Crosswalk document for Changes to
Instructions and Form CMS-416
Changes to the Form CMS-416
Line 12 of the form was revised to delete lines 12d, 12e and 12f. Due to changes that will be necessary to the CMS-416 under the Children’s Health Insurance Program Reauthorization Act of 2009 for data reported April 1, 2011, CMS had decided not to require States to collect this data at this time.
Changes to the Form CMS-416 Instructions
The instructions for section D. have been updated to reflect the availability of an electronic submittal process for the form CMS-416 and periodicity schedule. A hard copy submittal of the form is no longer required.
The instructions for Line 6 have been updated to reflect that State or local codes are no longer allowable and to acknowledge the January 1, 2009 code update by the American Academy of Pediatrics. Codes 99431 and 99432 have been deleted and codes 99460, 99461 and 99463 replace those codes.
Change in Burden
There is no change in burden for States to complete the form.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | CMS |
| File Modified | 0000-00-00 |
| File Created | 2021-02-03 |