Crosswalk

Crosswalk for Creditable Coverage Disclosure to CMS Form
Instructions and Screen Shots (CMS-10198)
Section # on Current CMS10198

Type of Change

Rationale for Change

Header

Deleted ‘Updated: August 1, 2009’

The revision date to the form based
on OMB approval will be included
next to the form number in the
footer

Throughout Document

Added in complete name of
‘Creditable Coverage Disclosure to
CMS Form’ where portions of the
phrase were missing

Corrections for consistency

Page 1

Modified hyperlink

Corrected link

Page 1 and Page 6

Deleted the date in which
Creditable coverage Disclosure to
CMS Guidance was updated

Information is not necessary. Current
guidance is posted on web and
includes effective date

Footer

Added ‘(Updated xx/xxxx)’ and
required OMB/PRA disclaimer

The revision date to the form based
on OMB approval will be included
next to the form number, similar to
the formatting of other CMS forms

Page 3

Minor text changes to correct
references to Federal Register and
Code of Federal Regulations
abbreviations

Adjusted to correct edits and make
more understandable by end reader

Page 5

Changed ‘health insurance issuers’
and ‘entities’ to ‘Plans’

Corrections to fix parallel structure
and ensure accuracy

Page 6

Adjusted language in item #2 to
reflect actual submission. Added
example.

Improve clarity and understanding

Page 6

Reworded sentence regarding
weblink to online tool; fixed link

Improve clarity and understanding;
correct link

Page 6

Modified language to address
ability to receive hard copy of
form in the event an entity does
not have Internet access by
contacting CMS. Clarified that
information collected in the form
is tailored based on the responses
provided. Removed link to
webpage as reference to the form
instructions.

Improve clarity and options for
completing Form. Link is unnecessary
when individual is reading the
document.

Page 8

Added Steps as shown in actual
online form. Clarified when
additional information is required
based on provided responses

Improve clarity and understanding

Page 9

Added note indicating that the
numbers used to describe the
various fields in the instructions
do not appear in the online Form.

Improve clarity and use while in the
tool

Page 9

Added information regarding the
proper name an entity should
submit when completing the form

Improve clarity and understanding

Page 9

Deleted note in section 5a and
adjusted language in 5b to clarify
proper actions entity should take
when completing the form

Language in 5a was duplicative to 5b
and improve clarity and
understanding

Page 10

Adjusted language to indicate that
entities should not include
individuals being claimed under
Retiree Drug Subsidy. Deleted
phrase about Medigap plans
offering prescription drug
coverage

Removed duplication among multiple
sentences. Fixed inaccuracy.

Page 10

Minor text edits to clarify proper
steps when completing the form

Improve clarity and understanding

Page 10

Removed section 9a header

Combined 9a and 9b into one section
to remove duplication and increase
understanding

Page 11

Removed section 9b header and
first couple sentences

Combined 9 a and 9b into one
section to remove duplication and
increase understanding

Page 11

Adjusted the sentence regarding
the definition of Retiree Drug
Subsidy

Eliminate duplication with the
previous sentence

Page 12

Correct the name of the
Creditable Coverage Disclosure to
CMS Guidance and weblink

Corrected errors

Page 12

Adjusted the sentence regarding
the definition of Retiree Drug
Subsidy

Eliminate duplication with the
previous sentence

Page 13

Correct the name of the
Creditable Coverage Disclosure to
CMS Guidance and weblink

Corrected errors

Page 13

Changed that if the date is not
entered following the online
format, it will result in an error
message

Improve clarity and understanding

Page 13

Created new subheader for 13a –
13c; adjusted language in 13a and
13b to indicate steps the entity
must take to correctly complete
the form. Deleted inaccurate text

Corrected errors; improve clarity and
understanding

Page 14

Adjusted language in 13c to
indicate steps the entity must take
to correctly complete the form.
Deleted inaccurate text

Corrected errors; improve clarity and
understanding

Page 14

Adjusted language in termination

Improve clarity and understanding

of a plan or option to explain the
proper steps the entity needs to
take to complete the form
Page 14

Changed that if the date is not
entered following the online
format, it will result in an error
message

Improve clarity and understanding

Page 15

Adjusted language in termination
of a plan or option to explain the
proper steps the entity needs to
take to complete the form

Improve clarity and understanding

Page 15

Removed section E header

Corrected inaccuracy; there is no
section E in the form

Page 16

Clarified the proper action if an
entity selects “clear all fields” in
the online form

Improve clarity and understanding

Page 16

Updated CMS response language
for the submission confirmation
message displayed in the online
Form

Correct inaccuracy

Page 17

Corrected weblinks

Correct inaccuracy

Page 18

Deleted incorrect weblink

Correct inaccuracy

Page 19

Added introductory text prior to
the screen shots to explain their
purpose and provide a disclaimer
that they may not be used for an
official submission to CMS by an
entity

Improve clarity and understanding

Page 19 – 35

Added in figure titles to explain
the screen shots presented, added
in subheaders to explain which
part/step of the online tool the

Update images for accuracy and
improve clarity and understanding

screen shots were referring;
added in new screen shots
Page 35 -37

Deleted old screen shots

Screen shots no longer represent the
actual online tool