CMS-10191 Self Disclosure Report

Attachment VI - Self Disclosure

Issue
Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23

Description of Issue
Including Root Cause

Date Disclosed

To Whom Was It
Reported

# of Members Impacted

Description Of Correction(s) Made,
Including Timelines

Attachment VI - Self Disclosure

Actions Taken To Resolve Negatively
Impacted Beneficiaries, Including
Outreach Description and Status

Date Outreach
Date Outreach
and Remediation and Remediation
Initiated
Completed