DV Manual: Crosswalk

CY 2020 DV
Throughout the document: "Appendix G: Example Site
Visit Agenda"

Page 4, Section 1.3 "• An SO that terminates its contract(s) to offer
Medicare Part C and/or Part D benefits, or that is
subject to a CMS termination of its contract(s), is not
required to undergo a DV review for the final contract
year’s reported data. Similarly, for reporting sections
that are reported at the plan benefit package (PBP)
level, PBPs that terminate are not required to undergo
a DV review for the final year’s reported data."

Page 5, Section 1.4 - "CMS requires that SOs and their
selected DV contractors use the processes and tools
contained in this Manual and its appendices to conduct
the annual DV. This includes each of the following
documents:"
Page 5, Section 1.4 - ". CMS expects to establish
consistency in the DV program by requiring that all
entities use appropriate tools and follow the same
process."

Section 3.2.2.1

CY 2022 DV

Type of
Change

Reason for
Change

Burden
Change

Update

Consistent
with current
technical
guidance.

None

Update

Consistent
with current
technical
guidance.

None

Deleted old text and replaced with "This manual and its appendices must be used to
conduct the annual data validation. The following
documents are included:"

Update

Consistent
with current
technical
guidance.

None

Deleted text

Update

Consistent
with current
technical
guidance.

None

Becomes new 3.2.2.2. New section 3.2.2.1 is "3.2.2.1
Access to HPMS requires a CMS user ID.
Questions regarding the user ID process should be
directed to [email protected]. Additional
information on obtaining HPMS access can be found
at the following link: https://www.cms.gov/ResearchStatistics-Data-and-Systems/Computer-Data-andSystems/HPMS/UserIDProcess."

Update

Consistent
with current
technical
guidance.

None

Update

Consistent
with current
technical
guidance.

None

Pages 3, 6 "Appendix G: Example Site Visit Agenda
for On-site or Virtual Visits"
Deleted old text and replaced with "• Organizations/sponsors that non-renew or
terminate during the measurement year or
reporting/data validation year and are not included in
the HPMS plan table.
• Organizations/sponsors with contracts or Plan
Benefit Packages (PBPs) that non-renewed or
terminated in 2021 or prior to July 1, 2022, are not
required to report 2021 Part C/D reporting
requirements data (due in 1Q of 2022), or undergo
Part C/D data validation of 2021 data (due June
2022)."

Deleted and replaced by " The DVC must create their user ID using EFI, then
email the letter from each SO for which they are
Section 3.2.2.3 under contract to complete the DV review. Since we
"One application must be completed for each user. The
will process the request for a new user ID first the
DVC must send the completed application(s), along
user will only get the HPMS main home page until a
with the letter from each SO (signed by the CEO) for
DV letter is received. The letters may be sent as email
which they are under contract to complete the DV
attachments to
review. Sending letters along with the form will speed
[email protected]:
up your process time. Should a form be received
without a letter, we will process but the user will only
Users may follow the instructions for getting their user
get the HPMS main home page until a DV letter is
ID by clicking the Instructions for Requesting
received. The letters may be sent as email attachments
Plan Access via EFI link under the Download section
to [email protected] or
on the CMS HPMS website:
[email protected] but forms (as
https://www.cms.gov/Research-Statistics-Data-andthey contain PII) must be sent via traceable carrier to:
Systems/Computer-Data-andSystems/HPMS/UserIDProcess.
Kristy Holtje
When the user gets to the “I am a” question, the user
Re: Plan Reporting Data Validation Reviewer HPMS
must select Data Validation Consultant from the drop
Access 7500 Security Blvd.
down. The system will automatically fill out the
Location: C4-17-24 / Mailstop:C4-18-13 Baltimore, MD
company name and Plan number. The HPMS team
21244-1850"
has also
created a video to walk a user through getting a new
CMS user ID: https://youtu.be/KAXwdnq1hKs"

CY 2020 DV

Becomes new 3.2.2.2. New section 3.2.2.1 is "3.2.2.1
Access to HPMS requires a CMS user ID.
Questions regarding the user ID process should be
directed to [email protected]. Additional
information on obtaining HPMS access can be found at
the following link: https://www.cms.gov/ResearchStatistics-Data-and-Systems/Computer-Data-andSystems/HPMS/UserIDProcess."

