Program Components:
Overview
This section provides an overview of the following topics:
- Introduction to Reconciliation: Review and Submit
- User Roles
- Communication for Reconciliation: Review and Submit
- Timing & Dependencies
- Rejecting Reconciliation: Review and Submit
- Negative Reconciliation Payment Requests
- Mandatory Payment Reduction
- What Happens After This Step Is Complete?
Introduction to Reconciliation: Review and Submit
The purpose of Reconciliation: Review and Submit is to allow the Authorized Representative to review and submit or reject the Reconciliation final payment request.
User Roles
Reconciliation: Review and Submit can only be completed by the Authorized Representative. The Account Manager or Designee with the Request Payment privilege will have “View Only” access to this step.
Communication for Reconciliation: Review and Submit
After Reconciliation: Review and Submit is complete and CMS' RDS Center completes the Reconciliation Determination process, CMS' RDS Center will send a Reconciliation Determination Email to the Authorized Representative, Account Manager, and Designee with the Submit Appeal privilege.
If you do not receive this email, contact CMS' RDS Center.
Timing & Dependencies
Reconciliation: Review and Submit cannot be started until all previous Reconciliation steps have been completed.
To guarantee a correct Reconciliation payment request, the Authorized Representative may revisit Reconciliation: Review and Submit as frequently as needed, before the step is completed and before the Reconciliation Deadline.
All Reconciliation steps up to and including Reconciliation: Review and Submit must be completed before the application's Reconciliation Deadline.
IMPORTANT: When a user account becomes locked after multiple failed login attempts for any reason—invalid Login ID, Password, or MFA code, or any combination of these—
- CMS’ RDS Center is prohibited by Federal Security Regulations to identify which login requirements were entered incorrectly.
- The user is now required to change their password.
- Passwords can be changed five (5) times in a 24-hour period.
- If a user changes their password the maximum five (5) times and then locks their account again on the same day, the user cannot change their password to unlock their account until 24 hours have passed.
Due to security reasons, the RDS Center does not have the authority to unlock accounts for Secure Website users. As a result, the 24 hours IMMEDIATELY PRECEDING a deadline can be very difficult to obtain remediation regarding account login issues, potentially resulting in a missed deadline and possible loss of subsidy.
After Reconciliation: Review and Submit is complete, it cannot be changed.
CMS' RDS Center processes Reconciliation payment requests after the payment determination is made. All Reconciliation payment requests are processed as timely as possible. Most payment requests are processed within 30 calendar days from the date of submission of the request and are sent using Electronic Funds Transfer (EFT).
Rejecting Reconciliation: Review and Submit
If the cost summary and resulting subsidy amount is incorrect, or the banking information is incorrect, the Authorized Representative must reject the Reconciliation payment request in Reconciliation: Review and Submit.
Rejecting the Reconciliation payment request based on the subsidy amount will change the following steps to "Incomplete": Reconciliation: Review Final Costs and Reconciliation: Banking Information. Rejecting the Reconciliation payment request based on the banking information will change Reconciliation: Banking Information to "Incomplete." These steps must be updated and recompleted by the Account Manager, Designees with the Request Payment privilege, and Cost Reporters before Reconciliation: Review and Submit can be recompleted.
Reminder: All Reconciliation steps up to and including Reconciliation: Review and Submit must be completed before the application's Reconciliation Deadline.
Negative Reconciliation Payment Requests
The final Covered Retiree List and Cost Reports submitted by the Plan Sponsor may result in a negative Reconciliation payment request. A negative Reconciliation payment request is considered an overpayment. In such cases, CMS will initiate immediate overpayment recovery action. For more information about overpayments, refer to Satisfy an Overpayment.
Mandatory Payment Reduction
The Centers for Medicare and Medicaid Services (CMS’) Retiree Drug Subsidy (RDS) Program is subject to the mandatory reductions in Federal spending in accordance with the Balanced Budget and Emergency Deficit Control Act of 1985 (BBEDCA), as amended.
CMS' RDS Center will apply a mandatory payment reduction to all plan months of April 2013 and beyond when calculating payment requests for affected applications.
Beginning with costs incurred in January 2024, CMS’ RDS Center will apply the mandatory payment reduction to each interim payment request and the Reconciliation final payment request.
For additional information on the RDS Mandatory Payment Reduction (i.e., sequestration) policy, refer to Mandatory Payment Reduction.
What Happens After This Reconciliation Step Is Complete?
After Reconciliation: Review and Submit is complete, the step is marked with a green check in the Left Navigation menu. Reconciliation will also be marked with a green check mark in the Left Navigation menu indicating that all steps are now complete. The status of the application will change to "Reconciliation Request Completed." On the Dashboard page, the application will be removed from the In Progress view and will display in the Completed view.
