Crosswalk

DRAFT – 12/6/16

Crosswalk of changes to 1932(a) SPA Preprint
CMS-PM-10120; OMB No: 0938-0933

A

Old
Section

A

Type of Change 1
Added PCCM entity language to first sentence
At end of Section A, added reference to new Appendix A for
Compliance Dates, and clarification that compliance
assurances are for no later than the applicable compliance
dates (see sentences beginning “Where the state’s
assurance…”)
Added references in left column to 42 CFR 438.2 (definitions)
and 438.6 (special contract provisions related to payment)
Under MCO, added compliance assurance about 42 CFR
438.6 regarding special contract provisions related to
payment.

B
B1

B

Deleted detailed assurance about bonus/incentive payments
(42 CFR 438.6(c)(5)(iv) - which the assurance text had
indicated was for PCCM, but actually had only applied to
MCO). As above, MCO section now has general compliance
assurance regarding 438.6 instead.
Deleted “Bonus/incentive payments” from under PCCM
(individual practitioners)

B2

B3

a. Edited header to use new term PCCM Entity (instead of
PCCM (entity based)).
b. Deleted “Bonus/incentive payments” from under
heading PCCM (entity based)
c. Added “Shared savings, incentive payments, and/or
financial rewards (see 42 CFR 438.310(c)(2))” as option
under PCCM entity.

B3

For PCCM Entity, added checklist for state to select functions,
based on list in 42 CFR 438.2
Changed “program” to “managed care program” in first 2
sentences

C

Rationale
To include “PCCM entity”, which is a new
managed care plan type under new
regulations.
To incorporate all future compliance dates
of new/revised sections of 42 CFR 438.

To incorporate key relevant sections that
are now cited in section B.
To prompt state to assure compliance with
relevant payment section, and to replace
previous assurance with 42 CFR
438.6(c)(5)(iv) regarding bonus/incentive
payments.
To correct error in previous version that
indicated applicability to PCCM, but the
regulation applied to MCOs.
To correct error in previous version that
indicated applicability to PCCM.
a. To use “PCCM entity” terminology,
from regulation
b. To correct error in previous version
that it indicated applicability to PCCM
c. This is relevant to note, as 42 CFR
438.310(c)(2) indicates that specific
quality-related regulations are
applicable to PCCM Entities that
receive such payments.
To prompt states to indicate the
function(s) of a PCCM Entity.
To be clearer.

References to the Final Rule are from the Medicaid and CHIP Managed Care Final Rule published in the Federal
Register on May 6, 2016, available at https://www.gpo.gov/fdsys/pkg/FR-2016-05-06/pdf/2016-09581.pdf.
1

1

DRAFT – 12/6/16

C

Old
Section

D2
D4

Type of Change 1

Rationale

Added language to cover new sections of regulations specific
to public process for programs with LTSS (42 CFR 438.70 and
438.110) (beginning with “If the program will include…”)
Added language regarding PCCM entity – “(including for
PCCM entities)”
Added 42 CFR 438.10(g)(2)(vii) as citation

To incorporate LTSS-specific regulations
related to public process, and prompt
states to give details regarding them.
To include new concept of “PCCM entity”.

D6

Added language to include PCCM entities – “… and PCCM
entities”

D7

Changed reference of 42 CFR 438.6(c) to 438.4

D7

Added assurances/references to 42 CFR 438.5, 438.7, 438.8,
and 438.74

D9

Changed reference from 45 CFR 92.36 to 45 CFR 75.326

D

Added D10, assurances regarding 438.66 (related to
monitoring)
Extensively revised to:
a. Separate population information in to three tables:
1. Included Populations (which includes Eligibility Groups
that can be subject to mandatory enrollment);
2. Voluntary Only or Excluded Populations; and
3. (Optional) Other Exceptions.
b. List specific Eligibility Groups and relevant citations to
regulation/Social Security Act.
c. Add Notes column (for each table)
d. Consolidate two Geographic Area columns that were
previously in main table

E

E

F1&2
F3

Under 3. (Optional) Excluded Groups, changed Intermediate
Care Facilities for the Mentally Retarded (ICF/MR) to
Intermediate Care Facilities for Individuals with Intellectual
Disabilities (ICF/IID)
Fully revised sections to reflect new regulation requirements
and structure in 42 CFR 438.54 – details of voluntary and
mandatory enrollment. Added citation to 438.54.
Changed cite from 42 CFR 438.50 to 42 CFR 438.54.

To include reference to relevant
regulations.
To include new concept of “PCCM entity”.
To reflect edit in organization of
information in relevant regulation (and
related edit to list of regulation sections
mentioned in 42 CFR 438.50(c)(6)).
To prompt state to assure compliance with
new sections of regulations that are
relevant to risk contracts.
To correct reference per 12/16/14 federal
register publication.
To prompt states to assure compliance
with new section of regulations.
a. To clarify which populations can be
subject to mandatory enrollment and
guide states to specifically indicate
how they address enrollment for the
populations that can’t be mandatorily
enrolled.
b. To elicit more accurate information
from states regarding included
Eligibility Groups.
c. In order to allow states to note
relevant specifics not captured
otherwise
d. To reduce redundancy and allow for
new columns, such as Citations, to fit.
To reflect change in terminology based on
Rosa’s Law (Pub. L. 111-256) and as in 42
CFR 483.400 – 483.480.
To reflect new regulations at 42 CFR
438.54.
To reflect new section of regulations.

