Crosswalk

2016 High Level Summary of Change or Crosswalk of Changes for
PRA Package CMS 10237: Part C - MA and 1876 Cost Plan Expansion Application

Revision/Clarification

1. Edits to entire document including the
addition of missing words, clarifying
language, capitalization, deletion of missing
spaces, and final dates

Purpose of the
Revision/Clarification

2014 Part C
Application

TECHNICAL CHANGES
To maintain a consistent format and
Entire
provide accurate timeframes and
Document
instructions.

Application
Section

Level of
Applicant
Burden
I=
Category Increases
burden
of
Comment D –
Decreases
burden
N – No
Change

All Sections

N/A

N

3.1

60-day

N

SUBSTANTIVE CHANGES
2. Revised attestation #3 to section 3.1 of
application: The Applicant attests that it
has at least 5,000 individuals enrolled for
the purpose of receiving health benefits
from the organization; or it has at least
1,500 individuals enrolled for purposes of
receiving health benefits from the
organization and the organization primarily
serves individuals residing outside of
urbanized areas as defined in §412.62(f)).
If the Applicant attests No, the
organization must submit a Minimum
Enrollment Waiver Request by uploading

This attestation was revised because
we are removing the option for the
applicant to select Not Applicable
(N/A). The only acceptable
attestation response to this attestation
will be either “yes” or “no.” If an
applicant meets the requirement as
set forth in §422.514(a), then they
would select “yes.” If an applicant is
unable to meet the requirements set
forth in §422.514(a), then they will
1

Section 3 Attestations

Experience &
Organization
History

2016 High Level Summary of Change or Crosswalk of Changes for
PRA Package CMS 10237: Part C - MA and 1876 Cost Plan Expansion Application

Revision/Clarification

the Minimum Enrollment Waiver Request
Upload Document and any supporting
documentation.
Note: The Applicant may count members
enrolled in other risk based health insurance
products offered by the organization (e.g.,
commercial, Medicaid).
Note: Your Minimum Enrollment Waiver
Request will only be considered once you
have met ALL application requirements.

3. Added Minimum Enrollment Waiver
Upload Document

Purpose of the
Revision/Clarification

2014 Part C
Application

Application
Section

Level of
Applicant
Burden
I=
Category Increases
burden
of
Comment D –
Decreases
burden
N – No
Change

select “no”. If the applicant selects
“no” to attestation #3 then the
organization must submit a Minimum
Enrollment Waiver Request by
uploading the Minimum Enrollment
Waiver Request Upload Document
and any supporting documentation.
If the applicant selects “no” and does
not upload this document then they
will receive a “NOT MET” for
failure to upload a Minimum
Enrollment Waiver Request.
The Minimum Enrollment Waiver
Section 3 Request Upload Document is being
Attestations
provided to applicants to complete in
support of their Minimum Enrollment
Waiver Request. It contains five
questions, four of which require an
2

3.2

Experience &
Organization
History

60-day

N

2016 High Level Summary of Change or Crosswalk of Changes for
PRA Package CMS 10237: Part C - MA and 1876 Cost Plan Expansion Application

Revision/Clarification

Purpose of the
Revision/Clarification

affirmative response. All five
questions request supporting
explanation/documentation if
applicable (if the applicant responds
“yes” to a question we request that
they provide support for the
affirmation). CMS considers this as
no change in burden due to the fact
that it helps the applicant understand
and complete the section accurately.
4. Added language to the Payment Information No language was provided in the
Form section stating that the Payment
application informing applicants of
Information form and supporting
when the Payment Information Form
documentation must be submitted to CMS
and supporting documentation was
by the date the Completed Applications are due.
due to CMS.
5. Deleted the upload requirements for the
applicant to complete and upload the “CMS
Contract Sample Matrix,” the “CMS
Provider Contract Required Provision

The upload requirements were
removed from section 3.9 because
CMS will no longer request a sample
of Provider Participation Contracts &
3

2014 Part C
Application

Section 1 –
General
Information

Application
Section

Level of
Applicant
Burden
I=
Category Increases
burden
of
Comment D –
Decreases
burden
N – No
Change

60-day

N

60-day

D

1.7 D Payment
information form

Section 3.9 and
CMS Provider
Section 8.3
Participation
Contracts and

2016 High Level Summary of Change or Crosswalk of Changes for
PRA Package CMS 10237: Part C - MA and 1876 Cost Plan Expansion Application

Revision/Clarification

Matrix” and the provider contracts that
CMS would name during the application
review process.

