CROSSWALK: Transmittal and Notice of Approval of State Plan Material

On the CMS-179 Form:
- Block 1 – expanded to accommodate YY-#### format (_ _ - _ _ _ _)
- Block 2 – lines added fr entry of 2-letter state codes
- Block 3 – XIX replaced with underlines (entry of either XIX or XXI)
- Block 5 Type of Plan Material – removed
- Block 6 (formerly Block 7) Federal Budget Impact – added (In WHOLE dollar amounts) for
consistent data submission
- General Form, all references to the former Regional Office structure changed to reflect one
CMCS

Rev

Revisions made to provide more consistent data
No
submission across states, and across departments
within states. Consistency is necessary for CMCS
to properly apply review procedures and to ensure
financial liability accruals are as accurate as
possible.

Instructions to Form CMS-179:
• Block 1 - Transmittal Number – Clarifying instructions added to define that the first two digits in
assigning numbers are required to be the calendar year of submission to ensure consistency
across states since each state could have a different fiscal year beginning/end date
• Block 2 - State – Changed instructions to utilize the 2-letter state abbreviation codes in line with
the SEA record identifying number
• Block 3 - Program Identification – Changed instructions to allow states to enter either XIX or XXI
as applicable
• Block 4 - Proposed effective date – added language clarifying what can or should be entered in
the effective date block based on submission timelines and public notice requirements
• Block 6 - Federal Budget Impact – added clarifying language as to which should be the first fiscal
year displayed and what should be included in amounts presented as federal impact; added
clarifying language that amounts should be actual and not rounded to thousands; this is necessary
to eliminate the potential for inconsistent data entry to SEA which could impact quarterly accruals
of CMS’s liability for pending SPAs
• Block 7/Block 8 - Page numbers in attachment AND page numbers superseded – added
clarifying language as to how to include pages which are new or pages which are being deleted
• Block 10 - Governor’s Review – amended citation of SMM 13026 B to 13026 A to appropriately
reference version of SMM available at cms.gov
• Block 14 - Date Submitted – added language to clarify that this field should not change unless
the state officially withdraws and resubmits the SPA
• Block 16 - Date Received – revised general language regarding the date received by CMS
• Block 23 - Remarks – added language to include explanations of strikethroughs and agreed to
pen & ink changes in the remarks
• General Instructions - changed references to former Regional Office structure to reflect one
CMCS

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

Burden Change

Reason for Change

Type of Change

2021 (new version)

December 2019
(old version)
On the CMS-179 form:
- Block 1 SPA numbering format XX-XXX
- Block 3 Program ID was limited to Title XIX
- Block 5 Type of Plan Material (99% are
amendments)
- Block 7 Requested FFP imact in thousands
- General Form, references to the former
Regional Office structure of CMCS