Reopening Reconciled Plan Years to Maximize Retiree Drug Subsidy

RDS Update

Plan sponsors participating in the Retiree Drug Subsidy program (RDS) who have discovered a subsidy shortfall can now reopen a previously reconciled plan year and request from the Centers for Medicare and Medicaid Services (CMS) the uncaptured reimbursement.  This process can be done up to four years after a plan year has been reconciled.  However, most plan sponsors don’t have the resources to assess whether they have missed out on past reimbursements.

KTP has the tools and expertise to discover errors in retiree eligibility and previously unreported claims information that may yield additional subsidy.  We will prepare all the information necessary for you to submit a Request for Reopening to CMS. This includes:

  • Validate all eligible retirees were included in the RDS subsidy process
  • Validate all claims are matched to eligible retirees in the plan
  • Calculate the additional RDS subsidy for recovery
  • Assist in communication process to the CMS in requesting the plan year be reopened
  • Reconcile the reopened plan year
  • Prepare and post final cost report for plan sponsor to request payment
  • Work with you, your PBM and CMS to efficiently and securely transfer eligibility data
  • Review CMS response