Cross Walk for Budget Forecast

Revisions Crosswalk (Form 276-16)

Budget Forecast

Note: In the Changes to Application column, the quoted words are what are to be entered. Example in issue #1 is “Blank”; do not enter the words that explain the change and that are outside of the quotations.

Issue #	Page #	Section	Action to be performed	Changes to the Application	Reason for the Change
	Worksheet S	Part 2, Reporting Period	Change date	FROM date should be changed from 1/1/2014 to “Blank” (show an input field).	To allow plans manual entry of the correct reporting period.
	Worksheet S	Part 2, Reporting Period	Change date	TO date should be changed from 12/31/2014 to “Blank” (show an input field).	To allow plans manual entry of the correct reporting period.
	Worksheet S	Certification by Officer of the plan, Row 48	Remove language	“…, except as noted” from the certification sentence.	This it to update the assertion, it should not include exceptions.
	Worksheet S	Row 59	Change form number	Change form number 276-08 to “276-16”.	To reflect the most recent change in the form number/year.
	Worksheet S	Disclaimer, Row 63	Change line to read:	Old: '24 hours to complete the budget forecast, 80 hours to complete the fourth quarter and final cost reports, and 12 hours to complete the first, second, and third quarterly reports; New: “'24 hours to complete the budget forecast, 80 hours to complete the 4th quarter and final cost reports, 4 hours to complete the semi-annual Interim, and 0 hours to complete the first,”	To reflect the updated cost report filing requirements.
	Worksheet S	Disclaimer, Row 64	Change line to read:	Old: and (2)for HCPPs, 16 hours to complete the budget forecast, 60 hours to complete the final cost report, and 8 hours to complete the mid-year report. If you have any comments New: “second, and third quarterly reports; and (2)for HCPPs, 16 hours to complete the budget forecast, 60 hours to complete the final cost report, and 4 hours to complete the semi-annual”	To reflect the updated cost report filing requirements.
	Worksheet S	Disclaimer, Row 65	Change line to read:	Old: concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, N2-14-26, Baltimore, Maryland New: “Interim report. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard,”	To reflect the updated cost report filing requirements.
	Worksheet S	Disclaimer, Row 66	Change line to read:	Old: 21244-1850 and to the Office of the Information and Regulatory Affairs, Office of Management and Budget, Washington, D.C. 20503. New: “Mail Stop C3-14-16, Baltimore, Maryland 21244-1850 and to the Office of the Information and Regulatory Affairs, Office of Management and Budget, Washington, D.C. 20503.”	To reflect the updated cost report filing requirements.
	Entire Worksheet A	Column C (excel column C)	Formatting change	Increase width size of excel Column C from 21 to “33”.	Increase column width to make sure that content is fully readable.
	Worksheet A, Part I	Part 2, Period From, Row 10	Change date	Change the input field from old 01/01/2012 to “Blank” (show an input field).	To allow plans to input the dates rather than updating this field each time we update the cost report.
	Worksheet A, Part I	Part 2, Period To, Row 11	Change date	Change the input field from old 12/31/2012 to “blank” (show an input field).	To allow plans to input the dates rather than updating this field each time we update the cost report.
	Worksheet A, Part II	Column Titled “Pay% (Ln13*Pt.IV, Col2,Ln4)”, Line 14	Change line to read	“Medicare Primary Rate (Ln13*Pt.IV, Ln4)”	To reflect Medicare Primary Rate
	Worksheet A, Part II	Line 12, Column 5	Changing formula	Change formula to: “=H88-H86”.	Due to issue #20, the lines that summed the columns had to be updated.
	Worksheet A, Part II	Line 14, Column 6	Adding a new formula	The blank cell should include the following formula: “=ROUND(I56*I99,4)”	To reflect the Medicare Part A PMPM costs
	Worksheet A, Part II	Line 14, Column 6,	Change formatting	Change the cell color from gray to “no color”	This will be a calculated field now, for consistency, we want it to show no color.
	Worksheet A, Part II	Line 14, Column 7,	Adding a new formula	The blank cell should include the following formula: “=ROUND(J56*J99,4)”	To reflect the Medicare Part B PMPM costs
	Worksheet A, Part II	Column 7 Line 14	Change formatting	Change the cell color from gray to “no color”	This will be a calculated field now, for consistency, we want it to show no color.
	Worksheet A, Part II	Line 14, Column 5	Formula change	This formula now adds Column 6, Line 14 and Column 7, Line 14 and rounds the total to 4 decimals.	Due to change #14 & #16, this field will just sum the two new formulas.
	Worksheet A, Part I & II	Row 60	Change form number	Change form number “276-08” to “276-16”.	To reflect the most recent change in the form number/year.
	Worksheet A, Part III	Old Line 10 – “Mental Health Copayment PMPM”	Remove	Remove this line entirely	This is a CMS change in Mental Health Services Coinsurance Percentage. Note that the Mental Health limitation no longer exists as of 2014, and Medicare will pay outpatient mental health services at the same level as other standard Part B Services.
	Worksheet A, Part III	Column Titled “Part B Costs less Deductibles (lines 7 minus sum of Lines 8 thru 10)”, New Line 10	Move line	Old Line 11 – “Part B Costs less Deductibles (lines 7 minus sum of Lines 8 thru 10)” will be moved to Line 10.	Due to issue #20, Line 11 needs to be renumbered and moved to a new Line 10.
