Crosswalk

CY 2023 List of Changes
CY 2023 PBP Changes
Landing Page
1. Update landing page to reflect the CY2023 year change.
SOURCE: Internal
PBP SCREEN/CATEGORY: Landing Screen
DOCUMENT: Appendix_C_PBP2023_Screenshots-SectionA-2021-12-27.pdf
PAGE(S): Page 9
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: To update the year references throughout the software.
IMPACT BURDEN: No impact
2. New variable fields for C-SNP other type description added to the section A-2 screen to be
populated with PBP download from HPMS
SOURCE: Internal
PBP SCREEN/CATEGORY: Section A-2
DOCUMENT: Appendix_C_PBP2023_Screenshots-SectionA-2021-12-27.pdf
PAGE(S): Page 2
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: To reflect updates within HPMS allowing new C-SNP type “Other”.
IMPACT BURDEN: No impact
Section B
1. Change “Copayment charged” variable label to “Observation Services copayment is charged.”
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: 9a Outpatient Hospital Services – Base 2
DOCUMENT: Appendix_C_PBP2023_Screenshots-SectionB-2021-12-27.pdf
PAGE(S): Page 107
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: Reduce confusion by clarifying question
IMPACT BURDEN: No Impact
2. Remove questions asking user to describe the meal benefit included in 14c14 Re-admission
Prevention. Require a note (existing field) when meals are selected under 14c14
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: 14c: Other Defined Supplemental Benefits– Base 2
DOCUMENT: Appendix_C_PBP2023_Screenshots-SectionB-2021-12-27.pdf
PAGE(S): 191
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: Level of detail not needed.
IMPACT BURDEN: Reduces Impact

CY 2023 List of Changes
3. Revise language in question under 14c12 Medical Nutrition Therapy (MNT) benefit related to
Coverage for Non-Medicare-covered diseases, removing request to specify and describe in notes
field.
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: 14c Other Defined Supplemental Benefits – Base 2
DOCUMENT: Appendix_C_PBP2023_Screenshots-SectionB-2021-12-27.pdf
PAGE(S): 191
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: Additional info not needed.
IMPACT BURDEN: No Impact
4. Separate notes fields are added for each subcategory (enhanced benefits) under 16a and 16b. The
general 16a and general 16b notes fields are removed.
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: 16a Preventive Dental Base 5 and 16b Comprehensive Dental Base 6
DOCUMENT: Appendix_C_PBP2023_Screenshots-SectionB-2021-12-27.pdf
PAGE(S): 221 and 227
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: To match notes fields with the specific benefits subcategory.
IMPACT BURDEN: No Impact
5. A question is added to the Reduced Cost Sharing for VBID/UF/SSBCI package screens for plans to
indicate intent to reduce cost sharing to $0 for all benefits.
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: #19a Reduced Cost Sharing for VBID/UF/SSBCI - Base 1 (Package Info)
DOCUMENT: Appendix_C_PBP2023_Screenshots-SectionB-VBID-UF-SSBCI-2021-12-27.pdf
PAGE(S): 13
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: Reduce burden to by potentially lowering number of cost sharing
questions plans to which plans will need to respond.
IMPACT BURDEN: No Impact
6. Retroactive Reimbursement questions have been removed from B19a and B19b.
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: B19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 18 and B19b Additional
Benefits for VBID/UF/SSBCI – Base 3
DOCUMENT: Appendix_C_PBP2023_Screenshots-SectionB-VBID-UF-SSBCI-2021-12-27.pdf
PAGE(S): 30 and 40
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: Information not needed/used
IMPACT BURDEN: Reduce burden
7. Maximum benefit amount question is revised to read “Is there a package level maximum coverage
amount?" and periodicity question is added for user to select the periodicity for package level
maximum coverage. Ability for user to select/indicate via picklist the non-medicare covered benefits
within the UF/SSBCI package that apply to the package level maximum coverage is added.
SOURCE: CMS Policy

CY 2023 List of Changes
PBP SCREEN/CATEGORY: B19b Additional Benefits for VBID/UF/SSBCI – Base 3
DOCUMENT: Appendix_C_PBP2023_Screenshots-SectionB-VBID-UF-SSBCI-2021-12-27.pdf
PAGE(S): 40
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: Clarify package level maximum coverage
IMPACT BURDEN: No Impact
8. “Every Month” is added as an option to all periodicity questions for Maximum Plan Benefit Coverage
for all 13i & 13i-O benefits.
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: VBID/UF/SSBCI 19B #13i
DOCUMENT: Appendix_C_PBP2023_Screenshots-SectionB-VBID-UF-SSBCI-2021-12-27.pdf
PAGE(S): pages 102, 105, 108,112, 114, 117,120, 123,126,133,136,139, and 142
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: provide users “every month” option for periodicity.
IMPACT BURDEN: No Impact
Section C
1. For each OON Group, a periodicity question is added for plans to select the maximum plan benefit
coverage periodicity.
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: OON – Groups – Base 1
DOCUMENT: Appendix_C_PBP2023-Screenshots-SectionC-2021-12-27.pdf
PAGE(S): 11
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: Capture periodicity for maximum plan benefit coverage amount.
IMPACT BURDEN: Slightly increases Impact
Section D
1. Additional screens are added to allow plans to enter up to 5 Reductions in Cost Sharing groups.
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: Reductions in Cost Sharing
DOCUMENT: Appendix_C_PBP2023-Screenshots-SectionD-2021-12-27.pdf
PAGE(S): 25, 32-35
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: to increase number of Reductions in Cost Sharing groups that can be
entered from 3 to 5.
IMPACT BURDEN: Slightly increases impact
2. Additional screens are added to allow plans to enter up to 5 Combined Benefit Packages.
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: Combined Benefits
DOCUMENT: Appendix_C_PBP2023-Screenshots-SectionD-2021-12-27.pdf
PAGE(S): 36, 40, and 41