Step-by-Step Instructions
This section provides step-by-step instructions to complete the following tasks:
Approve Reconciliation: Review and Submit
To access the RDS Secure Website and navigate to the Dashboard page, review instructions to access the RDS Secure Website.
On the Dashboard page:
- Select In Progress to view a list of all Applications in progress.
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Select the Application ID for which you want to view Reconciliation.
On the Application Overview page:
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Select Reconciliation.
On the Reconciliation page:
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Select Review and Submit.
On the Review and Submit page:
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Review the Amount of Reconciliation Payment Request and the Banking Information reviewed and/or updated in Reconciliation: Banking Information. The Amount of Reconciliation Payment Request will match the Net Subsidy Amount displayed in the Review Subsidy table. Negative dollar amounts display in parenthesis and red text.
Note: If Banking Information was changed during Reconciliation, the following text will display:
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Did banking information change since Reconciliation was initiated? Yes.
To view all Banking Information and verify the changes, select Manage Banking Information.
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Select the plus sign (+) to expand the Benefit Option Summary table to view how each Benefit Option contributes to calculation of the Amount of Reconciliation Payment Request.
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Review the Signature of Plan Sponsor Authorized Representative text box – this is the Reconciliation Agreement.
- Select the Banking Information is correct? YES radio button to certify the Banking Information for the application.
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Select Subsidy amounts are correct? YES radio button to certify the subsidy amounts for the application.
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Select the I have read and agree with the Reconciliation Agreement checkbox and select Submit to validate the Reconciliation payment request and complete Reconciliation.
On the Review and Submit page:
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The page refreshes to display a Success Message stating that Reconciliation has been completed for the application. Review and Submit is marked with a green check in the Left Navigation menu to indicate that the Reconciliation Payment Request has been submitted. The Review and Submit Completed Date field, Review and Submit Completed By field, and Review and Submit Status field are updated to reflect completion of Reconciliation
Note: CMS’ RDS Center recommends that you print this page for your records.
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Select Reconciliation.
On the Reconciliation page:
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Reconciliation is marked with a green check in the Left Navigation menu to indicate that Reconciliation is complete for this application.
Note: CMS’ RDS Center recommends that you print this page for your records.
Reject Reconciliation: Review and Submit
To access the RDS Secure Website and navigate to the Dashboard page, review instructions to access the RDS Secure Website.
On the Dashboard page:
- Select In Progress to view a list of all Applications in progress.
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Select the Application ID for which you want to view Reconciliation.
On the Application Overview page:
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Select Reconciliation.
On the Reconciliation page:
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Select Review and Submit.
On the Review and Submit page:
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Review the Amount of Reconciliation Payment Request and the Banking Information reviewed and/or updated in Reconciliation: Banking Information. The Amount of Reconciliation Payment Request will match the Net Subsidy Amount displayed in the Review Subsidy table. Negative dollar amounts display in parenthesis and red text.
Note: If Banking Information was changed during Reconciliation, the following text will display:
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Did banking information change since Reconciliation was initiated? Yes.
To view all Banking Information and verify the changes, select Manage Banking Information.
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Select the plus sign (+) to expand the Benefit Option Summary table to view how each Benefit Option contributes to calculation of the Reconciliation final payment request.
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Review the Signature of Plan Sponsor Authorized Representative text box – this is the Reconciliation Agreement.
- Select the Banking Information is correct? NO radio button to reject the Banking Information, if applicable.
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Select the Subsidy Amounts are correct? NO radio button to reject the subsidy amounts, if applicable.
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Select the I have read and agree with the Reconciliation Agreement checkbox and select Submit to reject the Reconciliation payment request.
If you rejected Banking Information only:
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On the Rejection due to Incorrect Banking Information warning, select Accept to confirm that the information is incorrect, or select Cancel to return to the Review and Submit page.
If you rejected Subsidy Amounts AND Banking Information OR Subsidy Amounts only:
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On the Rejection due to Incorrect Subsidy Amounts warning, select Accept to confirm that the information is incorrect, or select Cancel to return to the Review and Submit page.
On the Reconciliation page:
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The Left Navigation menu refreshes and the green check marks are removed to indicate the Reconciliation steps that must be recompleted:
- Reconciliation: Review Final Payment Request (Subsidy Amount rejected)
- Reconciliation: Banking Information (Banking Information or Subsidy Amount rejected)
- Reconciliation: Review and Submit (Banking Information or Subsidy Amount rejected)
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