 I didn't want to be, so the list that they gave to me. I like working with you guys. Nope, you got them all. OK, this was just handed to me. No, we're going to stop at 4.30. I lived in Virginia for a year, and these are going to be right here. They're in fact at 25, because as I put them down, they're going to go here. Are you all ready? Is everybody ready? I'm going to be putting it down here, so just be aware it's there. Welcome back. I have some really good news. What would make you happy? No, I'm not going away. What did I hear you? Did I let you out at 4.35, 4.40 if we got through all the questions? That would make you happy. Consider it done. We are going to shoot to be out of here at 4.40. So please do not synchronize your watches, because the official clock is up here. At 45 minutes, we will take a stretch break. Then they will reset the clock. We will take another 45 minutes. At about 4.30, Mark Hamelberg and I will close out the session. And then many of you have flights, so we are going to do our best to do that. As you see, we have a panel up here. To my immediate right is James Mayhew. To his right is Marilyn Harrington. To her right is James Crawl. And to his right is David LaMere. To my immediate left is David Gardner. To his left is Patricia Ambrose. And to her left is Joanne Sosnok. What we are going to do is similar to yesterday. I will read each question twice. The panel will then decide who is going to answer it. The first question. There was one. The question was. Why are you looking? Can I answer the question? Sure. One question that has been asked a couple of times that may be good to address here is the situation where the sponsor is developing a new plan for 1106 by 9.30. They know what the plan is going to be and the benefit option. So they can do the actual equivalent test station and provide that information. But the enrollment for the new plan doesn't occur until November. So what do you do with the retiree list when you have this submitted by 9.30.05? And we talked about this and we think that the best way for the sponsor to handle it is just make a guesstimate as to what are your retirees, what retirees are going to choose, what particular option, and submit that list. And then when you get the enrollment completed, you update that list with the changes placing the retiree in the correct benefit option. And so that would take care of the requirement to submit a retiree list by 9.30, yet have it updated by 1106 so you'll get paid accurately. Thank you. The question was calendar days on appeals. Do calendar days include federally recognized holidays? For example, Christmas, President's Day, 4th of July, et cetera. Calendar days would be included in the 15-day appeals calculation that would include weekend and federal holidays with the exception that if the 15th day fell on a holiday, the deadline would be the following day. If you have a non-calendar year benefit option, with the threshold and the limit change mid-year plan, would the $250 and $5,000 change mid-year and application period? If you have a non-calendar year benefit option, with the threshold and limit change mid-plan year, for example, would the $250 and $5,000 change mid-plan year and application period? The answer is yes, it would change during the mid-plan year. So let's say in the beginning of the plan year, you're using a particular threshold and cross-limit, and then CMS comes with the publicized, new publicized limit and threshold for the year and what the plan year ends. Because then they would have to make the adjustment during the plan year and then during reconciliation, the threshold that's in effect at the end of the plan year would apply to the whole plan year, so you would just have to make all the adjustment in reconciliation. Because the statute is clear that you use the cross-threshold and cross-limit for the calendar year and what the plan year ends. And just to add to that, if you decide that you know about the differences in what you submitted previously versus what you know now, in an interim payment request, you can go in and change the amounts you've entered for previous months. So you can make that adjustment for interim payments as well if you so choose, but you could also do it at reconciliation just the way Jim said. Do we need a business associate agreement with RDS to be in compliance with HEPA privacy? Do we need a business associate agreement with RDS to be in compliance with HEPA privacy? I would think we would need a little more information to really answer that question accurately, but generally the provision of the information to CMS necessary to qualify for the subsidy falls under the required by law exception under HEPA and so if the entity providing the information to CMS is a covered entity under HEPA privacy, then they would not need the individual authorizations from the individual beneficiary in order to provide that information to CMS and you would also not need a business associate agreement. How will drugs that are sometimes covered by Part D and sometimes covered by Part B handled? Will they be considered an allowable cost under the retiree drug subsidy? For example, Zofran and Kytril, when used for post chemotherapy nausea and vomiting they are covered by Part B, other uses they are covered by Part D. How will drugs that are sometimes covered by Part D and sometimes covered by Part B handled? Will they be considered an allowable cost under the retiree drug subsidy? For example, Zofran and Kytril, when used for post chemotherapy nausea and vomiting these are covered by Part B, other uses these are covered by Part D. Good question, addresses a complicated situation, but the bottom line is only Part D drugs are covered by the subsidy, so if a drug is paid for under Part B cannot submit those costs for subsidy payment. So whoever is submitting the cost, whether that be the PBM or the insurance carriers, they have to be aware of what category the costs fall into and it can only be a Part D cost. Our beneficiaries who are temporarily residing outside the continental United States considered ineligible for the subsidy. Our beneficiaries who are temporarily residing outside the continental United States considered