Cost Replacement or Cost Addition? Factors to Consider When Reporting Costs

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Successful Cost Reporting requires the Plan Sponsor to coordinate information with all involved stakeholders. Depending on the number of Cost Reporters involved and the number of sources being used to report data, costs may be added together or replaced when additional costs are reported.

In the case that a single Cost Reporter enters costs on the RDS Secure Website, the last saved costs will be displayed for interim costs, and the last reported final costs for all months will become the current costs for the Benefit Option. To replace or add to reported costs, the Cost Reporter selects the month, enters costs, and saves the data. The current costs are then used to calculate the interim subsidy payment. Months are re-reported to replace interim costs with final costs when completing Reconciliation.

In the case that multiple Cost Reporters report from a single source, a Plan Sponsor or Vendor is considered a single source regardless of the number of individual cost reporters assigned. The last cost report submitted is always considered to be the current one. When new costs are reported, the source of the costs is considered when determining whether to replace or add costs. If the cost report originates from the same source as the previous, it replaces the reported costs.

Additionally, it is important to remember that individual cost reporters have view only access to Mainframe cost reports.

In the case that multiple sources are reporting costs, additional factors must be considered when determining whether costs will be added or replaced. If a Vendor reports interim costs for a Benefit Option, and another Vendor or the Plan Sponsor reports final costs, the interim costs will not be combined with final costs when calculating final current costs. Only reported final costs that pass cost reporting edits and are accepted by the Plan Sponsor in Reconciliation Step 7: Review Final Costs will be included in current costs when calculating the Reconciliation Final Payment.

When reporting final costs, each source must report all plan months. If the month did not accrue any costs, a zero must be entered. Costs combine when reported by multiple sources, regardless of the order in which they are reported. Vendors and Plan Sponsor Designee Cost Reporters do not have view or edit access to costs reported by the other sources. The Account Manager, Authorized Representative, and Designees with Request Payment privilege are the only users able to view all reported costs, and must coordinate any required communication between Cost Reporters.

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