Crosswalk CMS-10427

Crosswalk for Changes to For-Profit PACE Study (CMS-10427)

Section on Original CMS-10427 (04/12) Submission	Subsection on Original CMS-10427 (4/4/12) Submission	Type of Change	Rationale for Change
PART A: Supporting Statement for Paper Reduction Act Submission	A. Justification 1. Circumstances Making the Collection of Information Necessary	Changed the number of for-profit PACE plans in program from 2 to 4	The number of plans changed after date of original submission and was updated in the document to reflect this.
PART B: Supporting Statement for Collection of Information Employing Statistical Methods	2. Procedures for the Collection of Information b. Statistical Precision and Minimum Detectable Differences	Changed number of not-for-profit PACE sites from nineteen to eleven	Previously, the number of distinct sites was counted separately. However, some of these sites were satellite offices of a site and changed as a single site.
Appendix A: Advance Mailing To PACE Enrollees	Exhibit A.1 Advance Letter to PACE Enrollees	Added an area to name the specific PACE program in the letter to beneficiaries	In Pennsylvania, the PACE name belongs to another organization; therefore the state refers to PACE as LIFE programs. The addition of the specific PACE program in the letter to beneficiaries will provide the beneficiaries with more information to understand the purpose of the project.
Appendix B: For-Profit PACE Study PACE Survey	A. Medical Care Question 8	Changed survey question from: “In the past year, did (you/SAMPLE MEMBER) ask the PACE center for help with transportation to take (you/him/her) to or from the PACE center?” to: “In the past year, did (you/SAMPLE MEMBER) receive help with transportation to take (you/him/her) to or from the PACE center?”	Transportation to PACE may be part of the care planning process for patients. The question was modified to reflect this.
Appendix B: For-Profit PACE Study PACE Survey	A. Medical Care Question 14	Changed survey question from: “In the past year, did you try to make any appointments for (yourself/SAMPLE MEMBER) to see a specialist doctor outside of the PACE center?” to: “In the past year, did (you/SAMPLE MEMBER) think (you/he/she) needed to see a specialist doctor, either inside or outside of the PACE center?”	PACE program staff may make specialist appointments on behalf of the patient. The question was modified to reflect this.

The remainder of the changes is minor updates to improve the documents and reflect the most current dates and status.