Crosswalk Document for Changes to IM final

Crosswalk Document for Changes to CMS-R-193

Important Message from Medicare

Submitted for Collection November 2009

Summary of Changes to CMS-R-193

Hospitals have used the Important Message from Medicare (IM) to inform original Medicare, Medicare Advantage, and other Medicare plan beneficiaries who are hospital inpatients about their hospital rights and discharge appeal rights. In particular, the IM provides information about a beneficiary’s right as a hospital inpatient and his or her right to a QIO review of a hospital discharge decision and offers a detailed description of the QIO review process.

This package incorporates minor formatting revisions to the form and the instructions to comply with section 508 accessibility requirements.

The following non-substantive changes have been made to the form and instructions:

• Changes in text style, line spacing, bullets, and line formatting were made to comply with section 508 accessibility reading options.

The following substantive changes have been made to the form and instructions:

• The blank area at the bottom right of page 1 of the form has been changed from “Date” to “Date/Time”. Since there are time limitations within the hospital expedited review process, inclusion of time documentation will facilitate the case review when requested by the beneficiary.

• Existing form instructions for insertion of the date upon signing the notice have been modified to include time, in addition to the date.

The IM is an existing collection and is in use. It is our expectation that the changes to the form and instructions will have little effect on burden for all users. The addition of a time notation on the collection is not expected to affect burden since this collection already requires an enrollee’s signature and date. Adding documentation of the time of day along with the date is a negligible change.

Burden is expected to decrease for hospitals based on the following:

• The availability of a section 508 compliant form for accessibility will prevent hospitals from having to invest their own work and financial resources to create an accessible document.