ineligible for the subsidy. I don't know the answer to that. Yeah, we're definitely going to have to check on that one posted in a Q&A on the website. Do all Medicare Part D entitled members have to be eligibility reported to CMS even if they are not applying for subsidy? Do all Medicare Part D entitled members have to be eligibility reported to CMS even if they are not applying for subsidy? Well, in a sense, they will, if they're on Part D, they will be reported to CMS through the Part D plan, through the PDP or MAPD, so they will be entered in the Medicare beneficiary database as Part D recipients through the PDP or the Part D plan. Can we apply an average actual rebate amount to each qualified retiree or must we look at specific drug data by individual and report actual rebate information per retiree? Can we apply an average actual rebate amount to each qualified retiree or must we look at specific drug data by individual and report actual rebate information per retiree? For the interim cost payment and reconciliation, you will be, that's correct, you will be providing an average rebate amount per retiree. Now, the actual rebate information and the actual rebate amount would have to be maintained for a potential audit to support that calculation of the rebate amount. Can you block the AR from receiving the multiple response emails? Someone at the CEO level may not wish to be that involved. Can you block the AR from receiving the multiple response emails? Someone at the CEO level may not wish to be that involved. I did talk to someone about this issue yesterday, so I made a note of it to go back and see what we can do. Certainly, we don't think we need to notify the authorized rep every time a file has been transferred. There are other cases where absolutely we do have to notify the authorized rep, of course, when the account manager starts the plan sponsor account and sets up their user IDs. Later on, I think that we might, so what I plan to do for our initial roll out in August is to limit the number of emails that go to the authorized rep. Down the road, I think we might try to add some switches that could be checked off when the authorized rep comes and registers to the website. They can indicate what they'd like to see and what they're interested in and what they aren't interested in. Is the term date on the retiree file the date the retiree is no longer in the plan or the date the retiree is no longer eligible for the subsidy, even though they may still be enrolled in the plan? I guess I'm a little puzzled by the last statement. I guess I'm not really sure what that's going to be. Can you help me understand? Yeah. Well, I think the term date would be, for the purposes of the data, would be the last date that the rep has been transferred to. I guess I'm a little puzzled by the last statement. I guess I'm not really sure what that's going to be. Can you help me understand? The purposes of the data would be the last date that the beneficiaries enrolled in the plan provided that it happened during the course of the plan year. If it's, because if they're no longer eligible to be accounted for the subsidy, when you report that, I mean, you keep the same term date, but CMS would send in a response file if that person is no longer eligible for the subsidy, and you would just take that person off the list altogether. Can payments be tied back to benefit options and so noted on the advice summary? Can payments be tied back to benefit options and so noted on the advice summary? I see no reason why I'm turning to Joanne here. I don't see any reason why we couldn't provide the benefit option unique identifier as long, well, I guess as long as a payment was linked to a particular unique benefit option, chances are that it could be more than one, so at that point I think it As far as the actual EFT will be made at application level, therefore it's expected at the combination of benefit option that were included in the actual payment request, but the actual payment notification or remittance advice or whatever we want to call it, we have the flexibility to include whatever level of detail is required by the plan sponsor community, so we're looking for your feedback again into what data elements you would like to see included in that, and down to the level of specificity you want us to go. I guess there's two mechanisms for giving us your feedback about that. The first would be obviously the upcoming paperwork reduction act notice that we'll have to do for payment requests. Part of that will have to be what I assume we're planning to do with respect to posting or we'll have to put something in there about how we're going to return to them information about the payments we make. The second mechanism is we do run periodic focus groups, and we'll just put this on our list of things to talk about with our focus groups, a very good point. Do you need to submit a separate application for each benefit parentheses HMO option? Do you need to submit separate applications for each benefit parentheses HMO options? I'm going to answer that question on its face. They're calling it an option, so I'm assuming that they save an option within a plan, and therefore, no, they would not have to submit an application for each option. They just submit one application for the other plan. And that assumes, Jim, that the options all have the same start and end dates. That's right. What is the expected turnaround time for CMS to communicate to employers if retiree is enrolled in Part D and the employer plan? What is the expected turnaround time for CMS to communicate to employers if retiree is enrolled in Part D and the employer plan? Well, if the purpose is for coordination with the retiree drug subsidy program, and you are currently claiming an individual for subsidy payments, when we receive notice from the Part D enrollment transaction processing system, the RDS Center rather receives that notice, we will be turning that around in just a matter of 24 hours. So, they're posting the alert to the account with the plan sponsor. It's going to be very rapid. You'll get it within a day or two when we find out it's just a matter of the batch processing. If my plan year is January 1, 2006 