Crosswalk

2017to2020_crosswalk_508.pdf

Medication Therapy Management Program Improvements - Standardized Format (CMS-10396)

Crosswalk

OMB: 0938-1154

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Insert member name above address, standard "Dear _" salutation
Removed instructions to update and take med list everywhere
Revising the formatting and design of the documents
Revising and streamlining the header and introductory text

PML and MAP
PML
PML instructions
PML in portrait orientation, separate tables for each
medication
Date I started using it, Date I stopped using it, Why I
stopped using it

Rev
Del
Rev
Rev

No
No
No
No

Renamed to Recommended To-Do list and Medication list, switched order Rev
Remove the plan logo from the header on the first page
Del

Clarity and ease of use
Save space, reduce burden

No
Yes

Add
Adding graphical icons, such as a lightbulb graphic and pencil graphic
Adding a header on all subsequent pages where sponsors would insert the
member’s name and date of birth
Add
Removed checkboxes, numbering
Rev

Draw attention to key messages

Yes (maybe)

Identify member, prevent errors
Simplicity and readability

No
Nl

Increase readability/accessibility,
reduce burden

No

Rev

Remove these fields

Del

Allergies or side effects
Other Information

Separated into 2 fields and moved to end of Medication List
Changed to My Notes and Questions

Rev
Rev

Member name and date of birth

Add CMR date to header

Add

MAP instructions
N/A

Removed numbering, changed name to Recommended To-Do List
Rev
Placing the “What we talked about” and “What I need to do” sections sideby-side;
Rev

What I need to do, What I did and when I did it

Combined into 1 column What should I do, add checkboxes

Personal Medication List
PML:“Goals,” “Reminders,” “Date I started using it,”
“Date I stopped using it,” and “Why I stopped using
it.”

Burden Change

Identify member, prevent errors
Clarity on purpose of document
Improve Readability
Improve Readability

Medication list in landscape orientation, all one table in line items

My Follow-up plan, Questions I want to ask

Reason for Change

Type of Change

2020 (new version)

2017 (old version)
Cover Letter heading
Cover Letter instructions
Cover Letter, MAP and PML
Cover Letter, MAP and PML
Medication Action Plan comes before Personal
Medication List
Plan header on first page of MAP

Rev

Combining the “My follow-up plan” and “Questions I want to ask” sections
into a “My notes and questions” section at the end of the document
Rev
Renaming the document from “Personal Medication List” to “Medication
List;”
Rev

Removed

Del

Seldom used, reduce burden
Increase readability, prioritize
information
Increase member engagement
Allow member to keep track of
medications and update

Yes

Increase readability, reduce burden

Yes

Increase readability, reduce burden
Increase readability/accessibility,
reduce burden, encourage
engagement

Yes

Increase readability, reduce burden

Yes

Increase readability

No

Increase readability, reduce burden

Yes

No
No
No

Yes

PRA statement on last page of summary
N/A

Moved PRA statement to cover letter page
Updated expiration date on cover pages and footnotes

Rev
Rev

Compliance with OSORA
Compliance with OSORA

No
No


File Typeapplication/pdf
File TitleMTM Standardized Format 2017 to 2020 Crosswalk
AuthorMDBG-DCOP 41816
File Modified2020-02-03
File Created2020-02-03

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