2

DRAFT – 12/6/16
Old
Section
F3
F3a
F3b

Type of Change 1
Added regulation citations to left column in subparts of F.3.
(based on citations in right column) -- e.g., for new 3a, cite
438.52 in left column
Deleted

G2

(Now F3a) Edited to reflect new specifics of 42 CFR 438.52
about choice requirements for MCO, PCCM, and PCCM
entity. Edited to specify this is regarding mandatory
enrollment.
(Now F3b) Changed to reflect that rural exception is for
MCOs only (not PCCM)
Added F3d, assurance regarding new section of regulation 42 CFR 438.71 - beneficiary support system
Deleted dropdown and word “months”

G3

Changed citation from 438.56(c) to 438.56 more broadly

G4

Changed language to be “…during the 90 days following the
date of their initial enrollment into the MCO, PCCM, or PCCM
entity. (Examples: state generated correspondence,
enrollment packets, etc.)” instead of the original language of:
“…during the first 90 days of their enrollment. (Examples:
state generated correspondence, HMO enrollment packets
etc.)”
Changed text to refer to 42 CFR 438.10 instead of 42 CFR
438.10(e) specifically.
Added language to include PCCM entities.
Changed open-ended request for list of benefits (“List all
benefits for which the MCO is responsible.”) to be table.
Table adds prompt for states to enter Medicaid state plan
citation (including attachment, page, and item numbers) for
each benefit, in order to be specific and tie each benefit to
those in State Plan. Added new instructions in section, which
explain how to complete the table.
Changed “internal grievance procedure” to “internal grievance
and appeal system”.
Changed section to focus on compliance assurances
regarding 42 CFR 438.62, 438.68, 438.206, 438.207, 439.208
(instead of “Describe how the state has assured adequate
capacity and services.”)

F3c
F3

H
H
I

J
K

L

Changed citation from 42 CFR 438.240, to 438.330 and
438.340.

L

Changed 1932(a)(5)(D)(c)(1)(A) citation to be 1932(c)(1)(A).

Rationale
To be consistent with formatting used in
the rest of the document.
Concept now explicitly covered in F1&2
(42 CFR 438.54(c)(4) and (d)(4)).
To reflect new specifics in 42 CFR 438.52.

To reflect change in 42 CFR 438.52.
To prompt state to assure compliance with
new section of regulation.
To be more flexible in accommodating
potential answers.
To be more inclusive of requirements
regarding disenrollment.
To be more specific about intent of “first
90 days of enrollment”, and to remove
reference to HMO.

Removed (e) to make applicable to
enrollees (not only potential enrollees).
To include new concept of “PCCM entity”.
To prompt states to link services provided
by the MCO to State Plan approved
services, making it easier to ensure that
the services are in fact State Planapproved.
To reflect new regulation text at 42 CFR
438.228.
To restructure as compliance assurance
(consistent with format of other sections
of pre-print document) and to add new
relevant section of regulations (42 CFR
438.68).
438.240 was deleted in new regulations,
and 438.330 and 438.340 are now the
relevant sections regarding quality.
To correct error in the previous version.
3

DRAFT – 12/6/16

L

Old
Section

Type of Change 1

Rationale

Changed to “The state assures that all applicable
requirements of 42 CFR 438.330 and 438.340, regarding a
quality assessment and performance improvement program
and State quality strategy, will be met.” from “The state
assures that a quality assessment and improvement strategy
has been developed and implemented.”

Changed format to be assurance of
compliance with relevant regulations and
mirror the format of other assurances in
this pre-print application.
Also, added language (underlined part is
added), to reflect terminology used in 42
CFR 438.330 and 438.340: “…quality
assessment and performance
improvement strategy and State quality
strategy”.
To correct error in the previous version.
To prompt states to assure compliance to
other new sections of the regulation that
are also relevant to external quality
review.
Changed format to be assurance of
compliance with relevant regulations and
mirror the format of other assurances in
this pre-print application.

M
M

Changed 1932(a)(5)(D)(c)(2)(A) citation to be 1932(c)(2)(A).
Added citations to 42 CFR 438.354 and 42 CFR 438.364

M

Changed to “The state assures that all applicable
requirements of 42 CFR 438.350, 438.354, and 438.364
regarding an annual external independent review conducted
by a qualified independent entity, will be met.” from “The
state assures that an external independent review conducted
by a qualified independent entity will be performed yearly.”
Added “Appendix A: Compliance Dates (from Supplementary
Information in 81 FR 27497, published 5/6/2016)”

N/A

To incorporate all future compliance dates
of new/revised sections of 42 CFR 438.

4