through December 31, 2006, should the initial submission include those not Medicare eligible at time of submission but will be Medicare eligible by December 31, 2006? If my plan year is January 1, 2006 through December 31, 2006, should the initial submission include those not Medicare eligible at time of submission but will be Medicare eligible by December 31, 2006? When we go to the Medicare beneficiary database, they post eligibility entitlement information three months in advance of if someone's working, I mean rather... Turning 65. Yeah, turning 65. So if the Medicare beneficiary database has posted this information, we're doing date checks and so we'll be able to validate your record if however it has not been, if it's six months prior to your retiree turning 65, we'll actually reject that record and say that they're not eligible for Medicare. So you'll have to send it later when getting closer to the date that that information would be posted on the Medicare beneficiary database. So obviously you have the freedom if you know the date that that person has gone to Social Security and signed up for Medicare, you could certainly, starting with that date, send that in as an ad record until you get a response that you would expect. When VDSA is used, is a retiree list required to be submitted or is referenced to VDSA participation sufficient? You must send in a retiree list through the VDSA process. There's other file exchanges with VDSA, but there is a special record type and a special file for the retiree list for the RDS Center. So the NTSA is required to be submitted for the retiree list for the RDS Center. So the answer is yes, you must send a retiree list in. What constitutes a plan, parentheses, 5500, ERISA, union agreement? What constitutes a plan, parentheses, 5500, ERISA, union agreement? The ERISA 5500 would just be one evidence of what constitutes a plan. You have to look at the overall administration of the plan by the plan sponsor. You have to look at it how it's administered for COBA purposes and for ERISA purposes. So the 5500 can be an indication of how many plans the sponsor actually had, it's only one indication out of several. For retirees who have enrolled in Part D who subsequently disenroll, how can a plan supervisor communicate this information to CMS to speed up the acceptance process? Or does the plan sponsor have to wait until this information is in the MBD database? For retirees who have enrolled in Part D who subsequently disenroll, how can a plan sponsor communicate this information to CMS to speed up the acceptance process? Or does the plan sponsor have to wait until this information is in the MBD database? You will have to wait until the Medicare beneficiary database has been updated. That's our source, that's the system of record for eligibility and entitlement information. If a company is self-insured that as part of its agreement with the TPA allows the TPA to keep any drug rebates, does the employer get to claim 100% of drug expenses since this is what they actually pay or do they still need to net out rebates? If a company is self-insured but as part of its agreement with the TPA, does the TPA get to keep drug rebates, does the employer get to claim 100% of drug expenses since this is what they actually pay or do they still need to net out rebates? If the TPA is the one that's tracking the cost, then the rebate received by the TPA must be reported because again it rebates against the cost incurred under the plan. So if it's the TPA, third party administrator is the one that incurring the cost on behalf of the sponsor, then those rebates would have to be reported. Will RDS address any questions the plan sponsor has on the reconciliation and final payment? Or will the BOA need to be involved? Will RDS address any questions the plan sponsor has on the reconciliation and final payment? Or will the BOA need to be involved? I guess it all depends on what address means. I think the reference is probably to the protected health information. The reference is probably to the HIPAA issue. If the TPA, well if the... Yeah, let me see a question. Yeah, well certainly if there are any questions, the plan sponsor is ultimately responsible for the application and for the submission of the data. If there are any questions on the application, certainly CMS would address those to the plan sponsor. If it involves some sort of inquiry concerning protected health information and the plan sponsor is not set up to receive protected health information, then some accommodation would have to be made. Either the question has to go to the benefit options administrator or the plan sponsor would have to make some arrangement to be able to receive protected health information. And one of the things that can help us identify who we can talk to is how you actually indicate that person is functioning on your behalf on the application when we list those various authorities for designees. So if you do assign a designee and you indicate that they can deal with retiree list information or payment request information, that just helps us figure out who we can talk to and who we can't talk to about protected health information. Joanne stated the reconciliation file should be submitted by the BOA to RDS in the same format as was indicated on the application. Does the insurer need to be prepared to submit on all three methods? Joanne stated the reconciliation file should be submitted by the BOA to the RDS in the same format as was indicated on the application. Does the insurer need to be prepared to submit on all three methods? No, you would choose between mainframe to mainframe and the HTTPS within the secure website for the trial file transfer. Am I correct in assuming that even if a plan sponsor enters into a VDSA, they still would have to choose another method, for example, mainframe to mainframe transfer for submission of the payment request and reconciliation files? Am I correct in assuming that even if a plan sponsor enters into a VDSA, they would still have to choose another method, for example, mainframe to mainframe transfer for submission of the payment request and reconciliation files? Yes, you are correct that the VDSA is a data exchange related