Crosswalk of Changes

Crosswalk Document for Changes to CMS-10095

Notice of Medicare Non-Coverage and

Detailed Explanation of Non-Coverage – Spanish Translations

Submitted June 2011 (Abbreviated Process)

Summary of Changes to CMS-10095 (Spanish Translation)

Background NOMNC - DENC

Skilled nursing facilities (SNF), home health agencies (HHA), and comprehensive outpatient rehabilitation facilities (CORF) providers must deliver written notice to Medicare enrollees no later than two days in advance of the proposed termination of Medicare-covered services. Advance notice is provided to an enrollee through the Notice of Medicare Non-Coverage (NOMNC).

If the enrollee submits a timely appeal of the termination decision to a Quality Improvement Organization (QIO), the plan must send a detailed notice to the QIO and the enrollee describing the reasons Medicare services should end. This detailed explanation is provided to the enrollee using the Detailed Explanation of Non-Coverage (DENC).

The notice requirements meet the regulatory requirements set forth at 42 CFR 422.624(b) and 422.626(e)(1)-(5). The purpose of the NOMNC and DENC is to help Medicare enrollees decide the rationale for terminating Medicare-covered services and whether and how to pursue an appeal.

OMB approved CMS-10095 on 10/29/2010; the English/Spanish versions of the NOMNC/DENC expire on 10/31/2013.

CMS is seeking OMB’s approval of minor updates to the Spanish translations of the NOMNC and DENC (described below). The English versions of the NOMNC and DENC and corresponding form instructions, also part of this package (CMS-10095), do not require updates at this time.

The proposed changes to the Spanish versions of the NOMNC and DENC 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 NOMNC and DENC require editorial fixes for consistency with the English versions of these notices.

Proposed Changes:

Notice of Medicare Non-Coverage (NOMNC)

1. Fixed Formatting: “Bolding” of the Titles and minor spacing issues

2. Fixed Typos: For example, first bullet on the page, added “de” before Medicare. Under “Cómo solicitar una apelación inmediata” replaced “La QIO” with “El QIO.”

3. Under “How to Ask For an Immediate Appeal,” (3^rd bullet) – Fixed the following error:

• Current English version states “The QIO will notify you of its decision as soon as possible, generally no later than the effective date indicated above.”

• Currently Spanish version informs beneficiaries the QIO will inform you of its decision as quickly as possible…two days after the end of the effective date of the notice.

• Proposed Fix to Spanish version parallels the current English version: “El QIO le notificará sobre su decisión tan pronto como sea posible, por lo general no más tarde de la fecha de vigencia de esta notificación.”

Detailed Explanation of Non-Coverage (DENC)

1. Fixed Formatting: “Bolding” of the Titles and minor spacing issues

2. Fixed Typos: For example –

   • First page, first two paragraphs, replaced “debe” with “deben.”

   • Second bullet, last paragraph, replaced  “política” (which means politics or politican) with “pólizas” (which means policy).