Crosswalk

CY 2019 High Level Summary of Change or Crosswalk of Changes for
PRA Package CMS 10237: Part C - MA and 1876 Cost Plan Expansion Application

CY 2019
Application
Section
MA and Cost
Plan
Application
Sections

Summary of Change

-Removed 2 Sections of the
MA and Cost plan
application.
-Removed 2 Sections of the
Cost Plan Application

Section 3
MA Application
Attestations

Section 3
MA Application
Attestations

-Reduced attestations from
150 to 89.

Modified 1 attestation

Justification for Change

MA and Cost Plan
-Removed RPPO Essential Hospitals
Section as this is now an operational
function.

PRA Package
Type
60 Day

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

60 Day

N

30 Day

N

-Combined Service Area and Health
Service (HSD) sections.
Cost Plan-only
- Removed the Full Financial Risk and
Budget Forecast sections as they are an
operational function.
-Consolidated and combined many
attestations to streamline application
submission.
-Removed many attestations already
covered under current regulations and
guidance.
-Modified attestation 3.8.6 to read as
follows: Applicant agrees that it will
provide all medically necessary durable
medical equipment, prosthetics, orthotics,
and supplies (DMEPOS), including access
to providers qualified to fit these devices,
to its Medicare enrollees in full agreement
with Chapter 4 of the MMCM.

1

CY 2019 High Level Summary of Change or Crosswalk of Changes for
PRA Package CMS 10237: Part C - MA and 1876 Cost Plan Expansion Application

CY 2019
Application
Section
Section 4
MA Application
Uploads

Section 4
MA Application
Uploads

Summary of Change

Removed 2 upload
requirements.

-Removed 3 upload
requirements.
-Renamed 1 upload template

Justification for Change

-Removed the State Licensure renewal
documentation requirement, as the CMS
State Certification Form is sufficient
authorization from the State.
-Removed Key Management Staff
Organizational Chart, as CMS already
receives a separate organizational chart
under a separate section.
-Removed the Medicare Part C
Compliance Plan and Crosswalk for Part C
Compliance Plan upload requirements for
MA-only non-network organizations.

60 Day

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

30 Day

D

60 Day

D

PRA Package
Type

-Removed the requirement to upload an
executed banking contract for Medical
Savings Account applicants.

Sections 2 and 4
HSD Process
and Instructions

Removed HSD submission
requirement and network
review

-Renamed the RPPO Upload template in
section 3.8 of the application to RPPO
Exception to the Written Agreement
Upload template.
Removed HSD submission and review
from the application as this is now an
operational function.

2

CY 2019 High Level Summary of Change or Crosswalk of Changes for
PRA Package CMS 10237: Part C - MA and 1876 Cost Plan Expansion Application

CY 2019
Application
Section
Sections 2 and 5
MA and SNP
Application
Instructions
Section 5 SNP
Application
Attestations

Section 5 SNP
Application
Uploads

Summary of Change

Added and Clarified
instructions.

Modified 2 attestations

Modified 1 upload

Justification for Change

PRA Package
Type

-Instructions were clarified and updated
60 Day
based on FAQs from past applicants (e.g.,
types of SNP applications, referenced
updated guidance).
-Modified section 5.4 of the application as 30 Day
follows: The SMAC documents will be due
by July 2, 2018.
-Modified section 5.5 of the application for
I-SNP Individuals Residing ONLY in
Institutions as follows: Applicant will only
enroll institutionalized individuals residing
in a long-term care (LTC) facility under
contract with or owned and operated by the
SNP.
- Modified one attestation in the upload
30 Day
document under section 5.13.3 of the
application as follows: 4.a. For institutional
equivalent individuals residing in the
community, provide a list of applicable
assisted living facilities or other residential
facilities, e.g., continuing care
communities. (Note: The use of Assisted
Living Facilities or other residential
facilities is optional for I-SNPs that serve
institutional equivalent individuals in the
community.)

3

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

N

N

CY 2019 High Level Summary of Change or Crosswalk of Changes for
PRA Package CMS 10237: Part C - MA and 1876 Cost Plan Expansion Application

CY 2019
Application
Section
Section 1
Application
Dates

Summary of Change

Justification for Change

Modified dates identified as
TBD

CMS incorporated dates for the application
and bid that were finalized in recent HPMS
memos to industry.

4

PRA Package
Type
30-day

Level of Applicant Burden
I = Increases burden
D – Decreases burden
N – No Change
N (this is a non-substantial
change)