Crosswalk for Revisions Budget 4-2013 vj508

Revisions Crosswalk (Form 276-08)
Budget Forecast
Note: In the Changes to Application column, the quoted words are what are to be entered. Example in issue #1 is “8”, do not enter the words that
explain the change and that are outside of the quotations.
Issue
#
1.

Page #

Section

Work
Sheet
A, Part
I

Column
Titled “Part I
– Prior Year
Statistical
Data”, Line 8
Columns 1-7,
New Line 8
titled “Part B
Costs Not
Subj. to Coin.

2.

Work
Sheet
A, Part
I

3.

Work
Sheet
A, Part
I

4.

Work
Sheet
A, Part
I

5.

Work
Sheet

Column
Titled “Part I
– Prior Year
Statistical
Data”, New
Line 8
Column
Titled “Part I
– Prior Year
Statistical
Data”, New
Line 9
Column
Titled “Part I

Action to be
performed
Add a new line:

Changes to the Application

Reason for the Change

A new line “8” should be inserted.

This is a CMS change that is
necessary to reflect regulatory
mandated coverage that is now
covered at 100% by Medicare.

This line should look
exactly like Line 7c
and perform the same
functions in each
column:

New Line 8 by column: Column 1 is a data entry field.
Column 2 takes the number entered in Column 1 and
divides it by Column 2, Line 0. Column 3 adds up
Column 4 and 5. Column 4 is blocked out grey (no
data entry is available in this column). Column 5 is
data entry. Column 6 is the ratio of Column 3 divided
by Column 2. Column 7 is blocked out grey as there is
no data entry.
“Part B Costs Not Subj to Coins”

This is a CMS change that is
necessary to reflect regulatory
mandated coverage that is now
covered at 100% by Medicare.

Move line

Old Line 8 – Administrative and General will be
moved to Line 9.

To account for the new Line 8,
Old Line 8 will now be Line 9.

Move line

Old Line 9 – Total Costs will be moved to Line 10.

To account for the new Line 10,
Old Line 9 will now be Line 10.

Change line to read:

This is a CMS change that is
necessary to reflect regulatory
mandated coverage that is now
covered at 100% by Medicare.

Page 1 of 10

Issue
#

6.

6.7.

Page #

Section

A, Part
I

– Prior Year
Statistical
Data”, New
Line 10
Column 1
and 2, Line
10

Work
Sheet
A, Part
I
Work
Sheet
A, Part
II

7.8.

Work
Sheet
A, Part
II

8.9.

Work
Sheet
A, Part
II

9.10.

Work
Sheet
A, Part
II

Action to be
performed

Changes to the Application

Reason for the Change

Formula Change

The formula will sum lines 1 through 9 instead of 1
through 8

The formula had to be changed
because one extra line was added.

Column
Titled “Part
II – Current
Year Cost &
Statistical
Data”, Line 8
Column
Titled “Part
II – Current
Year Cost &
Statistical
Data”, Line 8
Columns 1-7,
New Line 8
titled “Part B
Costs Not
Subj. to
Coins.

Change Title to:

“PART II – BUDGET YEAR COST &
STATISTICAL DATA”

This is a CMS change that is
necessary to better reflect that it is
the budgeted year cost and
statistical data.

Add a new line:

A new line “8” should be inserted titled “Part B Costs
Not Subj to Coins…..”. The original line 8 should be
moved right below this new line See Issue #1

This is a CMS change that is
necessary to reflect regulatory
mandated coverages that are now
covered at 100% by Medicare.

This line should look
exactly like Line 7c
and perform the same
functions in each
column:

This is a CMS change that is
necessary to reflect regulatory
mandated coverages that are now
covered at 100% by Medicare.

Column
Titled “Part
II – Current
Year Cost &
Statistical
Data”, Line

Move Old Line

New Line 8 by column: Column 1 is a data entry field.
Column 2 takes the number entered in Column 1 and
divides it by Column 2, Line 0. Column 3 takes
Column 2 and multiples it by Column 6, Part I.
Column 4 is a data entry line. Column 5 is blocked out
grey (no data entry is available in this column).
Column 6 is Column 5 minus Column 6.
Old Line 8 – Administrative and General will be
moved to Line 10 to better organize Part II of the
budget.

To account for the new Lines in
Part II, A&G will be moved to
Line 10.

Page 2 of 10

Issue
#

Page #

11.

Work
Sheet
A, Part
II
Work
Sheet
A, Part
II

12.

13.

14.

15.

16.

17.

10.18.

Work
Sheet
A, Part
II
Work
Sheet
A, Part
II
Work
Sheet
A, Part
II
Work
Sheet
A, Part
II
Work
Sheet
A, Part
II
Work

Section

Action to be
performed

Changes to the Application

Reason for the Change

Change numbering to:

“11” This change occurs on the far left and far right
side of this line.

