On September 1, 2023, CMS’ RDS Center implemented two new Reason Codes to communicate RDS eligibility information during retiree data transfers. These codes will support the conditions defined in 42 CFR § 423.4. The new Reason Codes are:
- 97 = Beneficiary is not lawfully present in the United States
- 98 = Beneficiary is incarcerated
Starting September 1, 2023, any RDS application that has not finalized retirees during Reconciliation and is still active will receive notifications for these two new conditions, as applicable to their retiree population.
What This Means
- Plan Sponsors and Vendors may receive numerous notifications related to these Reason Codes as the new edits are applied to existing RDS applications and Qualified Covered Retiree (QCR) populations.
- When a Notification is received, Plan Sponsors must process the Weekly Notification File and update Subsidy Period information in their internal systems so that the appropriate cost calculations can be performed.
- If the Plan Sponsor has initiated Reconciliation, a Covered Retiree List (CRL) must be requested after the last Notification File was created; the last requested CRL must be created by CMS’ RDS Center and the last created CRL must be downloaded by the Plan Sponsor to complete the Reconciliation: Finalize Covered Retirees step.
Reminder: Reason Codes are identification numbers that correspond to a specific message about a record in a Retiree Response File, a Weekly Notification File, or a Covered Retiree List. The reason code that is provided is from the most current Retiree Response File record or Weekly Notification File record for a retiree. Retiree Response records and Weekly Notification records should be reviewed and processed as soon as possible to assure accurate cost reporting. Records containing reason codes may require research. Federal law requires that cost data is submitted only for the QCRs, corresponding Subsidy Periods, and the Benefit Options in which each QCR is enrolled.
As a reminder, due to the sensitive nature of this information, CMS' RDS Center is not granted the authority to discuss specific entitlements with Plan Sponsors.
If you need more information, contact CMS' RDS Center.