Exhibit 6 has 5 bullets

Exhibit 13
"a.Organization
properly determines whether a
request is subject to the coverage determinations or the
exceptions process in accordance with 42 CFR
§423.566, §423.578, and the Prescription Drug Benefit
Manual Chapter 18, Sections 10 and 30. This includes
applying all relevant guidance properly when
performing its calculations and categorizations for the
above-mentioned regulations in addition to 42CFR
§423.568, §423.570, §423.572,§423.576 and the
Prescription Drug Benefit Manual Chapter 18, Sections
40, 50, and 130.
b.Organization
properly defines the term

“Redetermination” in accordance with Title 42, Part
423, Subpart M §423.560, §423.580, §423.582,
§423.584, and §423.590 and the Prescription Drug
Benefit Manual Chapter 18, Section 10, 70, and 130.
This includes applying all relevant guidance properly
when performing its calculations and categorizations.
c.Refer
to 42 CFR §423.1978-1986 and Chapter 18,

section 120 of the Medicare Prescription Drug Benefit
Manual for additional information and CMS
requirements related to re-openings."

CY 2022 DV

Type of
Change

Reason for
Change

Burden
Change

Replaced by
"
CMS developed a web-based DV Training for SOs
and DVCs to learn more about the DV program and
its specific requirements. The training is on cms.gov
on the MLN page and found at:
https://www.cms.gov/Outreach-andEducation/Medicare-Learning-NetworkMLN/MLNProducts/WebBasedTraining
During the DV preparation phase, all SO staff
involved in the DV should complete the CMS webbased DV Training to familiarize themselves with the
DV process and requirements.
Additionally, all DV staff are required to take the CMS
web-based DV Training prior to working on the DV
project. Once the training is completed, a certificate of
completion is generated. DVC staff should provide
training certificates to the SO before commencing
work on the DV.
The certificate of completion will automatically
generate upon successful completion of the course.
Any DVC staff that participated in a previous year’s
DV must still take the current year’s CMS web-based
DV Training."

Added "Census and/or sample data" as a bullet in
Exhibit 6

Update

Consistent
with current
technical
guidance.

None

Update

Consistent
with current
technical
guidance.

None

Update

Consistent
with current
technical
guidance.

None

Text replaced by updated RSC 4 for Part D CDR "Organization properly defines the term “Coverage
Determinations” in accordance with 42 C.F.R. Part
423, Subpart M, and the Parts C & D Enrollee
Grievances, Organization/Coverage Determinations
and Appeals Guidance. This includes applying all
relevant guidance properly when performing its
calculations and categorizations.
Organization properly defines the term
“Redetermination” in accordance with 42 C.F.R. Part
423, Subpart M, and the Parts C & D Enrollee
Grievances, Organization/Coverage Determinations
and Appeals Guidance. This includes applying all
relevant guidance properly when performing its
calculations and categorizations."

All instances of site visit throughout the document

Language modified to clarify on-site or virtual visits

Update

Section 4.4.3

Added "If SOs and DVCs elect to conduct a virtual
visit, designated SO staff can use virtual meeting
tool(s) or teleconference(s) to provide visual
demonstrations."

Update

Consistent
with current
technical
guidance.
Consistent
with current
technical
guidance.

None

None

CY 2020 DV

CY 2022 DV

Type of
Change

Reason for
Change

Burden
Change

Two exhibits are numbered as 16

Exhibits are renumbered to correct this.

Update

Consistent
with
document
flow.

None

Section 5.1.1

Deleted the following text "Note that the 90% accuracy threshold does not
apply to the individual grievance categories in the Part
C and Part D Grievances reporting sections; 100%
correct records are required for each data element
measured by Standard 3a in these reporting
sections."

Update

Consistent
with current
technical
guidance.

None

Update

Consistent
with current
technical
guidance.

None

Update

Consistent
with current
technical
guidance.

None

Update

Consistent
with current
technical
guidance.

None

Update

Consistent
with current
technical
guidance.

None

Exhibit 20 is renumbered as 21.
Section 5.1.3, Language preceding exhibit 20 -

Language modified to

"The DVC must also determine data element-level
findings for Sub-Standard 2.e,which examines each
data element for compliance with the applicable
reporting section criteria that varies across the data
elements reported by the SO. Exhibit 20 illustrates an
example of the FDCF for Standard 2, Sub-Standard
2.e, RSC-6 for the Part C and D Grievance reporting
sections."

"The DVC also determines data element-level
findings for Sub-Standard 2.e, which examines each
data element for compliance with the applicable
reporting section criteria that varies across the data
elements reported by the SO. For example, in Part D
Grievances, RSC-5, RSC-6, and RSC-7 provide the
calculations to determine the data element findings.
Exhibit 21 illustrates an example of the FDCF for
Standard 2, Sub-Standard 2.e, RSC-5 for the Part D
Grievance reporting section."

Exhibit 21, Standard 3a "Data elements are accurately
Becomes new Exhibit 22; Standard 3 a updated to
entered/uploaded into CMS systems and entries match
remove "entered/".
corresponding souce documents."

