Crosswalk Interim

Revisions Crosswalk (Form 276-16)

Interim Reporting

Note: In the Changes to Application column, the quoted words are what are to be entered. Example in issue #2 is “276-16”, 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	Certification by Officer of the plan, Row 48	Remove language	Removed “…,except as noted” from the certification sentence.	This it to update the assertion, it should not include exceptions.
	Work Sheet S	Row 59	Change form number	Changed form number 276-08 to “276-16”.	To reflect the most recent change in the form number/year
	Work Sheet 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.
	Worksheet C	Row 3	Add a subtitle	Added “PART I – COSTS”	For consistency we are adding a subtitle.
	Worksheet C	Part I, Line 11	Change line to read:	Old: Appropriate ratio from budget forecast (Worksheet A, Part I) New: “Applicable Projection Ratio from Budget Forecast (Worksheet A, Part V, Column 2, Line 2)”	To provide clarification to the cost plans, regarding what needs to be included on this line.
	Worksheet C	Row 33	Change form number	Changed form number …276-08… to “276-16”.	To reflect the most recent change in the form number/year

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