Glossary

User Roles:

AM

AR

AC

D

V

A

Accessibility - CMS' RDS Center complies with the regulations of Section 508 of the Rehabilitation Act and the Department of Health & Human Services (HHS) Section 508 Implementation Policy. CMS' RDS Program is committed to making all RDS Websites accessible to the widest possible audience.

Account Manager (AM) - A registered RDS participant who initiates and manages the Plan Sponsor account, assigns and manages other users, and manages the RDS Application Lifecycle.

Actual Cost Adjustment - The actual (as opposed to the expected) amount of cost adjustments is required when reporting final costs for Reconciliation. Actual Cost Adjustments are any discounts, chargebacks, rebates, and/or other price concessions given by the manufacturer or pharmacy to the Plan Sponsor that are attributable to Gross Retiree Costs between the Cost Threshold and Cost Limit. Actual Cost Adjustments are not eligible for subsidy and must be reported for each Benefit Option and plan month.

Actuary - A registered RDS participant employed by the Plan Sponsor to attest to the RDS application. The Actuary must be a member of and in good standing with the American Academy of Actuaries (AAA) that is contracted by the Plan Sponsor to attest to the Medicare Part D equivalence of Benefit Options.

Add/Update/Delete Retiree File - Now known as a Monthly Retiree List, this file is used to add, update, or delete Qualifying Covered Retirees as applicable.

Additional Documentary Evidence - A Plan Sponsor may submit additional documentary evidence for CMS' RDS Center to consider while reviewing the informal written reconsideration. A documentary evidence cover sheet that specifies the Application ID must be included.

American Academy of Actuaries (AAA) - Serves the public on behalf of the U.S. actuarial profession.

Annual Payment Frequency - Selecting an annual payment frequency allows one final payment request at Reconciliation.

Application - A complete RDS application includes a Valid Initial Online Application and a Valid Initial Retiree List.

Application Deadline - The Application Deadline is available on the Application Status page.

Application Deadline Extension – A one-time Application Deadline Extension may be requested prior to the original Application Deadline.

Application ID - See: Application Number

Application List - The Application List page lists all of the applications to which an Account Manager, Authorized Representative, Actuary, or a Designee is assigned.

Application Number - The Application Number is a unique number, assigned to an application that will not change.

Application Submission Process - A process by which a Plan Sponsor submits a Valid Initial Online Application and a Valid Initial Retiree List.

Attestation - The process by which an AAA Actuary attests to the Benefit Options in an RDS application.

Authorized Representative (AR) - A registered RDS participant who takes legal responsibility for the terms of the RDS Program by signing the Plan Sponsor Agreement and also takes part in other RDS Lifecycle processes.

Automated Clearing House (ACH) - A nationwide batch-oriented electronic funds transfer system governed by the NACHA Operating Rules, which provide for the interbank clearing of electronic payments for participating depository financial institutions. The Federal Reserve and Electronic Payments Network act as ACH Operators, central clearing facilities through which financial institutions transmit or receive ACH entries.

B

Bank Routing Number - A 9-digit number used to identify the bank in financial transactions.

Beneficiary - See: Qualifying Covered Retiree (QCR)

Benefit Option - A prescription drug plan offered by a Plan Sponsor to retirees.

C

CMS' RDS Center - CMS' RDS Call Center that handles all incoming calls and written inquiries about the RDS Program.

Coordination of Benefits (COB) Contractor - A third-party company contracted with CMS to consolidate the activities that support the collection, management, and reporting of other insurance coverage of Medicare beneficiaries. A Voluntary Data Sharing Agreement (VDSA) can be set up to exchange retiree data with CMS’ RDS Center.

Copybook - Used to define the physical layout and attributes of data in an input or output file and is designed to be copied into source programs used in Mainframe programming.

Cost Limit - The federally-defined amount of out-of-pocket expenses paid by, or on behalf of, the beneficiary. The amount exceeding the Cost Limit is not eligible for subsidy. It is adjusted in the same manner as the annual Medicare Part D deductible and the annual Medicare Part D out-of-pocket limit and is adjusted annually as defined in 42 C.F.R. §423.104(d)(1)(ii) and (d)(5)(iii)(B), respectively.

Covered Retiree List (CRL) - A list of a Plan Sponsor's Qualifying Covered Retirees.

Comma Separated Value (CSV) File - This file is also referred to as a "flat file" or "comma delimited file." Computer systems use this type of file to pass information back and forth between databases. Each line represents one entry or record and a comma separates each data element within a record.

D

Data Entry - The process of entering, modifying, or submitting costs using the RDS Secure Website.

Designee - An optional registered RDS participant used to complete tasks in the RDS Program Lifecycle to assist the Account Manager (AM) or the Authorized Representative (AR). The Designee may be assigned multiple privileges to enable specific RDS tasks to be performed.

