Coordinating Final Costs

User Roles:

AM

D

V

Program Components:

Reconciliation

Reconciliation Step 6: Manage Submission of Final Cost Reports requires the Plan Sponsor to monitor and verify submission of final costs for the entire Application and from all cost reporting sources. All costs reported after Reconciliation is initiated for an Application will be considered final cost reports.

Final cost reporting requires coordination by the Plan Sponsor and all Vendor(s) that are reporting cost data to appropriately apply each individual Qualifying Covered Retiree's (QCR) Cost Threshold and Cost Limit. The Plan Sponsor must apply the applicable Cost Threshold and Cost Limit for each QCR in an Application to all gross costs the Plan Sponsor chooses to report for that individual for the entire RDS Plan Year. The Plan Sponsor must not apply the Cost Threshold and Cost Limit separately to each discrete set of gross costs reported by each Vendor. If there are multiple sources reporting cost data for individual QCRs, each source can send cost data, however the Cost Threshold and Cost Limit for each QCR must be coordinated between each Vendor. The Plan Sponsor is responsible for coordinating calculated Cost Thresholds and Cost Limits for QCRs prior to reporting any cost data in Reconciliation Step 6: Manage Submission of Final Cost Reports. For more information about coordinating calculated Cost Thresholds and Cost Limits for QCR, go to: How should coordination of individual retiree costs be handled?

Reconciliation Step 6 requires that the Plan Sponsor close cost reporting to proceed to Reconciliation Step 7: Review Final Costs. Prior to closing cost reporting for Reconciliation, the Plan Sponsor, responsible Vendor, or third party must verify that at least one cost report has been submitted, completely and accurately, and accepted for each Benefit Option included in an Interim Payment. Final cost reports are not required for Benefit Options not included in Interim Payments. A cost report must be accepted for at least one Benefit Option listed in the Application to close cost reporting.

The Plan Sponsor should be aware of the status of all cost reporting from all Cost Reporters assigned to the Application. When using the Data Entry reporting method, to close cost reporting, cost reports may not be in "Data Entry: Saved" status and must be in the "Data Entry: Submitted" status. When using the Mainframe reporting method, cost reporting may be closed with cost reports in "Mainframe: Errors Detected" status if a final cost report was previously accepted for the Benefit Option or if Interim Payments were never requested for the Benefit Option. Plan Sponsors that are utilizing a Vendor for Mainframe reporting should coordinate with the Vendor to resolve any errors.

After Reconciliation Step 6 is marked closed, the Plan Sponsor can begin Reconciliation Step 7: Review Final Costs to confirm all final cost reports for the Application.

If you have questions or need additional information, contact CMS' RDS Center.