As a requirement of Reconciliation, Plan Sponsors must finalize their application's Covered Retiree List (CRL) and submit final cost data to CMS' RDS Center. Please review the following guidance and resources for successfully reporting final costs during Reconciliation.
In preparation for the final Reconciliation payment request, the Plan Sponsor must report the total gross covered retiree plan-related prescription drug costs and actual cost adjustments for the application. Final costs—Gross Retiree Costs, Threshold Reduction, Limit Reduction, and Actual Cost Adjustment—are entered and submitted on the RDS Secure Website using the Data Entry method or submitted through Connect:Direct transfer.
In Reconciliation: Manage Final Costs, the Account Manager or Designee with the Request Payment privilege manages the reporting of final costs for the application. The Account Manager with the Report Costs privilege can submit costs via Data Entry directly from this Reconciliation step, whereas Designees with the Report Costs privilege must submit costs via Data Entry using the Report Costs link in the left navigation menu of the application. After final cost reporting is complete, the Plan Sponsor closes final cost reporting by completing this step.
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.
For general information about reporting final costs, refer to Introduction to Finalizing Costs for Reconciliation. For information about assigning cost reporters to applications and benefit options, refer to Payment Setup. For information about how to prepare final costs, including cost report examples, refer to Prepare Cost Data. For information about common cost reporting errors that may result in an overpayment, refer to Avoid an Overpayment at Reconciliation.
For more information and step-by-step instructions for each Reconciliation step, refer to Reconciliation in the RDS User Guide.
IMPORTANT: To avoid missed program deadlines and delayed subsidy payments, ensure that your RDS user accounts and Multi-Factor Authentication (MFA) are active and that you are able to access the RDS Secure Website today! Please encourage all users assigned to your RDS applications to log in to the Secure Website as soon as possible, and well in advance of your deadline date(s). Do not wait until the last minute! For additional information, refer to Protect Your Subsidy: Ensure Your RDS User Account and MFA are Active on the RDS Public Website Announcements page.