Designee Pass Phrase - A phrase assigned to a Designee prior to registration as an additional security measure to ensure that the Designee was contacted by the Plan Sponsor. A Pass Phrase can be a word, short phrase, and/or numbers containing 4-30 characters. This phrase is not system-generated and is not transmitted to the Designee electronically. The Plan Sponsor must deliver this phrase to the Designee by some format outside of the RDS Secure Website (for example: email, telephone, etc.).

E

Electronic Data Interchange (EDI) Method – The data exchange method chosen by the Plan Sponsor for each Benefit Option to exchange retiree files with CMS' RDS Center throughout the Application Lifecycle.

Electronic Funds Transfer (EFT) - The method of electronically sending funds to a Plan Sponsor's bank account.

Estimated Cost Adjustment - An Estimated Cost Adjustment is reported for interim costs. The Estimated Cost Adjustment is the amount of the expected rebates and other price concessions attributable to the plan, for its qualifying covered retirees for Medicare Part D drug costs between the Cost Threshold and Cost Limit, and incurred during the plan year. The Estimated Cost Adjustment must be based on historical data and generally accepted actuarial principles.

Estimated Premiums - Estimated Premiums cannot be reported as final costs for Reconciliation. Plans that are fully-insured have the option to report Gross Retiree Costs or estimated percentage of premiums as interim costs. The estimated premium option is recommended for those fully-insured plans that do not have access to retirees' gross drug costs. Estimated percentage of premiums is the portion of premium costs (excluding administrative costs, risk charges, etc.) paid by the Plan Sponsor and by the Qualifying Covered Retiree that, based on a determination by the insurer using reasonable actuarial principles, is allocated to Gross Retiree Costs between the Cost Threshold and the Cost Limit.

F

Freedom of Information Act (FOIA) - The Freedom of Information Act (FOIA) is a Federal statute that allows individuals to request access to Federal agency records, except to the extent records are protected from disclosure by the Freedom of Information Act. Any FOIA requests concerning the RDS Program should be submitted in accordance with the U.S. Department of Health & Human Services' FOIA guidelines, located online at http://www.hhs.gov/foia.

G

Gross Retiree Costs - Non-administrative prescription drug costs incurred for Qualifying Covered Retirees for Medicare Part D eligible drugs (as defined in 42 C.F.R. §423.100) in the approved Subsidy Period, whether paid by the Plan Sponsor or retiree or a combination. Gross Retiree Costs must be reported by Benefit Option and plan month.

I

Interim Costs - The current incurred costs reported by plan month for a Benefit Option. Interim payment requests are calculated based on reported interim costs. Interim costs are comprised of Estimated Premiums or Gross Retiree Costs, Threshold Reduction, Limit Reduction, and Estimated Cost Adjustments.

Interim Payments - Plan Sponsors who have specified a Payment Frequency of Monthly, Quarterly, or Interim Annual may request an interim subsidy payments based upon the last reported interim costs.

L

Limit Reduction - The amount in excess of the federally defined Cost Limit, not eligible for the subsidy. The Limit Reduction amount is reported by Benefit Option and plan month.

M

Mainframe - A centralized, high performance computer that has the ability to handle multiple tasks concurrently. Costs data and retiree data may be sent to CMS' RDS Center by Mainframe transmission.

Medicare Beneficiary Database (MBD) - The Medicare Beneficiary Database is the system of record for all Medicare Beneficiary data. CMS' RDS Center verifies the Medicare enrollment and entitlement for each retiree using this database.

Medicare Part D Enrollment Rejection Notification - A Medicare Part D Enrollment Rejection Notification is information sent by CMS' RDS Center advising the Plan Sponsor that a Qualifying Covered Retiree has attempted to enroll in Medicare Part D.

Monthly Retiree List – Submitted to CMS’ RDS Center by a Plan Sponsor or Vendor for a given application to maintain accurate beneficiary data (add, update, or delete Subsidy Periods as applicable).

P

Pass Phrase - This may be a word, short phrase, and/or numbers containing 4-30 characters. If the Designee does not currently exist in the RDS Secure Website, the Plan Sponsor needs to add the Designee as a new user and create a Pass Phrase to give to the Designee. This Pass Phrase must be provided to the Designee before Registration, and it must be communicated to the Designee outside the RDS Secure Website. The Designee uses this Pass Phrase to complete the RDS Secure Website Registration process.

Payment Frequency - The Payment Frequency is the chosen frequency to submit Payment Requests. A Monthly Payment Frequency will allow the submission of up to twelve payment requests. A Quarterly Payment Frequency will allow the submission of up to four payment requests. An Interim Annual Payment Frequency will allow one payment request to be submitted.

Pharmacy Benefit Manager (PBM) - A third-party company (primarily responsible for processing and paying claims) contracted by a Plan Sponsor to administer prescription drug programs.

Plan - Prescription drug benefit program offered by a Plan Sponsor.

Plan Year - The RDS plan year may be calendar or non-calendar and corresponds with the start and end date of a Plan Sponsor’s drug benefit programs.

