Crosswalk

EXHIBIT A
SECTION 111 CRITERIA WORK SHEET (CMS-437)
CHANGE CROSSWALK
Note: For the purpose of this crosswalk, all Tag numbers have been removed from form CMS-437

LAW

CHANGES TO THE LAW

EXPLANATION

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42 U.S.C. 1395y (b)(7)(A)(i).
Required submission of
information by group health
plans
(A) Requirement
On and after the first day of
the first calendar quarter
beginning after the date that is 1
year after December 29, 2007, an
entity serving as an insurer or
third party administrator for a
group health plan, as defined in
paragraph (1)(A)(v), and, in the
case of a group health plan that is
self-insured and selfadministered, a plan administrator
or fiduciary, shall(i) secure from the plan
sponsor and plan participants
such information as the
Secretary shall specify for the
purpose of identifying
situations where the group
health plan is or has been(I) a primary plan to the
program under this
subchapter; or
(ii) submit such
information to the Secretary in
a form and manner (including
frequency) specified by the
Secretary.

The following
paragraph was added
to the law: (II) for
calendar quarters
beginning on or after
(A) Requirement
January 1, 2020, a
On and after the first day of primary payer with
respect to benefits
the first calendar quarter
beginning after the date that is 1 relating to prescription
year after December 29, 2007, an drug coverage under
part D; and
entity serving as an insurer or
third party administrator for a
group health plan, as defined in
paragraph (1)(A)(v), and, in the
case of a group health plan that is
self-insured and selfadministered, a plan administrator
or fiduciary, shall(i) secure from the plan
sponsor and plan participants
such information as the
Secretary shall specify for the
purpose of identifying
situations where the group
health plan is or has been(I) a primary plan to the
program under this
subchapter; or
(II) for calendar quarters
beginning on or after
January 1, 2020, a primary
payer with respect to
benefits relating to
prescription drug coverage
under part D; and
(ii) submit such
information to the Secretary in
a form and manner (including
frequency) specified by the
Secretary.

42 U.S.C. 1395y (b)(7)(A)(i).
Required submission of
information by group health
plans

Disclaimer Statement

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According to the Paperwork
Reduction of 1995, no persons are
require d to respond to a collection
of informa tion unless it displa ys a
valid OMB control numbe r. The
valid OMB control numbe r for this
inform a tio n collection is 0938-0358.
The time require d to comple te this
inform a tio n collection is estimate d
to average 15 minutes per
respons e, including the time to
revie w instructions , search existing
data resource s , gather the data
needed, and comple te and review
the informa tion collection. If you
have any comme nts conce rning the
accura cy of the time estimate(s) or
suggestions for improving this
form, please write to: CMS, Attn:
PRA Reports Cleara nce Office r,
7500 Security Boule va rd,
Baltim ore , Maryla nd 21244-1850.

Updated
disclaimer
statement to
include expiration
date and current
information for
PRA Reports
Clearance Officer.

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