HomeMy WebLinkAboutIsland Group-Medicare Part D
Date /~(/i1,h
Island Group Administration. Inc
Administrative Service Al!reement
Supplemental Services
Medicare Part D Administration
Island Group Administration, Inc. (administrator) agrees to provide the following additional services for
the Town of South old (client) in conjunction with the client's pharmacy benefit manager for an
additional service fee as expressed below, for the period 1/1/06-12/31/06:
1. Satisfying Creditable Coverage Notice Requirements under Medicare Part D.
2. Preparing Medicare Part D subsidy application(s), including:
~ Assessing drug coverage funding and relevant "benefit options".
~ As the Authorized Representative to register at the Retiree Drug Subsidy web page
maintained by CMS (Medicare), obtain a logon ID, and establish an electronic signature.
~ Serving as the Account Manager for the Subsidy Application, performing the following tasks
within the Retiree Drug Subsidy ("RDS") secure web site maintained by CMS:
- Obtain unique Plan Sponsor ID number
- Obtain unique application ID number
- Provide secure, dedicated e-mail address for CMS communications
- Complete all portions of the Application Form, including General Contact
Information, Qualified Basic Plan Information, Actuary Assignment, Electronic
Fund Transfer, Payment Frequency arrangements, Retiree List Submission with 12
fields of formatted demographic and other information for each Medicare Eligible
Individual.
~ Assist plan actuary in providing electronic actuarial attestation
~ As Authorized Representative provide electronic signature of the Subsidy Application.
3. Receiving and electronically responding to any CMS partial or complete rejections of the Subsidy
Application within the required period.
4. Electronically updating the Retiree file on an ongoing basis, including during Subsidy Payment
process, using the RDS Medicare format.
5. Work with PharmaCare in the preparation and filing of quarterly Subsidy Payment Requests, which
entail the following tasks:
~ Identifying and adjusting for non-Part D drugs.
~ Calculating the subsidy amount for each covered person.
~ Aggregating the individual covered persons subsidy calculations.
~ Electronically submitting cost data for all of the qualifying covered individuals in each
Benefit Option (multiple submissions if multiple Benefit OptionCs), including:
- Aggregate gross retiree costs (drug only) Aggregate threshold ($250) reduction
- Aggregate limit ($5,000) reduction
- Estimated cost adjustments
- Reconciling any changes for the previous payment requests.
~ Providing electronic confirmation to CMS that cost data is to be included in the subsidy
payment request.
~ Reviewing any and all subsidy payment rejections and making any appropriate appeals.
~ Electronically submitting payment request on behalf of the Plan Sponsor.
~ Confirming receipt of Electronic Funds Transfer deposit with plan sponsor.
~ Responding to any questions, demands or denials issued by CMS, which may include;
- Filing a IS-day appeal of a denied subsidy payment
- Requesting a hearing within IS days of a denied appeal
- Requesting a reopening of a denial
6. Working with PharmCare in performing the annual subsidy reconciliation as required by CMS within
IS months after the end of the plan year. This task includes the electronic filing of the following data
for each covered individual for each month
- Subsidy application number
- Unique benefit option identifier applicable to that covered individual for that month
- Covered individuals Social Security number
- Amount of drug costs incurred each month during the plan year
- Covered individual's name, date of birth, and gender
- 12 months' gross retiree costs, threshold reduction, limit reduction, and actual cost
adjustments
- Date and time of data file creation
7. Responding to any questions, demands or denials issued by CMS in connection with annual subsidy
reconciliation. These responses may include:
- Filing a IS-day Appeal of a denied payment
- Requesting a hearing within IS days of a denied Appeal
8. Providing Plan Sponsor upon request with the data and information necessary to assist in the event
the Plan Sponsor is selected by CMS for audit during the six-year period following receipt of a
subsidy payment.
The fee for the aforementioned services will be set at a maximum of 20% of the gross recovery from
Medicare RDS. The Town of South old will receive the subsidy in full, and Island Group Administration will
forward a bill for services performed under this Agreement to the Town for payment. This fee will be
assessed at the time the subsidy is received from RDS.
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Town of South old, Client-Plan Sponsor