DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
 
Center for Medicaid and CHIP Services 
 
CMCS Informational Bulletin  
 
DATE:   October 10, 2012  
 
FROM:   Cindy Mann, Director  
Center for Medicaid and CHIP Services (CMCS)  
 
SUBJECT:   Reminder: Annual Reassignments for certain Low Income Subsidy (LIS)                  
Eligible Individuals  
 
Background Information on the CMS Process for Reassigning LIS - Eligible Beneficiaries  
 
Each year, the Centers for Medicare & Medicaid Services (CMS) processes annual reassignments for 
certain LIS-eligible individuals.  This Informational 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.  
 
CMS performs the following tasks to reassign LIS-eligible beneficiaries:  
  Identifying beneficiaries whose LIS eligibility will continue in 2013;  
  Identifying which plans in each Prescription Drug Plan (PDP) region have a 2013 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.gov/Medicare/Eligibility-and-
Enrollment/MedicarePresDrugEligEnrol/Downloads/FINALPDPEnrollmentandDisenrollmen
tGuidanceUpdateforCY2012-REV872012forCY2013.pdf 
  CMCS Informational Bulletin  Page 2 
 
 
  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/Medicare/Eligibility-and-
Enrollment/MedicareMangCareEligEnrol/Downloads/FINALMAEnrollmentandDisenroll
mentGuidanceUpdateforCY2012-Revised872012forCY2013.pdf 
 
CMS Notifications to Beneficiaries  
All beneficiaries in continuing plans received an Annual Notice of Change from their 2012 Part D 
plan by September 30, 2012.  In addition, CMS will mail the following notices to affected 
beneficiaries:  
  PDP Reassignment Notice: In late October 2012, 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 2013.  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 2013, but their PDPs premium will be above the regional LIS benchmark amount in 2013. 
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 2013.  
 
 
  CMCS Informational Bulletin  Page 3 
 
  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 2013 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 2012 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 http://www.cms.gov/Medicare/Prescription-
Drug-Coverage/LimitedIncomeandResources/LIS-Notices-and-Mailings.html 
The model beneficiary letters also will be posted on this Web page, as they become 
available.  
 
State Notification  
In October, CMS will send 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 17, 2012, CMS will send two files, if applicable, to each state.  The first will list the LIS-
eligible individuals in their state who will receive a blue PDP reassignment letter and the second file 
will list the 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 sends 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 on or after October 15.  
 
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.  If you have questions regarding the information presented 
in this bulletin, please contact Tracey Baker (tracey.baker@cms.hhs.gov) or at 410-786-7794. 
 
 
Attachment  
 
  CMCS Informational Bulletin  Page 4 
 
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  Position  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 
 
Data Field   Length  Position  Position  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  
 
  CMCS Informational Bulletin  Page 5 
 
Data Field   Length  Position  Position  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 Web  50  508  ...   557  CHAR    
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  NUMER CCYYMMDD  
Effective Date   IC  
Beneficiarys Part D Premium  3  567  ...   569  CHAR   100, 075, 050, or 
Subsidy Percentage   025  
Beneficiarys PDP Region ID Code   2  570  ...   571  NUMER  
IC  
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  DECIM  
Premium Liability   AL  
Filler   8  696  ...   703  NUMER Zero  
IC  
Beneficiarys Next Years Contract  5  704  ...   708  CHAR    
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  DECIM Used when the premium 
Premium Liability   AL   is 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 
 
   
 
  CMCS Informational Bulletin  Page 6 
 
Re-Assignment State Response Files - Trailer Record 
Data Field   Length   Position   Position  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   NUMER Right justified.  
IC    
Count = Number of detail 
records.  
Filler   758   43   ...   800   CHAR   Spaces  
Record Length =                       800