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LORI HULSE MONTEFUSCO
ASSISTANT TOWN ATTORNEY
lori.montefusco@town.southold.ny.us
SCO'IT A. RUSSELL
Supervisor
PATRICIAA. FINNEGAN
TOWN ATTORNEY
patricia.finnegan@town.southold.ny.us
KIERAN M. CORCORAN
ASSISTANT TOWN ATTORNEY
kieran.corcoran@town.southold.ny.us
Town Hall Annex, 54375 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1939
Facsimile (631) 765-6639
OFFICE OF THE TOWN ATTORNEY
TOWN OF SOUTHOLD
MEMORANDUM
To:
Ms. Elizabeth A. Neville, Town Clerk
From:
Lynne Krauza
Secretary to the Town Attorney
Date:
July 27,2006
Subject:
Medicare Part D - Retiree Drug Subsidy Distribution
Agreement for NYSHIP Participating Employers
For your records, I am enclosing the original, fully executed Agreement in
connection with the referenced matter. Also attached is a copy of the resolution
authorizing Scott to sign same.
If you have any questions, please do not hesitate to call me. Thank you
for your attention.
Ilk
Enclosures
cc: Mr. John Cushman, Comptroller (w/encls.)
Medicare Part D
Retiree Drug Subsidy Distribution Agreement
for NYSHIP Participating Employers
The New York State Department of Civil Service (the Department) shall administer the Medicare
Part D Retiree Drug Subsidy (RDS) on behalf of each participating employer (the Employer) in
the New York State Health Insurance Program (NYSHIP). The Department shall provide to each
Employer its RDS based upon the actual drug utilization of each employer's qualified enrollees
based upon the enrollment information provided by the Employer. In order to effect this
distribution, the Department ~e Employer: (" ,\ (A _ /'l
(Insert Agency Neme) t!J / 1\/ h t..J.D. 4~ d
(Insert Agency Code) (13 ((7 7 '"-) . agree to the following:
1. The DEPARTMENT shall be responsible for all aspects of administering the
RDS with the Centers for Medicare and Medicaid Services (CMS), including
but not limited to, filing RDS applications and providing required
documentation.
2. The DEPARTMENT shall, as soon as practicable, submit enrollment and
claims data to the CMS for the purpose of claiming the RDS subsidy
attributable to NYSHIP enrolled individuals deemed by CMS to be eligible for
such subsidy. The enrollment data used for claiming the RDS shall be that
maintained by the Employer; it is the responsibility of the Employer to ensure
that its enrollment data as it appears in the New York Benefit and Enrollment
System (NYBEAS) is accurate.
3. The DEPARTMENT shall distribute to the Employer any Medicare Part D
RDS amount due the Employer for its qualified enrollees under the NYSHIP
as soon as practicable after such funds are received from CMS. The
distribution shall be made in the form of a credit to the Employer's monthly
NYSHIP bill.
4. The monthly RDS credit applied to an Employer's bill shall be based on the
Department's calculation of each Employer'S share of the RDS paid to the
DEPARTMENT by CMS. The actual amount due each Employer will be
based upon the results of an audit conducted by CMS not more than 15
months after the end of each calendar year. Any adjustments to the
Employer's RDS amount as the result of such audit shall be made as soon as
practicable by the DEPARTMENT as a credit to the Employer's monthly bill if
the original RDS amount was underpaid or as a charge to the Employer's
monthly bill if the original RDS amount was overpaid.
r: :~":~,. t..l,"J'''!J
5. In the event the Employer withdraws or is expelled frd\r1''f-.NSHlP;, t~iamoonf"~~!'
of any underpayment(s) of the RDS for prior years ideb!iiie.O,lbr,lOlugh..tJUl.~i~ ;";;;',
process shall be made by the DEPARTMENT to the Employer within 30-days
following the completion of such audit provided that there are no outstanding
balances due to the Department by the Employer.
Page 1
6. In the event the Employer withdraws or is expelled from NYSHIP, the
Employer agrees that the amount of any overpayment(s) of the RDS for prior
years identified through the audit process shall be transmitted to the
Department within thirty (30) days of receipt of a notice calling for such
payment. The EMPLOYER agrees that in the event it fails to, or is unable to,
transmit the amount due as required hereinabove, it shall be subject to the
withholding of any allotment, apportionment, or payment of local assistance
aid, education aid, or any other state aid as appropriated as determined by
the Comptroller of the State of New York in an amount equal the amount of
such default as determined by the DEPARTMENT.
7. The audit findings of CMS and/or the Department shall be the sole basis for
determining the amount of any RDS overpayment or underpayment.
8. This agreement shall be deemed executory only to the extent of monies
available to the DEPARTMENT from the Medicare Part D RDS and no liability
shall be incurred by the DEPARTMENT beyond the monies available for the
purposes hereof.
IN WITNESS WHEREOF, the parties have executed this agreement on the dates
indicated.
APPROVE~:
BY: re~
CHIEF ISCAl OFFICER OR DESIGNEE
PARTICIPATING EMPLOYER
DATE: .s /31 /iJ(;'
APPROVED:
B~~~
NEW YORK STATE DEPARTMENT
OF CIVil SERVICE
DATE: 71shz
I
ACKNOWLEDGEMENT:
d
SWORN TO BEFORE ME THIS ...!/ day
of 'fi)nt ' 20~.
~~
ACKNOWLEDGEMENT:
SWORN TO BEFORE ME THIS ) 1 day
of ;r A1 ' 20.Q{...
)~~7J~/-
JEFfREY M. BRAUDE
NGlalY Public, Slate of New v01'fI
Qualnied in Albany Co. No. 02BR614061l9
Commission Expires Jan. 3D, 20-1..!L
LINDA J COOPER
NOTARY PUBUC, State of New York
NO. Of C0482251l3, Suffolk C~~"'!;
Term Expires December 31, 2
Page 2
'-\~-
RESOLUTION 2006-506
ADOPTED
DOC ID: 1902
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2006-506 WAS
ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON
JUNE 6, 2006:
RESOLVED that the Town Board of the Town of Southold hereby authorizes and directs
Supervisor Scott A. Russell to execute the Medicare Part D Retiree Drue Subsidy
Distribution Aereement for NYSHIP Participatioe Emplovers, subject to the approval of the
Town Attorney.
ar~CfCl.Q-;p..
Elizabeth A. Neville
Southold Town Clerk
RESULT: ADOPTED [UNANIMOUS)
MOVER: William P. Edwards, Councilman
SECONDER: Daniel C. Ross, Councilman
AYES: Wickham, Ross, Edwards, Russell, Krupski Jr.
ABSENT: Louisa P. Evans