Program Components:
This section provides an overview of the following topics:
- Timing & Dependencies
- User Roles
- Methods for Submitting Final Costs
- Reconciliation: Manage Final Costs
- Reconciliation: Review Final Costs
Timing & Dependencies
Final cost reporting can begin after the Covered Retiree List is finalized and Reconciliation: Finalize Covered Retirees is marked "Complete" in the Left Navigation menu of the application. Final costs can only be submitted for the Qualifying Covered Retirees, Subsidy Periods, and Benefit Options listed on the final Covered Retiree List agreed to by the Plan Sponsor in Reconciliation: Finalize Covered Retirees. The finalized Covered Retiree List must be distributed to those preparing costs on behalf of the Plan Sponsor.
After Reconciliation: Finalize Covered Retirees is complete, the Application Status changes to "Reconciliation Cost Reporting Opened" and Cost Reporters can begin reporting final costs in Reconciliation: Manage Final Costs.
CMS' RDS Center accepts final cost reports when the status of the application is "Reconciliation Cost Reporting Opened," Payment Setup is complete, and the Reconciliation Deadline has not passed.
User Roles
A Cost Reporter may be the Account Manager, a Plan Sponsor Designee, a Vendor, a Vendor Designee, or any combination thereof that meets the business needs of the Plan Sponsor.
Account Manager
The Account Manager with the Report Costs privilege for the Benefit Option may enter costs in the RDS Secure Website in Reconciliation: Manage Final Costs.
Designee Cost Reporters
All Designee Cost Reporters must view or report costs through the Report Costs workflow available from the Left Navigation menu of the application. Designee Cost Reporters with the Data Entry Reporting method can enter cost data by selecting Report Costs from the Left Navigation menu of the application.
Vendors
Vendor Designee Cost Reporters with the Data Entry Reporting method can enter cost data by selecting Report Costs from the Left Navigation menu of the application.
Vendors submitting costs using Connect:Direct submission work with CMS' RDS Center representatives to establish a connection. If there is an issue with the file format, CMS' RDS Center will contact the Vendor.
Note: All final cost reports submitted to CMS' RDS Center must contain aggregated Gross Retiree Costs, Cost Threshold Reduction, Cost Limit Reduction, and Actual Cost Adjustment amounts for all plan months by Benefit Option. During final cost reporting, the system performs editing on all submitted final costs.
Methods for Submitting Final Costs
The Plan Sponsor establishes the method and sources (Plan Sponsor and/or Vendors) for submitting final costs for each Benefit Option in Payment Setup. The Account Manager and Authorized Representative can review and update Payment Setup as necessary to support the Reconciliation process. For Vendors, the Plan Sponsor only needs the Vendor ID. The method for communicating costs to CMS RDS Center was determined when the Vendor first set up their ID with CMS' RDS Center.
Final costs are entered and submitted on the RDS Secure Website using the Data Entry method or submitted through Connect:Direct transfer.
For information about how to prepare final costs, refer to Prepare Cost Data.
Reconciliation: Manage Final Costs
In Reconciliation: Manage Final Costs, the Account Manager or Designee with the Request Payment privilege manages the reporting of final costs for the application. After final cost reporting is complete, the Plan Sponsor closes final cost reporting by completing this step. The Application Status changes to "Reconciliation Cost Reporting Closed." A Plan Sponsor can reopen final cost reporting at any time prior to the completion of Reconciliation: Review and Submit, and prior to the Reconciliation Deadline.
For step-by-step instructions for completing this Reconciliation step, refer to Reconciliation: Manage Final Costs.
Reconciliation: Review Final Costs
In Reconciliation: Review Final Costs, the Account Manager or Designee with the Request Payment privilege reviews the final costs and either accepts or rejects the final cost reports. The RDS system runs validation checks against all accepted final costs. The amount of the Reconciliation payment request is calculated from the final costs accepted in Reconciliation: Manage Final Costs. A Plan Sponsor can reopen the review of final costs at any time prior to completion of Reconciliation: Review and Submit, and prior to the Reconciliation Deadline. The Plan Sponsor can also enter revisions to final costs that were accepted in this step, if necessary.
Note: Quick Access Reports (QAR) may be used to assist and accelerate the cost reporting activities of Vendors and Plan Sponsors by delivering consolidated cost reporting information.
For step-by-step instructions for completing this Reconciliation step, refer to Reconciliation: Review Final Costs.
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