Crosswalk

Crosswalk for Changes to Imposition of Cost Sharing under Medicaid and Supporting Regulations

Contained in 42 CFR Sections 447.50 – 57 (CMS-R-53)

Section
OMB# 0938-1148
Cost Sharing Amounts –
Categorically Needy Individuals
(Attachment 4.18-A, page 1)

Cost Sharing Requirements
(Attachment 4.18-A, page 2)

Type of Change

Rationale for Change

Conversion of previous preprints
into a fillable PDF format.
Information now collected on
PDF G2a.

Conversion allows for simplified
data input and improved
electronic submission through
the MMDL system. As a result of
the revisions to the templates,
there will be little if no increase
in burden estimates because it is
expected that although the
structure and content has been
revised, the type and amount of
information required to be
submitted by the States is much
the same, if not less because
much of the information that
was previously entered by the
state is now prepopulated,
which will require less time and
for state, as well as reduce errors
that require back and forth
between CMS and the state.

Conversion of previous preprints
into a fillable PDF format.
Information now collected on
PDF G1.

Conversion allows for simplified
data input and improved
electronic submission through
the MMDL system. As a result of
the revisions to the templates,
there will be little if no increase
in burden estimates because it is
expected that although the
structure and content has been
revise, the type and amount of
information required to be
submitted by the States is much
the same, if not less because
much of the information that
was previously entered by the
state is now prepopulated,
which will require less time and
for state, as well as reduce errors
that require back and forth
between CMS and the state.

Added a section for the state to

This information related to non-

Section
OMB# 0938-1148

Type of Change
indicate if they charge cost
sharing for preferred drugs and
non-emergency use of the ED.
Added a section for the state to
attest that they meet the public
notice requirements of 42 CFR
447.57.

Cost Sharing Limitations
(Attachment 4.18-A, page 3)

Conversion of previous preprints
into a fillable PDF format.
Information now collected on
PDF G3 .

Added a section related to the
5% aggregate limit on cost
sharing and for the states to
indicate how they track an
individual’s cost sharing.

Rationale for Change
preferred drugs and noonemergency use of the ED has
always been collected from
states but not in a streamlined
an efficient manner. This will
allow for more efficient review
of SPAs and reduce the need for
time consuming interactions
with the states to collected
information needed to ensure
the state is in compliance with
the statute and regulations.
Conversion allows for simplified
data input and improved
electronic submission through
the MMDL system. As a result of
the revisions to the templates,
there will be little if no increase
in burden estimates because it is
expected that although the
structure and content has been
revise, the type and amount of
information required to be
submitted by the States is much
the same, if not less because
much of the information that
was previously entered by the
state is now prepopulated,
which will require less time and
for state, as well as reduce errors
that require back and forth
between CMS and the state.
This information related to the
aggregate limit has always been
collected from states but not in a
streamlined an efficient manner.
This will allow for more efficient
review of SPAs and reduce the
need for time consuming
interactions with the states to
collected information needed to
ensure the state is in compliance
with the statute and regulations.

Section
OMB# 0938-1148
Cost Sharing Amounts –
Medically Needy Individuals
(Attachment 4.18-C, pg 1)

Cost Sharing Amounts –
Medically Needy Individuals
(Attachment 4.18-C, pg 2)

Type of Change

Rationale for Change

Conversion of previous preprints
into a fillable PDF format
Information now collected on
PDF G2b.

Conversion allows for simplified
data input and improved
electronic submission through
the MMDL system. As a result of
the revisions to the templates,
there will be little if no increase
in burden estimates because it is
expected that although the
structure and content has been
revise, the type and amount of
information required to be
submitted by the States is much
the same, if not less because
much of the information that
was previously entered by the
state is now prepopulated,
which will require less time and
for state, as well as reduce errors
that require back and forth
between CMS and the state.

Conversion of previous preprints
into a fillable PDF format.
Information now collected on
PDF G1.

Conversion allows for simplified
data input and improved
electronic submission through
the MMDL system. As a result of
the revisions to the templates,
there will be little if no increase
in burden estimates because it is
expected that although the
structure and content has been
revise, the type and amount of
information required to be
submitted by the States is much
the same, if not less because
much of the information that
was previously entered by the
state is now prepopulated,
which will require less time and
for state, as well as reduce errors
that require back and forth
between CMS and the state.

Added a section for the state to
indicate if they charge cost
sharing for non-preferred drugs

This information related to nonpreferred drugs and noonemergency use of the ED has

Section
OMB# 0938-1148

Type of Change
and non-emergency use of the
ED.
Added a section for the state to
attest that they meet the public
notice requirements of 42 CFR
447.57.

Cost Sharing Amounts –
Limitations
(Attachment 4.18-C, pg 3)

Cost Sharing amounts - Targeting

Rationale for Change
always been collected from
states but not in a streamlined
an efficient manner. This will
allow for more efficient review
of SPAs and reduce the need for
time consuming interactions
with the states to collected
information needed to ensure
the state is in compliance with
the statute and regulations.

Conversion of previous preprints
into a fillable PDF format.
Information now collected on
PDF G3.

Conversion allows for simplified
data input and improved
electronic submission through
the MMDL system. As a result of
the revisions to the templates,
there will be little if no increase
in burden estimates because it is
expected that although the
structure and content has been
revise, the type and amount of
information required to be
submitted by the States is much
the same, if not less because
much of the information that
was previously entered by the
state is now prepopulated,
which will require less time and
for state, as well as reduce errors
that require back and forth
between CMS and the state.

Added a section related to the
5% aggregate limit on cost
sharing and for the states to
indicate how they track an
individual’s cost sharing.

This information related to the
aggregate limit has always been
collected from states but not in a
streamlined an efficient manner.
This will allow for more efficient
review of SPAs and reduce the
need for time consuming
interactions with the states to
collect information needed to
ensure the state is in compliance
with the statute and regulations.
This information was previously
collected on a preprint that is
sun setting (Attachment 4.18-F)
This new template allows the

Section G2c developed for
identification of specific group or
groups of individuals targeted
for cost sharing

Section
OMB# 0938-1148

Type of Change

Rationale for Change
information to be collected from
states in a more streamlined an
efficient manner. This will allow
for more efficient review of SPAs
and reduce the need for time
consuming interactions with the
states to collect information
needed to ensure the state is in
compliance with the statute and
regulations.

Attachment 4.18-B

No change

Attachment 4.18-D

No change

Attachment 4.18-E

No change

N/A – Subject matter is not
addressed in this fillable Pdf
N/A – Subject matter is not
addressed in this fillable Pdf
N/A – Subject matter is not
addressed in this fillable Pdf