Crosswalk: Attachment B

MLR Report worksheet 1 cells Rev
A8, A10, B1

Burden Change

Reason for Change

Type of Change

CY 2023 MLR Report
(proposed version)

CY 2020 MLR Data
Form (current
version)
MLR Data Form cells
A8, A10, B1

Cell label that refers to the "MLR Data Form for Contract No
Year [XXXX]" changed to refer to the "MLR Report for
Contract Year [XXXX]" to reflect terminology used in the
Contract Year 2023 Policy and Technical Changes to
the Medicare Advantage and Medicare Prescription
Drug Benefit Programs proposed rule (CMS-4192-P;
RIN 0938-AU30), to reflect the terminology CMS will use
to refer to the MLR data submission for contract year
2023 and subsequent contract years.

MLR Data Form cells
MLR Report worksheet 1 cells Rev
H1
MLRC5
Data Form cell A4 H1
MLRC5
Report worksheet 1 cell Rev
A4

Update year reference (e.g., CY2020, CY 2021, etc.).

No

MLR Data Form cells
E6, F6

MLR Report worksheet 2 cells Rev
C29, C34, D29, D34

Removed number "6" from field label and moved field
label and associated data field from MLR Data Form
cells E6 and F6 to MLR Report worksheet 2, cells to
C29 and D29, respectively. The field label and data field
at MLR Report worksheet 2 cells C29 and D29 is
duplicated in MLR Report worksheet 2 cells C34 and
D34, respectively.

Yes. Currently, users must manually enter
data into the field at MLR Data Form cell F6.
This field, which will now appear at MLR
Report worksheet 2 cells D29 and D34, will
be filled in automatically by the MLR Report
software, based on other user-entered data.
This will result in a small reduction in the
burden to complete this specific field.

MLR Data Form cells
E7, F7

MLR Report worksheet 2 cells Rev
C36, D36

Revised field label ("7. Remittance Amount") to read
"Remittance amount for [applicable contract year]", and
moved field label and associated data field from MLR
Data Form cells E7 and F7 to MLR Report worksheet 2,
cells to C36 and D36, respectively.

Yes. Currently, users must manually enter
data into the field at MLR Data Form cell F7.
This field, which will now appear at MLR
Report worksheet 2 cell D36, will be filled in
automatically by the MLR Report software,
based on other user-entered data. This will
result in a small reduction in the burden to
complete this specific field.

Revised "General Information" to read "Section 1:
No
General Information". The revised form includes multiple
sections, so the section designation is needed.

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

MLR Data Form cells
E12 through E27 and
H12 through H27

MLR Report worksheet 3 cell Rev
A62 through A78 and D62
through D78

N/A

MLR Report worksheet 2
Add
(other than cells C29, C34,
C36, D29, D36, and D34) and
worksheet 3 (other than cell
A54)

Moved location of PRA disclosure statement and
No
revised statement to reflect increase in time required to
complete the proposed MLR Report form (from 36 hours
to 61.1 hours), consistent with the changes in the
Contract Year 2023 Policy and Technical Changes to
the Medicare Advantage and Medicare Prescription
Drug Benefit Programs proposed rule (CMS-4192-P;
RIN 0938-AU30).
Added field labels and collection for additional
Yes
categories of data that CMS proposes to collect,
consistent with the proposed changes in the Contract
Year 2023 Policy and Technical Changes to the
Medicare Advantage and Medicare Prescription Drug
Benefit Programs proposed rule (CMS-4192-P; RIN
0938-AU30).

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

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