CY 2023 List of Changes
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: to increase number of Combined Benefit Packages that can be
entered from 3 to 5.
IMPACT BURDEN: Slightly increases impact
3. For each Combined Benefits package, a new question is added to capture Combined Benefit
Maximum mode of delivery (Debit Card, Reimbursement, Other).
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: Combined Benefits
DOCUMENT: Appendix_C_PBP2023-Screenshots-SectionD-2021-12-27.pdf
PAGE(S): 37-41
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: to capture Combined Benefit Maximum mode of delivery
IMPACT BURDEN: Slightly increases impact
4. For each Combined Benefits package, new questions are added to capture whether Combined
Supplemental Benefits are offered with a shared visit limit, number of shared visits, and periodicity.
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: Combined Benefits
DOCUMENT: Appendix_C_PBP2023-Screenshots-SectionD-2021-12-27.pdf
PAGE(S): 37-41
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: to capture shared visit limits for Combined Supplemental Benefits
IMPACT BURDEN: Slightly increases impact
Section Rx - general
1. The following questions are removed: Does plan utilize floor pricing?; Does plan utilize ceiling
pricing?; and Do you pay for over-the-counter medications (OTCs) under the utilization management
program?
SOURCE: CMS Policy
PBP SCREEN/CATEGORY: Medicare Rx General
DOCUMENT: Appendix_C_PBP2023-Screenshots-SectionRx-2021-12-27.pdf
PAGE(S): 2
CITATION: 42 CFR 422.256
REASON WHY CHANGE IS NEEDED: Questions no longer needed/used
IMPACT BURDEN: Reduces Impact

CY 2023 Formulary Changes
1. CMS is adding an optional criteria field for MAPD plans to indicate if they are requiring a Part B drug
prior to a Part D drug.
SOURCE: CMS, Internal
Formulary Screen/Category: CY 2023 Prior Authorization File Record Layout

CY 2023 List of Changes
PAGE(S): 2
Document: Appendix_C_PA_Record_Layout
CITATION: CMS Model
REASON WHY CHANGE IS NEEDED: Currently no indicator exists to communicate this requirement
imposed by plans to beneficiaries and providers. Plans are now instructed to include "Part B before Part
D Step Therapy" in the “Other Criteria” field, but have received failure notices when this language is not
included in their criteria.
IMPACT BURDEN: Reduces impact

CY 2023 MTMP Changes
1. There is a requirement to remove following text and combine the sections: Data Evaluated to Identify
Beneficiary as At-Risk (Select one or more options): ; Data Evaluated to Identify Chronic Conditions
(Select one or more options):
SOURCE: CMS, Internal
MTMP SCREEN/CATEGORY: MTMP – Enter/Edit - Program Information
DOCUMENT: Appendix_C_MTMP2023_Mockups_09282021.pdf
PAGE(S): 1
CITATION: Lessons Learned
REASON WHY CHANGE IS NEEDED: To streamline data collected in the MTMP
IMPACT BURDEN: Reduces impact
2. There is a requirement to remove following text: Data Evaluated to Identify the Number of Covered
Part D Drugs (Select one or more options):
SOURCE: CMS, Internal
MTMP SCREEN/CATEGORY: MTMP – Enter/Edit – Multiple Covered Part D Drugs
DOCUMENT: Appendix_C_MTMP2023_Mockups_09282021.pdf
PAGE(S): 2
CITATION: Lessons Learned
REASON WHY CHANGE IS NEEDED: To streamline data collected for MTMP
IMPACT BURDEN: Reduces impact
3. There is a requirement that the Drug claims check box is checked and disabled.
SOURCE: CMS, Internal
MTMP SCREEN/CATEGORY: CY 2023 MTMP – Enter/Edit – Targeting
DOCUMENT: Appendix_C_MTMP2023_Mockups_09282021.pdf
PAGE(S): 3
CITATION: Lessons Learned
REASON WHY CHANGE IS NEEDED: To meet the Business requirements need
IMPACT BURDEN: No impact