Summary of Public Comments

High-Level Summary of Changes to the Part C Application for the 2013 Application Season
(from 60-day to 30-day comment period)

Revision

2013 Part C
Application

Purpose of the Revision

Application Section

Category of
Comment

Level of
Applicant
Burden
I=
Increases
burden
D–
Decreases
burden
N – No
Change

Section 2.4

60 day

N

GENERAL INFORMATION AND INSTRUCTIONS
1. Revised section 2.4 Applicant Seeking to Offer
Special Needs Plans (SNPs) (page 15) to state:
"New and expanding SNPs must complete and
timely submit a separate SNP proposal. Existing
SNPs that require re-approval under the NCQA
SNP Approval process should only submit their
Model of Care written narrative, Model of Care
Matrix Upload Document and will not be required
to submit any other portion of the MA application
or SNP proposal, unless specifically noted (e.g.,
in the instructions for submission of contracts
with State Medicaid Agencies). Please refer to
APPENDIX I: Solicitations for Special Needs
Plan (SNP) Proposals for specific instructions
and details".
High level edits to entire
document including addition of missing words,
capitalization, deletion of missing spaces and
renumbering.

Clarification

General
Information

1

High-Level Summary of Changes to the Part C Application for the 2013 Application Season
(from 60-day to 30-day comment period)
ATTESTATIONS
2. Revised Attestation #2 to read:
"Applicant is in compliance with all State
requirements and is not under any type of
supervision, corrective action plan, or special
monitoring by the State regulator with respect to
financial requirements.”
3. Revised Attestation #10 last bullet to read:
• Acknowledgement of all calls received via an
alternative technology within one business day.

Clarification

Fiscal
Soundness
(3.17)

Attestation #2

60 day

N

To comply with current regulations

Medicare
Operations
(3.12)

Attestation #10.

60 day

N

4. Revised Attestation to read as follows:

Clarification

Claims (3.14)

Attestation #4

60 day

N

Clarification

Appendix 1:
SNP Proposal

Definitions

60 day

Appendix 1:
SNP Proposal

SNP Instructions

“Applicant agrees to give the beneficiary prompt
notice of acceptance or denial of a claim’s
payment in a format consistent with the appeals
and notice requirements stated in 42 CFR Part
422 Subpart M.”

HSD TABLES or INSTRUCTIONS
None

TEMPLATES
None

SNP APPLICATION SECTION
5. "If applicable" was added to each definition
section where the Part D premiums are
indicated.
6. Revised Attestation on page 96 to state: "An
MA organization currently offering a SNP that
requires re-approval under the NCQA SNP
Approval process should only submit its Model
of Care written narrative and Model of Care

Revision/Clarification in response to PRA
comment.

2

N
60 day

N

High-Level Summary of Changes to the Part C Application for the 2013 Application Season
(from 60-day to 30-day comment period)
Matrix Upload Document and will not be required
to submit any other portion of the MA application
or SNP proposal, unless specifically noted (e.g.,
in the instructions for submission of contracts
with State Medicaid Agencies). Any SNP that
received a two- or three- year approval will not
be required to submit any other portion of the
MA application or SNP proposal unless
specifically noted (e.g., to meet the requirement
for contracting with a State Medicaid Agency).
7. Revised Section 14 to state: "Note: Complete
this section if the applicant is currently in
contract negotiations with the State for initial
contracts to amend, update and/or renew an
existing contract for the application year.”
8. Revised Section 15 to state: "Please complete
and upload this document into HPMS per HPMS
MA Application User Guide Instructions for
completed (i.e., signed) contracts with the State
Medicaid Agency. This applies to previously
signed contracts that are still effective because
they are a multi-year contract or an evergreen
contract.”

Clarification

Appendix 1:
SNP Proposal

Section 14

60 day

N

Clarification

Appendix 1:
SNP Proposal

Section 15

60 day

N

3