CMS has incorporated into its CHIP state plan model template (OCN 0938-0707; CMS-R-211) three OMB-approved subject-specific templates. When we last submitted the model template and Supporting Statement for OMB review/approval, we did not explicitly state that we were incorporating the three templates into the model template. Consequently, CMS has revised the model template’s Supporting Statement to clarify that the three subject-specific templates have been incorporated into the model template. CMS is also requesting that OMB discontinue the OCNs of the subject specific templates, which include:
OCN 0938-1075: State Option for Supplemental Dental-only Coverage
OCN 0938-1076: Implementation of Required Dental Benefit Coverage in Separate CHIP Programs
OCN 0938-1068: State Option Pre-print to Include Pregnant Women
The burden hours and costs of the subject specific templates are incorporated into the unified estimates for the revised model template as reflected in the Supporting Statement. There is no net change to the burden hours or cost estimates.
In addition, upon review of the model template as previously submitted to OMB, we noticed it contained many clerical and typographical errors. CMS is taking this opportunity to make technical corrections to the template as non-substantial changes. These changes are listed in a separate crosswalk document.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Mitch |
| File Modified | 0000-00-00 |
| File Created | 2021-01-30 |