	Worksheet A, Part III	Old Line 11, New Line 10	Change numbering to:	“10” This change occurs on the far left and far right side of this line.	Due to issue #20, Line 11 needs to be renumbered and moved to a new Line 10.
	Worksheet A, Part III	Old Line 11, New Line 10, Column 3	Formula change:	The formulas in these cells include an additional line. Formula needs to be updated from: Old: =+J80-SUM(J81:J83)”to New: “=+J80-SUM(J81:J82)”.	Due to issue #20, the lines that summed the columns had to be updated.
	Worksheet A, Part III	Old Line 11, New Line 10	Change line to read:	“Part B Costs less Deductibles (lines 7 minus sum of Lines 8 and 9)”.	Due to issue #20, reference to line 10 had to be removed.
	Worksheet A, Part III	Old Line 12, New Line 11	Move line	Old Line 12 – “Part B Coinsurance (line 11 times 20%)” will be moved to Line 11.	Due to issue #20, Line 12 needs to be renumbered and moved to a new Line 11.
	Worksheet A, Part III	Old Line 12, New Line 11	Change numbering to:	“11” This change occurs on the far left and far right side of this line.	Due to issue #20, Line 12 needs to be renumbered and moved to a new Line 11.
	Worksheet A, Part III	Old Line 12, New Line 11	Change line to read:	“Part B Coinsurance (Line 10 times 20%)”	Due to issue #20, reference to Line 11 had to be replaced with Line 11.
	Worksheet A, Part III	Old Line 13, New Line 12	Move line	Old Line 13 – “Part B Coinsurance on Carrier Paid Bills PMPM (Attach Worksheet)” will be moved to Line 12.	Due to issue #20, Line 13 needs to be renumbered and moved to a new Line 12.
	Worksheet A, Part III	Old Line 13, New Line 12	Change numbering to:	“12” This change occurs on the far left and far right side of this line.	Due to issue #20, Line 13 needs to be renumbered and moved to a new Line 12.
	Worksheet A, Part III	Old Line 13, New Line 12	Change line to read:	“Part B Coinsurance on MAC Paid Bills PMPM (Attach Worksheet)”	To reflect the correct 3rd party payer, CMS now refers to the Carrier and Intermediaries as MACs. Coinsurance is paid by the MACs.
	Worksheet A, Part III	Old Line 14 – “Part B Coinsurance on Intermediary Paid Bills PMPM (Attach Worksheet)”	Remove	Remove this line entirely	Intermediaries no longer pay the coinsurance.
	Worksheet A, Part III	Old Line 15 - “Total Deductible and Coinsurance (Sum of Lines 3, 8, 9, 10, 12, 13 and 14)”	Move line	Old Line 15 – “Total Deductible and Coinsurance (Sum of Lines 3, 8, 9, 10, 12, 13 and 14)” will be moved to Line 13.	Due to issue #31, Line 15 needs to be renumbered and moved to a new Line 13.
	Worksheet A, Part III	Old Line 15, New Line 13	Change numbering to:	“13” This change occurs on the far left and far right side of this line.	Due to issue #31, Line 15 needs to be renumbered and moved to a new Line 13.
	Worksheet A, Part III	Old Line 15, New Line 13, Column 1	Formula change:	The formulas in these cells include additional lines. Formula needs to be updated from: Old “=+H74+H81+H82+H83+H86+H87+H88” to New “=+H74+H81+H82+H85+H86”.	Due to issue #20 & #31, the lines that summed the columns had to be updated.
	Worksheet A, Part III	Old Line 15, New Line 13, Column 3	Formula change:	The formulas in these cells include an additional line. Formula needs to be updated from: Old: =+J81+J82+J83+J86+J87+J88 New: “=+J81+J82+J85+J86”	Due to issue #20, the Total Deductible and Coinsurance formula had to be updated.
	Worksheet A, Part III	Old Line 15, New Line 13	Change line to read:	“Total Deductible and Coinsurance (Sum of Lines 3, 8, 9, 11 and 12)”	Due to issue #20 & #31, the lines that summed the columns had to be updated; therefore, reference to deleted cells had to be updated.
	Worksheet A, Part V	Old Row 105, New Row 103	Change line to read:	“PART V - ANNUAL PROJECTIONS”	To reflect a revised purpose of this reporting section. The budget report is now utilized to calculate the annual projection instead of CMS requesting plans to report on semi-annual projections. The Row moved up automatically due to issue #20 and #31.
	Worksheet A, Part V	Header, Columns J, Old Row 104 New Row 102	Change line to read:	“Projection”	Due to change in #31, we need to change the header for consistency.
	Worksheet A, Part V	Line 1	Change line to read:	“Total Medicare Cost Per Capita Rate (Part II, Col 5, Line 13”	To reflect the correct Line reference.
	Worksheet A, Part V	Line 2	Change line to read:	“Total Costs Per Member Per Month (Part II, Col 2, Line 11”	To reflect the correct Line reference.
	Worksheet A, Part V	Line 3	Remove	Remove this line entirely	This line is no longer applicable.
	Worksheet A, Parts III, IV & V	Old Row 115, New Row 110	Change form number	Change form number “276-08” to “276-16”.	To reflect the most recent change in the form number/year.
	Worksheet B	Line 1	Change line to read:	Total deductible and coinsurance (Worksheet A, Part III, Col 1, “Line 13”).	To reflect the correct Line reference.
	Worksheet B	Line 2	Adding a word	Add “Involuntary” to the beginning of line #2.	To specify the type of under or over collection.
	Worksheet B	Line 3	Change line to read:	Medicare Member Months for the period (Worksheet L, Column “2”, Line 10).	To change, for consistency, the Column description from Roman Numeral to Arabic Numeral,
	Worksheet B	Line 22	Change form number	Change form number from “276-08” to “276-16”.	To reflect the most recent change in the form number/year.

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