to the retiree list and this is payment data which includes additional information in addition to the retiree information. Since VDSA is a mainframe to mainframe exchange, the expectation would be that you would also pick mainframe to mainframe and therefore lessen the amount of connectivity issues that would occur. I just want to clarify one point. Joanne's absolutely right that you would not send your payment related or reconciliation related files through VDSA. However, mainframe to mainframe is not going to be the only option for VDSA in the future. They're implementing a file transfer process similar to what RDS is doing. I'm not sure if they're using secure FTP or HTTPS, but there'll be other options. Don't worry about it. Yeah, things change very fast. What level of detail will be reported for disallowed drug costs? That would only come up in a audit because disallowed drug costs would only become a claimed level data. Now, if you're talking about disallowed specific, I don't know. Clearly, we're defining the data elements for audit in the near future. That's one of the things we're discussing now internally at CMS. Can I see the question? It's also conceivable that as you're sending in your reconciliation data files, we'll be doing some data edit checks when we're processing those files. It is possible if we add up the data for a specific retiree, and it ends up being more than the obvious maximum for that given plan year that a specific retiree can receive, then a file might be rejected for clarification, thinking that there might be some sort of data entry error at some point on your end. Again, we're still working out the payment processes at that level, but it is conceivable that there could be the results of an audit pointing to disallowed amounts and some sort of reject of a file based on some very high level and basic calculations we do aggregated at the retiree level. For fully insured plans, you said it was possible to submit claims or premium. Does that apply to the final reconciliation as well? No. For reconciliation, you can only provide actual cost data broken out per individual retiree and the actual rebate data. The premium option is only available for the interim payment during the course of the plan year. How will CMS coordinate that? The premium option is only available for the interim payment during the course of the plan year. How will CMS coordinate individuals who are in more than one plan? For example, spouse in one plan and member in another and they list each other as dependents. How will CMS coordinate individuals who are in more than one plan? For example, spouse in one plan and member in another and they list each other as dependents. For our purposes, if you have a spouse and a member in two different options, we treat them as unique records. So in our system there really is no interdependency. Yeah, just to clarify, we would actually in that case if one of the individuals was claimed for the subsidy by two different plan sponsors. I think that's the case here. We would post two subsidy records on our database and expect to see cost information associated with that separately. So in other words, we can handle two subsidy periods that overlap each other for one individual as long as it's a different plan and different plan sponsor. I don't know, Jim, if we want to add a little bit of information from the policy perspective about what happens if there are two different plan sponsors involved with a specific retiree, the same retiree, but they're involved with two different plan sponsors claiming them for subsidy. Obviously, both would be subject to the maximum amount that a plan sponsor could receive for a given year in subsidy payments. I don't know if we want to clarify that a little bit. Well, it's just that if they have a retiree who's on two retiree plans, whoever is primary would track their cost and if they meet the cost threshold, they could get the subsidy. And then whoever is a secondary, if they meet the definition of a qualified retiree scripts and drug plan and they're actually equivalent and they're just paying for the cost sharing from the first plan, they could conceivably also get the subsidy provided that they meet the cost threshold. And of course, the second plan could not get the subsidy submit the same cost as the first plan did, but certainly they could submit their separate cost in the plot for the subsidy. It's also conceivable as we think about our strategies for audits that we may identify this as a potential area for targeted audits knowing that coordination of benefits is not always perfect, so we do need to make sure that we're not paying for the same costs twice. Are A.R. and A.M. logins computer specific or is it just email specific? I guess I would answer that by saying they are person or user specific. You can use your login ID from a different computer, two different computers. So the authorized rep will have a unique SSN. They will have a unique email address and they will have a unique login ID as will the account manager and every other user of the website, secure website. Right. Correct me if I'm wrong, but we're not logging IP addresses or anything like that. They would prevent you from accessing from multiple places. So we are not. After we submit the initial retiree file for the September 30, 2005 deadline, when do we start sending monthly change files? After we submit the initial retiree file for the September 30, 2005 deadline, when do we start sending monthly change files? The simple answer to that is as soon as you're prepared to and as soon as you have identified changes that you previously sent to us, or you've identified information that you previously sent to us that you know is now out of date. So if you send your initial retiree list in very early in the window of time to apply for this transition period, as soon as you are prepared to send in an update file, we will be ready to receive it, provided that the application has been processed. Yeah, you would want to wait until you receive your response file back and your application has been approved, obviously, and take that response file and process it because you'll need that information to know how to create your