CDMS portal falls entirely outside of the RDS Program’s purview, CMS’ RDS Center will not provide technical support for this web application. Please refer to CMS’ Electronic Filing page for support and contact information for the OH CDMS portal. User manuals are included on this page to assist with the registration process and the functionality of the Hearing Officer module.
If you have questions or need additional information, please contact CMS' RDS Center.