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New RDS Reason Codes Coming

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Program Components:

Retiree Management

In the coming months, CMS’ RDS Center will implement two new Reason Codes that will be used to communicate RDS eligibility information during retiree data transfers. These codes will support the conditions defined in 42 CFR § 423.4 stating that a retiree is not eligible for RDS subsidy when: 

  • the retiree is not legally present in the United States and/or 
  • the retiree is incarcerated

The two new Reason Codes are:

            97 = Beneficiary is not lawfully present in the United States

            98 = Beneficiary is incarcerated

CMS’ RDS Center will communicate additional information, including the date on which these codes will be made available, in the coming months.

Please note that once these codes are implemented, 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. Plan Sponsors and Vendors may receive numerous notifications when this new initiative is first implemented.

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

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