update file. And again, yes, we encourage you to start that monthly process as soon as you're able to so we can get the most accurate subsidy periods posted out on the Medicare beneficiary database before November 15th enrollment starts. And just to add to that, also, we will be posting alerts, and I think we described yesterday, lots of reasons why we might be giving alerts, part de-enrollment of a retiree or changes to Medicare A or B, effective in term dates in the Medicare beneficiary database. We're posting those alerts, so if you know you're going to be sending an update file, you're best to take those in, digest them, process them on your end, and then send a final netted update file to us so that you know that you have the most recent and accurate information. How can a plan determine if they pass the gross and net test prior to completing the application? How can a plan determine if they pass the gross and net test prior to completing the application? Well, they can hire an actuary as soon as they know what the benefits are going to be for 2006. So if they know right now what the benefits are going to be in 2006, they can hire an actuary right now and the actuary will do the calculation and let them know. I know a lot of plans are in fact doing that and a lot of plans already know at this point whether their plans are actually equivalent to the defined standard prescription drug benefit under Part D. If the final decisions regarding 2006 contributions and plan design are not made by September 30th, typically determined in the November timeframe, can the actuary rely upon information supplied by the plan sponsor on anticipated changes for 2006? If the final decisions regarding 2006 contributions and plan design are not made by September 30th, typically determined in the November timeframe, can the actuary rely upon information supplied by the plan sponsor on anticipated changes for 2006? The answer is yes, provided that the information given to the actuary is given enough information to make reasonable projections as to the changes, there's nothing wrong with an actuary doing yesterday's station on the projected changes. If the changes go into effect and the actuary realizes perhaps that the actual value is different from the projected value and is a material change in the actuarial value, then the plan sponsor would be under an obligation to resubmit the actual equivalent destination to the RDS Center. We're also being very generous with extensions this year and I'm sure next year we will be as well. So if you're uncomfortable in submitting your application in final until you have a little bit more information, if you need an extra 30 days, we will grant an extension as long as you've started your application online at the RDS Center. As we showed you yesterday in the demo, there's a drop-down on that. Was it the application summary screen? For the extension. Right. It's the plan sponsor application list. So everyone who is at least that far in the application process will be granted a 30-day extension if asked. If a dependent is disabled and Medicare eligible, are they subsidy eligible? If a dependent is disabled and Medicare eligible, are they subsidy eligible? The answer is really continued on the status of the participant. If the participant is not in current employment status, in other words, if the participant is also retired, then the dependent who is disabled and Medicare eligible, not enrolled in Part D, can also be counted for the subsidy, can be counted for the subsidy. If an employer offers several different plans, some of which are self-funded and some of which are fully insured, does the account manager have to submit an application for each individual plan? For example, fully insured HMOs and self-funded PPOs, MCOs, and EPO plans. If an employer offers several different plans, some of which are self-funded and some are fully insured, does the account manager have to submit an application for each individual plan? For example, fully insured HMOs and self-funded PPOs, MCOs, and EPO plans. Well, the questioner uses the word plan. So I'm assuming that they're administered as separate plans. If that's the case, then you must file an application for each plan. So if, in fact, they are benefit-optimized under a single plan, as long as the options are within the same plan year timeframe, then you could submit one application with multiple benefit options. Again, it will evolve down to how to benefit or administer. And Jim, also just a point of clarification for my education as well. If you have that situation that was in the example and you decide you're going to combine them all as benefit options under the same application, do not each of those benefit options then also have to stand on their own at the gross test? Absolutely. Each benefit-optimized design would have to pass the gross test. And then, of course, the plan sponsor would have the option to aggregate the option together for the net term. Can the actuary also perform the role of account manager on an application? Can the actuary also perform the role of an account manager on an application? At this time, the answer to that would be no. The actuary would only be able to take on the role as the actuary, and another person would have to be an account manager. And in fact, that's going to be a... Well, let's just leave it at that. We are going to take this under advisement. We do want to make sure that there are several people involved in the application prior to approval. So we like the idea from a security and fraud prevention perspective that the authorized rep, the account manager, and the actuary are all three distinct people. We do understand that there are some concerns about overlapping responsibilities, and we'll take this under further advisement and see what we can do in the future. But for your submission of your initial applications, you need to have three separate individuals perform those roles. Why do you need the social security number and date of birth of the AM? Why do you need the social security number and date of birth of the AM? That's a security requirement for us to authenticate individuals interacting with our RDS Center website. That's a requirement