Reconciliation

Within 15 months after the application Plan Year End Date, Plan Sponsors must complete Reconciliation to finalize their application's Covered Retiree List and submit final cost data to CMS' RDS Center. A Plan Sponsor that received interim payments must submit to CMS, after the end of the plan year, the total gross covered retiree plan-related prescription drug cost and actual cost adjustments for the application. The sum of the interim payments is compared with the final subsidy payment determination for the application. A Plan Sponsor that did not receive interim payments, and that wishes to receive a subsidy, must use the Reconciliation process to submit final cost reports and submit its one and only subsidy payment request for the Plan Year.

All RDS applications have a maximum payment frequency of monthly interim payments, consistent with the general payment rules regarding timing set forth in 42 C.F.R. 423.888(b)(1). Although 12 interim payment requests are permitted, a Plan Sponsor may choose to submit fewer than 12 interim payment requests, or forego interim payments and instead choose to submit one final payment request during Reconciliation as described in 42 C.F.R. 423.888(b)(2)(ii).

Note: Are you a Plan Sponsor working with a Vendor, or are you a Vendor representative new to the RDS Program? The RDS Welcome Kit offers the following Vendor-related materials:

• Communicating With Your RDS Vendor: This resource for Plan Sponsors is part of the Account Manager Quick Start Guide. Visit this page to learn how to communicate with your Vendor throughout the application lifecycle and get some tips for success.
• Vendor Quick Start Guide: This guide for new RDS Vendor representatives offers tips and resources for getting started as a Vendor representative, managing retiree enrollment, and cost reporting.

Select a topic for more information to complete Reconciliation tasks: