DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, MD 21244-1850 
 
Center for Medicaid, CHIP, and Survey & Certification 
 
CMCS Informational Bulletin 
  
 
DATE:  October 14, 2011 
 
FROM:  Cindy Mann, Director 
  Center for Medicaid, CHIP and Survey and & Certification (CMCS) 
 
SUBJECT:  Reminder: Annual Reassignments for certain Low Income Subsidy (LIS)eligible 
Individuals   
 
CMCS CONTACT: Tracey Baker, 410-786-7794, tracey.baker@cms.hhs.gov 
 
In June, the Centers for Medicare & Medicaid Services (CMS) started the process of annual 
reassignments for certain LIS-eligible individuals and issued a June 29, 2011, Informational 
Bulletin laying out the steps in that process. This is the second of two Bulletins about this 
process for 2011.  This Bulletin provides an update on the next steps in the process to ensure that 
States understand their role in ensuring that dual eligible beneficiaries have timely, affordable, 
and comprehensive coverage under the Medicare Part D prescription drug benefit.   
Background Information on the CMS Process for Reassigning LIS - Eligible Beneficiaries 
 
CMS performs the following tasks to reassign LIS-eligible beneficiaries: 
 
  Identifying beneficiaries whose LIS eligibility will continue in 2012; 
  Identifying which plans in each PDP region have a 2012 premium at or below the LIS 
benchmark for that region (or have volunteered to waive a de minimis amount above the 
benchmark);  
  Identifying non-renewing PDPs and Medicare Advantage (MA) plans; 
  Confirming that beneficiaries are assigned to plans in their region of residence, based on 
State Medicare Modernization Act (MMA) files; and,  
  Determining which individuals are subject to reassignment. In general, we reassign only 
full subsidy individuals who have not chosen a plan on their own in the past.  In the case 
of plan non-renewals, we reassign all individuals with full or partial subsidies. 
 
For your information, detailed guidance and additional information can be found in following 
documents: 
 
  Section 40.1.5 of Chapter 3 (Eligibility, Enrollment, and Disenrollment) of the Medicare 
Prescription Drug Benefit Manual, available on the Web at: 
http://www.cms.hhs.gov/MedicarePresDrugEligEnrol/ 
 
    Section 40.1.8 of Chapter 2 (on Enrollment and Disenrollment) of the Medicare Managed 
Care Manual (Chapter 2), available on the Web at: 
http://www.cms.gov/MedicareMangCareEligEnrol/ 
 
  Guidance memo entitled 2012 Reassignment of Low-Income Subsidy Beneficiaries in 
PDPs dated September 1, 2011, available on our website at: 
http://www.cms.gov/PrescriptionDrugCovContra/01_Overview.asp#TopOfPage 
 
CMS Notifications to Beneficiaries  
 
All beneficiaries in continuing plans received an Annual Notice of Change from their 2011 Part 
D plan by September 30, 2011.  In addition, CMS will mail the following notices to affected 
beneficiaries: 
 
  PDP Reassignment Notice:  In late October 2011, CMS will mail blue notices to all 
LIS beneficiaries who will be reassigned to a new PDP because the plan into which they 
were previously auto-enrolled will have a premium above the regional LIS benchmark; or 
their current PDP is terminating.  
 
  MA Reassignment Notice:  Also in late October, CMS will mail blue notices to all 
LIS beneficiaries enrolled in an MA plan that is terminating or has a service area 
reduction.  These individuals will also be assigned to PDPs.  
 
Unless individuals make an election on their own, they will be automatically assigned to the plan 
identified in the notice. To assist them in making an election, both of these blue reassignment 
notices will include a list of locally available plans that have no premium liability for people 
eligible for the full premium subsidy in 2012.  Beneficiaries can use this information to compare 
their plan options.  Except in plan termination situations, the notice also will inform them of the 
new monthly premium amount, if they stay in their current Part D plan.    
 