of our CMS security policy, and we went back and forth for long periods of time on this, and our Office of General Counsel... We went to our Office of General Counsel for advice on this issue, and they determined that the use of social security number and date of birth are appropriate and legal for this means. Correct me if I'm wrong, Dave, but that's also for the protection of the plan sponsor, in that obviously that makes the account more secure, because only person with that particular social security number can enter the account. Okay. We have lapsed the first 45 minutes. We're going to take a seven-minute break. Come back and do another series of questions. We'll be back in seven minutes. Our next question is, as a prescription TPA, do you recommend each group client manage their own application or the TPA manage each group under one account number at the TPA? As a prescription TPA, do you recommend each group client manage their own application or the TPA manage each group under one account manager at the TPA? For that purposes of answering that question, I would assume that they mean group client mean the plan sponsor, and the answer to that is each plan sponsor must submit their own application. It is the plan sponsor that's ultimately responsible for that application. The authorized plan representative must be an employee of the plan sponsor. One that signs the application and it's a plan sponsor that's going to get the payment. So a vendor would not be able to submit one application for multiple sponsors. In what circumstances would you contact the benefit plan administrator as opposed to the plan sponsor? Will you notify the plan sponsor when and why you contact the benefit option administrator? I'll take the first crack at that and perhaps Dave can supplement my answer. Again, the plan sponsor that's ultimately responsible for the application, so all communications from YARDS Center would go through, you know, one of the things that's going to happen in the future is that you're going to be able to contact the benefit option administrator as opposed to the plan sponsor. The YARDS Center would go through the plan sponsor. There might be this situation that I talked about earlier involving protected health information, but I can't imagine that the YARDS Center would contact the vendor about protected health information without at least notifying the plan sponsor. That's correct. We have no communications plan where the plan sponsor wouldn't at least know that there were communications happening. If bank information changes for EFT, what is the process? If bank information changes for EFT, what is the process? There will be a link as you sign onto the secure website. There will be a page for you to update your EFT information. It will cause us to put the application on hold, so if you're in the mode where you're already receiving payments, we need to obviously revalidate that banking information. So, you know, that's approximately 10 days, 10 business days. And that could ultimately affect the pace at which we pay you in terms of, you know, if that time frame essentially would be added to the 30-day window that we have to actually make a payment. So, we have to make sure that where we're sending the money is accurate before we can kick off that final payment process. If a person is eligible for Medicare due to the employment history of their spouse, will they have coverage under their social security number or their spouses? If a person is eligible for Medicare due to the employment history of their spouse, will they have coverage under their social security number or their spouses? I assume they're probably asking coverage under Medicare and not necessarily an RDS-specific question. Well, if the question really boils down to under the sponsors plan, that's certainly up to the sponsor how they're going to administer the program and whether or not the spouse would have coverage under the social security number of the participant regardless of that. In order to qualify for the subsidy for the spouse, they're going to have to obtain the social security number of the spouse and put that on the qualifying coverage entirely list. And regardless of whether or not a particular Medicare beneficiary is being claimed or attempted to be claimed by a plan sponsor for subsidy, Medicare still does assign a unique number to every Medicare beneficiary. And that's not necessarily based on his or her social security number. There's an algorithm and it's too complicated to explain here, but there is a logic to how your Medicare number, your health insurance claim number, HIC number we've been referring to, is defined and it's all depending on you and your spouse and a series of events that happen that could affect your entitlement or ability to enroll in certain aspects of Medicare A and B. When you apply for the subsidy in year two, do you need to set up all of the roles of bank information, plan options, et cetera, again? Or is it saved and accessible to select again for the year two application? Could I see the question? I'm so sorry. We were having kind of a little slide. I'm sorry. I can take a crack at it and you can fill in when you're ready. We are thinking about some customer friendly type options on the website where you can fill in your application. You can fill in your application. You can fill in your application. You can fill in your application. You can fill in your application. Some customer friendly type options on the website where if things look similar from one year to another, we can pre-populate certain areas of the application so that you're not data entering again. Now, that'll only work, of course, if things haven't changed. Now, we haven't defined those, that functionality yet since we're still dealing with initial applications for day one, August one. But we are thinking about subsequent releases of the website where conceivably certain portions of an application could be carried over and as we define that, we'll be doing a Q&A on it or a fact sheet letting you know what we're thinking about and how we're going to carry information over to make it a little more easy in subsequent years so that you don't keep having the data enter