Crosswalk - Data Form

Burden Change

Reason for Change

Type of Change

2018 (new version)

2015 (old version)
Filenames
MLR Report

Filenames
MLR Data Form

Rev Title and cell labels that refer to the "MLR Report" No
changed to refer to the "Data Form" to reflect
terminology used in the Contract Year 2019 Policy
and Technical Changes to the Medicare
Advantage and the Medicare Prescription Drug
Benefit Programs proposed rule (CMS-4182-P;
RIN 0938-AT08) (82 FR 56336) to describe MLR
data submission for contract year 2018 and
subsequent contract years.

MLR Worksheet 1 cell H1

MLR Data Form cell H1

No

MLR Worksheet 1 cell A4

MLR Data Form cell A3

Rev Update year reference (ex: CY2014, CY2015,
CY2016, etc.).
Rev; Revised "Section 1: General Information" to read
Red "General Information". The revised form does not
include multiple sections, so the section
designation is no longer needed. This cell is
moved up to A3 because the MLR Data Form as
revised no longer includes any information in cell
A2.

MLR Worksheet 1 cells A5, C5

MLR Data Form cells A4,
C4

Rev; Removed number "1" from field label and moved
Red field label and associated data field from A5 and
C5 to A4 and C4, respectively, due to
redesignations of other cells in columns "A" and
"C", as described in this Crosswalk.

No

MLR Worksheet 1 cell A6

MLR Data Form cell A6

MLR Worksheet cells A7, C7

MLR Data Form cells A5,
C5

Rev Removed number "2" from field label, consistent
No
with changes to other field labels described in this
Crosswalk.
Rev; Removed number "3" from label of field for
No
Red "Organization Name" and moved field label and
associated data field from A7 and C7 to A5 and
C5, respectively, based on the position of this field
relative to other fields in Table 12 of the Contract
Year 2019 proposed rule referenced above (CMS4182-P) (82 FR 56459).

MLR Worksheet 1 cells A8, C8

MLR Data Form cells A9,
C9

No

Rev; Removed number "4" from field label and changed No
Red "Date MLR Report Finalized" to read "Date MLR
Data Form Finalized". Field labels and data fields
moved from A8 and C8 to A9 and C9, respectively,
due to redesignations of other cells in columns "A"
and "C", as described in this Crosswalk.

Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesgnation.

MLR Worksheet 1 cell A10

MLR Data Form cell A11

MLR Worksheet 1 cells A2, A21,
A37, A53, A64, A73, A86, A90,
A92, A94, B22 to B35, B37 to
B40, B43 to B46, B49, B53, B54,
B57, B61, B62, B64 to B71, B73
to B78, B81 to B84, B86 to B88,
B90, B92, B94, B96 to B274, 96
to 274, C94, C96 to C274, D94,
D96 to D274, E94, E96 to E274,
F94, F96 to F274, G94, G96 to
G274, H21, H23 to H35, H38,
H39, H41 to H51, H55, H56, H58
to H63, H65 to H71, H74 to H77,
H79 to H84, H87, H88, H90, H94,
H96 to H274, I21, I23 to I35, I38
to I39, I41 to I51, I55 to I56, I58 to
I63, I65 to I71, I74 to to I77, I79 to
I84, I94, I96 to I274, J94, J96 to
J274, K94 to K274, L94, L96 to
L274, M94, M96 to M274

Rev; Removed number "5" from field label and changed No
Red "Contact Information for any questions from CMS
regarding this report" to read "Contacts for any
questions from CMS regarding the above
information". Cell redesignated due to
redesignations of other cells in column "A", as
described in this Crosswalk.
Del

Deleted worksheet # because the revised
collection only includes one sheet.
Deleted "Total $" column header and "PMPM"
headers and data fields because this cost/revenue
information will not be collected by the MLR Data
Form as revised.
Deleted Plan-Specific Data because this
information will not be collected by the MLR Data
Form as revised.

Yes. This
change
eliminates the
requirement to
report certain
categories of
data.

MLR Worksheet 1 cells A11 to
A14, A16 to A19, C12 to C14,
C17 to C19
MLR Worksheet 2 cells C34, D34

MLR Data Form cells A12 to Red Cells redesignated due to changes to cells in other No
A15, A17 to A20, C13 to
rows, as described in this Crosswalk.
C15, C18 to C20
MLR Data Form cells A7,
Rev; Moved field label at MLR Worksheet 2 cell C34 to No
C7
Red and data field at cell D34 to MLR Data Form cells
A7 and C7, respectively, based on the text of the
field label and the field's relative position in Table
12 of the Contract Year 2019 proposed rule
referenced above (CMS-4182-P) (82 FR 56459).
The Adjusted MLR data field is modified so that it
is no longer a calculated field. Users of the revised
collection will enter the contract's Adjusted MLR
directly.

MLR Worksheet 2 cell C36, D36

MLR Data Form cells A8,
C8

Rev; Moved field label at MLR Worksheet 2 cell C36 to
Red and data field at cell D36 to MLR Data Form cells
A8 and C8, respectively, based on the text of the
field label and the field's relative position in Table
12 of the Contract Year 2019 proposed rule
referenced above (CMS-4182-P) (82 FR 56459).
The Remittance Amount data field is modified so
that it is no longer a calculated field. Users of the
revised collection will enter the contract's
Remittance Amount directly.

Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesgnation.

No

MLR Worksheet 3 cell A54

MLR Worksheet 2 (all cells
except C34, C36, D34, D36)
MLR Worksheet 3 (all cells
except A54)

MLR Data Form cell A24

Rev; PRA Disclosure Statement amended to reflect
Red change in burden estimate from 47 hoursper
respondent to 36 hours per respondent. PRA
Disclosure Statement moved to end of MLR Data
Form.
Del This change reflects the revisions to the MLR
reporting requirements as proposed in the Contract
Year 2019 Policy and Technical Changes to the
Medicare Advantage and the Medicare
Prescription Drug Benefit Programs proposed rule
(CMS-4182-P; RIN 0938-AT08) (82 FR 56336).

Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesgnation.

No

Yes. This change
eliminates (1) the
requirement to
report certain
categories of
data and (2) the
requirement
provide a
narative
explanation of
expense
allocation
methodologies.