  Choosers Notice:  In early November, CMS will mail tan notices to LIS beneficiaries 
who are in a PDP in which they will have a premium liability, but are not being 
reassigned by CMS because they actively chose their current plan.  These so-called 
choosers voluntarily elected their current PDP (that is, they were not auto-enrolled, 
facilitated-enrolled, or reassigned into their current PDP by CMS) and will qualify for 
100 percent premium subsidy in 2012, but their PDPs premium will be above the 
regional LIS benchmark amount in 2012.  Like the blue reassignment notice, the tan 
choosers notice will inform them of the new monthly premium amount for which they 
will be liable if they stay in their current PDP and include a list of PDPs that have no 
premium liability for people eligible for the full premium subsidy in 2012. 
 
  Affordable Care Act (ACA) Formulary Notice:  In December, CMS will mail a 
second blue notice to all LIS beneficiaries who will be reassigned to a new PDP.  This 
includes those reassigned in the PDP and MA reassignments processes referenced above.  
This second notice will identify which drugs in their current drug regimen are covered in 
the 2012 plan to which they are being reassigned, and how to request an exception to 
obtain a drug that is not included in the plans formulary. 
 
  CMS has created a guide to 2011 Part D mailings sent from CMS, Social Security and the plans.  
This guide will summarize each notices message, explain when it will be sent, and include the 
color of the paper on which the notice will be printed.  This guide is available on our Limited 
Income and Resources Web page at 
https://www.cms.gov/limitedincomeandresources/downloads/2011mailings.pdf . The model 
beneficiary letters also will be posted on this Web page, as they become available. 
State Notification 
 
This month, CMS sent to each State files containing the names of individuals who have been  
reassigned in order to assist States in providing effective customer service to affected 
beneficiaries.  On October 7, CMS  sent a file to each State listing the LIS-eligible individuals in 
their State who will receive a blue PDP reassignment letter.  On October 14, CMS sent a second 
file to each state listing LIS-eligible individuals who will receive a blue MA reassignment letter.  
Customer service representatives at 1-800-MEDICARE will be prepared to answer questions 
about the reassignment process and about beneficiaries full range of options.  In addition, plan 
information will be available at www.medicare.gov.   
 
The reassignment files that CMS sent to States will contain a list of full duals, partial duals, 
Supplemental Security Income (SSI)-only eligible individuals, and approved LIS applicants 
residing in their State who will be receiving blue notices from CMS informing them that they 
will be reassigned.  Individuals whom a State Pharmaceutical Assistance Program has requested 
that CMS carve-out of the reassignment process, under its authority to enroll on behalf of its 
members, will not be included in this file.  This exclusion will ensure that such beneficiaries are 
reassigned only once.  The file format is attached.  These reassignments will subsequently appear 
on your normal monthly MMA response file starting October 19.  
 
Thank you for your continued assistance with our efforts to ensure that low-income Medicare 
beneficiaries, including dual eligibles, maintain affordable and comprehensive coverage under 
the Medicare Part D prescription drug benefit.   
 
Attachment 
 
 
 
 
 
   
  Attachment A  State Reassignment File Layout  
 
Exchange Name: SRA (State Response) 
(where x can be H for header and T for trailer) 
Re-Assignment State Response Files - Header Record 
Data Field  Length  Position  Format  Valid Values 
Header Code  8  1  ...  8  CHAR  SRA for re-assign state 
notification file. 
Sending Entity  8  9  ... 16  CHAR  CMS      
(CMS + 5 spaces) 
File Creation Date  8  17  ... 24  CHAR  CCYYMMDD 
Date file was created. 
File Control Number  9  25  ... 33  CHAR  Spaces 
Filler  767  34  ... 800  CHAR  Spaces 
Record Length =   800           
 