the exact same information again. We are thinking about it. If you file for an application extension, do you also have 30 days extension to send in the retiree list? If you file for an application extension, do you also have 30 days extension to send in the retiree list? The 30-day extension applies to the entire application. The retiree list, the initial retiree list is considered part of the application, so the answer is yes. If the RDS application is submitted timely but incorrect information is found to exist later after September 30, do you have a cure period? I'm not sure if that's referring to retiree list, the portion of the application or other portions of the application. If it's other portions of the application, certain things can be changed after you submit. Others cannot. We have to do that. We have to do that. We have to do that. We have to do that. We have to do that. changed after you submit, others cannot. We just talked about the banking information. There is going to be a facility to allow you to update that. What are some other things that we can change after an application is processed? Contact information for individuals involved, designees can be added or removed, account managers can be changed, authorized reps can be changed. So if that's what's meant I mean you can you can change things or correct things that that are processed with an approved application. Retire list of course will be updated monthly as changes occur and you know of changes. So that's an ongoing thing that's going to happen all the way through the point of reconciliation for a certain plan year. I think also they might be asking if there's an opportunity to correct something on their application. Let's say they just get it in under the filing deadline and there was a typographical error in the EFT information say for the bank account. So our pre-note process to validate that bank account failed. They would have an opportunity since they did submit the application by the filing deadline they would have an opportunity to correct that and resubmit it and not be held to that filing deadline issue. Is that a correct understanding? That's that's how I understand it. I guess I'm just trying to think this through because there's a lot of permutations that can happen operationally as as people are submitting and I'm not sure one thing we haven't considered is if if somebody submits last minute say it's the day before it's even September 30th or if they get an extension it's the last day in October will they be able to withdraw an application correct information and then resubmit and not be considered late. That's a that's a permutation I'm not sure we've thought about any thoughts on that. If not we can deal with it in a Q&A on the website. We need to think that situation. We have to make sure somebody documents that here. I don't I don't know if I guess we can do it. If retiree overrides their part D enrollment rejection and enrolls in part D an employer plan sponsor will still permit retiree to stay in employer plan. How does the employer collect subsidy as secondary payer if the employer subsidy period is closed out? If the retiree overrides their part D enrollment rejection and enrolls in part D an employer plan sponsor will still permit retiree to stay in employer plan. How does the employer collect subsidy as secondary payer if the employer subsidy period is closed out? The employer would not be eligible to collect the subsidy once that retiree enrolls in part D because they no longer meet the definition of a qualifying cover to retiree so there will be no subsidy payment after the part D enrollment. And they could but they could just to clarify and Jim's right but they could claim the plan sponsor could claim subsidy for costs incurred up to the date of that part D enrollment so up to the last day of the month prior to that enrollment. Right, correct. Does DOL PWBA now EBSA agree that 100% of subsidy belongs to employer? Does DOL PWBA now EBSA agree that 100% of the subsidy belongs to the employer? Absolutely. It's clear under the law that the subsidy payment goes to the employer and we've kept Department of Labor in the loop you know rulemaking process and they certainly don't have any issues with that. Fully insured premium by definition does not reflect retiree out of pocket cost sharing. Can an adjustment be made to the premium for this when submitting cost data based on premium? Fully insured premium by definition does not reflect retiree out of pocket cost sharing. Can an adjustment be made to the premium for this when submitting cost data based on premium? That's an excellent question. And the answer is no. You can only use the premium for the basis of your cost but then in reconciliation for final payment the retiree cost sharing will come in to play there because the final payment will be based on cost incurred under the plan and also cost incurred by the cost sharing incurred by the retiree. For audit will employers get requests for claim sets or will you go directly to our health plan carriers? For audit will employers get requests for claim sets or will you go directly to our health plan carriers? Whenever we determine that we've defined a subject for audit, a plan sponsor for audit the communication will go to the plan sponsor including the type of audit it is and of course we're still defining this but we do conceive that that will go that communication will always go to the plan sponsor and it will be essentially be up to the plan sponsor to determine how we are going to get that information and if it's obviously only available at the benefit option administrator's location then if it's an on-site audit we would go there to get it and if it's an electronic desk review kind of audit we would request that information come in from that entity. Will you please provide clarity on subsidy eligibility for non-retiree disables and ESRDs whether participant, spouse or dependent? Would you please provide clarity on subsidy eligibility for non-retiree disabled and ESRDs whether participant, spouse or dependent? I'm going to give a footnote here and then whoever is going to answer this question I will hand it to you. Perhaps some sort of matrix C reverse