Retiree Response Files are created whenever CMS' RDS Center receives a retiree file on behalf of the Plan Sponsor.
Weekly Notification Files are sent by CMS' RDS Center after the Valid Initial Online Application is completed and submitted and until Reconciliation Step 4 is marked complete.
Weekly Notification Files are created when beneficiaries approved for subsidy under the application have a notification event. Events that may affect a Plan Sponsor's ability to receive subsidy payments for a beneficiary include, but are not limited to: a change in Medicare entitlement, the death of a beneficiary, disenrollment, enrollment, or attempted enrollment into a Medicare Part D plan.
Retiree Response Files and Weekly Notification Files MUST be processed by Plan Sponsors and its agents so internal records reflect the correct Qualifying Covered Retiree (QCR) information, Benefit Options, and associated Subsidy Periods. Cost data can only be reported for the QCRs, corresponding Subsidy Periods, and the Benefit Option in which each QCR is enrolled.
Review this section for an overview of the following topics:
When a Plan Sponsor submits a Valid Initial Retiree List or Monthly Retiree List for an RDS application, CMS' RDS Center verifies the Medicare entitlement for each beneficiary by checking the Medicare Beneficiary Database (MBD) system of record for this information. CMS' RDS Center sends a Retiree Response File that includes a record for each Qualifying Covered Retiree (QCR) sent in the retiree list indicating the period of time during the plan year that the Plan Sponsor may claim subsidy.
The Retiree Response File records contain all the original fields sent by the Plan Sponsor, plus the Determination Indicator, Subsidy Dates, and Reason Codes. The Retiree Response File may contain multiple responses (records) for a single beneficiary in the event that there is a gap in subsidy based on Medicare entitlement.
Retiree response records should be reviewed and processed as soon as possible to assure accurate cost reporting. Response records containing reason codes may require research.
Reason codes are identification numbers that correspond to a specific message about a record in a response file or a notification file. The reason code provided is from the most current Retiree Response File record or Weekly Notification File record for a QCR.
When there is an event that may impact a Plan Sponsor's ability to receive subsidy for a beneficiary, CMS' RDS Center is notified by Medicare. When CMS' RDS Center receives notifications from Medicare, the system re-evaluates the beneficiary's eligibility for subsidy. Events that may affect a Plan Sponsor's ability to receive subsidy payments for a beneficiary include, but are not limited to: a change in Medicare entitlement, the death of a beneficiary, disenrollment, enrollment, or attempted enrollment into a Medicare Part D plan.
CMS' RDS Center conveys notifications and any resulting changes in approved subsidy periods to Plan Sponsors using Weekly Notification Files that are sent once a week when beneficiaries covered under the application have a notification event.
CMS' RDS Center only sends a notification for retirees who have ever qualified for an RDS Subsidy Period. A notification record is not generated if the retiree never qualified for the RDS subsidy (regardless of the reason).
If the elected notification method is Mainframe to Mainframe, VDSA, or MIR, Weekly Notification Files do not appear on the RDS Secure Website unless the elected notification method specified a copy to the RDS Secure Website. If the elected notification method is RDS Secure Website and no Weekly Notification Files are available to download, there are no notification events.
A Covered Retiree List (CRL) may be requested and downloaded using the RDS Secure Website. The purpose of requesting and downloading the CRL is for comparison of the Plan Sponsor's internal records with those of CMS' RDS Center. Plan Sponsors should request, download, and review the CRL on a regular basis to make sure that the Qualifying Covered Retirees (QCRs), Benefit Options, and Subsidy Periods correspond to the Plan Sponsor's internal records.
The CRL file includes the same fields contained in Retiree Response Files plus two additional fields that identify the source that last submitted each QCR. The CRL includes all QCRs having at least one Benefit Option where at least one Subsidy Period exists. A separate record is created for each unique QCR, Benefit Option, and Subsidy Period combination. Retiree records rejected by CMS' RDS Center will not be reflected in this list.
During Reconciliation, the Plan Sponsor is required to review and agree to the CRL. Plan Sponsors may only submit costs for the QCRs, Benefit Options, and corresponding Subsidy Periods listed in the CRL that has been downloaded from CMS' RDS Center.
A Medicare Part D Enrollment Rejection Notification File is information provided by CMS' RDS Center advising the Plan Sponsor that a beneficiary, for whom they are requesting subsidy, has attempted to enroll in Medicare Part D. CMS' RDS Center sends a notification with the existing Subsidy Periods and appropriate Reason Code 20: Beneficiary attempted to enroll in Medicare Part D and received an initial rejection to the Plan Sponsor.
Medicare Part D Enrollment Rejection Notifications can be viewed at any time using the View Medicare Part D Enrollment Rejection Notifications link on the RDS Secure Website. There is no need to wait for the weekly file.
The Medicare Part D Enrollment Rejection Notification means that the beneficiary has been initially rejected for Medicare Part D. The notification is the Plan Sponsor's cue to contact the beneficiary who applied for Medicare Part D. If the beneficiary overrides the rejection and enrolls in Medicare Part D, the Plan Sponsor's subsidy period for that beneficiary is terminated and CMS' RDS Center notifies the Plan Sponsor as such in the Weekly Notification File.
Plan Sponsors may not receive subsidy for beneficiaries enrolled in Medicare Part D.
Qualifying Covered Retiree (QCR) counts are available on the RDS Secure Website after the RDS application is approved by CMS' RDS Center. The retiree counts are calculated from the approved retiree Subsidy Periods. The retiree counts are refreshed on a daily basis and reflect the most recent retiree data derived from the Retiree Response File and Weekly Notification Files. When Reconciliation Step 4: Finalize Covered Retirees is marked "Complete," the retiree counts are frozen and are no longer recalculated.
Retiree counts are displayed by application, Benefit Option, and plan month within the Benefit Option. The unique retiree count is the total number of individual QCRs for the entire application. The Benefit Option unique retiree count is the number of individual QCRs for the Benefit Option. The application retiree count does not match the sum of the retiree counts for the Benefit Option if a retiree is covered under more than one Benefit Option. The monthly retiree count by Benefit Option displays the number of unique QCRs for a given plan month within a Benefit Option.