Crosswalk

Revisions to Form CMS-685 ESRD Network Semi Annual Cost Report Forms

Issue #	Cell, Column or Row	Action to be performed	Changes to the Spreadsheet	Reason for the Change
	Tab Name	Revise as follows:	Replace: NW Semi Annual With: Network Semi Annual Jan-Jun	Revised for clarification purposes.
	A1	Add the following:	Network Semi Annual Report January-June	Spreadsheet should have a title for 508 purposes.
	A2	Revise as follows:	Replace: RFP Number: With: Contract #	Revised to have a more precise identification number.
	Row 4 Medicare Costs 5 - 8	Revise as follows:	Replace:  5. NETWORK QUALITY IMPROVEMENT PROGRAM, 6. COMMUNITY INFO. & RESOURCES, 7. ADMINISTRATION, 8. INFORMATION MANAGEMENT With: 5. Transition Costs General Requirements (C.3) Patient and Family Engagement (c.4.1.A) Evaluate and Resolve Grievances (C.4.1.B.1) Promote Use of ICH CAHPSs (c.4.1.B3) Address Issues Identified through Data Analysis (C.4.1.B.4) Patient Appropriate Access to in Center Dialysis Care (C.4.1.C) Vascular Access Management (C.4.1.D) Patient Safety: HAIs (C.4.1.E) Population Health Innovation Projects (C.4.2) Support for ESRD QIP & Performance Improvement on QIP Measures (C.4.3.A) Support for Facility Data Submission to CROWNWeb and NHSN (C.4.3.B)	Revised because previous titles are outdated because a new Statement of Work (SOW) has been issued. New titles align to the new SOW.

Issue #	Cell, Column or Row	Action to be performed	Changes to the Spreadsheet	Reason for the Change
5.	Columns C,F,I,L, O, R	Delete	Delete “Hourly Rate” columns	Hourly rates columns have been removed to reduce the burden for ESRD Network reporting these costs. CMS can calculate the hourly rates by dividing the total number of hours by the costs.
6.	Columns T-AA	Delete	Delete columns associated with monthly ESRD Network cost reporting	Certain ESRD Network contracts were previously cost-reimbursement contracts and therefore, required monthly reporting. However, currently all ESRD Network contracts are fixed-priced. As a result, less frequent (Semi Annual) cost reporting is required. Columns associated with monthly cost are no longer needed.
7.	Tab SIMS Semi Annual	Delete	Delete SIMS Semi Annual spreadsheet	No longer applicable
8.	Tab COMB. NW & SIMS	Delete	Delete Combination Network SIMS spreadsheet	No longer applicable
9.	Row 23 & 28	Delete	Delete Additional Positions and Temporary Labor rows	Break out is no longer needed for type of position. Instead CMS is requiring that each staff person is included in the form.
10.	Direct Labor (Column A)	Add 2 rows	Add to cell A25: 18. Name (Position) Add to cell A26: 19. Name (Position)	Revised to allow for additional ESRD Network staff.
11.	Direct Labor (Column A)	Add 1 row	Add to cell A27:Additional Staff (Attach Schedule)	Revised to allow for additional ESRD Network staff.
12.	Direct Labor (Column A)	Add 1 row	Add to cell A28: 21. OT and Bonuses (attach Schedule)	Added an overtime and bonus line.in order to segregate regular salary from overtime and awards.
13.	Row 44	Delete	Delete e.name row	CMS experience has shown that four rows for subcontractor names are sufficient.

Issue #	Cell, Column or Row	Action to be performed	Changes to the Spreadsheet	Reason for the Change
14.	Row 61	Delete	Delete TOTAL COSTS WITH FEE	The “Total costs with fee” row has been removed to reduce the burden for ESRD Network reporting these costs. CMS can calculate fee/profit by subtracting total costs from the contract award amount.
15.	Spreadsheet	Add	Another Spreadsheet that is the same format as the Network Semi Annual Jan-June spreadsheet	CMS added the spreadsheet to ensure that 12 months of costs are available within one Excel workbook verses needing to review two separate Excel workbooks.
16.	Tab Name for second spreadsheet	Add	Tab name: Network Semi Annual July-Dec	See explanation under 15 above explaining the need for a tab for each of the 6 month reporting periods. The tab name reflects the applicable 6 month reporting period
17.	Column AD and AE	Add	Cumulative total columns for base contract hours and costs	Added column for the purpose of summing the total base contract costs and hours for the two reporting periods (Jan –June) and (July – Dec).
18.	Columns AF and AG	Add	Cumulative total columns for base contract and special projects hours and costs	Added column for the purpose of summing the total base contract/special project costs and hours for the two reporting periods (Jan –June) and (July – Dec).
19.	A1	Add the following:	Network Semi Annual Report July-December	Spreadsheet should have a title for 508 purposes.

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