Language following Exhibit 24 "* CMS has added a reporting section criteria (RSC #5)
which will be used by the DVCs to confirm that the data
does not have any logical errors. RSC #5 includes data
integrity checks, thatchecks that the DVC must verify at
the data element level. These data integrity checks
include confirming that a data element does not include
outlier records. [for example, under Part C Organization
Determination and Reconsideration (ODR), RSC 5.g
checks if the date of disposition for each reopening
(Subsection #5, Data Element N) is within the reporting
quarter]. The checks also include confirming that a data
element has a valid value [for example, under Part
CODR,RSC5.jverifiesthe validity of the data submitted
for reopening disposition (Subsection #5, Data Element
O) as being either Fully Favorable, Partially Favorable,
Adverse, or Pending]."

Deleted
"[for example, under Part C Organization
Determination and Reconsideration (ODR), RSC 5.g
checks if the date of disposition for each reopening
(Subsection #5, Data Element N) is within the
reporting quarter]. The checks also include confirming
that a data element has a valid value [for example,
under Part CODR,RSC5.j verifies the validity of the
data submitted for reopening disposition (Subsection
#5, Data Element O) as being either Fully Favorable,
Partially Favorable, Adverse, or Pending]."

Section 5.4.2

Paragraph modified to

"If the SO disagrees with any of the findings submitted
by the DVC, it may submit information indicating this
disagreement to CMS within 30 calendar days of the
date that final findings are submitted via the PRDVM."

"If the SO disagrees with any of the findings submitted
by the DVC, it may submit information indicating this
disagreement to CMS by the June 30th data
validation deadline."

CY 2020 DV

CY 2022 DV

Type of
Change

Reason for
Change

Burden
Change

Added a paragraph at the end

Section 6.2.1

"Contracts can view their data validation results in
HPMS (https://hpms.cms.gov/). To access this page,
from the top menu select “Monitoring,” then “Plan
Reporting Data Validation.” Select the appropriate
contract year. Select the PRDVM Reports. Select
“Score Detail Report.” Select the applicable reporting
section. If you cannot see the Plan Reporting Data
Validation module, contact
[email protected]."

Update

Consistent
with current
technical
guidance.

None

Update

Consistent
with current
technical
guidance.

None

Update

Consistent
with current
technical
guidance.

None

Update

Consistent
with current
technical
guidance.

None

Replaced with
Section 6.3

"An SO has the right to appeal:
•
Reporting section score of less than 95%
"An SO has the right to appeal any Not Pass
•
Non-compliant data validation standards/subdetermination(s) it receives for the Part C and/or Part D standards i.e., a "No" or a 1, 2, or 3 on the 5-point
reporting sections or for the overall combined Part C
Likert scale in the specific data element's data
and Part D determination. Please note that the pass/not validation
pass thresholds are not applied to individual reporting •
Contracts that score < than 95% on either Part C
sections."
and/or Part D overall
•
Contracts that score < than 95% in their combined
Part C and Part D score "
Section 6.3
"•For
each Not Pass determination included in the
appeal, list the following information:
o
Indicate whether the appeal pertains to the overall
Not Pass for Part C and/or Part D reporting sections
o
CMS contract number(s) that received the subject
Not Pass determination
o
Justification for appeal
o
Include as attachment any documentation
supporting the justification for appeal. The
documentation must have been in existence at the time
of the DV. For example, if after the DV, the SO
resubmits corrected data, revises a policy and
procedure, or corrects a programming code that
caused it to improperly calculate reported data; the SO
cannot submit documentation of these corrections to
appeal a Not Pass determination.
Once the appeal is received, CMS will carefully
consider the justification and any supporting
documentation to determine if the Not Pass
determination should be changed to a Pass
determination. CMS has not established a timeframe
for the consideration of SO appeals."

Section 6.2.2

Modified to
"•For
each appeal, list the following information:
o
Justification for appeal
o
Include as attachment any documentation
supporting the justification for appeal. The
documentation must have been in existence at the
time of the DV. For example, if after the DV, the SO
resubmits corrected data, revises a policy and
procedure, or corrects a programming code that
caused it to improperly calculate reported data; the
SO cannot submit documentation of these corrections
to appeal.
Once the appeal is received, CMS will carefully
consider the justification and any supporting
documentation to determine if any changes should be
made. CMS has not established a timeframe for the
consideration of SO appeals."

Passing Data Validation - Minimum Threshold:
"CMS has established 95% as the passing DV
threshold for each reporting section, as well as for the
Part C, Part D, and combined scores. SOs may view
their individual contracts’ validation results in HPMS.
CMS will send follow-up communication to active
contracts scoring below 95% on the overall Part C,
Part D, or combined score."