2007

Disclosure to CMS Form, Instructions and Screen Shots

Explanation of Changes to OMB Approved Package 0938-1013

The Disclosure to CMS Form #10198 and Instructions and Screen Shot documents were approved by OMB on February 1, 2007. The Employer Policy and Operations Group (EPOG) began working with the CBC/ Website Project Management Group (WPMG) and the Disclosure to CMS contractor to move the OMB approved Disclosure to CMS Form, Instructions and Screen Shots to the CMS website. Due to CMS OIS website requirements, the Disclosure to CMS Form was required to be converted into the CMS Stellent website format before loading onto the CMS website. As a result of the changes to the Disclosure to CMS Form into website format, minor modifications were required to be made to the Disclosure to CMS Form such as adding drop down menus. Drop down choices were added under the State field and Type of Coverage field. Due to the change to the drop down list of States, a “Country” field needed to be added so that foreign domiciled entities that offer prescription drug coverage to US Citizens that are Medicare eligible could complete the Disclosure to CMS Form. In addition, due to the change in the format of the Disclosure to CMS Form, EPOG needed to update the Instructions and Screen Shots to provide instructions and screen shots for the new Stellent webpage Disclosure to CMS Form format. EPOG also made some grammar changes to the Instructions, such as capitalizing things and making references to documents, titles and regulations consistent throughout the Disclosure to CMS Form Instructions and Screen Shots document. This improved Stellent format of the Disclosure to CMS Form was posted on April 1, 2007 and we have gotten many positive comments that the Disclosure to CMS Form is easier for the public to complete. EPOG has not posted the Instructions and Screen Shots document because we need to have this document approved by OMB under OMB No. 0938-1013.