Federal regulations at 42 CFR § 423.800 specify the requirements of Part D sponsors in the administration of the low-income subsidy program, including the reduction of cost sharing for subsidy-eligible individuals. In certain cases, CMS systems do not reflect a beneficiary's correct low-income subsidy (LIS) status at a particular point in time. As a result, the most up-to-date and accurate subsidy information has not been communicated to the Part D plan.

To address these situations, CMS created the best available evidence (BAE) policy in 2006. This policy requires sponsors to establish the appropriate cost-sharing for low-income beneficiaries when presented with evidence that the beneficiary's information is not accurate.

Please look through the downloads area below for materials related to the CMS BAE policy.

Click the selection that best matches your information needs.  Please check back, as we will continue to update this page as additional materials are issued.

Downloads
CMS RO BAE Contacts (v10.31.08) [ZIP, 8KB] Memo: Clarified BAE Guidance (v08.04.08) [PDF, 96KB] BAE Assistance Worksheet (v08.12.08) [ZIP, 4.73KB] Memo: Part D Guidance - Low-Income Subsidy (LIS) Status Corrections Based on Best Available Evidence (v06.27.07) [PDF, 234KB] Memo: Medicaid Status for Part C and D Risk Adjustment and Part D Cost Sharing Implementation Status for 2008 Payment (v11.27.07) [89.9 PDF] Reminder on BAE Policy (v11.01.07) [4.75KB, ZIP] Memo: Reconciling CMS Low-Income Subsidy (LIS) Status and "Best Available Data" Policy for 2006 and 2007 (v12.06.06) [91.7KB, PDF]
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Page Last Modified: 11/03/2008 9:36:53 AM
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