6. Deleted the upload requirements for the
applicant to complete and upload the “CMS
Administrative/Contracting Required
Provision Matrix,” and ”executed
administrative management contracts or
letters of agreement for each contractor or
subcontractor (first tier, downstream, and
related entities).”
7. Deleted attestation number 5 “Applicant has
submitted and received CMS approval for
an initial or service area expansion
application during at least one of the past
two (2) Medicare Advantage application

Purpose of the
Revision/Clarification

Agreements for review. CMS will
still require applicants to complete
the attestations in this section. CMS
continues to hold the MAO
responsible for the compliance of its
providers and subcontractors with all
contractual, legal, regulatory, and
operational obligations.
The upload requirements were
removed from section 3.10 because
CMS will no longer be reviewing
Contracts for Administrative and
Management Services.

This attestation was deleted because
the upload requirement for applicants
to submit “executed administrative
management contracts or letters of
agreement for each contractor or
4

2014 Part C
Application

Application
Section

Level of
Applicant
Burden
I=
Category Increases
burden
of
Comment D –
Decreases
burden
N – No
Change

Agreements

Section 3.10
and Section 8.4 Contracts for
Administrative and
Management
Services

60-day

D

Section 3.10

60-day

D

Contracts for
Administrative and
Management
Services

2016 High Level Summary of Change or Crosswalk of Changes for
PRA Package CMS 10237: Part C - MA and 1876 Cost Plan Expansion Application

Revision/Clarification

Purpose of the
Revision/Clarification

2014 Part C
Application

Application
Section

Level of
Applicant
Burden
I=
Category Increases
burden
of
Comment D –
Decreases
burden
N – No
Change

review cycles.”

subcontractor (first tier, downstream,
and related entities).”
HSD INSTRUCTIONS, TABLES AND EXCEPTION PROCESS
1. Deleted the requirement to collect the
CMS no longer needs to collect the
CMS Certification Number (CCN) from CCN number.
the MA Facility and HSD instructions.
The CCN verifies the facility is
Medicare certified and for what type of
service.
APPENDIX I: Solicitations for Special Needs Plan (SNP) Proposal

MA Facility
Table and
HSD
Instructions

N/A

60-day

D

1. Removed “C-SNP, D-SNP and I-SNP
Proposal application” sections

APPENDIX I:
Solicitations
for Special
Needs Plan
(SNP)
Proposals

APPENDIX I:
sections 1, 4 and 7

60-day

N

To be consistent with the electronic
application which does not require
this information.

5

2016 High Level Summary of Change or Crosswalk of Changes for
PRA Package CMS 10237: Part C - MA and 1876 Cost Plan Expansion Application

Revision/Clarification

Purpose of the
Revision/Clarification

2. Removed C-SNP, D-SNP and I-SNP
Service area sections

To be consistent with the electronic
application which does not require
this information.

3. Removed C-SNP upload document

To be consistent with the electronic
application which does not require
this information.

6

2014 Part C
Application

Application
Section

APPENDIX I:
Solicitations
for Special
Needs Plan
(SNP)
Proposals
APPENDIX I:
Solicitations
for Special
Needs Plan
(SNP)
Proposals

APPENDIX I:
sections 2, 5, and 8

APPENDIX I:
section 13

Level of
Applicant
Burden
I=
Category Increases
burden
of
Comment D –
Decreases
burden
N – No
Change
60-day
N

60-day

N