Plan Sponsor - The organization participating in the RDS Program.

Plan Sponsor Account - An account with the RDS Program created by a Plan Sponsor Organization to take part in CMS' RDS Program.

Plan Sponsor Agreement - A legal and binding document between the Plan Sponsor and CMS' RDS Center. The Plan Sponsor Agreement defines the terms and conditions of the RDS Program.

Plan Sponsor Payment Agreement - Plan Sponsor Payment Agreement states that the signor agrees to all of the clauses of the Payment Agreement. The Payment Agreement must be electronically signed to submit a payment request.

Plan Sponsor ID - A unique number assigned to a Plan Sponsor for the duration of their participation in the RDS Program.

Q

Qualifying Covered Retiree (QCR) - An RDS eligible retiree or beneficiary. A QCR must be a retiree, spouse, or dependent; must be covered under the Plan Sponsor’s Prescription Drug Plan; and eligible for but not enrolled in a Medicare Part D plan.

R

Reason Codes - The identification numbers that correspond to a specific message about a record in the Retiree Response File.

Reconciliation - The process where after the end of the plan year, the Plan Sponsor finalizes the Covered Retiree List and submits all final cost data and the final payment request.

Retiree - Beneficiaries who are eligible to enroll in Medicare Part D but are not enrolled.

Retiree Counts - Retiree Counts are used to validate cost data for an application. The Monthly Retiree Count and the Plan Year Retiree Count represent the number of Qualifying Covered Retirees (QCRs) having coverage in a given month or plan year. The Plan Year Retiree Count is the total number of unique QCRs for the entire application plan year.

Retiree Drug Subsidy (RDS) – Program offered by CMS to reimburse Plan Sponsors for a portion of their eligible expenses for retiree prescription drug benefits.

Retiree File - The retiree file is a collection of data about the individual(s) for whom the Plan Sponsor has applied for subsidy. This is a generic term used to describe the Valid Initial Retiree List and Monthly Retiree List.

Retiree Record - See: Retiree File

Retiree Record Layout - The specified format for the retiree file or retiree record.

Retiree Response File - A Retiree Response File is sent to Plan Sponsors in response to retiree information that was submitted.

S

Sample Retiree File Spreadsheet - A pre-formatted spreadsheet available to all RDS Plan Sponsors to submit their retiree files.

Section 508 - Section 508 requires that individuals with disabilities seeking information or services from this document have access to and the ability to use information and data that is comparable to that provided to the public who are not disabled.

Social Security Administration (SSA) - The Federal agency that, among other things, determines initial entitlement to and eligibility for Medicare benefits.

Subsidy - The amount CMS' RDS Center approves for payment to an RDS Plan Sponsor.

T

Threshold Reduction - The amount below the federally defined Cost Threshold - not eligible for subsidy. The Threshold Reduction amount is reported by Benefit Option and plan month.

U

Unique Benefit Option Identifier (UBOI) - This identifier is used for the Benefit Options in each application. This could be an Rx Group Number.

Upload a File - The process to upload a file to the RDS Secure Website. The Upload Retiree File link is located on the Manage Retirees page. This link is used to upload both the Valid Initial Retiree List and subsequent Monthly Retiree List.

User Agreement - Describes the terms and conditions on which CMS offers users access to the RDS Secure Website.

User Registration - The process that allows an organization to participate in the RDS Program by registering an Account Manager, Authorized Representative, Actuary, and Designees.

V

Valid Initial Online Application - The Valid Initial Online Application consists of 8 steps. A Plan Sponsor will define the details regarding their application, which is done by completing the first 7 steps of the Application Submission Process. Step 8 allows the Authorized Representative (AR) to sign the Plan Sponsor Agreement and submit the Valid Initial Online Application to CMS' RDS Center.

Valid Initial Retiree List - The first transfer of retiree information from the Plan Sponsor to CMS' RDS Center. The Valid Initial Retiree List is a collection of data about the beneficiaries for whom the Plan Sponsor is seeking subsidy. Using the selected Retiree EDI Method chosen for the Benefit Option, a Plan Sponsor must submit a Valid Initial Retiree List to CMS' RDS Center as part of the Application Submission Process.

Vendor - A third-party company contracted by a Plan Sponsor to report cost data or manage retiree files.

Vendor ID - An identification number assigned to a Vendor as a form of verification of the Vendor's contract with the Plan Sponsor.

Voluntary Data Sharing Agreement (VDSA) - This agreement authorizes CMS and an employer, or insurer or agent on behalf of an employer, to electronically exchange health insurance benefit entitlement information.

W

Weekly Notification File - Unsolicited message from CMS' RDS Center concerning a Qualifying Covered Retiree (QCR) and the related Medicare Entitlement or Subsidy Coverage.

Weekly Notification Reason Codes - These are identification numbers included on records within Weekly Notification Files. Each reason code relates to a specific message regarding entitlement, enrollment, or approved RDS Subsidy Period.

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