CMS Pub. 100-18, ch. 13, App. E

In order to establish the correct premium, cost sharing and deductible levels with

the correct effective dates for current, prior, and prospective enrollees, Part D

sponsors should refer to the Weekly/Monthly Transaction Reply Report (TRR).

The Weekly and Monthly TRRs provide full replacement Low Income Subsidy

(LIS) profiles to plans in response to Part D enrollments and PBP changes as well

as any LIS change that impacts a Part D enrollment period. Therefore, the TRR is

the definitive source of LIS eligibility information. Unlike much of the data

provided in the TRR, LIS eligibility information is not based on current payment

month (CPM) reporting.

Changes in LIS Data Reporting

Sponsors may now submit BAE assistance requests to CMS through the Health

Plan Management System’s Complaints Tracking Module (CTM). See Section

70.5.3 - Part D Sponsors’ Responsibility When BAE is not available.

(Other Sources of LIS Data)

Although the TRR has become the primary source of LIS eligibility information,

plans will continue to receive a number of reports and/or data sources containing

LIS information. While each of these files may contain some LIS information

about sponsors’ enrollees, none of these contain the comprehensive LIS profile

that is provided on the TRR.

1. Batch Completion Status Summary (BCSS): This report is in response to plan

submitted transactions. Because it is not provided for CMS generated transactions

(i.e., auto/facilitated enrollments), it is not intended to be a source of LIS data.

2. Low Income Subsidy/Late Enrollment Penalty Data File: This data file

contains beneficiary level low income subsidy and the late enrollment penalty

payment and adjustment details. Late enrollment penalty details are provided for

direct bill beneficiaries only.

3. LIS/Part D Premium Data File : This data file displays beneficiaries from the

premium profile table who have a low income designation. It is provided on a bi -

weekly basis and is the reference file that is used to determine the LIS Match Rate.

4. LIS History Data File (LISHIST): This report provides a comprehensive list of a

sponsor’s current LIS membership. The data on each beneficiary spans the most

recent 36 consecutive months of contract enrollment. Near year end, this report

will also inform plans whether beneficiary is LIS in the next calendar year.

5. Weekly LIS Activity History (LISAHD): This report informs plans holding

current, prior, and prospective enrollments that some element of LIS changed

during the beneficiary’s enrollment in the contract.

In addition to using data in the regularly issued reports above, in December of

each year, Part D sponsors should consult the one-time Loss of Subsidy File. This

file reports those who have lost their deemed status for the following calendar

year. The TRC used for this special file type is TRC-996, and the record layout is

F.30 in the PCUG appendices. See: https://www.cms.gov/Research-Statistics-

Data-and-Systems/CMS-Information-technology/mapdhelpdesk/Plan_Communications_User_Guide.html