Due to issue #8, Line 9 needs to be
renumbered and moved to a new
Line 10.

Column
Titled “Part
II – Current
Year Cost &
Statistical
Data”, New
Line 11
New Line 11,
Columns 1-7

Change line to read:

“Total Costs (Sum Lns. 1-10)…..”

Due to issue #8, the lines that
summed the columns had to be
updated.

Formula Change:

The formulas in these cells now include the additional
line. So, the sum in each of Columns 1-7 are Lines 110

Due to issue #8, the lines that
summed the columns had to be
updated.

Old Line 11,
New Line 12.

Change numbering to:

“12” This change occurs on the far left and far right
side of this line.

Due to issue #8, Line 11 needs to
be renumbered and moved to a
new Line 12.

Old Line 12,
New Line 13

Change numbering to:

“13” This change occurs on the far left and far right
side of this line.

Due to issue #8, Line 12 needs to
be renumbered and moved to a
new Line 13.

Old Line 13,
New Line 14

Change numbering to:

“14” This change occurs on the far left and far right
side of this line.

Due to issue #8, Line 13 needs to
be renumbered and moved to a
new Line 14.

Old Line 12,
New Line 13

Change line to read:

“Medicare Costs (Ln 11 - 12)…..”

Due to issue #8, the lines that
summed the columns had to be
updated.

Part I

Remove:

Remove PART I entirely

This is a CMS change that

10
Old Line 10,
New Line 11

Page 3 of 10

Issue
#

Page #

Section

Action to be
performed

Changes to the Application

Sheet
B

11.19.

Work
Sheet
B

Title in
Upper Right

Remove:

12.20.

Work
Sheet
B

13.21.

Work
Sheet
B

14.22.

Work
Sheet
B

Column
Change Title to read:
Titled “Part
IIUnder/Over
Collection for
Budget
Period”
Old Column
Add:
Titled “Part
IIUnder/Over
Collection for
Budget
Period”(Chan
ged in issue
#21
Old Column
Change line to read:
Titled “Part
IIUnder/Over
Collection for
Budget
Period”, Line
2

“Part I & II”

“DETERMINATION OF BUDGETED
VOLUNTARY UNDER COLLECTION OF
PREMIUMS FOR THE BUDGET PERIOD”
“PREMIUM DETERMINATIONS ARE COVERED
BY THIS PART”

Reason for the Change
removed Part I of the budget. This
is being supplanted by Worksheet
N (Final Cost Report). Part I is no
longer needed.
Due to Issue # 9, there is no need
to have a “Part I or Part II”
because the original “Part I” has
been removed. It should just state
the Worksheet.
This is a CMS change that
renames the title, making it more
specific to what is actually
performed on the Work Sheet.
There is no Part II due to issue #9.

“Period From:________”
“To:________”

This is a CMS change, since it was
removed as a section of Part I,
which needs to be included in this
box. These cells should be locked
and pull the dates from Work
Sheet A, Part I.

“Under (over) collection for the period (Worksheet N,
Col 3, Line 11 or 12b,
respectively)...................................................................
.....”

This is a CMS change that
instructs the user to enter the
proper amount from the right
worksheet and line.

Page 4 of 10

Issue
#
15.23.

Page #

Section

Work
Sheet
B

16.24.

Work
Sheet
B

17.25.

Work
Sheet
B
Work
Sheet
B

18.26.

19.27.

Work
Sheet
B

Action to be
performed
Add a new line:

Changes to the Application

Reason for the Change

Old Column
Titled “Part
IIUnder/Over
Collection for
Budget
Period”, Line
3 (push
original line
3 to line 4)
Column 1,
Add number value:
Line 3 (This
is the new
line 3 that
was added)

“Medicare Member Months for the period (Worksheet
L, Column II, Line
1)….………………..……………………”

This is a CMS change that is
necessary to compare the current
budgeted Member Months to the
prior year Member Months.

Make this an unlocked whole number cell.

Column 2,
Line 3

“XXXXXXXXXXX”

This Cell allows the user to enter
the prior year’s Member Months.
This will be used to calculate a
ratio of Prior Year Member
Months to Current Year Budgeted
Member Months.
This is a CMS change because it is
an unused column for this line

Make X’s out of the
line:

Old Column
Change numbering:
Titled “Part
IIUnder/Over
Collection for
Budget
Period”, Line
4 (This is the
old line 3)
Old Column
Change line to read:
Titled “Part
IIUnder/Over
Collection for

From 3 to “4” (This has to be done on the first & last
column with a blank title)

Due to issue #25, this line needs to
be pushed back to Line 4.

“Ratio of (Wkst B, Col 1, Line 3) to (Wkst A, Part IV,
Col 2, Line1)………………. “

This is a CMS change that shows
where the numbers are coming
from to determine the ratio.