Re-Assignment State Response Files - Detail Record 
Data Field  Length  Position  Format  Valid Values 
Record Type  3  1  ...  3  CHAR  DTL 
Beneficiarys Health Insurance  12  4  ...  15  CHAR    
Claim  
Beneficiarys SSN  9  16    24  CHAR  Filled with Spaces if the 
SSN is not present. 
Representative Payee Name  44  25  ...  68  CHAR    
Beneficiarys First Name  12  69    80  CHAR   
Beneficiarys Middle Name  1  81    81  CHAR   
Beneficiarys Last Name  28  82  ...  109  CHAR  Last name starts in position 
83 if a middle initial is 
present. Last names that 
exceed the length will have 
the last characters dropped. 
Beneficiarys Address Line 1  40  110  ...  149  CHAR  Filled with the Address 
Beneficiarys Address Line 2  40  150  ...  189  CHAR  Filled with the Address, if 
available. 
Beneficiarys Address Line 3  40  190  ...  229  CHAR  Filled with the Address, if 
available. 
Beneficiarys Address Line 4  40  230  ...  269  CHAR  Filled with the Address, if 
available. 
Beneficiarys Address Line 5  40  270  ...  309  CHAR  Filled with the Address, if 
available. 
Beneficiarys Address Line 6  40  310  ...  349  CHAR  Filled with the Address, if 
available. 
Beneficiarys City  26  350    375  CHAR  Filled with the City  
Filler  1  376    376  CHAR  Spaces 
Beneficiarys State  2  377    378  CHAR  Filled with the State Code 
Filler  1  379    379  CHAR  Spaces 
Beneficiarys Zip Code  10  380  ...  389  CHAR  Filled with the Zip Code 
Beneficiarys Next Years  50  390  ...  439  CHAR   
Organization Marketing Name  
  Data Field  Length  Position  Format  Valid Values 
Beneficiarys Next Years Plan  50  440  ...  489  CHAR   
Name  
Beneficiarys Next Years Plan  18  490  ...  507  CHAR   
Member Services Toll-Free 
Number  
Beneficiarys Next Years Plan  50  508  ...  557  CHAR   
Web Address  
Beneficiarys LIS Subsidy Co- 1  558  ...  558  CHAR 
1 - high co-pay 
Payment Category 
2 - low co-pay 
3 - no co-pay 
4 - 15%  
Beneficiarys Next Years Assign  8  559  ...  566  NUMERIC  CCYYMMDD   
Effective Date  
100, 075, 050, or 
Beneficiarys Part D  3  567  ...  569  CHAR 
025 
Premium Subsidy 
Percentage 
Beneficiarys PDP Region ID  2  570  ...  571  NUMERIC   
Code 
Beneficiarys Current Years  50  572  ...  621  CHAR   
Organization Name  
Beneficiarys Current Years Plan  50  622  ...  671  CHAR   
Name  
Beneficiarys Current Years Plan  18  672  ...  689  CHAR   
Member Services Toll-Free 
Number  
Beneficiarys Current Years Plan  6  690    695  DECIMAL   
Premium Liability 
Filler  8  696    703  NUMERIC  Zero  
Beneficiarys Next Years  5  704    708  CHAR   
Contract Number 
Beneficiarys Next Years PBP  3  709    711  CHAR   
Number 
Beneficiarys Current Years  5  712    716  CHAR   
Contract Number 
Beneficiarys Current Years PBP  3  717    719  CHAR   
Number 
Beneficiarys Next Years Plan  6  720    725  DECIMAL  Used when the premium is 
Premium Liability  increasing, decreasing, or 
remaining the same amount 
that is above the 
benchmark for the 
following year.  
 
Contains next years 
premium for the current 
plan. 
Filler  75  726  ...  800  CHAR  Spaces 
Record Length =   800           
 
   
  Re-Assignment State Response Files - Trailer Record  
Data Field  Length  Position  Format  Valid Values 
Trailer Code  8  1  ...  8  CHAR  TRL for re-assign state 
notification file. 
Sending Entity  8  9  ...  16  CHAR  CMS       
(CMS + 5 spaces) 
File Creation Date  8  17  ...  24  CHAR  CCYYMMDD 
Date file was created. 
File Control Number  9  25  ...  33  CHAR  Spaces 
Record Count  9  34  ...  42  NUMERIC  Right justified. 
 
Count = Number of detail 
records. 
Filler  758  43  ...  800  CHAR  Spaces 
Record Length =   800