Crosswalk of Changes

Crosswalk Document for Changes to CMS-10003

Notice of Denial of Medical Coverage – Spanish Translation

Submitted June 2011 (Abbreviated Process)

Summary of Changes to CMS-10003 (Spanish Translation)

Background - NDMC

Medicare health plans are required to issue the Notice of Denial of Medical Coverage (NDMC) when a request for a medical service is denied in whole or in part. This notice informs beneficiaries of the reasons their request was denied and of their right to file an appeal. Medicare health plans, including Medicare Advantage plans, cost plans, and Health Care Prepayment Plans (HCPPs), are required to use this standardized notices. (42 CFR 422.568 and Chapter 13 of the Medicare Managed Care Manual.)

OMB approved CMS-10003 on 10/29/2010; the currently approved English/Spanish versions of the NDMC expire on 10/31/2013.

CMS is seeking OMB’s approval of minor updates to the Spanish translation of the NDMC (described below). The English version of the NDMC and English/Spanish version of the Notice of Denial of Payment and corresponding form instructions, also part of this package (CMS-10003), do not require updates at this time.

The proposed changes to the Spanish version of the NDMC are not expected to affect the amount of time required to prepare an individual notice.

Rationale for Changes

CMS recently learned the currently approved Spanish version of the NDMC requires editorial fixes for consistency with the English version of the NDMC.

Non-substantive changes to NDMC:

1. First full Paragraph (under “¿Qué ocurre si no estoy de acuerdo con esta decisión?): Editorial fixes required (e.g., replaced “el aviso” with “este aviso”).

2. Second bullet (“appeal rights”):  Replaced language to indicate “with” (as opposed to “without”) support.  (Replaced “el apoo.” with “rấpida sin el.”)

3. Reference to form number at bottom of NDMC: Replaced language to accurately describe “form number.” (Replaced “Formularies” with “Formulario de”.)