Page 5 of 10

Issue
#

Page #

20.28.

Work
Sheet
B

21.29.

Work
Sheet
B

22.30.

Work
Sheet
B

Section
Budget
Period”, Line
4 (This is the
new line 4
due to issue
#24, which
pushed lines
down)
Column 1,
Line 4 (New
Line 4, old
line 3 that
was moved)
Old Column
Titled “Part
IIUnder/Over
Collection for
Budget
Period”, line
5 (This is the
new line 5,
old line 4 that
was pushed
down due to
issue #24)
Old Column
Titled “Part
IIUnder/Over
Collection for
Budget
Period”, line

Action to be
performed

Changes to the Application

Reason for the Change

Formula change:

The formula under this ratio was changed to pull the
correct numbers from (Wkst B, Col 1, Line 3) to
(Wkst A, Part IV, Col 2, Line1).

This is a CMS change that is
necessary because the formula
changed due to issue #25.

Change numbering
and placement to:

From 4 to “5” (This has to be done on the first & last
column with a blank title)

This is a change due to the
additional line entered from issue
#25.

Change line to read:

“Adjusted Under (Over) Collection for the period
(Line 2 times Line 4).........................................”

This is a CMS change that shows
how to calculate the correct
amount.

Page 6 of 10

Issue
#

Page #

23.31.

Work
Sheet
B

24.32.

Work
Sheet
B

25.33.

Work
Sheet
B

26.34.

Work
Sheet
B

Section
5 (Old line 4,
new line 5
from issue
#24)
Column 2,
Line 5
(Old line 4,
new line 5
from issue
#24)
Old Column
Titled “Part
IIUnder/Over
Collection for
Budget
Period”, Line
5 (Old line 5,
new line 6)
Column
Titled “Part
IIUnder/Over
Collection for
Budget
Period”, Line
6 (Old line 5,
new line 6)
Column 2,
line 6 (Old
line 5, new
line 6)

Action to be
performed

Changes to the Application

Reason for the Change

Change of formula:

This formula now multiplies Line 2 times Line 4.

This is a CMS change that
calculates the correct amount due
to the previous changes to the
form.

Change numbering
and placement to:

From 5 to“6” (This has to be done on the first & last
column with a blank title)

This is a CMS change due to the
additional line entered from issue
#25.

Change line to read:

“Total allowed to be collected during the budget
period (Line 1 plus Line
5)...................................................................”

This is a CMS change that shows
how to calculate the correct
amount.

Change of formula:

This formula now adds line 1 and line 5

This is a CMS change that
calculates the correct amount due
to the previous changes to the
form.

Page 7 of 10

Issue
#
27.35.

Page #

Section

Action to be
performed
Change numbering
and placement to:

Work
Sheet
B

Column
Titled “Part
IIUnder/Over
Collection for
Budget
Period”, Line
6 (Old line 6,
new line 7)

28.36.

Work
Sheet
B

Column
Change line to read:
Titled “Part
IIUnder/Over
Collection for
Budget
Period”, Line
7 (Old line 6,
new line 7)

Changes to the Application

Reason for the Change

From 6 to“7” (This has to be done on the first & last
column with a blank title)

This is a change due to the
additional line entered from issue
#25.

Total amounts to be charged in budget year, including
Medicare enrollee copayments (Attach
Worksheet)...........

This is a CMS change that shows
how to calculate the correct
amount.

Page 8 of 10

Issue
#
29.37.

Page #

Section

Work
Sheet
B

Column
Titled “Part
IIUnder/Over
Collection for
Budget
Period”, Line
7 (Old line 7,
new line 8)

30.38.

Work
Sheet
B

31.39.

Work
Sheet
B

Action to be
performed
Change numbering
and placement to:

Changes to the Application

Reason for the Change

From 7 to“8” (This has to be done on the first & last
column with a blank title)

This is a change due to the
additional lines entered from issue
#25.

Column
Change line to read:
Titled “Part
IIUnder/Over
Collection for
Budget
Period”, Line
7 (Old line 7,
new line 8)

“Budgeted Voluntary under collection for the budget
period (Line 6 minus Line 7)
......................................................................”

This is a CMS change that shows
how to calculate the correct
amount.

Column 2,
Line 8 (Old
line 7, new
line 8)

This formula now subtracts Line 7 from Line 6

This is a CMS change that
calculates the correct amount due
to the previous changes to the
form.

Change Formula:

Page 9 of 10

Issue
#
32.40.

Page #
Work
Sheet
B

Section

Action to be
performed
Line Between Add Formula
Line 7 and 8

Changes to the Application

Reason for the Change

“The Premium entered is greater than the allowed
Premium” appears if Line 7 is greater than Line 6

The “error” message will alert the
plan and CMS reviewer that the
proposed Premium is greater than
the allowed Premium.

Page 10 of 10