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pdfCover letter
Cover letter
Cover letter
Cover letter
Type of Change
Suggested edit
60-day
comment
Cover letter
Reintroduce optional space for barcodes, document
reference numbers, beneficiary identifiers, case
numbers, or document title
Add
Add plan/pharmacy/organization name to end of
cover letter
Add
Add TTY to MTM provider contact information
Add
Additional optional contact details, such as days and
hours of operation, or the option to direct
beneficiaries to call a department, rather than a
Add
specific person.
Action Plan
Change "pharmacist" to "MTM provider"
Rev
Change "Su Lista de Medicamentos le ayudará a
monitorear susmedicamentos y saber cuando y
como tomarlos" to "Su Lista de Medicamentos le
ayudará a monitorear sus medicamentos y saber
cuándo y cómo tomarlos"
Rev
Add page for information regarding the safe disposal
of prescription medications
Add
Medication List
Add optional "Other Information" box back
Cover letter (Spanish)
Medication List
Medication List (Spanish)
Add
Change "side effect history" to "side effects I have
had"
Rev
Change "Como lo tomo | Por que lo tomo" to "Cómo
lo tomo | Por qué lo tomo"
Rev
General
General
Change order back to action plan before medication
list
Rev
General
Add "My Notes and Questions" to end of document Add
Corrected page numbering from "Page 1 of 2 to
"Page 2 of 3 and "Page 2 of 3 to "Page 3 of 3"
Rev
Added -1850 to the zip code in the PRA disclaimer
English version
Rev
General
Changed CMR acceptance rate in burden
calculations from 87% to 71.8% based on updated
data through 2019
Rev
General
Updated BLS wage chart from 2018 to 2020
Rev
General
Burden Change
Reason for
Change
Plan flexibility
No
Ease of identification
Improved beneficiary
accessibility
No
Plan flexibility
No
No
More inclusive language
since not all MTM providers
are pharmacists
No
Correct typographical errors No
Regulatory requirement
Plan flexibility to include
information that doesn't fit
elsewhere
Yes
No
To avoid confusion between
potential side effects and
actual adverse events the
patient has experienced
No
Correct a typographical error No
Increase portability and ease
of use for beneficiaries by
allowing them to detach the
medication list from the rest
of the document (especially
since the medication list is in
landscape and the rest of the
document in portrait
orientation)
No
More inclusive language for
recommendations that do
not necessarily require
actions, e.g. safe disposal
information
No
Correct a typographical error No
Correct a typographical error No
To calculate a more accurate
burden estimate using more
current data
Yes
To calculate a more accurate
burden estimate using more
current data
Yes
File Type | application/pdf |
File Title | 30-day crosswalk |
Author | MDBG-DCOP 41816 |
File Modified | 2021-05-04 |
File Created | 2021-04-12 |