example I will tell you that you all will not be able to see this. It is going to be passed to Jim. Thank you Jim. I'm going to turn it back. I cannot be expected to answer that in the short period of time. Let me just talk about the end stage renal disease because we haven't addressed that. We make a specific provision in the final rule that end stage renal disease can be counted for the subsidy even during the first 30 months that they are end stage renal disease even though despite the fact in that first 30 month the employer plan will remain primary and Medicare is secondary. That's the one exception we make to the MSP rule there that end stage renal disease can be counted for the subsidy for day one along with the Medicare eligible and not enrolled in part D. Now the first part of the question let me just review it really quickly. Okay. Non-retiree disabled. Now I assume you mean again you can collect a subsidy for disabled depend on their active employment status. And this also applies to the end stage renal disease. If they are actively working you cannot collect the subsidy for those. If they are not working if they don't have current employment status under the MSP rule then you certainly can collect the subsidy for those folks. Now just feeling that out just a little bit more they could be claimed for subsidy by the employer that is the source of their current employment. If they had if they have previously retired from another company then that company could if it meets of course all the criteria to participate in the RDS program could claim that individual as they incur costs that qualify. Right. And in response to this matrix I really appreciate the thought and the effort that went into developing this matrix and we will be issuing guidance on what is the qualifying covered retiree and I actually developed a matrix for that guidance and hopefully we'll be getting that out in a couple weeks. So what I'm going to do is I'm going to take this home with me and I'm going to see if this adds anything to my matrix. So thanks for the question. I really appreciate the effort you put into this. The slides say that payment frequency may not be changed once the application has been submitted and approved. Does this mean never changed or will there be a process to change for a future calendar year? The slides say that payment frequency may not be changed once the application has been submitted and approved. Does this mean never changed or will there be a process to change for a future calendar year. In the annual election, so when every time you have to reapply every plan year, so every plan year you can elect, you have to elect a payment frequency so you can change that for a new plan year. Just a little bit more information. For example, a plan sponsor in their application chooses the monthly payment frequency option. It doesn't mean you have to submit a payment request every month. It means you have the ability to request up to as frequently as monthly. So if you choose, if you're on a calendar year plan and you choose monthly and you don't submit a payment request for the first nine months of the year, in the 10th month of that year you can submit a payment request that would incorporate data for the first ten months of that year and the current month. So you just have to break it out as we showed you what we're thinking in the interim payment requests. It would have to be broken out, the cost that is on a month by month basis. So you can, is there anything we need to add to that? Is Mark in the room please? Mark, you want to come on up. We have now reached the point where we are ready to close this session. Before I turn the podium over to Mark Camelberg to close the RDS National Conference I would like to express my thanks to each of you for your active participation. To our presenters, RDS, CMS and C2 squared staff, a special thanks for your excellent work in planning the conference. To the Wyndham staff, our AV team, our interpreters and Remedy staffing, thank you for a job well done. I wish you a safe journey home and I now introduce Mark Camelberg. I think the only person that hasn't been thanked so far that should be is Charlotte. Thank you for a terrific job for keeping the trains running and all that. I will only keep you another minute. My heartfelt thanks to everybody for coming and for so many of you for sticking around to the very bitter end. I think it's a reflection, I hope, that you thought the information you were receiving was useful, was informative and I think obviously over the course of the last two days we've heard some particularly useful comments back from you and as I said right at the beginning on day one that the reason we are where we are today is because of those insightful and constructive comments that we receive from you folks in the community and obviously the last two days have shown that that in fact will continue. So we really appreciate far more than I could express to you the comments that you've given us. We have a few things that we need to do to think about. Keep your eye on the website and if you're on the employer listserv which I urge people to get on to if they're not already, you'll get updates when there are updates and one last, two last parting comments. One is again harkening back to something I mentioned earlier. All of this is obviously critically important to understand on a going forward basis but it also is a critically important part of all of this is adequate communication with your retirees about what you're planning to do, so they understand what their options are and I again offer my interest in continuing to partner with people out there to understand how you intend to do it and to give you information that might help you do that communication with retirees. The last point is that you all are not alone in this. We want to continue to partner with you throughout this process so I very much hope that we can continue these sorts of discussions even when we've worked through the last details we can continue them in coming weeks and months. So thank you again on behalf of CMS and everybody else that's worked so hard to put together this conference. Thank you and safe journeys. Bye bye.